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Managing Irregular Corneas with Soft Lenses

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Managing Irregular Corneas with Soft Lenses JANUARY/FEBRUARY 2020 REVIEW OF CORNEA & CONTACT LENSES CONTACT LENS FITTING FOR COMPROMISED CORNEAS Managing Irregular Corneas with Soft Lenses brighten your astigmatic patients’ day Clinical observations will aid in choosing a lens designwith that o expanded ers the appropriate features for patients. Page 12 prescription options. The obliques are here! clariti® 1 day toric will have the largest number of prescription options of any SiHy 1-day toric lens.1 How Lenses Help Corneas Prescribe even more patients SiHy at the price of a hydrogel. Page 8 Visit claritiGivesYouMore.com to learn more. Prosthetic Lens Fitting Pearls Page 18 Tackling Post-op CL Challenges Additional axes also Page 24 coming soon When Old Mainstays Save the Day in the -2.25 cylinder and Page 38 plus powers. ALSO: Blink Mechanics: Why it Matters — EARN 2 CE CREDITS toric Page 30 ©2019 CooperVision 8607 12/19 from the experts in torics: more prescription options than ever clariti® 1 day toric: has around-the-clock axes, will have the largest number of prescription will expand its prescription enabling you to provide coverage options of any SiHy 1-day toric contact lens1 options by nearly 50%1 for most astigmatic patients2 additional prescription options sphere power cylinder axes plano to -6.00D -0.75, -1.25, -1.75 10°, 20°, 30°, 40°, 50°, 60°, 70°, 80°, 90°, 100°, 110°, 120°, 130°, 140°, 150°, 160°, 170°, 180° (0.25D steps) -2.25 10°, 20°, 70°, 80°, 90°, 100°, 110°, 160°, 170°, 180° -6.50D to -9.00D -0.75, -1.25, -1.75 10°, 20°, 60°, 70°, 80°, 90°, 100°, 110°, 120°, 160°, 170°, 180° (0.50D steps) -2.25 10°, 20°, 90°, 160°, 170°, 180° +0.25D to +4.00D -0.75, -1.25, -1.75 10°, 20°, 70°, 80°, 90°, 100°, 110°, 160°, 170°, 180° (0.25D steps) axes in purple indicate prescriptions now available. axes in teal indicate prescriptions available in Spring 2020. fit a wider range of daily disposable toric patients in clariti® 1 day toric contact lenses. 1. 2019 CooperVision study; data on file. Based on the number of published prescription options available across all soft lenses from Alcon, Johnson & Johnson, and Bausch & Lomb; UK and US; April 2019. Prescription includes sphere, cylinder, axis & ADD combinations. 2. Around-the-clock axes in 10° from plano to -6.00DS in -0.75DC, 1.25DC, and -1.75DC. ©2019 CooperVision 8607 12/19 JANUARY/FEBRUARY 2020 REVIEW OF CORNEA & CONTACT LENSES CONTACT LENS FITTING FOR COMPROMISED CORNEAS Managing Irregular Corneas with Soft Lenses Clinical observations will aid in choosing a lens design that o ers the appropriate features for patients. Page 12 How Lenses Help Corneas Page 8 Prosthetic Lens Fitting Pearls Page 18 Tackling Post-op CL Challenges Page 24 When Old Mainstays Save the Day Page 38 ALSO: Blink Mechanics: Why it Matters — EARN 2 CE CREDITS Page 30 NEW Cornea Scleral Profile Scan for the Pentacam® Beyond the Cornea! The new Pentacam® CSP Report measures, where others are just estimating Measure beyond past boundaries when fitting scleral lenses. The new CSP Report creates 250 images within the measuring process. The tear film independent measurement with automatic release allows coverage up to 18 mm with the same fixing point. Visit www.pentacam.com to learn more Toll free 888-519-5375 Follow us! [email protected] www.oculususa.com contents Review of Cornea & Contact Lenses | January/February 2020 features Managing Irregular Corneas with Soft Lenses Clinical observations will aid in choosing a lens design that offers the appropriate features. 12 By Tiffany Andrzejewski, OD Colored Contacts: More Than a Pretty Eye departments These lenses have both therapeutic and prosthetic applications. News Review By Karen K. Yeung, OD, and Rachel 4 Wong, BS Vitamin D, DED and myopia; OCT-A and CNV 18 6 My Perspective Overcoming Post-op Our Ongoing Mission Contact Lens Challenges By Joseph P. Shovlin, OD Follow this step-by-step approach when fitting specialty lenses. By Langis Michaud, OD 8 Practice Progress 24 Contact Lenses for the Compromised Cornea By Andrew Fischer, OD, Mile Brujic, OD, and David Kading, OD CE: Blink Mechanics: Why it Matters This incredibly important 10 Fitting Challenges function has huge Rosacea: A Double Whammy implications for dry eye and contact lens wear, especially when it goes awry. By Vivian P. Shibayama, OD, and Cory Collier, OD 30 By Marc-Matthias Schulze, PhD, Dipl. Ing.(AO) 38 The GP Experts Old Mainstays Can Save the Day By Lindsay Sicks, OD, and Tiffany Andrzejewski, OD 40 Corneal Consult No Pain, No Gain By Kerri Norris, OD Edited By Aaron Bronner, OD, and Alison Bozung, OD 42 The Big Picture Last Line of Defense By Christine W. Sindt, OD REVIEW OF CORNEA & CONTACT LENSES | JANUARY/FEBRUARY 2020 3 News Review IN BRIEF ■ Researchers recently observed Vitamin D’s Role Examined dysbiosis in the lid microbiome of symptomatic contact lens wearers, efi ciencies in vitamin D have parameters and look at associations and they found lid margin exfoliation been tied to many conditions, with other ocular infl ammatory reduced the number, frequency of including autoimmune diseases, such as graft-vs.