RCCL JUNE 2016 REVIEW OF CORNEA & CONTACT LENSES SPECIAL ISSUE: Research and Clinical Practice New Ideas from ARVO 2016 P. 10 Post-Refractive Rigid Lens Use P. 16 Fitting Orthokeratology Lenses P. 22 CXL and Semi-Sclerals P. 28 Reinventing Brimonidine P. 40 Supplement to Recycling Cyclosporine • Improving Patient Relations • Understanding Insurance Coverage 001_RCCL0616_Cover.indd 1 5/31/16 4:39 PM Ready to be your patients’ most trusted expert? Prescribe oxygen. MyDay® daily disposable clariti® 1 day clariti® 1 day multifocal clariti® 1 day toric With CooperVision’s largest portfolio of silicone hydrogel 1-day contact lenses you can fit virtually all patients into a 1-day lens that provides high oxygen, comfort and convenience. From the uncompromising performance of MyDay® to the breadth of the clariti® 1 day family, CooperVision is the only one you need to serve your 1-day patients. For brighter, healthier eyes ready to take on the world, the prescription is oxygen. And the opportunity is yours. Contact your CooperVision sales representative or visit prescribeoxygen.com for more information. ©2015 CooperVision® 1751 12/15 RCCL0416_Coopervision.indd 1 3/22/16 3:24 PM contents Review of Cornea & Contact Lenses | June 2016 departments features Building a Foundation for a 4 News Review Better Future: ARVO 2016 Considering New Treatments for Abstract Review Neovascularization; Study on SPK An expert weighs in on new ideas in the Lesion Size May Lead to Better fi eld of cornea and contact lens care. Equipment 10 By Joseph P. Shovlin, OD 6 My Perspective Corneal Crosslinking: Fitting Rigid Lenses After Its Time Has Come Refractive Surgery By Joseph P. Shovlin, OD Corneal and scleral GP lenses cover the ‘last mile’ for patients who need 8 Pharma Science & Practice correction after LASIK and PRK. By Melanie Frogozo, OD Recycling Cyclosporine 16 By Elyse L. Chaglasian, OD, and Tammy Than, MS, OD Unusual Clinical Cases in Orthokeratology 40 Practice Progress For the right patient, these lenses may Brimonidine Breakup be life-changing. Two challenging cases provide insights into the fi tting process. By Mile Brujic, OD, and Jason R. Miller, OD, MBA 22 By Daddi Fadel, DOptom Out of the Box Contact Lens Use Following 42 Corneal Crosslinking Making the Best of It An irregular cornea patient presents By Gary Gerber, OD needing better vision following a corneal stabilization procedure. What do you do? 28 By Boris Severinsky, OD Case Report: Look Before You Judge The most unique cases sometimes present as the most mundane. 34 By Mohammad Tallouzi, OD Medically Necessary Contact Lenses: Medical Plan or Vision Plan Responsibility? Do you know how to work with the ON THE COVER 36 insurance company to achieve the Optometry student photoshoot image biggest bang for your buck? courtesy of Cardiff University in Cardiff , By Robert L. Davis, OD Wales, United Kingdom. Become a Fan on Follow Us On Facebook Twitter /ReviewofCorneaAndContactLenses @RCCLmag REVIEW OF CORNEA & CONTACT LENSES | JUNE 2016 3 0003_RCCL0616_TOC.indd03_RCCL0616_TOC.indd 3 55/31/16/31/16 44:30:30 PPMM News Review IN BRIEF Considering New Treatments ■ Certain characteristics including in- creased vascularity may be a risk factor for Neovascularization for recurrence of pterygium following surgery, reports research published online in the journal Cornea.1 Researchers in Korea collected data on clinical and demographic fl ibercept may be a diameter and comprising approx- variables of 149 subjects including length, better alternative than imately 15% of the total corneal width, area and vascularity of pterygium and age and sex of patients. Anterior seg- bevacizumab in regulat- area. Corneal samples were collect- ment photos were taken prior to the proce- Aing the advancement of ed on day 21 for histological and dure, and patients were followed up with at one year postoperatively. Recurrence rate corneal neovascularization, reports fl at-mount immunofl uorescence was measured at 18.8% of the patients, with research published online in the analyses. Results in all three groups univariate analysis demonstrating that rela- 1 tive length and width of the pterygium and journal Cornea. Previous studies indicated that neovascular sprout- degree of vascularity were all correlated have investigated whether target- ing began at the limbal area on day with the trend. Multivariate analysis, how- ever, demonstrated only higher vascularity ing vascular endothelial growth three following injury and reached was correlated with recurrence. As such, factor—a key cytokine in the de- maximum intensity around days automated image analysis of anterior seg- ment photos could assist with determining velopment of blood vessels in both seven through nine; however, those which patients might develop pterygium normal and abnormal patients (i.e., subjects treated with afl ibercept again, the researchers concluded. in the case of a tumor or in tissues exhibited a signifi cantly smaller 1. Han SB, Jeon HS, Kim M, et al. Risk factors for recurrence after pterygium surgery: an image anal- undergoing abnormal angiogene- relative area of neovasculariza- ysis study. Cornea. 