Optometric Office October 2018 by First Vision Media Group

OPTOMETRIC OFFICE PRODUCTS AND TECHNOLOGY FOR YOUR PRACTICE

ONE-TO-ONE: USING NEUROLENS AS A PRACTICE BUILDER

CONTACT LENSES: LATEST RESULTS FROM MYOPIA CONTROL STUDY

OCTOBER 2018

PHARMACEUTICALS: TREATING BACTERIAL KERATOCONJUNCTIVITIS

SIX DEVICES FOR YOUR DRY EYE PRACTICE DIAGNOSTIC AND TREATMENT TECHNOLOGY EVOLVES SUPPLEMENT TO VCPN OCTOBER 2018

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OPTOMETRIC OFFICE EDITORIAL STAFF

Table of Contents

VP, Editorial John Sailer | JSailer@ FVMG.com Editor-in-Chief Jeffrey Eisenberg | JEisenberg@FVMG.com Editor Cara Aidone Huzinec | CHuzinec@FVMG.com

Creative Director Megan LaSalla | MLaSalla@FVMG.com Production and Web Manager Anthony Floreno | AFloreno@FVMG.com Contributing Writers Lindsay Berry, OD Joseph Sowka, OD, FAAO, Dipl.

BUSINESS STAFF President/Publisher Terry Tanker | TTanker@FVMG.com Executive Vice President Shawn Mery | SMery@FVMG.com Vice President, Marketing Debby Corriveau | DCorriveau@FVMG.com Regional Sales Manager Eric Hagerman | EHagerman@FVMG.com

EDITORIAL ADVISORY BOARD Jeffrey Anshel, OD • Sherry Bass, OD • Murray Fingeret, OD • Ed De Gennaro, MEd, ABOM • Deepak Gupta, OD • Alan Homestead, OD • Nikki Iravani, OD • Bill Jones, OD Alan G. Kabat, OD • Kenneth A. Lebow, OD, FAAO • Jerome A. Legerton, OD, MBA Scot Morris, OD • John Schachet, OD • Eric Schmidt, OD • Leo Semes, OD Peter Shaw-McMinn, OD • Joseph Sowka, OD, FAAO Jennifer Stewart, OD • J. James Thimons, OD

DEPARTMENTS

16 | New Product Gallery

FEATURES 10 | INSTRUMENTS: Six Devices for Your Dry Eye Practice

INDUSTRY ADVISORY BOARD Dwight Akerman, OD, Alcon Laboratories, Inc., a Novartis Company Steve Baker, EyeFinity • Joseph Boorady,OD, TearScience, Inc. Sally M. Dillehay, OD, Visioneering Technologies, Inc. Dave Hansen, OD, Ophthalmic Consultant • Carla Mack, OD, Alcon Laboratories, Inc. Dave Sattler, Dave Sattler Consulting Michele Andrews, OD, CooperVision, Inc. • Ellen Troyer, Biosyntrx, Inc. Millicent Knight, OD, Johnson & Johnson Vision Care, Inc.

Throughout this magazine, trademark names are used. Instead of placing a trademark or registration symbol at every occurrence, we are using the names editorially only with no intention of infringement of the trademark.

12 | CONTACT LENSES: Study Evaluates Myopia Control 13 | PHARMACUETICALS: Patient’s Discomfort Has OD Seeing Red www.Facebook.com/OptometricOffice www.Twitter.com/OO_Magazine www.Linkedin.com/showcase/Optometric-Office-Magazine

VIEWS

Jeffrey Eisenberg

THE GIVING SEASON BEGINS

Normally, you’d have to wait another month for this column to discuss what a generous and giving profession optometry is. But in a year with devastating wildfires in California and, more recently, Hurricane Florence’s visit to the Carolinas, this seemed like an ideal time to reflect on the generosity of the optometric profession. Whenever there’s news of a hurricane hitting the U.S., I think back to an OD I interviewed many years ago. This doctor’s practice was all but destroyed when Hurricane Andrew tore through Homestead, FL., with winds of up to 165 m.p.h., yet he immediately opened up an office in a trailer so that he could help patients replace lost eyewear and contact lenses. This doctor and his family also opened their home, which was damaged but still habitable, to employees whose homes were damaged or destroyed and, for good measure, rescued a bedraggled looking dog that was obviously displaced by the storm. Last year, following Hurricanes Harvey, Irma and Maria, ODs and industry contributed to organizations such as the American Red Cross and Optometry’s Fund for Disaster Relief, which itself was created in response to Hurricane Katrina in 2005. According to the fund’s webpage (AOAFoundation. org/OFDR), more than 430 donors contributed in 2017, enabling the fund to award $349,500 to doctors and $16,650 to students of optometry. Industry jumped in as well, providing relief funds for doctors and helping patients replace lost eyewear. That same generosity came through in August. Describing to the AOA News an Armageddon-like scenario of the Carr

fire in California, husband and wife optometrists Curtis and Janet Newcomb had to evacuate their own home in Redding and then the home of friends, yet they kept their practice open providing not only eyecare, but hugs and prayers as well. The same for optometrist Meredith Turner, who described treating patients daily for eye irritation and allergies from the smoke. The Newcombs also described how their vendors supplied cases of rewetting drops for patients and firefighters, and how their lab was ready to help with replacement eyewear. Optometry has not always received the most favorable coverage from the mainstream press. For example, as the FTC mulls changes to the Fairness to Contact Lens Consumers Act, the profession’s desire to protect patients’ ocular health has become confused with trying to deny consumers a choice as to where they obtain their lenses. The same when optometrists try to expand their scope of practice so they can provide greater care to their patients. However, besides contributing in extreme situations such as hurricanes or wildfires, optometry is a profession that provides free eye exams to infants at age six months, provides outreach of vision services to communities, and brings eyecare to individuals in other parts of the world. It’s a profession whose colleges also serve as a primary source of vision care to the surrounding community. It’s a profession whose members lobby to ensure public safety against illegal contact lens sellers and for continued access to care for veterans and that has vowed to become part of the solution to the opioid epidemic. It’s also a profession that makes a difference every day in the lives of patients, whether it’s treating a binocular vision disorder that would otherwise prevent a child from succeeding in school, spotting an individual’s otherwise undiagnosed diabetes, or helping an older patient with vision loss due to AMD perform the most basic of tasks. Let the season of giving continue.

