Tear osmolarity is often thought to be important in ocular surface disease, in addition to contact lens wear. Of course there is the debate about what it means to measure osmolarity in the meniscus, compared with over the precorneal tear film but still I think it is important to think about osmolarity issues in our patients. We know that the tear film evaporates much faster in contact lens wearers, and of course this is a driver of increased osmolarity, so keep this in the forefront of your thoughts in managing the issue of contact lens discomfort.

Contamac announced the appointment of Martyn Lewis as Business Development and Project Manager.

Lewis, who was Group Business Development Manager at Goodfellow Cambridge for the past five years, is returning to Contamac, where he will be responsible for the overall commercial management and execution of new projects and technologies such as Hydra-PEG. (For more information on Hydra-PEG technology see the February 1, 2015 issue of CLT.) This builds on his previous experience at Contamac when he was active in promoting Contamac’s range of GP, hydrophilic and silicone hydrogel products in Europe, the Middle East and Asia.

The American Optometric Association (AOA) will celebrate its 13th annual Paraoptometric Recognition Week September 13-19, 2015, which will honor paraoptometrics for their dedication to the patients they serve and to the profession of optometry.

The AOA Paraoptometric Resource Center (PRC) suggests a variety of ways to celebrate the week and encourages doctors to be creative in planning their festivities. Paraoptometric Recognition Week promotional kits are available to AOA members free of charge and include a poster, a table top tent, handouts for ODs with tips for staff recognition, information about AOA associate member enrollment and staff certification, and more. Kits may be requested by contacting pararecognition@aoa.org.

To learn more information about Paraoptometric Recognition Week, paraoptometry and the benefits of paraoptometric certification, visit aoa.org/paraoptometrics or call 800.365.2219, ext. 4108.

Registration is open at www.GSLSymposium.com for the 10th Global Specialty Lens Symposium to be held January 21 – 24, 2016 at Caesars Palace Las Vegas, Nevada. Plan now to attend this meeting for insightful presentations by international experts in the field, hands-on demonstrations of cutting-edge products and valuable continuing education credits.

In addition, the Program Committee of the GSLS invites the submission of Papers, Posters and images for the Photo Contest. Web submissions only. Deadline for submissions is August 31, 2015. Visit www.GSLSymposium.com for more information.

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Eleven Biotherapeutics, Inc., a clinical-stage biopharmaceutical company discovering and developing protein therapeutics to treat diseases of the eye, announced dose administration for the first patients in a Phase 3 study of EBI-005 for the treatment of moderate to severe allergic conjunctivitis. This Phase 3 study was designed and initiated following the completion in October 2014 of a Phase 2 study in which EBI-005 exhibited biological activity in improving the symptoms of late-phase allergic responses in patients with moderate to severe allergic conjunctivitis. This included statistically significant improvements in mean change from baseline in patient reported ocular itching, tearing and associated nasal symptoms compared to vehicle-control at the second to last and final assessment time points following allergen exposure in a modified direct conjunctival allergen provocation test (CAPT) model.

The company anticipates reporting top line data from this Phase 3 study in the first quarter of 2016.

This multi-center, double-masked, randomized, vehicle controlled Phase 3 pivotal trial is designed to evaluate the safety and efficacy of EBI-005 for up to four weeks in patients with moderate to severe allergic conjunctivitis in an environmental setting. Approximately 250 patients will be randomized 1:1 to receive treatment with EBI-005 or with vehicle. If the results of this first Phase 3 trial are favorable, Eleven intends to initiate a second Phase 3 trial in the second half of 2016.

Primary Eyecare Network (PEN), a division of ABB Optical Group, is offering eye care practitioners several educational events in September. The September calendar offers opportunities for ECPs and office staff to better prepare for the October 1st transition to ICD-10 and more, including six hours of American Board of Opticianry (ABO) or Certified Paraoptometric (CPO) continuing education credit in the popular one day bi-annual Quick Six event.

Among the events scheduled for September are:

• September 2 - Preparing for ICD-10 Webinar, 12:30 p.m. to 1:30 p.m. PDT - Free for PEN members; $15 for non-members
• September 10 - TOMMI: The ABCs of OCT, 5 p.m. to 9 p.m. PDT - Levi’s Stadium, Santa Clara, Calif.; Free. Approved for two hours of continuing education from the Council on Optometric Practitioner Education (COPE).
• September 23 - Quick Six, 9 a.m. to 4 p.m. PDT - Emeryville, Calif. Full Day: $225 for PEN members; $340 for non-members; Hourly rates available.

For more information on these and other events or to register, please visit PrimaryEye.net or e-mail education@primaryeye.net.

Have you seen an interesting case lately? Would you like to share it with your colleagues? An image from that case could appear in Contact Lenses Today in the coming weeks!

We welcome photo submissions from our 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 a detailed explanation of the photo and your full name, degree or title, and city/state/country.

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We Can’t Compromise Vision When Considering Use of Multifocal Lenses for Myopia Progression Management

Myopia progression management is a “hot topic” in eye care today. We all are becoming more aware of the ocular health, quality of life and economic implications of myopia and are also aware of the dramatic increase in the prevalence rates of myopia worldwide. Peripheral myopic defocus treatment modalities for myopia progression are being incorporated via both corneal reshaping treatments and multifocal daytime contact lens therapy. Visual performance during waking hours by those undergoing such therapies is still important and will impact compliance to therapy.