-host dis- isolation and ratio of gram-positive D 1 rods and cocci. They added that the diseases, lymphoma and various ease-induced dry eye. number of bacteria, the ratio of rods forms of neuropathy. Two studies to cocci and lipase activity correlated assessed how low levels of the SHADE FROM UV DAMAGE with lash contamination and anterior blepharitis, while bacterial lipase vitamin increased the risk of certain With myopia on the rise worldwide, correlated with meibomian gland conditions. The fi rst analyzed the researchers continue to search for secretions and tear evaporation link between low levels and dry modifi able risk factors. A recent rates. Lid treatment converted 10 symptomatic contact lens wearers to eye severity in those with Sjögren’s study shows neonatal vitamin D lev- asymptomatic lens wearers. syndrome. 1 The second looked at els aren’t one of them, as they don’t Siddireddy JS, Vijay AK, Tan J, et al. E ect of eye- neonatal levels possibly signaling appear to play a role in the later lid treatments on bacterial load and lipase activity 2 in relation to contact lens discomfort. Eye Cont myopia as adults. development of the condition. Lens. November 29, 2019. [Epub ahead of print]. The case-controlled investigation ■ In a new study published in Contact DRY EYE SEVERITY compared dried blood taken shortly Lens & Anterior Eye, researchers showed While the relationship between after birth from both myopic and that multifocal contact lenses can increase light distortion e ects under low levels of serum vitamin D and healthy male newborns. low-light conditions. The investigators Sjögren’s syndrome have shown Since the time of year a person looked at 14 eyes of seven contact lens contrasting results in previous is born has been associated with patients and used a light disturbance analyzer device to characterize the light. investigations, Korean researchers later myopia risk—and neonatal In addition, the study found the size reported that vitamin D levels may vitamin D status is highly dependent and shape of the pupil correlates with be associated with dry eye severity in on season of birth due to maternal the size and shape of the distortion. The elliptical pupil produced the largest Sjögren’s syndrome. sun exposure late in gestation—a discrepancy in the distortion size The study enrolled 74 eyes of team of researchers looked into between the vertical and horizontal 74 patients diagnosed with prima- whether prenatal exposure to low directions. The team didn’t note any di erence between the center-distance ry Sjögren’s syndrome. The more levels of vitamin D could factor into and center-near designs. severe eye was used for analysis. visual development and adult visual Monsalvez-Romin D, Gonzazlez-Meijome J, Only women were included, and the dysfunction. Esteve-Taboada J, et al. Light distortion of soft multifocal contact lenses with di erent pupil size average age was 53. The study di- The investigators analyzed neona- and shape. Cont Lens Anterior Eye. December 4, vided the patients into three groups: tal vitamin D3 levels of 457 myopic 2019. [Epub ahead of print]. vitamin D defi ciency (48 patients), and 1,280 healthy males from the ■ Cornea experts from Spain created vitamin D insuffi ciency (14 subjects) Danish Conscript Registry. After a simple network classifi er system they say can detect keratoconus with and a healthy, control group (12 adjusting for maternal age, maternal signifi cant accuracy, and it can be patients). ethnicity, maternal and paternal easily used with any placido-based The average vitamin D level was education and season of birth, the topographic system. Their study detailed a new Bayes classifi cation 20.4±8.0ng/mL. The study noted a researchers found seasonal variation model for keratoconus detection that strong negative correlation between of birth didn’t affect myopia risk, used primary placido-based corneal serum vitamin D levels and corneal and low neonatal vitamin D3 levels indices noted in the literature and computed directly from the image and conjunctival staining scores. also didn’t appear to increase the of the discs refl ected on the cornea. Additionally, the Schirmer I value chance of developing the condition.2 Researchers said the Bayes classifi er and tear break-up time showed a showed perfect discrimination ability 1. Lee JH, Kim SJ, Byun YS, et al. The asso- among normal and keratoconic corneas, signifi cant positive link with vitamin ciation of serum vitamin D level with the with 100% of sensitivity and specifi city, D levels.
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