*** Jeffrey Eisenberg | Editor-In-Chief | JEisenberg@FVMG.com

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resonates with my patients is that there’s a medical issue going on. And now we have a new technology to calm the trigeminal nerve, and your symptoms can be alleviated or even eliminated. . This technology has been incredibly valuable to me, and I believe that trigeminal nerve overstimulation is going to be a new and significant issue for optometrists, and that’s. It is expressed as chronic headaches, neck and shoulder pain, and computer vision syndrome. We’re all tied to our phones and computers now. So, headaches or blurred vision or just asthenopia discomfort at the computer are all things that originate from a disparity between your peripheral and your central nervous system.

ONE-TO-ONE

Nicole Thomas

Nicole Thomas, eyeBrain Medical’s vice president, marketing, and Eric Bender, OD, discuss how neurolens can alleveate patients’ symptoms and help build your practice. Bender, who has been in practice in Tustin, CA, for more than 15 years, is a consultant for eyeBrain Medical. Jeffrey Eisenberg: So neurolens officially launched this past spring? Nicole Thomas: We’re really excited because neurolens is bringing something completely new to the optometry practice. The neurolens system is comprised of a unique measurement device and a brand new category of lens design. What we found was that over half of patients coming into optometry practices were experiencing symptoms such as headaches, eye strain and neck tension that were not able to be addressed by regular computer lenses. Through clinical research, we discovered that these symptoms were correlated with eye misalignment. So we developed a system to measure it, and we developed a new category of lenses to treat it. neurolenses feature a contoured prism, which addresses eye misalignment at distance, intermediate and near. And 93% of our patients report that their headaches, neck tension and eye strain are being relieved. Eric Bender, OD: This is a tremendous opportunity for independent practices. We’re using a technology to treat a disparity between the central and the peripheral vision, which calms down the trigeminal nerve. When you have a difference between eye alignment from far to near, the trigeminal nerve becomes overstimulated, and so neurolenses are like a medical treatment we can apply to calm that down and alleviate patient symptoms. What

We measure a patient using the neurolens Measurement Device, and I’ve chosen to integrate it into my pre-testing. So, essentially every patient that comes through the office gets tested. It’s so powerful and new to have that information right from the beginning. NT: We offer them a lifestyle questionnaire, too. EB: So they get tested and they also fill out a questionnaire, “Do you get headaches? Do you get neck pain? Do you have dizziness? Do you feel discomfort when using a computer? Are your eyes dry?” These are major topics that a lot of our patients feel and have. JE: I’ve been hearing about the neurolens for digital eye strain, but it sounds like a lot more than that for other conditions as well. EB: The real opportunity is for optometrists to treat things we haven’t been able to treat before, especially now when you use the lifestyle index to solicit and ask, “Do you get headaches?” Because people don’t always associate the optometrist with being able to fix your headache. Our test is on is, on average, three to five minutes, so it’s simple to add into the pre-testing routine. JE: What is the learning curve like in terms of using the equipment? Is it something your techs are able to do? EB: With anything new that you bring into an office, you have to dedicate time. Within a few weeks, it’s smooth. But it is something new that you need to figure out and get involved with training your staff. NT: We have a dedicated team for each practice that spends two days training the doctor and the staff. They line up patients ahead of time. We give them the Lifestyle Index so they have patients that they can test and apply the knowledge once the device is delivered EB: And what I’ve done is train all of my staff. I usually have five employees in my office. All staff has been trained on the machine so that anyone can start the neurolens and test patients. Frankly, I think everyone in a practice should be c cross-trained anyway. For the complete interview, go to OptometricOffice.com. O p tometr ic O ffic e. c om | Oct obe r 2018 3

THINK ABOUT YOUR EYES

Daily disposable contact lenses are especially popular now—so popular that my practice prescribes them to about 85% of our patients. Most of our patients are children younger than 18 and adults with traumatic brain injuries. Pediatric patients often have poor hygiene habits. Adults with brain injuries often suffer from dry eye and low blink rate or are at increased risk for developing infection. These patients benefit from the use of daily disposable contact lenses to minimize the risk of complications such as corneal problems from over-wear, dryness, or discomfort.

MANY ADVANTAGES

Daily disposable contact lenses have many advantages. First, patients appreciate the convenience factor. They no longer have to worry about cleaning lenses each night or remembering to switch to a new pair. They simply just throw away each pair at night and open a new, fresh pair in the morning. Travel also becomes easier because they don’t have to worry about bringing contact lens solution or cases. Second, daily disposable contact lenses are healthier for the cornea because patients are less likely to over-wear their lenses. Daily disposable contact lenses also have significantly less potential for protein build-up on the lens due to replacement schedule. The result: improved comfort for our patients. Finally, daily disposable contact lenses are my preferred option for patients who wear contact lenses part time. I have several adult patients who prefer to wear contact lenses only in social settings, and daily disposable contact lenses are a great option for this type of wear.

EDUCATION

I’ve had some patients who feel that throwing away lenses at the end of each day is wasteful; therefore, they choose to wear the lenses for a few days or more at a time. Patient education becomes especially important so they understand the risk of over-wearing contact lenses. Daily disposable lenses also tend to be more expensive than bi-weekly or monthly lenses. However, the cost of daily disposable lenses has become more comparable to monthly lenses due to rebates and not having the costs of associated care products.

