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International Newsletter and Forum on Rigid Gas Permeable Contact Lenses, Corneal Shape, Health and Vision |
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Excellence
 The 2013 Global Specialty Lens Symposium in Las Vegas was an excellent meeting. Apart from the record-breaking attendance (over 500 attendees from 32 countries), it was the content of the lectures that really was inspirational to eye care practitioners in the field, students and residents and certainly to those of us who do research. The meeting was a great mix of all of that. (R)GP lens topics were alternated with information on scleral lenses, soft specialty topics, hybrids, dry eye, etc. This is truly an exciting time for the specialty lens industry. Brien Holden received the inaugural GSLS award of excellence. Professor Holden is a world leader in vision science, eye health and blindness prevention. In his acceptance speech, he combined all of that - focusing on myopia control worldwide and what it could mean to health care if we could reduce the number of high myopes, for instance those over 5D. In his inspirational talk, he also covered the options available to us today. Although we don't have all the answers, he made it pretty clear that there is - in one way or another - a place for this in our practices. He also thanked the audience for their contributions to the field - as pioneers in the specialty lens field, including those involved in orthokeratology, have paved the road to where we are today. Eef van der Worp
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Exposed
 To stay within the 'theme' of the Global Specialty Lens Symposium, this I-site newsletter section links to a number of publications on scleral lenses. To demonstrate the diversity within this modality, these all include exposure-related topics. Weyns, Koppen and Tassignon report on 'Scleral Contact Lenses as an Alternative to Tarsorrhaphy for the Long-Term Management of Combined Exposure and Neurotrophic Keratopathy,' a series of three case reports published in Cornea. In Contact Lens & Anterior Eye, a number of papers on scleral lenses can be found. In a paper called 'Use of mini scleral contact lenses in moderate to severe dry eye,' Alipour, Kheirkhah and Jabarvand Behrouz look at grades III and IV dry eye disease patients whose symptoms could not be controlled by conventional treatment and who were subsequently, successfully, fitted with scleral lenses. Grey et al report on 'Scleral contact lens management of bilateral exposure and neurotrophic keratopathy.' The case reports on a patient with bilateral exposure and neurotrophic keratopathy resulting from bilateral cranial nerve (CN) palsies, including V, VI and VII, which caused lagophthalmos and anaesthetic corneas. The patient subsequently development vascularisation and keratinisation of the inferior cornea. Daily wear of the scleral lenses that were fitted have protected and hydrated the cornea, enabling corneal surface recovery while retaining visual and social function. Photo: Jason Jedlicka.
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History & Future of Scleral Lens Fitting
If anything, the Global Specialty Lens Symposium showed that scleral lenses have concurred their place in our field. Scleral lenses have made an interesting journey through time since the first blown-glass shells of Fick. Tim Bowden wrote a very interesting piece on the early days of scleral lenses that appears on the college of optometrists (UK) website. Some companies are using large trial lens sets these days, from which scleral lenses can potentially be dispensed. But even that is not unique, as the paper by Bowden illustrates. At the same time, ultra modern techniques are now used to image the anterior ocular surface. Luo and Jacobs report on optical coherence tomography (OCT), for instance, as a non-invasive, high-resolution and high-speed imaging modality that has enjoyed rapid growth in ophthalmology since its development 20 years ago. Modern anterior segment OCT may be capable of generating three-dimensional ocular surface maps of the cornea and sclera with potential application in contact lens fitting. Other techniques to image the ocular surface may include fringe topography, as presented at the GSLS by Robert Iskander.
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Eyelid
 This Japanese study involved 194 eyes of 98 patients with either bilateral or unilateral ptosis with long-term (R)GP lens wear. The average spherical equivalent refractive error was significantly higher in the severe than in the moderate, mild and no ptosis eyelids, and the average duration of (R)GP wear was significantly longer in the severe than in the moderate and mild ptosis eyelids. Path analysis also showed that the severity of ptosis is significantly influenced by patient age. Hence, the conclusion of the study is that high myopia, patient age and long-term (R)GP wear are risk factors associated with the progression of ptosis, and eyecare practitioners should be aware of the signs and symptoms in contact lens practice. Watanabe et al, J Jpn Ophthal
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GP Lenses Change Lives - Be Part of It!
 The GP Lens Institute (GPLI) is the educational division of the Contact Lens Manufacturers Association (CLMA). The GPLI is dedicated to providing practitioners with educational and practice-building resources to enable them to fully benefit from the many advantages of GP (oxygen permeable) and custom specialty soft contact lenses. The GP Lens Institute has a fresh new look with a redesigned logo and website. Don't miss it!
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Bifocal High-lights
High-riding (R)GP contact lenses are not unusual and may not always lead to problems. But in cases with translating (R)GP designs, this type of fitting will result in a poor visual outcome, especially for distance. Patients will complain of double vision while viewing distance objects. As soon as they lower their head position, vision seems improve. On the other hand, near vision often works quite well. This article will look at the efficacy of three different fitting options to solve a superiorly dislocated contact lens: changing to a peripheral toric lens design, increasing the prism ballast and truncating the superior part of the lens. Some of these changes can make a huge difference in your success with translating bifocal (R)GPs, according to the authors.
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Upcoming Events
- GPLI 2013 webinar series
- CCLSNZ, March 21-24, Roturua NZ
- COOK, March 29-31, Shanghai CN
- Innovative Sclerals, April 11-12, Hertford UK
- Cornea Day, April 19, San Francisco US
- Vision By Design, April 4-7, Chicago US
- CIOCV 2012, April 13-14, Braga PT
- EAOO, April 18-21, Malaga ES
- EFCLIN, May 9-11, Vilamoura PT
- BCLA, June 6-9, Manchester UK
- EurOK/IAO, June 28-30, Brussels BE
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I-site is an educational newsletter that is distributed on a monthly basis and provides an update on rigid gas permeable related topics (scientific research, case reports and other publications worldwide). I-site is objective and non-political. Its editor Eef van der Worp, optometrist, PhD, FAAO, FBCLA, FIACLE, FSLS is a lecturer for a variety of industry partners, but is not related to any specific company. Please contact us at: i-site@netherlens.com.
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