CLT, edited by Jason J. Nichols, OD, MPH, PhD, is a free weekly newsletter for eye care professionals who prescribe contact lenses.

Have you noticed a change in the attitudes and/or behaviors of practitioners and clinical researchers in terms of contact lenses? I remember not that long ago when we had spirited debates about microbial keratitis, oxygen permeability, “solution-induced” corneal staining, and infiltrates. Have these issues been resolved? Or did the field tire of these discussions and refocus its energies on more exciting aspects of contact lens wear like specialty lenses and myopia management? It is definitely something to think (or talk) about.

Jason J. Nichols, OD, MPH, PhD

CooperVision Specialty EyeCare Introduces “Beyond the Limbus” Workshops

CooperVision Specialty EyeCare has announced a new series of workshops focused on scleral lens fitting, consultation, and practice management that will launch in September. The Beyond the Limbus (BTL) dual-tracked series offers master’s training for intermediate and advanced scleral lens fitters, as well as basics training for support staff and eyecare professionals (ECPs) who have not been exposed to scleral contact lenses. The workshops—which are available to ECPs in the United States and Canada—will consist of a single-day intensive training session geared for varying skill levels.

The master’s training will cover advanced troubleshooting and design options, case reports, practice management tools and support, and practice efficiency and workflow. Attendees who complete this course will be certified as Master Scleral Lens Fitters.

The basics training will run concurrently, providing support staff, opticians, technicians, or new scleral lens fitters with a foundational understanding of scleral lenses. Attendees will learn what a scleral lens is, how to identify patients who can benefit from scleral lenses, application and removal, care and handling, practice workflow, and what patient educational resources are available.

The series will consist of five BTL: Sept. 18 in Detroit, Oct. 9 in San Francisco, Oct. 16 in Boston, Nov. 6 in Toronto, and Nov. 13 in Los Angeles.

To learn more or to register, visit 2604005.hs-sites.com/beyondthelimbusfall2022.

GSLS Early Bird Pricing

The Global Specialty Lens Symposium (GSLS) is the leading global contact lens conference with delegates attending from dozens of countries. The four-day conference—being held from Jan. 18-21, 2023, in Las Vegas—focuses on the successful management of ocular conditions using today’s specialty contact lenses through interactive educational platforms including expert panel discussions, breakout lecture sessions, and clinical workshops.

Register by Oct. 31 for Early Bird Rates.

AAO and AAOF Announce Award Winners

Each year, the American Academy of Optometry (AAO) and American Academy of Optometry Foundation (AAOF) recognize individuals who have made significant contributions and excelled in the profession. The 2022 award recipients are:

Ann E. Elsner, PhD, Charles F. Prentice Medal Award/AAO
James S. Wolffsohn, BSc, MBA, PhD, Glenn A. Fry Lecture Award/AAOF
Jack Phu, OD, PhD, Irvin M. and Beatrice Borish Award/AAO
Sajeesh Kumar, PhD, American Academy of Optometry – Essilor Award for Outstanding Contributions to International Optometry/AAO
Jerry Cavallerano, OD, PhD, William Feinbloom Award/AAO
Hector C. Santiago, OD, PhD, Brien Holden Humanitarian Award/AAO
Loretta B. Szczotka-Flynn, OD, PhD, Carel C. Koch Medal/AAO
Joseph C. Lehman, OD, MS, The Julius F. Neumueller Award in Optics/AAOF
Sherry J. Bass, OD, Vincent Ellerbrock Clinician Educator Award/AAO “Myopia Control: Why Each Diopter Matters”
Mark A. Bullimore, MCOptom, PhD, and Noel A. Brennan, MScOptom, PhD, Garland W. Clay Award/AAO
Jason S. Ng, OD, PhD, Michael G. Harris Family Award for Excellence in Optometric Education/AAOF
Herbert Wertheim, OD, DSc, MD, Honorary Fellowship Award/AAO
Joan M. Exford, OD, Life Fellowship Award/AAO Chris A. Johnson, PhD, DSc, Life Fellowship Award/AAO
Joseph P. Shovlin, OD, Tony Adams Eminent Service Award/AAO
William D. Carter, Founders’ Award/AAO
Robin L. Chalmers, OD, Max Schapero Lecture Award /AAO
Sandra Block, OD, MEd, MPH, Henry B. Peters Award/AAOF