Lindsay Berry, OD

Specifications and design are subject to change. Please contact your local distributor for details.

IT’S ALL IN A DAY

Lindsay Berry, OD, is a member of the Texas Optometric Association and among more than 20,000 doctors listed on the Think About Your Eyes online locator. Think About Your Eyes is a nationwide public awareness initiative promoting the importance of an annual eye exam and overall vision health. First Vision Media Group supports Think About Your Eyes as a media partner.

CASE HISTORY

A thorough case history and lifestyle questionnaire can be helpful in determining the best contact lens replacement schedule for a patient. Patients who travel, are prone to dry eye or protein build-up on their lenses, are active or participate in sports, or have a history of poor compliance with contact lens care are ideal candidates for daily disposables. Patients should visit your office annually for a comprehensive exam to keep you aware of their vision and lifestyle habits. I’m proud to be a supporter of Think About Your Eyes, which educates patients on the importance of an annual eye exam and encourages them to take action to maintain their vision health. This is especially important for daily disposable contact lens wearers. Daily disposable contact lenses have proven to be easier to use and more healthy for patients, so they should always be considered when prescribing contact lenses. (For a listing of daily disposable contact lenses, see “At-A-Glance: Daily Disposable Contact Lenses,” page 14.) O|O

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Please note: The availability of the products and features may differ in your country. Specifications and design are subject to change. Please contact your local distributor for details.

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PRODUCT | BUZZ LAUNCHES, PROMOTIONS, MERCHANDISING, EVENTS AND OTHER THINGS TO KEEP YOU IN THE KNOW.

MACULOGIX ACADEMY TEACHES ADAPTDX USERS

MacuLogix, Inc. has launched its AMD Academy, an online learning community available at no cost for current users of the AdaptDx dark adaptometer. The launch features 21 video-based learning modules to educate new users about how to prepare and run the test, how to manage patient data and more. Experienced AdaptDx users can also access the learning modules at any time to revisit certain topics and to gain or share helpful tips on the discussion forum. The company plans to add learning modules, including best practices and practice workflow. General education on age-related macular degeneration will be added in the future. Go to MacuLogix.com.

ALCON EXPERIENCE ACADEMY INCLUDES TRAINING

Alcon, a division of Novartis, has unveiled the Alcon Experience Academy, which offers face-toface training and online educational resources for healthcare professionals, including eyecare practitioners.

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As part of this effort, Alcon is launching a new online portal with a library of educational materials, including more than 500 training videos, with additional content added regularly to the home screen. It will also feature webcasts developed by eyecare specialists from around the world, along with personalized videos and curricula across several disease states and focus areas. The website materials primarily focus on real-world surgical case studies, and resources specific to optometry are due to be released early next year. Go to AlconExperienceAcademy.com.

J&J LAUNCHES NEW LASIK TREATMENT

Johnson & Johnson Vision has launched the iDESIGN Refractive Studio, which allows doctors to take a precise measurement of the eye inside and out so that each patient can receive a personalized LASIK procedure. The device is approved

BLANCHARD TEACHES STUDENTS ABOUT SCLERAL LENSES

Blanchard Contact Lenses has launched the Onefit Scleral Lens Excellence Award program in partnership with optometric educational institutions across the country. The program will provide third- and fourth-year students with opportunities to develop and enhance their experience with scleral lenses. Students who complete each element of the four-part program will receive the Onefit Scleral Lens Excellence Award along with a certificate redeemable for their choice of a Onefit or Onefit MED diagnostic fitting set. Information is available through the schools themselves, or interested students can call Blanchard at 800.367.4009 and ask for Beth Clark, director of marketing communications. Go to BlanchardLab.com/products/ Onefit or BlanchardLab.com/products/ Onefit-Med.

for myopia, hyperopia, and mixed astigmatism and is indicated for wavefront-guided monovision LASIK in presbyopic myopic patients. The iDESIGN Refractive Studio takes five measurements—wavefront aberrometry, wavefront refraction, corneal topography, keratometry and pupillometry—in a single one-click capture sequence. Go to JJVIsion.com.

B+L GEL RESOLVES POST-CATARACT SURGERY PAIN

The Sept. 4, 2018 Journal of Cataract and Refractive Surgery includes results of Bausch + Lomb’s Phase 3 multicenter study that evaluated the clinical safety and efficacy of submicron loteprednol etabonate ophthalmic gel, 0.38%. Results of the double-masked, vehicle-controlled study showed that this investigational formulation was significantly more

effective than the vehicle in completely resolving ocular inflammation and pain following cataract surgery and that it had an acceptable safety profile regardless of whether it was administered two or three times per day. Submicron loteprednol etabonate ophthalmic gel, 0.38% has a reduced concentration and reduced dosing frequency versus existing formulations of loteprednol etabonate. Go to Bausch.com.

MATI’S EVOLUTE ALLEVIATES POST-CATARACT PAIN

Also in post-op cataract care, Mati Therapeutics Inc. has completed a planned interim analysis of an ongoing Phase II clinical trial evaluating the safety and efficacy of nepafenac delivered in the Evolute sustained ocular drug delivery platform in 75 patients who underwent cataract surgery. The primary endpoint is to evaluate pain, and the secondary endpoint is to evaluate inflammation following surgery. Pain scores favored nepafenac over placebo at days one, two and three post-op. At day three, 71% of patients treated with nepafenac experienced no pain versus 12% in the placebo arm. Post-operative inflammation, as determined by cell and flare scores, also favored the Evolute arm. The treatment was generally well tolerated, with no unexpected side effects reported. Go to MatiTherapeutics.com.

