In last week’s issue, I provided some perspective on costs of healthcare in the United States relative to the government’s investments in biomedical research aimed at understanding etiology of disease states. Related to this are the ideas of traditional and new routes of drug discovery for the treatment of disease—traditional routes being the idea of small molecules targeted at disease treatment for the masses. History has shown that while this often works, there are many instances when these treatments fail to work in patients and it has often been unclear as to the reason why. It is now commonly believed that the human genetic code creates individual biological variability that sometimes renders traditional treatments ineffective. We are seeing more and more about the idea of “personalized medicine” and I am certain we will observe a future trend of “personalized eyecare.” In fact, there is no doubt this is happening in the contact lens practice—with highly specialized and custom made contact lenses being manufactured specific to a patient’s eye.

In March 2015, Utah’s Contact Lens Consumer Protection Act was signed into law making Utah the first state to ban contact lens manufacturers’ UPP (Unilateral Pricing Policy) pricing. Manufacturers with UPP programs, without any agreement with the reseller, announce a minimum resale price (MRP) and refuse to make further sales to any reseller that sells below the announced price. The Utah law was to go into effect this month. Similar legislation has been introduced in several other states, but none appear to be close to enactment at this time.

In 2013 Alcon put UPP pricing into place, initially applicable only to Dailies Total1. In 2014, Alcon extended this to other specified contact lens brands and Bausch + Lomb and Johnson & Johnson Vision Care introduced their own UPP pricing for specific contact lens brands. In the latter part of 2014, CooperVision continued a UPP policy in regards to the pricing of Clariti contact lenses, which were part of the company’s acquisition of Sauflon Pharmaceuticals Limited.

In April Alcon, B+L and J&J Vision Care filed separate federal lawsuits, claiming that the law was unconstitutional, to stop the state from enforcing the new law. They also requested an injunction to delay the effective date of the law until the suit is resolved.

On May 11, a U.S. District Court judge denied the request for a preliminary injunction. However, just days later, the 10th Circuit Court of Appeals granted a temporary injunction. The court gave the state until May 26 to file a response.

These legal challenges are likely to continue to play out in the near future.

Under license from UltraVision CLPL, UK, Art Optical has been manufacturing and supplying Intelliwave prescription Hydrogel & SiH contact lenses in the United States and Asia since 2008. Both companies recently agreed to extend this successful relationship to 2020 and beyond, and build on it by including additional technology to create new GP multifocal and other specialty contact lens designs.

Art Optical uses advanced software and designs within its own state-of-the-art engineering platforms in Grand Rapids, Michigan, to help manufacture the latest contact lenses in numerous custom design variations. The technology package has been created, supplied and is supported by UltraVision CLPL in the UK.

UltraVision CLPL is one of the largest independent contact lens manufacturers in Europe and supplies manufacturing software, advanced designs and support to many contact lens laboratories throughout the world, with technology licensees in North America, South America, Europe, Asia, and Australasia.

Salus University, the Philadelphia VA Medical Center (PVAMC), Montgomery County Community College (MCCC), Community College of Philadelphia (CCP) and the Department of Defense Hearing Center of Excellence and Vision Center of Excellence collaborated on a health screening program for student veterans. The Salus Veterans Readiness Initiative Multisensory Screening and Care pilot program offered free multisensory (vision, hearing, balance) screenings, follow-up treatment and rehabilitation.

Salus optometry and audiology faculty and students conducted customized multisensory screenings at CCP and MCCC. PVAMC provided on-site liaison and outreach, including assistance with VA health care enrollment and case management. This screening program will serve as a model as this initiative continues.

Exposure to blast and other trauma during the post-9/11 conflicts can cause mild traumatic brain injury and/or post-concussion syndrome. Exposure to blast and trauma is also associated with sensory dysfunction and symptoms including blurry vision, headaches, aversion to light and sounds, dizziness and trouble hearing. These problems can substantially hinder the community reintegration process for veterans, including educational performance and employability.

Veterans with sensory dysfunction typically pass standard vision and hearing tests. A more in-depth exploration using specialized visual and auditory assessment can uncover these conditions and dictate the appropriate treatment to help these veterans get back to their lives.

This eye developed Epidemic Keratoconjunctivitis (EKC) two years ago. This ocular disease is caused by an adenovirus. The superior palpebral conjunctiva developed a membrane which caused significant discomfort. This eye was fit with a scleral lens which, in addition to allowing the patient to see clearly, has eliminated her ocular discomfort.