Glaukos Licenses iVeena’s Investigational Keratoconus Therapy

Glaukos has acquired an exclusive global license to develop and commercialize iVeena Delivery Systems’ investigational pharmacologic treatment for keratoconus, IVMED-80. IVMED-80 is a proprietary disease modifying topical eye drop with orphan drug designation (ODD) that upregulates lysyl oxidase (LOX) and induces pharmacologic corneal crosslinking to strengthen the cornea and treat keratoconus.

CORE Develops 3D Bio-Printing Method for Ophthalmic Drug Delivery Research

Using a commercially available masked stereolithography printer (mSLA) retrofitted with humidity and temperature controls, plus a new gelatin-based ink formulation, a team of scientists from the Centre for Ocular Research & Education (CORE) 3D bio-printed an in vitro eye model in under three hours. The resulting “eye” included aqueous, vitreous, and blood chambers, a blood outlet/inlet, aqueous and vitreous outlets, and a 500μm-thick cornea—absent any artificial support structures. Phosphate-buffered saline was used as an aqueous and vitreous humor mimic in the corresponding drug delivery study, which measured contact lens-delivered dye transfer in each chamber and channel. The team’s future work will focus on adding diffusion barriers to better simulate drug diffusion through ocular tissues, experimenting with copolymer inks to extend each model’s lifespan, and fine-tuning physiological dimensions.

How routinely are you fitting the orthokeratology modality OUTSIDE of when it is used for myopia control?

Click here to view results.

Brian Chou, OD, ReVision Optometry, San Diego

This is not Intacs but Ferrara rings, an intrastromal corneal ring that is implanted for keratoconus (outside the United States). Optical coherence tomography (OCT) of the Ferrara ring (left) reveals a triangular cross-section (versus a hexagonal one seen with Intacs). Ferrara rings form a smaller optical zone radius than Intacs. Like all corneal surgeries for keratoconus, a rigid surface contact lens—in this case a scleral lens (right)—is almost always needed afterward to create a smooth anterior refracting surface.

We thank Dr. Chou for this image and welcome photo submissions from our other readers! It is easy to submit a photo for consideration for publishing in Contact Lenses Today. Simply visit cltoday.com/upload/upload.aspx to upload your image. Please include a detailed explanation of the photo and your full name, degree or title, and city/state/country.

The Social Determinants of Myopia

Social determinants of health can impact specialty contact lenses. This is becoming a hot topic in medicine as research expands, plus the wide range of data mining and collection that can be done currently. The five key areas (determinants) are economic stability, education access and quality, social and community context, health care access and quality, and environment.¹ With a key area of eye care and specialty contact lenses focusing on myopia control including contact lens options and orthokeratology, are we leaving a large population behind?

Myopia is a major health issue around the world. The World Health Organization estimates that half of the population of the world may be myopic by 2050.^2,3 Data suggests that after the pandemic, there was a shift in myopia prevalence. The prevalence of myopia in children 6 to 8 years old in 2020 was 21.5% at 6 years, 26.2% at 7 years, and 37.2% at 8 years. These levels were significantly higher than the highest prevalence of myopia within 2015 and 2019 for these age groups: 5.7% at 6 years in 2019, 16.2% at 7 years in 2018, and 27.7% at 8 years in 2018.⁴ Generally, individuals who undergo myopia control of some kind come from a higher socioeconomic background.

There are areas in the world in which access to clean water is a primary concern or access to routine vision care is problematic. We must do more, and we must do better to ensure that those who are in need of this care, have access to care. Let us all work toward a better future for our children—for those in need—not just a select few.