REGULATORY REVIEW

News Think About Your Eyes, a national public awareness campaign about the importance of scheduling an annual eye exam with an optometrist, has added the California, Delaware, and Massachusetts state optometric associations to the current group of leadership states, bringing the total number of state associations supporting the campaign to 44 and the number of listings to 22,000.

Research Center and six new endowed chairs for faculty.

A partnership between the California Optometric Association, Anthem Blue Cross Medi-Cal Health Plan, and Ampla Health helped Chico residents build relationships with the local community health center and healthcare providers and learn about how to prevent and manage diabetes to avoid such consequences as blindness and amputations.

Eyevance Pharmaceuticals has acquired Paragon BioTeck, which recently reformulated its FRESHKOTE family of lubricant eye drops as a preservative-free product available in a multi-dose bottle and in singleunit vials.

Andrew J. Viterbi, co-founder and retired vice chairman and chief technical officer of Qualcomm Inc., has donated $50 million to the University of California, San Diego, which will go toward The Viterbi Family Department of Ophthalmology, The Viterbi Family Vision

EyePoint Pharmaceuticals has elected Göran Ando, MD, as its next chairman, succeeding David J. Mazzo, PhD, who will remain on the board and serve as chair of the compensation committee. Clearside Biomedical, Inc. has appointed Lester Rodríguez as vice president, quality.

Kodiak Sciences Inc. has completed enrollment of patients in the company’s phase 1 safety and tolerability study of KSI-301, an intravitreally administered anti-VEGF agent, for the treatment of neovascular agerelated macular degeneration and diabetic eye disease. Thomas J. Chirillo has been named chief commercial officer with neurolens.

The U.S. Food and Drug Administration has acted on two supplemental Biologics License Applications from Regeneration Pharmaceuticals, Inc. The FDA approved the application for using EYLEA (aflibercept injection) in patients who have wet AMD and accepted for review the application for using EYELEA to treat diabetic retinopathy. In other news, the FDA: • Approved Dompé’s Oxervate (cenegermin) for the treatment of neurotrophic keratitis. • Approved INVELTYS (loteprednol etabonate 0.1%), a twice-daily ocular corticosteroid from Kala Pharmaceuticals, Inc. for treating postoperative inflammation and pain following ocular surgery. • Granted Fast-Track designation to MeiraGTx Holdings Plc for its AAV-CNGB3 gene therapy product candidate for the treatment of achromatopsia.

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THE ZEISS SUBJECTIVE REFRACTION SYSTEM: Effective, Precise, Compelling

“

BENNY PEÑA, OD • TEXAS STATE OPTICAL • FREDERICKSBURG, TX

ZEISS has made it possible for me to spend less time on refractions so that I can spend more time evaluating patients’ ocular health and prescribing the best lenses.

”

My name is Dr. Benny Peña, and I switched to the ZEISS digital refraction system. If you didn’t know that ZEISS makes a subjective refraction system, let me tell you about my experience. It does a lot of things very well. The core of the system has three components: a digital phoropter called VISUPHOR®, a digital display called the VISUSCREEN®, and the i.Com mobile user interface. The first thing that struck me when I first saw the system is how totally modern it looks. Instead of a plastic-covered phoropter shaped like an everyday phoropter, the VISUPHOR looks like a pair of flat panels. The VISUSCREEN is very flat, very sharp and very bright. The user interface is on an iPad, and you can tell that it was made for touch because the layout is very simple. Everything looks like it was designed to fit together as a complete system, right from the beginning. But it was only after I started using it that I could really sense how much attention ZEISS paid to details.

THE VISUPHOR PHOROPTER

The phoropter allows me to set corneal vertex distance using illuminated viewing ports on the front of the phoropter, by viewing a side profile of each eye. There is no need to crane my neck or peer behind the phoropter. Although the patient’s PD can be automatically uploaded and set from pre-test data or patient records, the VISUPHOR has another nice touch: crosshair reticles to adjust the monocular PD.

Other phoropters have an indicator light to show if the patient is in contact with the forehead rest, but ZEISS provides an indicator both on the phoropter and on the iPads user interface. The forehead rest is broad and fairly flat making it very comfortable for the patient and very easy to clean. In fact, the entire phoropter housing is so simple that cleaning it is a breeze compared to other phoropters I’ve used. And today’s patients really pay attention to cleanliness!

IPAD USER INTERFACE

I really enjoy the user interface. The iPad lets me change position easily while maintaining control at all times. The other digital phoropters I looked at all had control panels that looked gimmicky with lots of buttons and controls. I thought they could be difficult to operate. A great feature about a software-defined touch interface is that controls can be upgraded, and ZEISS has already provided new features and capabilities. I wouldn’t get that kind of upgrade capability with a user interface controlled by knobs and buttons on a hardware panel.

VISUPHOR, VISUSCREEN and i.SCRIPTION are registered trademark of Carl Zeiss Vision USA.

The ZEISS user interface only shows me controls for the test I’m doing at the moment. That’s because the software is based on workflows. I created my own workflow based on my needs, but it would be possible for another doctor to use his or her own customized workflow or a standard work flow. Basically a work flow is a sequence of a set of tests to be performed in every refraction, and you can have several defined workflows for different kinds of exams. ZEISS also provides a “Freestyle Mode” to switch away from a defined workflow in case a particular patient requires a different test. Of course the user interface allows the doctor to let the patient experience different refractions, but the ZEISS system’s total wireless integration makes it easy to compare values such as the power of the patient’s current glasses, i.Scription® wavefront refraction, or a previous refraction pulled from an EHR system. All refraction results that are available are displayed on a convenient list and can be shown to the patient at the touch of a button on the iPad.

of targets, including pediatric pictures. Another feature I’d like to explore more is using inverted contrast or low contrast letters, especially for patients who have unique requirements or are especially sensitive to slight prescription changes.

