International Newsletter and Forum on Rigid Gas Permeable Contact Lenses, Corneal Shape, Health and Vision
 February 2016
In This Issue
Column
Scleral Lens Fit
Orthokeratology
Ageing & Keratoconus
Keratoplasty
GPLI webinars
I(n)-site-the-practice
Agenda
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Column
Sharing Ideals

Wrapping up the recent Global Specialty Lens Symposium (GSLS) in Las Vegas, a few things come to mind. First of all - the excitement. With about 1,000 attendees and exhibitors present from 32 countries, 45 states and Puerto Rico, this years' GSLS was the biggest in its history. The meeting marked its 10th anniversary as well. The next edition of I-site newsletter will highlight topics and cover posters and papers with the latest research from the meeting. From a professional point of view, no specific lens modality stuck out - sclerals, hybrids, corneal GPs and soft specialty lenses all had their fair share of podium time. One thing for me that really gained a lot of momentum was 'new technolology' in general. New technology to analyze ocular surface shape, to make scleral impressions, to measure corneal aberrations - and optical coherence tomography instruments for corneal epithelial pachymetry measurements and to image and analyze soft lenses in-vitro: they were all very prominent on the agenda and in the exhibit hall. These new developments can really make a difference going forward. For a taste of this: see the GSLS website, as many handouts of presentations and poster PDFs can be downloaded. But the biggest thing, reflected in the numerous comments directed toward the organisation, was the warmth, comradeship and shared love for this great profession and industry. Or, as Craig Norman, the chairman and initiator of the GSLS meeting, put it: 'what I value most is the friendship I felt - it's a wonderful thing that close relationships can be built around a small piece of plastic and the instruments used to fit them.' One can't argue with that.
Eef van der Worp 
Sclerals
Critical Measurements to Improve Scleral Lens Fitting

Fitting scleral lenses in the past has been more of an art than a science in many respects. The future of scleral lens fitting figures to be more scientific, driven by precise ocular surface measurements and software that can customize a lens to the individual eye. In the immediate term, using the technology that is available will streamline the fitting process while we wait for a technological revolution in scleral lens fitting to occur. The above are statements by Jason Jedlicka in his article in Review of Cornea & Contact Lenses in which he looks, among other things, at lens selection based on HVID, corneal shape and sagittal height - and at assessing lens fit using OCT. In conclusion, he states: gathering as much data as possible can help streamline the process and provide better outcomes (CE approved course).
Orthokeratology
Orthokeratology, Ocular Surface & Meibomian Glands
The aim of this study was to investigate the influence of overnight orthokeratology (OOK) on the ocular surface and Meibomian glands of children and adolescents. Fifty-eight subjects using OOK were included, and a significant increase in OSDI score and corneal and conjunctival staining scores were noted compared with baseline values at 36 and 24 months. Ocular surface and Meibomian gland changes were seen in 2 patients (3.5%). One patient exhibited an increase in OSDI score, concurrent with a decrease in tear break-up time, at 36 months and minor loss of Meibomian glands at the distal portion of the lower lid at 24 months. The other patients exhibited the development of papillary hypertrophy and Meibomian gland distortion at 24 months. Based on these findings, the investigators concluded that OOK is a relatively safe modality. However, given the potential changes in the Meibomian glands and tear film stability, special attention must be given to children with baseline Meibomian gland distortions or a history of allergic conditions, the paper concludes.
Na et al, Eye & Contact Lens - Jan 2016
Keratoconus
Effect of Ageing on Keratoconic Corneas

The purpose of this study was to explore the potential effect of aging on the corneal curvature and corrected visual acuity in patients with long-term keratoconus, because of the paucity of these patients older than 50 years. The age of patients at their last examination was 53.8 years (range 44-67 years). Disease onset was self-reported to be at age 18.4 years. First examination was at age 25.1 years, and the mean number of years between first and last examination was 28.7 years. Mean central corneal curvature was 6.87mm (48.77D) and 6.56mm (51.09D) at the first and last examination, respectively: a statistically significant difference. However, the last measurement of corneal curvature was found to remain approximately constant over the years from about 20 to 50 years after onset. The mean best-corrected visual acuity was also found to be relatively stable after 20 years of age.
PKP
Indications for Keratoplasty at Three Academic Centers

A retrospective review was performed for the indications for keratoplasty from 2002 to 2012 based on surgical specimens originating from three different academic centers in the US. Interestingly, graft failure accounted for approximately 30% to 40% of indications for keratoplasties during that period. This number in these academic centers was more than double and in some cases triple that of the Eye Bank Association of America (EBAA) data. These higher frequencies of regrafting may represent a referral bias of patients with complicated cases to academic centers, who then may require multiple keratoplasties.
Webinars
Contemporary Eye Care
 
Contemporary means 'living or occurring at the same time' or 'belonging to or occurring in the present,' as frequently used to describe art forms. The GPLI continues to provide us with excellent clinical education in the form of online webinars. These can be seen live or viewed afterward via the Archive Page, providing us with a wide range of contemporary specialty lens modalities that are covered. Emerging Technologies to Improve Your Success with Hybrids and Sclerals was the title of the January webinar by Jeffrey Sonsino, and Contemporary Scleral Lens Applications in Ocular Surface Disease and Lens Care was presented by Michael Ward, FCLSA, FAAO in December of last year.
I(n)-site-the-practice   
Hybrids to the Rescue 

A 55-year-old male presented to the clinic for a comprehensive eye exam. He had undergone RK surgery over 20 years ago in both eyes. His prior contact lenses included soft toric lenses, soft multifocal lenses and soft monovision lenses. We had tried scleral lenses in the past, and he did achieve good vision with them. However, he could not master insertion and removal, so he discontinue  d the scleral lenses. At this year's exam, we decided to attempt a hybrid lens fit; we chose a newer design indicated for oblate corneas. The best fitting lens OD had a 355 micron vault, and the best fitting lens OS had a 305 micron vault. Both lenses exhibited about 95 microns of central clearance, which will likely decrease somewhat when the lenses are worn on an all-day basis. 
International Agenda
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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.