CLT, edited by Jason J. Nichols, OD, MPH, PhD, is a free weekly newsletter for eye care professionals who prescribe contact lenses.
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June 20, 2021

There are a variety of organizations representing eyecare professionals—associations, academies, societies, forums, boards, sections, councils, clubs, colleges, and so on. There are almost too many to wrap your head around! In thinking about all of these organizations in eyecare, what is it that prompts your involvement? What do you value in an eyecare organization, and what matters most to you? Please send any thoughts or comments that you have to Thank you in advance.
Jason Nichols

Jason J. Nichols, OD, MPH, PhD

1-800 Contacts Wins Case Against FTC Antitrust Complaint

1-800 Contacts received a favorable court decision after a five-year battle with the Federal Trade Commission (FTC). On June 11, the U.S. Court of Appeals for the Second Circuit ruled that the FTC failed to provide evidence to support claims of anticompetitive practices. The court’s decision confirms that the original complaint had no evidentiary merit and that the agreements were lawfully put in place to protect 1-800 Contacts’ trademark. The final ruling states that the FTC “incorrectly concluded that the agreements are an unfair method of competition,” and the court sent the case back to the commission with orders to dismiss the administrative complaint.

AAOF Announces the 2021 Joe and Janet Barr Early Career Cornea and Contact Lens Research Award Recipient

The American Academy of Optometry Foundation (AAOF) announced the recipient of the Joe and Janet Barr Early Career Cornea and Contact Lens Research Award. Gulnoza Azieva is a second-year OD/MS student at the State University of New York College of Optometry. Her research project focuses on the development of a protocol to assess the ocular surface in the marmoset and to identify reliable parameters that will help with the assessment of CLIDE (contact lens-induced dry eye).

The award is intended to provide an entering first- or second-year MS or PhD vision science or physiological optics student attending a school/college of optometry support of $2,000 for research project seed funding in the areas of cornea/ocular surface or contact lenses. The applicant can be in a graduate program alone or combined with a professional/residency program. Ms. Gulnoza will be honored at Academy 2021 Boston.


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Treehouse Eyes Launches Consumer Marketing Campaign

Treehouse Eyes announced the launch of a consumer marketing campaign to educate parents about childhood myopia and to drive consultations into its 45 locations around the country.

The marketing campaign, which began in mid-April, will initially run for three months and is targeting parents in the San Francisco Bay and greater Washington, DC metro areas. It includes partnerships with local parent influencers to educate their followers, content sponsorship with parent-focused digital media partner Red Tricycle, local interviews with journalists, and paid social media and targeted Google Ads.


Visus Therapeutics Announces Executive Leadership Appointments

Visus Therapeutics Inc. announced the appointment of six new senior leaders including Tim Grinstead as COO; James Burke as vice president of Research; Patrick Hughes, PhD, as vice president of Pharmaceutical Development; Lisa Simpson as vice president of Clinical Operations and Compliance; Guru Sharma, OD, as director of Ophthalmology and Clinical Development; and Alex Oh as vice president of Intellectual Property.

Mr. Grinstead has managed a diverse range of organizations that developed and manufactured biologics, solid oral dosage forms, semi-solids, sustained-release and modified-release dosage forms, sterile injectables, long-acting injectables, and liquid formulations. He was previously vice president and general manager for Alkermes, Inc. and vice president of Manufacturing for Ophthotech (Iveric Bio), leading its biotech manufacturing that focused on a late-stage clinical pipeline of injectable products for diseases of the eye.

Mr. Burke has been appointed to lead all pre-clinical development. He spent more than 30 years at Allergan. He also is the co-inventor of intraocular biodegradable polymeric implants for lowering intraocular pressure (IOP), treating macular degeneration, improving vision, preventing retinal dysfunction, and treating ocular vasculopathies and of the use of subtype selective alpha-2 agonists for the treatment of chronic pain and the lowering of IOP without cardiovascular side effects. He is also the inventor of selective alpha-2 agonists in combination with subtype selective alpha-2 antagonists or Na+/H+ inhibitors for lowering IOP.

Dr. Hughes will be responsible for providing CMC leadership to support the innovation, development, and commercialization of pharmaceutical formulations and drug delivery systems. Prior to joining Visus Therapeutics, he was vice president, Drug Delivery Innovation at Glaukos.

Ms. Simpson was recently vice president of R&D Compliance for AbbVie and Allergan, where she oversaw healthcare compliance policies, training, and monitoring for all R&D functions and therapeutic areas including ophthalmology, gastroenterology, central nervous system, medical aesthetics, women’s health, and anti-infectives.

Previously, Dr. Sharma was involved in corneal wound healing research at the LSU Eye Center. Dr. Sharma most recently served as an ocular anatomy professor at the College of Optometry at Western University of Health Sciences.