VISUSCREEN DISPLAY

I already mentioned that the VISUSCREEN is very bright and very sharp. It is fully integrated and wirelessly linked to the user interface and phoropter. Whatever is displayed on the screen is also displayed on the iPad’s user interface. That is a lot more natural than twisting around to see what the patient is looking at! I can do the whole refraction without ever turning my back on the patient. I like to randomize letter presentation to keep patients from memorizing charts or “locking in” on a single letter during cross cylinder testing, so it’s a great benefit to have a “what you see is what they see” display right in front of me! The display can show many kinds

The complete integrated system provides capabilities that advance the experience of refraction. One of those is split-prism monocular refraction that takes the cross-cylinder test to a next generation: instead of having to remember which view is better, the patient gets to compare both views at the same time. I find this easy for the patient to understand and makes this part of the refraction very efficient. Another useful feature is the artificial star built into the VISUSCREEN. With this you can directly simulate the effect of your refraction on night vision.

I use an iProfiler and use this feature to demonstrate the improvement of the i.Scription.

EHR INTEGRATION

I also love the seamless wireless integration with our ExamWRITER software. We can automatically transfer data from pre-testing to the phoropter, and when I’ve finished the latest refraction, I just tap a button on the iPad and a button on the computer, and everything is sent directly to my EHR. Plus whenever another of our doctors has a visit with one of my patients, any of the patient’s previous refractions can be uploaded to the phoropter, making it easier to understand what’s going on. Patients love the ZEISS refraction experience, and most of them comment on our state-of-the-art technology. They love that lenses in the phoropter change quickly and quietly and tests are set up to proceed quickly and efficiently to a conclusion. In fact, I appreciate that too because ZEISS has made it possible for me to spend less time on refractions so that I can spend more time evaluating patients’ ocular health and prescribing the best lenses and lens enhancements for their lifestyle.

Brought to you by Carl Zeiss Vision, Inc.

INSTRUMENTS

SIX DEVICES | FOR YOUR DRY EYE PRACTICE

As the definition of dry eye disease evolves, so, too, does the diagnostic and treatment technology. By J ef f rey Eisenberg When the Tear Film and Ocular Surface Society, or TFOS, held meetings of its Dry Eye Workshop II (DEWS II), its members established one of the goals was updating the definition of “dry eye disease.” Consider: In 1995, the NEI defined dry eye as “tear deficiency or excessive tear evaporation, which causes damage to the interpalpebral ocular surface and is associated with symptoms of discomfort.”1 In 2007, the TFOS, following its first Dry Eye Workshop, began describing dry eye as a “multifactorial disease of the tears and the ocular surface.”2 By 2017, DEWS II had updated the definition further. Dry eye, it said, 10 Oct o b e r 2 0 1 8 | O p to m e tri c O f f i c e .c o m

“is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface.”3 While many traditional tools are still important—such as the Dry Eye Questionnaire or Ocular Surface Disease Index, staining, and tear break-up time—diagnostic technology has evolved along with the definition, with several devices introduced in the last year alone. New treatment devices have evolved as well.

LACRYDIAG

Earlier this year, Quantel Medical debuted its LacryDiag ocular surface analyzer, which has been approved by the U.S. Food and Drug Administration. LacryDiag allows you to perform a noncontact exam, measuring the lipid, aqueous and mucinic layers of the tear film. Specifically, you can perform interferometry and meibography, plus you can measure tear meniscus height and non-invasive tear break-up time— all of which are recommended in DEWS-II. You can then obtain an exam report, complete with patient images, and edit in one click.

CRYSTAL TEAR REPORT

OCULUS added a Crystal TEAR Report to its Keratograph 5M corneal topographer. The report walks you through all the necessary assessment criteria for a comprehensive dry eye analysis, lets you manually enter your dosage recommendations for individual treatments and summarizes all results in a printout that can also be used for patient education. The printout includes your personal logo on the Crystal TEAR Report, an easy-tounderstand color-coded pie chart for assessment of dry eye disease, explanations of abbreviations and technical terms that the patient can understand, comprehensible presentation of individual measurements and their results, clear explanation of the treatment goal along with the necessary therapeutic steps and space for the doctor’s personal recommendation.

which then measures osmolarity. A reading of more than 300 mOsm/L, indicates loss of homeostasis, and a difference of more than 8 mOsm/L indicates instability of the tear film, according to the company, which added that the test has a positive predictive value of 89%.

TEARCARE

Sight Sciences, Inc., initiated the OLYMPIA study of its TearCare System in patients with dry eye disease. The TearCare System is fully customizable and allows the patient’s eyes to remain open and blinking during the procedure. Soft, flexible devices conform to the eyelids to deliver a sufficient level of energy

TEARLAB

Also on the osmolarity front, TearLab Corporation launched the TearLab Osmolarity System in Brazil in March and later this year plans to resubmit its 510(k) filing with the FDA after addressing the agency’s questions. With TearLab, you can measure the osmolarity of tears in patients you believe may have dry eye disease. The system consists of the TearLab Osmolarity Test Card, the Osmolarity Test Pen, which holds the test card while you collect the tear samples, and the TearLab Osmolarity System,

The sterile, single-patient-use, disposable iLux Smart Tip has an inner pad and an outer pad. The inner pad slips behind the eyelid being treated, while the outer pad is pressed against the outer surface of the eyelid during heating and compression. Both pads are covered with a soft, biocompatible silicone material. The iLux Smart Tip contains precision temperature sensors that continually monitor inner and outer eyelid temperature and maintain safe, therapeutic heat levels during treatment. O|O

I-PEN

OCuSOFT Inc. formed a distribution agreement with I-MED Pharma Inc., a Montreal-based biotechnology company to make the I-PEN Osmolarity System available in the United States. The handheld device uses sensors that allow you to measure the palpebral conjunctiva to determine osmolarity. The I-PEN measures the electrical impedance in the tear-soaked tissues 192 times in less than five seconds and calculates the osmolarity of the tear film of the eye.

view the eyelid margin through the magnifier, then warm the eyelid tissue within a therapeutic target range to melt the meibum blocking the orifices, and then apply compression to the eyelid to express the melted meibum through the orifices. iLux can treat both upper and lower eyelids. You control the amount of heat and pressure at all times.