2016. [Epub ahead of print.] sis)—is a good way to possibly treat tion than either the control or the ■ Soft contact lens wearers with dry eye this condition. bevacizumab groups. Additionally, symptoms may also exhibit reduced tear menisci, reports a study in the May 2016 Researchers from Tel Aviv a difference in the rate of change of issue of Eye and Contact Lens.1 A reduction University in Israel investigated the the neovascularized area over time in tear volume is one of the common factors associated with ocular surface disease; in- effects of afl ibercept or bevacizum- between the afl ibercept group and deed, previous research has indicated there ab administered to Sprague-Dawley both the control and bevacizumab are more abnormal corneal nerve morpho- logic changes in patients with the aqueous rats with induced chemical burns. groups was observed, but not be- tear defi ciency form of dry eye. However, Thirty-one animals were random- tween the control and bevacizumab to date no research has examined whether symptomatic contact lens wearers have ized to receive either subconjuncti- groups, suggesting the latter is not had a similar reduction in corneal nerve val injections of 0.08mL afl ibercept as effective in this application. density due to reduced tear volume. In this study, scientists in China found that upper (25mg/mL), 0.05mL bevacizumab “In conclusion, this suggests that and lower tear menisci height and area (25mg/mL) or 0.05mL physiologic afl ibercept may hold promise as an were signifi cantly lower in patients who wore soft contact lenses, compared with saline using a 30-G needle applied effective modality for use in patients those who did not. Interestingly, this eff ect 1mm distal to the limbus at the 6 with corneal neovascularization,” occurred specifi cally in the midperipheral area of the cornea. o’clock and 12 o’clock positions. the researchers conclude. As such, 1. Hu L, Chen J, Zhang L, et al. Eff ects of long- Afl ibercept is a VEGF-trap mole- “further investigation is warranted term soft contact lenses on tear menisci and corneal nerve density. Eye Contact Lens. 2016 cule that is both known to act as to determine the effi cacy of sub- May;42(3):196-201. a receptor decoy for all isoforms conjunctival afl ibercept in inducing ■ A study investigating corneal densitom- of VEGF-A and also bind VEGF-B regression of preformed versus etry and higher-order aberrations (HOAs) one year post-transplantation of Bowman’s and placental growth factors 1 mature corneal vessels, its minimum layer found that corneal HOAs decreased and 2 to enhance the antiangio- effective dose and safety profi le and for both anterior and posterior corneal surfaces following surgery, while corneal genic response, while bevacizumab other possible modes of application backscattering increased. Neither trend has previously been confi rmed to in animals and humans.” RCCL correlated with alterations in corrected inhibit chemically-induced neovas- distance visual acuity, however. These re- 1. Gal-Or O, Livny E, Sella R, et al. Effi cacy of sults, published online in the journal Cornea, cularization via its own action on subconjunctival afl ibercept versus bevacizumab for suggest further research involving larger 2,3 preventional of corneal neovascularization in a rat populations with patient-subjective visual VEGF-A. model. outcomes and contrast sensitivity analysis is Degree of corneal neovascular- 2. Sener E, Yuksel N, Yildiz DK, et al. The impact of needed to help further explain the eff ect of subconjunctivally injected EGF and VEGF inhibitors corneal backscattering on optical quality.1 ization was evaluated on post-in- on experimental corneal neovascularization in rat model. Curr Eye Res. 2011;36:1005-1013. 1. Luceri S, Parker J, Dapena I, et al. Corneal jury days one, three, seven, nine 3. Oner V, Kucukerdonmez C, Akova YA, et al. densitometry and higher order aberrations after and 13 via corneal photography, Topical and subconjunctival bevacizumab for corne- bowman layer transplantation: 1-year results. Cor- al neovascularization in an experimental rat model. nea. 2016. [Epub ahead of print.] with burn area measuring 2mm in Ophthalmic Res. 2012;48:118-123. 4 REVIEW OF CORNEA & CONTACT LENSES | JUNE 2016 0004_RCCL0616_News.indd04_RCCL0616_News.indd 4 55/31/16/31/16 44:38:38 PPMM RRCCLCCL REVIEW OF CORNEA & CONTACT LENSES 11 Campus Blvd., Suite 100 Newtown Square, PA 19073 Telephone (610) 492-1000 Fax (610) 492-1049 Editorial inquiries: (610) 492-1006 Advertising inquiries: (610) 492-1011 Study on SPK Lesion Size May Email: [email protected] EDITORIAL STAFF Lead to Better Equipment EDITOR-IN-CHIEF Jack Persico [email protected] SENIOR ASSOCIATE EDITOR ata from a study on Institut Universitaire de France Aliza Becker [email protected] epithelial lesion size in su- instilled fl uorescein into 10 pa- CLINICAL EDITOR Joseph P.