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

There is no question that myopia management is one of the hottest topics in eye care today in terms of clinical and basic research and clinical practice. Gaps in knowledge continue to be filled almost every day, with new findings emerging that show the benefits (and limitations) of various diagnostic or therapeutic approaches. Many practitioners report implementing myopia management in their practices. However, what is not so clear is what issues remain as the most critical knowledge gaps that need to be filled to really move myopia management forward into the mainstream standard of care? Is it just a matter of having a broad enough array of treatment options for myopia control? Or, is it a matter of health insurance coverage of myopia management? We welcome your thoughts on these issues, particularly as we think about programming for the 2021 Global Myopia Symposium, which will be held on Sept. 17 to 19, 2021.

Jason J. Nichols, OD, MPH, PhD

Bausch + Lomb Launches Alaway Preservative Free Antihistamine Eye Drops

Bausch + Lomb (B+L) announced the U.S. launch of Alaway Preservative Free (ketotifen fumarate ophthalmic solution 0.035%) antihistamine eye drops, an over-the-counter (OTC), preservative-free antihistamine eye itch relief drop approved by the U.S. Food and Drug Administration (FDA).

According to B+L, Alaway Preservative Free is formulated to block the release of histamines and reduce allergic inflammation. Working right at the source of eye itch symptoms, Alaway provides relief within minutes and lasts up to 12 hours with one dose, according to the company.

Alaway Preservative Free will be available for purchase at most national retailers, including Walgreens, CVS, Walmart, and Amazon. A 10-day supply (20 single-dose vials) will have a manufacturer’s suggested retail price of $14.99.

CooperVision Specialty EyeCare Launches New Fitting Software for Paragon CRT and Dual Axis Contact Lenses

CooperVision Specialty EyeCare launched its Paragon CRT Software for eyecare professionals (ECPs). The easy-to-understand, topography-guided tool includes several features aimed at simplifying the fitting process for first-time CRT and CRT Dual Axis contact lens prescribers, according to the company.

With a few on-screen clicks, ECPs will be able to change lens parameters, assess fluorescein patterns of different lenses on the same patient, and see simulated lens changes on a patient’s eye prior to ordering warranty exchanges. In addition, ECPs can upload patient topography maps and customize CRT and CRT Dual Axis lenses for each patient. The software is available to download at ecp.paragonvision.com/software.

Paragon Vision Sciences to Host Webinar

Paragon Vision Sciences will be hosting a webinar with Micaela Crowley, OD. During the webinar, she will demonstrate how Onefit Med & Onefit Med+ advanced scleral lenses enhance and simplify the fitting experience. Webinar attendees will learn all about the lenses’ design options & enhancements, parameter selection, and online fitting tools. Case reports will be presented during the session.

The webinar will be held on March 9 at 9:00 p.m. ET. To register, visit https://register.gotowebinar.com/register /942779956850371595?source=email+campaign.

Stay Updated

For the most up-to-date COVID-19 news and tips for eyecare providers, visit bit.ly/2WxiFbA.

And, you can now sign up to receive the weekly PentaVision COVID-19 News Roundup newsletter, a joint publication from Contact Lens Spectrum, Eyecare Business, and Optometric Management.

Refresh Digital Lubricant Eye Drops Tackle Eye Dryness Due to Everyday Screen Use

Allergan released Refresh Digital, a new lubricant eye drop formulated to specifically relieve dryness and irritation that may occur from prolonged screen time. Refresh Digital features proprietary HydroCell technology that supports all three layers of the tear film to keep eyes hydrated, according to the company. Refresh Digital is available in both a multidose bottle and preservative-free, single-use vials; it can be purchased online and at retail locations nationwide where over-the-counter eye drops are sold.

Submit A CE Proposal for GMS

The Global Myopia Symposium (GMS) Program Committee is accepting CE proposals for one-hour CE breakout sessions and two-hour workshops for the 2021 GMS, which will be held virtually Sept. 17 to 19, 2021. All submissions are due by 5:00 p.m. EST on March 15. Click here to submit your CE proposal - https://bit.ly/21GMSCE.

Do you believe that contact lens wear is associated with meibomian gland atrophy or disfiguration?

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Your Interesting Case Photo Here in the Next Issue

Have you seen an interesting case lately? Would you like to share it with your colleagues? An image from that case could appear in Contact Lenses Today in the coming weeks!

We welcome photo submissions from our readers! It is easy to submit a photo for consideration for publishing in Contact Lenses Today. Simply visit http://www.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.

New Approaches to Contact Lens Practitioner Education in Light of the Myopia Pandemic and the Post-COVID World

When considering the challenges of contact lens education of eyecare practitioners (ECPs) in this ever-changing and challenging world, two significant factors come to mind. The global COVID-19 and myopia pandemics have impacted the practice of eye care in multiple ways. A significant impact has been felt in the education of ECPs. The COVID-19 pandemic led educational institutions worldwide to move toward online delivery, while the impact of dramatic increases in myopia prevalence on eye health has required a significant shift in its management that requires ECP education.

A recent publication investigated the current status and future requirements of global contact lens education in light of these developments.¹ An online survey among 546 educators, conducted in May 2020, investigated changes to contact lens education delivery before and after the onset of the pandemic. A total of 214 responses were received from 32 countries.