1. Lemp MA. Report of the National Eye Institute/Industry workshop on Clinical Trials in Dry Eyes. CLAO J. 1995 Oct;21(4):221-32.

for a specific period of time to liquefy meibum. The randomized, controlled trial is evaluating the safety and effectiveness of the TearCare System vs. a daily regimen of combined warm compress therapy and lid massage. The primary endpoint is tear breakup time at one month, and several other endpoints will be evaluated to assess changes in patients’ dry eye signs and symptoms. Researchers will follow individuals for six months, re-treat them, and then follow them for another six months. The device is expected to be available in 2019.

ILUX

The iLux evaporative dry eye system from Tear Film Innovations received 510(k) clearance from the FDA in December 2017. The system lets you

2. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007 Apr;5(2):75-92. 3. Nelson JD, Craig JP, Akpek EK, et al. TFOS DEWS II Introduction. Ocul Surf. 2017 Jul;15(3):269-275.

O p tometr ic O ffic e. c om | Oct obe r 2018 11 O p tom

CONTACT LENSES

STUDY EVALUATES | MYOPIA CONTROL Latest data on the MiSight lens show show slower myopia progression among children. New four-year study data show a significant impact of a specialty contact lens for slowing the progression of myopia in children, including those whose treatment begins later. CooperVision presented four-year data from the Clinical Evaluation of a Dual-Focus Myopia Control 1-Day Soft Contact Lens Study, a multi-year study, during last month’s BCLA Asia conference in Singapore. The ongoing clinical trial is assessing CooperVision MiSight, a specially designed, dual-focus myopia control one-day soft contact lens, in reducing the rate of progression of juvenile-onset myopia. The lens is commercially available as CooperVision MiSight 1 day in select countries, though MiSight is not approved in the United States.

PHYSIOLOGICAL CHANGES

During the fourth year of the study, researchers studied physiological changes among 100 myopic children from Singapore, Canada, England, and Portugal. “The treatment is continuing to work for children who have been wearing MiSight contact lenses for the entire study, and their axial length progression in this last year has slowed further. This illustrates the benefits of beginning myopia management as early as possible to maximize the benefit,” said Paul Chamberlain, director of research programs for CooperVision. After year three, myopia progression slowed in children wearing the MiSight contact lens by 59%, as 12 Oct o b e r 2 0 1 8 | O p to m e tri c O f f i c e .c o m

measured by mean cycloplegic spherical equivalent and 52%, as measured by mean axial elongation of the eye when compared to the children in the control group wearing a single-vision one-day contact lens. x

• Axial length growth of 0.07mm in the MiSight group and 0.06mm in the previous control group, compared to 0.10mm seen in the MiSight group in year three, represents further myopia slowing as the children age. • There were no significant differences in myopia progression rates for two demographically matched populations in their first versus fourth years of MiSight contact lens wear.

TO FIVE BILLION

SLOWER PROGRESSION

In the fourth year, children in the original control group were refit with the myopia control lens and continued to be tracked separately. Use of the dual-focus contact lens—which has alternating visual correction and treatment zones—was effective in slowing myopia progression in both groups, according to the company. Specifically: • There was a significant reduction in myopic progression for the previous single-vision oneday wearers, indicating that the MiSight lenses are also effective when beginning myopia management at an older age. • There were no significant differences between groups for change in spherical equivalent refractive error and axial length over 12 months.

The prevalence of myopia is projected to increase from approximately two billion people worldwide in 2010 to almost five billion people in 2050, bringing with it near- and long-term health challenges.1 Not only does it create blurred vision, but it also increases the likelihood of conditions later in life, such as glaucoma, cataract, retinal detachment and myopic maculopathy if not addressed. Though children benefit at whatever age the treatment is started, treatment is more effective in reducing final levels and the future risk of related vision impairment issues, said Stuart Cockerill, senior director, myopia management. O|O 1. Holden BA, Fricke TR, Wilson DA, et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016 May;123(5):1036-42.

WHERE TO FIND IT CooperVision, Inc. 800.341.2020 | CooperVision.com

PHARMACEUTICALS

CASE REPORT: DISCOMFORT | HAS OD SEEING RED Fluoroquinolones helped treat this patient’s bacterial keratoconjunctivitis. By J o seph S owka, OD , FAAO, D ipl. A 23-year-old Asian male presented with bilateral redness and irritation as well as thick, sticky discharge. He reported that his lids were “glued shut” upon awakening. The symptoms, he said, began several days earlier—first in the right eye, then the left—and had been worsening. Visual acuity was 20/30 in both eyes. Both eyes had conjunctival injection with mild diffuse epitheliopathy and papillary hypertrophy.

Dosing is every two hours to four times daily depending upon the clinical presentation. Instruct the patient not to go below the recommended minimum dosing or taper off antibiotics, because this might promote resistance.

The patient had bacterial keratoconjunctivitis for which I prescribed Novartis’ Ciloxan (ciprofloxacin 0.3%). I instructed him to instill one drop every hour and to use a saline lavage as needed. Twenty-four hours later, the discharge was gone.

mucopurulent discharge. Tarsal papillae are common, and the cornea may show punctate epithelial erosion. Symptoms include generalized ocular discomfort. When the cornea is involved, the patient may experience foreign-body sensation and decreased acuity. Heavy loads or virulent organisms may be hard to eradicate without ocular damage.

