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International Newsletter and Forum on Rigid Gas Permeable Contact Lenses, Corneal Shape, Health and Vision |
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Caesar Salad
 Caesar salad's is named after restaurateur Caesar Cardini, an Italian immigrant who operated restaurants in Mexico and the United States. According to his daughter Rosa, her father invented the dish when a Fourth of July rush in 1924 depleted the kitchen's supplies. Cardini made do with what he had, adding the dramatic flair of the table-side tossing "by the chef." In any case, the salad has nothing to do with Julius Caesar, the Roman general and statesman. What does all this have do with scleral lenses? Two things, maybe. First: fitting scleral lenses is not always what it looks like. Starting with scleral lens fitting may seems simple - but it can be a challenge for the beginner practitioner. What do you need, and where to start? One of the fundamental courses hosted by the Scleral Lens Education Society at the recent Global Specialty Lens Symposium (GSLS) contained a full course for beginners - and some of the handouts of this meeting can be downloaded. In Jason Jedlicka's presentation, he describes 'what you need' (instrumentation, fitting sets, accessories, knowledge and, oh yes, patients). What is also clear for scleral lens fitting is that one has to be creative and at times has to improvise - just like with salads, apparently. For more advanced scleral lens stuff and some interesting creative solutions: excellent poster material is available from the GSLS website, some of which is covered in this newsletter. Back to Caesar, whether you like salads or not: next year is the 10-year anniversary meeting of GSLS - which will be held in Caesar's Palace, Las Vegas. |
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Today and Tomorrow
Another fundamentals course at GSLS focused on 'Building the Myopia Control Practice,' by Marco van Beusekom ('Working with Kids and Parents in the CL Practice'), Ron Beerten ('Using Technology to Increase Success in Orthokeratology for Myopia Control') and Thomas Aller ('Soft Lenses for Myopia Control Today and Tomorrow'). A number of handouts are downloadable via the link below. In the general session 'The Future of Myopia Management with Contact Lenses,' the discussion was moderated by Brien Holden (Where to from here - Possibilities and Probabilities). Earl Smith (What's new in understanding of myopia induction?), Monica Jong (Who is at risk and what are the consequences of high myopia?) and Thomas Aller (Myopia control - my way) completed the session. A Free Paper presentation by Zhi Chen showed that relative peripheral corneal power change in myopic orthokeratology is negatively correlated to two-year axial length growth in children. Chad Rosen looked at 'Do Asian and Caucasian Eyes Respond the Same With Overnight Corneal Reshaping?' They did find a difference in mean spherical equivalent between Asians & Caucasians when incorporating starting age groups. Bruce Morgan et al looked at the use of OCT imaging of corneal reshaping lenses and concluded that the system they used was capable of measuring the very small micron changes seen in the post lens tear film and corneal epithelium of corneal reshaping lenses. The Michigan College of Optometry (US) also introduced a very informative website myopiacontrol.org.
GSLS 2015 Downloadable Agenda & Handouts
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Global Specialty Lens Symposium
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Let's Settle This Once and For All
 The title of a poster by Adeline Bauer and Josh Lotoczky (Michigan College of Optometry) at GSLS was 'Let's Settle This Once and For All.' They found that scleral lenses completed about 25% of their overall settling within the first 20 minutes. All lenses showed at least 50% of their final settling by the one hour mark. After four hours, the lenses completed the majority of their settling. The average percentage of settling after four hours was 87.2%. Bray et al from the University of Waterloo (CA) presented the results of a pilot study on the changes in over-refraction after scleral lens settling. Based on OCT measurements, they concluded that scleral lens clearance diminishes over a 6-8 hour period after lens placement on the eye and that with this, a small change in over-refraction was noted, up to 0.25D in magnitude.
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Global Specialty Lens Symposium
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Dealing with Conjunctival Anomalies
Sara Berke-Silva and Andrea Janoff presented a poster at GSLS titled 'Scleral Lens Fit for Keratoconus with Pterygium: To Notch or Not.' They described a case in which a notched edge was used and three ways of measuring a pterygium for notch placement were identified. Another poster on the same topic, by Brooke Messer, looked at utilizing micro-vaults to improve comfort and cosmesis in scleral lens wearers with pingueculae. Micro-vaults can be described as a small, round, raised area located in the peripheral curves of the scleral lens. They can be customized to the location, size and depth of the conjunctival anomolies. Regarding conjunctival anomolies: Laura Di Meglio and Crystal Remington looked at the management of conjunctival nodular hypertrophy (CNH), that was induced by tight scleral lenses. CNH is descibed as an elevated, opaque conjunctival mass that is inflamed and injected. This can develop when a tight-fitting lens impinges on the conjunctiva and causes mechanical injury to the tissue. This finding can result in patient discomfort, lens awareness and decreased wear time.
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Making Lens Care a Specialty
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(R)GP Lens Surface Wettability and Demodex
A 64-year-old white female presented to the office complaining of foggy, hazy vision for the past month. Her past history included corneal (R)GP lens wear for 40 years; she was recently refit into scleral lenses due to dry eye symptoms about two years prior. Her visual acuities were 20/50 in the right eye and 20/40 in the left eye. Six months prior, her visual acuities were 20/25 in the right eye and 20/25 in the left eye. No over-refraction helped improve acuity in either eye. Slit lamp examination revealed flakes on both eyelids with Demodex. Demodex is a genus of tiny parasitic mites that live in or near hair follicles of mammals. Lid treatment was advised and solved her problem. Even with heavy duty gas permeable lens cleaners, lens wettability problems may still manifest if lid problems remain unresolved. If lid hygiene is addressed and treated quickly, this could lead to a fast improvement, yielding better patient comfort and clear vision.
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Sur(e)vey Reminder
A survey, SCOPE It Out! (Scleral Lenses in Current Ophthalmic Practice: an Evaluation) tries to find information about scleral lens fits today so that we can be more certain about things such as: are scleral lenses fitted more for corneal irregularity or for ocular surface disease? The survey seeks individuals who currently fit scleral lenses, and the authors would like to include the experience and insights of as many as possible. The survey will take no more than 5-10 minutes to complete. All participants will be entered in a drawing for a $250 VISA gift card. Please click on the link below, and be sure to participate.
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Upcoming Events
- CLSS, March 14-15, Billund (Dk)
- World Cornea Congress, April 15-17, San Diego (US)
- AOMC, April 16-19, Houston (US)
- EAOO, May 14-17, Budapest (HU)
- IACLE 3rd World Conference, May 24-28, Manchester (UK)
- BCLA, May 29-31, Liverpool (UK)
- EurOK, July 10-12, Budapest (HU)
- ISCLS, Aug 29-Sept 3, St. Gallen (CH)
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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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