Mr. Oh will be responsible for developing and leading Visus Therapeutics’ global intellectual property strategy. Most recently, he served as senior counsel at Bristol Myers Squibb, where he formulated global IP (intellectual property) strategy, managed patent procurement and portfolios, handled administrative proceedings, negotiated complex IP and corporate transactions, and oversaw external partnerships and collaborations. He has also served as an adjunct professor at the University of Washington School of Law since 2011.

Clinical Image
Scott Samples, NCLE-AC, Dean McGee Eye Institute, Oklahoma City, OK

image This patient had radial keratotomy (RK) that resulted in an overcorrection, and his surgeon performed a “lasso” in an attempt to re-steepen the cornea. Vision is correctable to 20/25+ with a scleral lens.

We thank Scott Samples 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 to upload your image. Please include a detailed explanation of the photo and your full name, degree or title, and city/state/country.


Bumps on the Fitting Road

Sometimes the easy part of specialty lenses is the disease diagnosis, and the hard part is the fitting process. Some scleral lens patients may ask “How long will this process take?” Or, an ophthalmology resident whom I am teaching may ask the same question. While some patients are straightforward, certain lumps and bumps are more complicated. My response to the more complicated patients is “It is as if I am fitting an obstacle course, and it may take a bit more time.”

Many patients have multiple ocular surface disease conditions in addition to dry eye. Some may have pingueculae or pterygia that require special considerations. Others may have glaucoma tubes or blebs that warrant fitting adjustments. For pingueculae and pterygia, I will usually “build” around the area. I will use a diagnostic lens and the slit lamp to measure vertical and horizontal dimensions. If feasible, I estimate the height and then discuss it with a lab consultant. For minor areas, I may simply alter the toricity to land more softly over those areas (for example, flattening the peripheral curve in one meridian). Another option for pingueculae or glaucoma drainage devices is to use a notch. In those cases, the lab will direct you on what is recommended, and it is likely that photos and measurements will be needed. Regardless, close monitoring of the fit is advised after a good fit is achieved.


Too Tight for Torics

Soft toric lenses have come a long way. As a grammar student, I recall my mother struggling with her contact lenses that came in a bottle. These very expensive lenses cost more than my bicycle. They seemed to be very important, but she always complained about them and her stigma. I didn’t understand why she wouldn’t just ditch them and buy me a new bicycle—not that I was bitter.

Now, if someone doesn’t like their soft toric lenses, they could just switch brands. Knowing what we know about sagittal depth and toric lens fitting, we can pretty easily become successful with our off-the-rack lenses.

But every now and then, we encounter patients who say that their vision is blurry between blinks but that it always comes back to clarity. Naturally, we think, “Oh, there must be instability with the rotation.” Therefore, we would expect to see the lens rotate on blink. If that is the case, we need to find a lens that will “tighten up” to reduce rotation. However, what happens when you look in the slit lamp and notice that the lens is not rotating?

When the lens does not rotate but a patient complains of blurred vision, it may be due to the lens being too tight and “warping” when the patient blinks. Here’s what you should do: 1) Look at the auto-refractor and see whether there is stability in the over-refraction sphere component. 2) Notice on retinoscopy whether the mires remain stable within the blink. 3) Using a topographer, keratometer, or autorefractor, watch the rings when the patient moves; if they alter with the blink, then your patient’s lens is vaulting and flexing between blinks. In this case, you need to find a lens that has less sagittal depth or is a flatter lens. With this, you may find stability in both the cylinder rotation and the spherical flexure.


Superior Limbic Keratoconjunctivitis: A Comprehensive Review

Superior limbic keratoconjunctivitis (SLK) is characterized by chronic inflammation of the limbus and the superior bulbar and tarsal conjunctiva. Patients also often have fine punctate staining of the limbus and adjacent area, superior limbic proliferation seen as thickening of the limbal epithelium and surrounding conjunctiva, and occasionally filaments at the superior limbus and upper cornea. SLK frequently presents with ocular irritation, foreign body sensation, and photophobia. SLK can be associated with other ocular and non-ocular conditions, such as thyroid disease. Although the pathogenesis of SLK is still unknown, it is thought to be related to mechanical injury, tear film instability, or an autoimmune/inflammatory etiology.

Many patients who have SLK can be asymptomatic or can have symptoms that resolve or remit spontaneously. For symptomatic SLK, patients are managed medically with treatments such as lubricants, topical anti-inflammatory or immunomodulatory medications, punctal occlusion, and bandage contact lenses. Patients who have symptoms refractory to medical management may need surgical interventions.

In this report, the authors detail the current literature on the epidemiology, clinical manifestations, associated conditions, histopathology, pathogenesis, and treatment of SLK.

Lahoti S, Weiss M, Johnson DA, Kheirkhah A. Superior Limbic Keratoconjunctivitis: A Comprehensive Review. Surv Ophthalmol. 2021 May 30;S0039-6257(21)00133-8. [Online ahead of print]
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