DEFENSE BREAKDOWN

MANAGEMENT

Bacterial keratoconjunctivitis is the result of a breakdown in the ocular defense system. An antigen-antibody reaction causes an inflammatory response to bacteria and exotoxins, which may alter corneal metabolism. Common causes include Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae and Pseudomonas aeruginosa. The resulting discharge can be toxic to the cornea. Epithelial breakdown and erosion can occur in bacterial conjunctivitis, and when this happens it is then termed bacterial keratoconjunctivitis. Punctate keratitis comes from mucopurulent discharge. Signs include conjunctival injection (inferior greater than superior) that may extend to the episclera, sticky

Bacterial conjunctivitis is largely a benign, self-limiting disease, and treatment is not mandatory. Studies have shown that past three days of infection, the use of topical antibiotics shows no additional benefit. Culture and sensitivity testing is usually time-consuming and expensive, so we reserve this only for hyperacute or unresponsive presentations. Instead, many clinicians begin treatment with broad-spectrum antibiotic therapy immediately. Fluoroquinolones represent the best option today, particularly the fourthgeneration fluoroquinolones. These include Bausch + Lomb’s Besivance (besifloxacin 0.6%), Novartis’ Moxeza (moxifloxacin 0.5%) and Allergan’s Zymaxid (gatifloxacin 0.5%).

However, fourth-generation fluoroquinolones are very expensive. If the patient’s finances or insurance coverage are considerations, older-generation generic fluoroquinolones— Ciloxan, Allergan’s Ocuflox (ofloxacin 0.3%) and Santen’s Quixen (levofloxacin 0.5%)—are very effective and inexpensive. Other agents, such as Allergan’s Polytrim (polymyxin B sulfate and trimethoprim ophthalmic solution) and Alcon’s Tobrex (tobramycin), remain viable options. O|O Joseph Sowka, OD, FAAO, Dipl, is a professor at Nova Southeastern University in Fort Lauderdale, FL. He is chief, Advanced Ocular Care; director, The Glaucoma Service; and chair, Department of Optometric Clinical Sciences.

O p tometr ic O ffic e. c om | Oct obe r 2018 13

AT-A- GLANCE

DAILY DISPOSABLE CONTACT LENSES

BRAND

BC/DM DK (MM)

MATERIAL/ POWERS (D) H2O

Alcon Laboratories | 800.451.3937 | Alcon.com DAILIES 8.7/14.0 26 @ -3.00D nelfilcon A/ AquaComfort 69% Plus

DAILIES 8.7/14.0 AquaComfort Plus Multifocal

26 @ -3.00D nelfilcon A/ 69%

DAILIES AquaComfort Plus Toric

8.8/14.4

26 @ -3.00D nelfilcon A/ 69%

DAILIES TOTAL1

8.5/14.1

156 @ -3.00D delefilcon A 33%

+0.50 to +6.00 -0.50 to -6.00 (0.25 steps) +6.50 to +8.00 -6.50 to -15.00 (0.50 steps) Plano to -10.00 +0.50 to +6.00 (in 0.25 steps) Add: low, medium, high Plano to -6.00 +0.25 to +4.00 (0.25 steps) -6.50 to -8.00 (0.50 steps) Cylinder: -0.75, -1.25, -1.75 Axis: 10°, 20°, 70°, 80°, 90°, 100°, 110°, 160°, 170°, 180° +0.50 to +6.00 -0.50 to -6.00 (0.25D steps) -6.50 to to -12.00 ( 0.50D steps)

BENEFITS

• Blink-Activated Moisture for added refreshment with every blink • ideal for those with allergies or who use digital devices

• Precision Profile Design for clear vision at all distances and a smooth transition from center near to intermediate and far. • consistent add power for decreased fit time and improved performance at all distances • dual thin zone Precision Curve lens design • Blink-Activated Moisture

• water-gradient contact lens • approaches 100% water at the outer surface so all that touches the eye is a cushion of moisture • nine out of 10 wearers say the lens feels like nothing • available in a multifocal version

Bausch + Lomb | 800.828.9030 | Bausch.com Biotrue ONEday

8.6/14.2

nesofilcon A/ Plano to -6.25 (0.25D steps) • maintains 98% of its moisture for up to 16 hours 78% -6.50D to -9.00D (0.50D • features UVA/UVB protection steps) • aspheric optics +0.25D to +6.00D (0.25D steps)

Biotrue ONEday for Astigmatism

8.4/14.5

nesofilcon A/ Plano to -6.00 (0.25D steps) 78% Cylinder: -0.75, -1.25, -1.75, -2.25 Axis: 10°, 20°, 60°, 70°, 80°, 90°, 100°, 110°, 120°, 160°, 170°, 180° -6.50 to -9.00 (0.50D steps) Cylinder: -0.75, -1.25, -1.75, -2.25 Axis: 10°, 20°, 60°, 70°, 80°, 90°, 100°, 110, 120°, 160°, 170°, 180° +0.25 to +4.00 (0.25D steps) Cylinder: -0.75, -1.25, -1.75; Axis: 20°, 70°, 90°, 110°, 160°, 180°

14 Oct o be r 2 0 1 8 | O p to m e tri c O f f i c e .c o m

• maintains 98% of its moisture for up to 16 hours • evolved, blink-inspired peri-ballast lens designed for comfort and stability • provides consistently clear vision all day • features UVA/UVB protection

BRAND

BC/DM DK (MM)

MATERIAL/ POWERS (D) H2O

BENEFITS

Clearlab | 888.777-7147 | ClearlabUSA.com Eyedia Fresh Daily Disposables

8.6 or 8.7/14.0

25.3

hioxifilcon A/ +6.00 to 58% -10.00

• Aquagrip technology enables lens to retain water content • Spin Cast technology reproduces accurate lens prisms • Green manufacturing technology uses 70% less water and plastic • excellent for dry eye and allergy patients