We thank Dr. Boshnick for the image and we welcome photo submissions from our other readers! It is easy to submit a photo for consideration for publishing in Contact Lenses Today. Simply visit http://www.cltoday.com/upload/upload.aspx to upload your image. Please include an explanation of the photo and your full name, degree or title and city/state/country.

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Want to Build a Top CL Practice?

If you are looking to build a top-notch contact lens (CL) practice, both in terms of professional reputation and financial viability, it goes without saying that you, the practitioner, must understand the nuances of contact lens materials, designs, optics and solutions like few others. “Dabbling” never made anyone an expert. But just as important as your knowledge and experience is your customer service. And a vital, but often underappreciated, aspect of this service is the contribution of an excellent contact lens technician.

Let’s look at the dispensing (insertion/removal, or training) visit for new lens wearers. It is their first-ever experience applying a contact lens to their eyes, and they are understandably apprehensive. If it doesn’t go smoothly, they are more likely to drop out of contact lenses, even though the fit and vision may be perfect. A good technician utilizes a positive attitude, patience, CL knowledge, and a good sense of humor to put the patient at ease. A successful dispensing visit can set the stage for a lifetime of healthy contact lens wear.

1. http://www.clspectrum.com/articleviewer.aspx?articleID=12674
2. http://www.reviewofoptometry.com/content/d/contact_lenses___and___solutions/c/28450/dnnprintmode/tr
ue/?skinsrc=%5Bl%5Dskins/ro2009/pageprint&containersrc=%5Bl%5Dcontainers/ro2009/simple

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Ortho-K Is OK for Adults Too

Jesse is a 34 year old male (-3.50DS OU) whom I saw recently for a new patient eye exam. He told me that he has always wanted to wear contact lenses but has failed at every lens he has tried. I asked him what he has tried over the years and he reports that he has tried monthly, 2-week, and daily lenses. Thinking myself confident, I fit Jesse in my favorite single use lenses, only to see him back a week sooner than I anticipated with half the lenses in hand. Having just finished a myopia consult for a child, whom I fit into orthokeratology, I presented Ortho-K as an option to Jesse. He was immediately intrigued by the opportunity to not have to wear glasses or contact lenses during the day time. After a short struggle with lens fit, as happens in some orthokeratology patients, I am proud to say that Jesse has 20/20 vision uncorrected OD, OS.

There are many adults who can benefit from orthokeratology. If you have not considered orthokeratology for your child or adult patients in the last three years, I highly encourage you to call your laboratory and have a discussion with them. The lenses and fitting process have improved and are better and simpler than ever. I’m OK, you’re OK, let’s all do Ortho-K.

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The purpose of this study was to quantify on-eye rotational and translational stability of three scleral contact lens stabilization methods and to model the variation in visual acuity when these movements occur in a wavefront-guided correction for highly aberrated eyes.

Three lens stabilization methods were integrated into the posterior periphery of a scleral contact lens designed at the Visual Optics Institute. For comparison, a lens with no stabilization method (rotationally symmetric posterior periphery) was designed. The lenses were manufactured and lens movements were quantified on eight eyes as the average SD of the observed translations and rotations over 60 minutes of wear. In addition, the predicted changes in acuity for five eyes with keratoconus wearing a simulated wavefront-guided correction (full correction through the fifth order) were modeled using the measured movements.

For each lens design, no significant differences in the translation and rotation were found between left and right eyes, and lenses behaved similarly on all subjects. All three designs with peripheral stability modifications exhibited no statistically significant differences in translation and rotation distributions of lens movement and were statistically more stable than the spherical lens in rotation. When the measured movements were used to simulate variation in visual performance, the three lenses with integrated stability methods showed a predicted average loss in acuity from the perfectly aligned condition of approximately 0.06 logMAR (3 letters), compared with the loss of over 0.14 logMAR (7 letters) for the lens with the spherical periphery.

The researchers concluded that all three stabilization methods provided superior stability, as compared with the spherical lens design. Simulations of the optical and visual performance suggest that all three stabilization designs can provide desirable results when used in the delivery of a wavefront-guided correction for a highly aberrated eye.

Ticak A, Marsack JD, Koenig DE, Ravikumar A, Shi Y, Nguyen LC, Applegate RA. A Comparison of Three Methods to Increase Scleral Contact Lens On-Eye Stability. Eye Contact Lens. 2015 May 2. [Epub ahead of print]

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