A study was conducted that evaluated the visual performance of multifocal and various single vision soft contact lenses vs. a control single vision contact lens.¹ At baseline, forty-four myopic participants (aged 18-35 years) were fit bilaterally with a control lens (Air Optix Aqua). At four follow-up visits, a total of 16 study lenses (5 single vision and 11 multifocal lenses) were fit contralaterally. After 1 hour of lens wear, participants rated (scale 1-10) vision clarity (distance, intermediate and near), magnitude of ghosting at distance, comfort during head movement, and overall comfort. Distance high contrast visual acuity (HCVA), central refraction and higher order aberrations, and contact lens centration were measured. Analysis of results found that for single vision lenses, vision ratings were not significantly different to the control lens (p>0.005). The control outperformed Acuvue Oasys, Clariti Monthly and Night and Day in HCVA (p<0.005). Most refraction and higher order aberration measures were not different between lenses. For multifocal lenses, the majority of vision ratings (84%) were better with the control (p<0.005). HCVA was better with the control (p<0.005). Proclear Multifocal lenses showed greatest differences at distance and near, and were more commonly inferiorly decentered (p<0.005). The authors concluded that design differences between single vision lenses had a small impact on visual performance. However, lenses featuring multifocality decreased visual performance, in particular when power variations across the optic zone were large and/or the lens was significantly decentered.

These results should be considered as we venture further into the use of distance center multifocal daytime wear contact lenses for the management of progressive myopia in young individuals. Although there may be a significant influence on myopia progression rates with the use of these lenses, if there is significant visual compromise the patients may not accept this form of lens wear. Developing contact lens designs that provide acceptable visual performance while still influencing axial elongation and myopia progression rates will be a key to successful myopia management.

On a personal note, you may note that the late professor Brien Holden is a co-author on this paper. His recent passing was a shock to many of us who knew and respected him. His loss has left a significant hole in our profession and especially in the field of myopia management which, among many other concerns, was a passion of Brien’s professional life. We all must in our own way continue his work. He is already greatly missed.

1. Fedtke C, Bakaraju RC, Ehrmann K, Chung J, Thomas V, Holden BA. Visual performance of single vision and multifocal contact lenses in non-presbyopic myopic eyes. Cont Lens Anterior Eye. 2015 Jul 27. [Epub ahead of print]

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The Neglected Conjunctiva

I have the unique opportunity to share my clinical day with optometry students and residents. I am fortunate to have a captive audience as I chatter on about patient cases and outcomes.

I often find myself in a dissertation about the conjunctiva. The conjunctiva, I believe, is oft neglected as clinicians drive the biomicroscope in to examine the all-powerful and highly regarded clear cornea. When challenged by infection, trauma, contact lenses and dry eye in its many forms, the conjunctiva will react and, with long-term disruption, will ultimately malfunction. Dr. Jeff Gilbard, ocular surface pioneer, noted that indeed the conjunctiva will exhibit changes before the cornea in dry eye disease.¹

Thus it was no surprise to me that a recent study suggests that palpebral conjunctival sensitivity may be more critical than the corneal sensitivity when assessing dry eye.² Think of those symptomatic patients with conjunctivochalasis for example.

I am confident that the conjunctiva will be the new frontier in ocular surface disease study. I urge you to critically evaluate the conjunctiva in your dry eye evaluations.

1. Gilbard JP. Tear Film Osmolarity and Keratoconjunctivitis Sicca. CLAO J. 1985 Jul-Sep;11(3):243-50.
2. Cox SM, Nichols JJ. Association Between Meibomian Gland Testing and Ocular Surface Sensitivity. Cornea. 2015 Jul 22. [Epub ahead of print]

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The purpose of this study was to investigate the relationship between axial length (AL) increase and baseline spherical equivalent refractive errors (SER) in myopic children wearing orthokeratology contact lenses (OK).

One hundred fifteen Chinese (115 right eyes) children wearing OK were enrolled in this cohort study. Gender, age, baseline SER, corneal power, corneal astigmatism, and AL at baseline and 2 years after wearing OK were collected. Univariate analysis and trend test were used to estimate the relationship between change in AL and baseline SER.

After univariate analysis, a statistically significant relationship was found between change in AL and baseline SER (β=0.061, 95% CI: 0.015-0.111, P=0.015). In the trend test, after adjusting for potential confounders, higher SER was associated with smaller increases in AL (P trend=0.041).

The researchers concluded that the SER at baseline was associated with AL growth in myopic children wearing OK. The higher SER was associated with slower AL growth and control the development of myopia.

Fu AC, Chen XL, Lv Y, Wang SL, Shang LN, Li XH, Zhu Y. Higher spherical equivalent refractive errors is associated with slower axial elongation wearing orthokeratology. Cont Lens Anterior Eye. 2015 Aug 4. pii: S1367-0484(15)30017-5. doi: 10.1016/j.clae.2015.07.006. [Epub ahead of print]

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