CooperVision | 800.341.2020 | CooperVision.com

clariti 1 day

8.6/14.1

somofilcon A/ +8.00 to -10.00 56%

• silicone hydrogel material • available in toric and multifocal • UVA/UVB protection

Clearsight 1Day

8.7/14.2

ocufilcon B/ +6.00 to -10.00 52%

MyDay Daily Disposable

8.4/14.2

stenfilcon A/ +6.00 to -10.00 54%

• • • • • • •

UVA/UVB protection thinner design reduces lid interaction lenticulated design promotes easy handling available in toric UVA/UVB protection silicone hydrogel breakthrough Smart Silicone chemistry creates soft, naturally wettable lens for improved comfort • aspheric optics • available in toric

Johnson & Johnson Vision. | 800.843.2020 | JNJVisionPro.com

1-DAY ACUVUE DEFINE

8.5/14.2

25.5

1-DAY ACUVUE MOIST

8.5 or 9.0/14.2

25.5

ACUVUE OASYS 1-Day

8.5 or 9.0/14.3

121

etafilcon A/ 58%

-0.25 to -6.00 (0.25D steps) -6.50 to -9.00 (0.50D steps) +0.50, +1.00 etafilcon A/ -0.50 to -6.00 58% (0.25D steps) -6.50 to -12.0 (0.50D steps) +0.50 to +6.00 (0.25D steps) senofilcon A/ +6.00 to -12.00 38%

• Lacreon technology • one of the highest UV blocking lenses available in daily disposable • may help allergy sufferers • one of the highest UV blocking lenses available in daily disposable • may help allergy sufferers • also available in multifocal and for astigmatism

• Hydraluxe technology • tear-like molecules that integrate with patient’s own tear film to decrease dryness • highest UV protection • available in toric

Menicon America | 800.MENICON | MeniconAmerica.com

Miru 1day

8.6/14.2

25.38

hioxiﬁlcon A/ +0.50D to +4.00 (0.25D steps) 57% -0.50D to -6.00 (0.25D steps) -6.50 to -10.00 (0.50D steps)

• CENTRAFORM Technology results in a smooth edge profile for reduced friction when blinking • Outer surface of lens is always facing up in package eliminating confusion in lens orientation and minimizing risk of touching inner surface of lens

Visioneering Technologies, Inc. | 844.884.5367 | VTIVision.com NaturalVue etafilcon A/ +4.00 to -12.25 (0.25D 8.3/14.5 19.73x10-11 • Neurofocus Optics technology that works naturally with Multifocal 1 (cm2/sec) steps) 58% the brain to automatically focus the eyes for clear vision Day Contact Add: universal extended near, far and everywhere in between Lenses with depth of focus design NeuroFocus encompasses requirements • UV blocking: average of 98% in the UVB range of 280nm to 315nm and 84% in the UVA range of 316nm to 380nm. Optics up to +3.00D

For a longer listing of daily disposables, go to OptometricOffice.com. O p tometr ic O ffic e. c om | Oct obe r 2018 15

NEW PRODUCT | GALLERY AIR OPTIX MULTIFOCAL COMBINES PRECISION AND MOISTURE

Alcon’s new AIR OPTIX plus HydraGlyde Multifocal contact lenses incorporate Precision Profile Design to offer clear, seamless vision at near, intermediate and distance. The lenses also feature lasting lens surface moisture through the HydraGlyde Moisture Matrix and deposit protection with Alcon’s unique SmartShield Technology. The new AIR OPTIX plus HydraGlyde Multifocal contact lenses will be widely available beginning Oct. 1. Go to AirOptix.com.

FDA CLEARS HEIDELBERG’S OCT ANGIOGRAPHY MODULE

Heidelberg Engineering has received clearance from the U.S. Food and Drug Administration for its OCT Angiography Module. OCTA is a noninvasive imaging technique that provides 3D visualization of perfused ocular vasculature. Combined with structural OCT and dye-based angiography, the OCTA technology is designed to give clinicians a more comprehensive understanding of ocular abnormalities. The additional module is now available for new and existing SPECTRALIS upgradeable diagnostic imaging devices. Go to HeidelbergEngineering.com.

NEW GLAUCOMA DRUG LEAVES OUT PRESERVATIVE

Sun Pharmaceutical Industries Ltd. and Sun Pharma Advanced Research Company Ltd. (SPARC) have received FDA approval of their New Drug Application for XELPROS (latanoprost 0.005%) for the reduction of elevated intraocular pressure in patients who have open-angle glaucoma or ocular hypertension. XELPROS was developed using SPARC’s proprietary Swollen Micelle Microemulsion technology, which helps solubilize drugs that otherwise have limited or no solubility. This technology eliminated the need for the preservative benzalkonium chloride, or BAK. In randomized, controlled clinical trials of patients with open-angle glaucoma or ocular hypertension, XELPROS lowered IOP by a mean of up to 6mm Hg to 8mm Hg. XELPROS will be commercialized in the U.S. by Sun Ophthalmics, the branded ophthalmic division of Sun Pharmaceutical Industries. Go to SunPharma.com or MyXELPROS.com. 16 Oct o b e r 2 0 1 8 | O p to m e tri c O f f i c e .c o m

Healthy Eyes Start with Healthy Eyelids The root cause of anterior blepharitis is the overproduction of oils. Surfactants in OCuSOFT® Lid Scrub® Eyelid Cleanser dissolve and remove oil, debris and desquamated skin. When the most severe conditions occur, the combination of OCuSOFT® Lid Scrub® and OCuSOFT® HypoChlor® (0.02% Hypochlorous acid) is ideal. To achieve optimum results, CLEAN all oil, debris and other contaminants associated with eyelid irritations using OCuSOFT® Lid Scrub® Eyelid Cleanser and then SPRAY OCuSOFT® HypoChlor® for fast action against microorganisms.

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