1. U.S. Department of Health and Human Services/Office of Disease Prevention and Health Promotion. Social Determinants of Health. Available at health.gov/healthypeople/priority-areas/social-determinants-health. Accessed Aug. 19, 2022.
2. Morgan IG, Ohno-Matsui K, Saw SM. Myopia. Lancet. 2012;379:1739-1748.
3. WHO/Brien Holden Vision Institute. The Impact of Myopia and High Myopia. Presented at the Global Scientific Meeting on Myopia. Sydney. Available at myopiainstitute.org/wp-content/uploads/2020/10/Myopia_report_020517.pdf. Accessed Aug 25, 2022.
4. Wang J, Li Y, Musch DC, et al. Progression of Myopia in School-Aged Children After COVID-19 Home Confinement. JAMA Ophthalmol. 2021 Mar 1;139:293-300.

Ortho-k Secrets to Success

Orthokeratology (ortho-k) has been a huge part of my practice. While I have a dry eye and scleral lens practice, there is a strong lure for manipulating a corneal tissue in a manner that makes someone see better and prevents kids from consequences of myopia as they age.

Ortho-k is perceived to be hard, and it isn’t anything to breeze over, but the last couple of years have seen major advances. Success rates have shot through the roof in the last three years, partially due to a lens and lab change that has helped my practice streamline things. However, the changes are largely due to toric lens utilization. One study reports that 20% of children have > 2.00D of cylinder¹ and another reports that 33.6% of Asian kids have astigmatism.²

It should not be presumed that one can fit toric corneas in spherical lenses and be just as successful as with toric lenses. Ortho-k needs a good seal to achieve the treatment that is being sought. As such, getting a lens to have a given clearance on the eye, but not too much, provides good treatment for patients who have astigmatism. In my experience, these lenses tend to work as well or better than spherical lenses, because the lenses are specifically designed for the cornea and fit very well. While there can be some troubleshooting, work with your lab to maximize your results.

1. Harvey EM, Dobson V, Clifford-Donaldson CE, Green TK, Messer DH, Miller JM. Prevalence of astigmatism in Native American infants and children. Optom Vis Sci. 2010 Jun;87:400-405.
2. Kleinstein RN, Jones LA, Hullett S, et al. Refractive error and ethnicity in children. Arch Ophthalmol. 2003 Aug;121:1141-1147.

Differences in Practitioner Experience, Practice Type, and Profession in Attitudes Toward Growing Contact Lens Practice

The purpose of this study was to investigate eyecare practitioners’ attitudes and perceptions toward potential interventions that could enhance contact lens (CL) practice across the world, and how this is influenced by their practice setting.

A self-administered, anonymized survey was constructed in English and then forward and backward translated into six more languages. The survey was distributed online via social media platforms and mailing lists involving reputed international professional bodies.

In total, 2,222 responses from 27 countries that had sufficient responses were analyzed (female: 53%; median age: 37 years). Most of the respondents were optometrists (81.9%) and 47.6% were from standalone/independent practices. Median working experience in CL prescribing was 11 years (IQR: 18.0, four to 22 years). More than two-third of the respondents were very hopeful (22.9%) or hopeful (45.1%) about the future of their CL practice.

Among the potential interventions proposed, continuous update of knowledge and skills and competently managing CL-related complications were rated the most important (median score: 9/10 for each). Practitioners working in national/regional retail chains expressed higher proactivity in recommending CLs (9/10) than those in local chains, hospitals, and universities (for all 8/10, P < 0.05). National differences were also identified in eyecare practitioner attitudes and perceptions (P < 0.05).

The study provided important information to delineate a variety of elements characterizing CL practice across the world. These insights can serve as a basis to design strategies at national and international levels.

Thite N, Desiato A, Shinde L, et al. Differences in Practitioner Experience, Practice Type, and Profession in Attitudes Toward Growing Contact Lens Practice. Eye Contact Lens. 2022 Aug 15. [Online ahead of print]