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International Newsletter and Forum on Rigid Gas Permeable Contact Lenses, Corneal Shape, Health and Vision |
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Coming of Age
 Happy New Year to everyone! Another year over. Good news for those of us who are getting old: research shows that older people are the happiest of all ages. People in their twenties give themselves a high wellness rating; that number diminishes toward middle-age, with a dip around age 50. After that, the curve goes up again as we get older, forming a giant 'U-shape.' Research has established that this has to do with changes to the brain. The highest wellness scores are seen in people between 82 and 85 years old! David Brooks in the New York Times writes about this: 'elder happiness is an accomplishment, not a condition.' He further introduces the term 'bifocalism': the ability to see the same situation from multiple perspectives. He refers to Anthony Kronman of Yale Law School, who wrote, 'Anyone who has worn bifocal lenses knows that it takes time to learn to shift smoothly between perspectives and to combine them in a single field of vision. The same is true of deliberation.' This is almost too easy a bridge to the subject of our presbyopic contact lens wearers. It is clear that (R)GPs for presbyopes provide the best optical outcome of all lens options - including refractive surgery, in my view. They automatically correct the bulk of corneal astigmatism and higher-order aberration, move on the ocular surface to allow translation and the use of different focal points, and different lens design and segment options are available. Craig Norman in Contact Lens Spectrum simply puts it like this: 'Corneal (R)GP lenses are a viable option for presbyopes and need to be included among the recommendations that we give our patients today.' Also see this month's I(n)-site-the-practice by Brooke Messer on multifocal (R)GP lenses - for a happy presbyope indeed. |
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Actual Eye Growth
You may have heard lectures at ARVO or BCLA regarding the topic, but now Helen Swarbrick and her ROK (research in orthokeratology) group in Sydney Australia have published their research in the highly ranked journal 'Ophthalmology.' They investigated the effect of overnight orthokeratology (OK) contact lens wear on axial length growth in East Asian children with progressive myopia. After 6 months of lens wear, axial length had increased in the (R)GP-wearing eye but showed no change in the OK-wearing eye. During the second 6-month phase of lens wear, in the OK-wearing eye there was no change from baseline in axial length at 12 months, while in the (R)GP-wearing eye, the 12-month increase in axial length was statistically significant. The (R)GP lens-wearing eye showed progressive axial length growth throughout the study. These results provide evidence that, at least in the initial months of lens wear, overnight OK inhibits axial eye growth and myopia progression compared with conventional (R)GP lenses.
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'Scleral Lens Talk'
 One of the best scleral lens webinars out there is available online through the Scleral Lens Education Society website. This November webinar was hosted by Stephanie Woo, and on 'staff' were renowned scleral lens experts Jason Jedlicka, Brooke Messer and Langis Michaud. Topics of discussion include how to deal with scleral lens fogging in clinical practice, how to incorporate toric scleral lenses to follow the shape of the anterior ocular surface better, how to manage surface wettability and surface debris issues, and also pingueculae: how to deal with that? In the annual GP issue of Contact Lens Spectrum (see fifth item in this newsletter), a ' Scleral Lens Case Grand Rounds' article also focuses on managing scleral lenses in daily practice, featuring Ed Bennett, Greg DeNaeyer, Melissa Barnett, Muriel Schornack, Stephanie Woo and Derek Louie. Photo: Jan Pauwels - UZ Antwerp.
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Application & Removal
Two new animation videos that could be of benefit to scleral lens practitioners and their patients are available from Optimed - a UK company specializing in eye care instruction videos. See the ' advising-patients-large-diameter-lenses' blog on the company's website for objective, generic animations on both large diameter lens application and large diameter lens removal.
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Annual Special on (R)GPs
 The October issue of Contact Lens Spectrum hosted a special on (R)GPs. Caroline and André look at the evolution of corneal (R)GP lenses, subdividing them into four categories, from normal myopia and hyperiopia correction (category 1) to torics (category 2), orthokeratology and presbyopia (category 3) and (R)GPs for the irregular cornea (category 4). In a column in this special, Nixon makes a good point for the case that corneal (R)GP lenses still have value for irregular corneas. In addition, one could argue that scleral lenses in this sequence are the next option. Scleral lenses also get attention in this special, including articles by Kojima et al and also by Brujic and Kading regarding the use of OCT in scleral lens evaluation, while Gates, Miller and Edrington look at blanching and impingement in scleral lens fitting.
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Demanding Vision at all Distances
The increased use of computers and handheld electronic devices in the daily routine of our presbyopic patients has created a need in the contact lens market. The presbyopes of today need a multifocal contact lens that can provide excellent visual performance at intermediate distances without degrading distance and near vision. For patients demanding acute vision at all distances, a translating (R)GP multifocal contact lens with alternating optics can be a good option. A 59-year-old Caucasian male and new patient presented to our office. Multifocal scleral lenses with an aspheric design were prescribed because he was an avid golfer. Unfortunately, this option ultimately failed because of dissatisfaction with the quality of his all-around vision, possibly due to his small pupil size. A translating corneal lens was fitted; the patient was immediately able to take advantage of the alternating optics, and he instantly noted increased clarity in his all-around vision. He was especially impressed with his improved productivity because he was no longer struggling to read small graphs or charts on his computer.
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Upcoming Events
- Global Specialty Lens Symposium, Jan 22-25, Las Vegas (US)
- CLSS, March 14-15, Billund (Dk)
- World Cornea Congress, April 15-17, San Diego (US)
- AOMC, April 16-19, Houston (US)
- IACLE 3rd World Conference, May 24-28, Manchester (UK)
- BCLA, May 29-31, Liverpool (UK)
- EurOK, July 10-12, Budapest (HU)
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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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