Prior to COVID-19 restrictions, 23% of educators had conducted more than 50% of their total teaching online; however, 69% expected to conduct more than half of their teaching online by the end of 2020, and 12% anticipated 90% or more of their teaching would be online. Some 76% of educators expected to provide more online lectures after the pandemic, and 63% anticipated new methods to deliver practical education. Around one-half were planning to introduce new online teaching platforms (54%) and more online assessment methods (53%).

The global need for increasing numbers of skilled personnel points to a crucial role for educators in teaching the contact lens practitioners of the future. The authors stated that contact lens education delivery was already evolving prior to COVID-19, and changes that are currently occurring may lead to permanent differences in the way that contact lenses are taught in future.

The management of myopia onset and progression is now becoming a standard of care in ophthalmic practice. It is based on an ever-growing body of evidence, and contact lenses play a significant role in myopia management. As such, we are faced with a challenge of disseminating information and educating the eyecare profession. The COVID-19 pandemic has forced education to pivot from its traditional teaching methods to a dramatically greater dependence on remote and virtual teaching methods. With challenge comes opportunity. And, in the case of education, we can clearly see this as an opportunity to disseminate information across borders, without walls, and to a much larger audience in a more efficient way. Remote and virtual learning is here to stay and surely will continue to be applied to ECP education and specifically to education regarding myopia management. This is a good thing!

1. Naroo SA, Morgan PB, Shinde L, Lee C, Ewbank A. Contact lens education for the practitioners of the future. Ophthalmic Physiol Opt. 2021 Feb 20. [Online ahead of print]

I Bet Perry Mason Never Investigated This

I have to confess, I love the MeTV television network. Being of “baby-boomer” age, the shows that MeTV broadcasts are nostalgic and, in a funny way, comforting. But I’m sure that you are wondering what this confession could possibly have to do with this “Ocular Surface Update” column?

Well, every time I watch Perry Mason (played by actor Raymond Burr), I think that he must have experienced dry eye at some time. Do an internet search for a picture of “Perry Mason,” and look at that scleral show!

Scleral show is an anatomical condition in which the sclera area is visibly exaggerated due to constitutional, evolutive, or endocrine etiology.¹ Any condition that creates laxity or that limits motion of the lower eyelids can contribute to scleral show. This could include a number of congenital craniofacial defects. It may be related to trauma during which the facial bones had been fractured and subsequent healing and scar tissue formation limits movement or if the lower lid is not positioned properly. Scleral show can occur with aging, as the lower lid loses its muscle tone and the skin becomes more elastic. It also can occur with losing soft tissue volume in the cheeks. Another common cause of scleral show is weak bony support of the eye (i.e., flat cheek bones). For our friend Perry, large eyes and relatively flat cheeks set him up for scleral show and, with an increased ocular surface, exposure-related dry eye.

I do not know whether Raymond Burr was symptomatic for dry eye, but I do know that he was a horticulturist, lived in Fiji, and collected seashells.² That lifestyle placed him in a perpetually humid environment—perhaps this was an unconscious physical comfort response. I wonder about it all the time. Perhaps a hobby questionnaire is in order?

1. Loeb R. Scleral show. Aesthetic Plast Surg. 1988 Aug;12:165-170.
2. 11 things you might not know about Raymond Burr. Decades. Available at https://www.decades.com/lists/11-things-you-might-not-know-about-raymond-burr. Accessed Feb 24, 2021.

Ocular Health of Children Wearing Daily Disposable Contact Lenses Over a Six-Year Period

The purpose of this study was to report on the ocular health and safety of children fit with soft hydrogel daily disposable contact lenses and followed for six years in a double-masked clinical trial investigating the performance of a dual-focus contact lens designed to control myopia progression.

Children aged 8 to 12 years, naïve to contact lens wear, were enrolled across four international sites. During years 1 to 3, children were randomized to either MiSight 1 Day or Proclear 1 Day (both omafilcon A, CooperVision, Inc.). The lenses were identical in material and geometry except for the front optical zone design. At the end of year 3, all those wearing Proclear 1 Day were switched to MiSight 1 Day; therefore, all wore MiSight 1 Day in years 4 to 6. Subjects agreed to wear the lenses at least 10 hours/day, six days/week. After dispensing, study visits were at one week, one month, six months, and every six months until six years. At each visit, ocular measurements and subjective responses were recorded. Biomicroscopy used 0 to 4 grading scales; grade 0 represented no findings.

The study enrolled 144 children (69 female, 75 male; mean age 10.1 years; mean cycloplegic spherical-equivalent refraction –2.11D; ethnicities included 34 East-Asian, 12 West-Asian, and 79 Caucasian). Of those enrolled, 92 participants completed the six years. Only three subjects discontinued due to an ocular adverse event (AE). No contact lens-related AEs were classified as serious. The incidence rate of infiltrative AEs was 0.61% (6.1/1,000 wearing-years; 95% CI: 0.24% to 1.57%). The most common biomicroscopy findings were limbal, bulbar, and tarsal hyperemia and tarsal roughness. In the study, 99% of all biomicroscopy findings were grade 1 or lower. After six years of lens wear, ocular health by biomicroscopy was similar to pre-lens wear.

The researchers concluded that across the six years, there were no contact lens-related serious AEs, and biomicroscopy showed no significant changes. Results suggest that children this age can successfully wear daily disposable hydrogel contact lenses with minimal impact on ocular physiology.

Woods J, Jones D, Jones L. Ocular health of children wearing daily disposable contact lenses over a 6-year period. Cont Lens Anterior Eye. 2021 Feb 3;S1367-0484(20)30204-6. [Online ahead of print]