Supplement to


Telescopic Sclerals May Ease AMD Burden

  • A telescopic scleral lens unveiled at the annual American Association for the Advancement of Science meeting could one day replace more cumbersome bioptic telescopes mounted through spectacle lenses to improve the vision of patients suffering from age-related macular degeneration (AMD). The telescopic scleral incorporates a concentric pattern of circular reflectors that act as mirrors to enlarge objects to 2.8 times their actual size. A pair of modified 3D television glasses block either the magnifying portion of the scleral contact lens or its unmagnified center by electrically changing the orientation of polarized light.

    Microbial Keratitis Moves to the ‘burbs

  • Infectious keratitis is more common in patients who live in suburban areas and during non-winter months, according to a four-year study of keratitis patients in eastern Pennsylvania published in the March 2015 Cornea. Pseudomonas aeruginosa was found to be the most common bacteria and Fusarium the most common fungus in contact lens-related cases, while Staphylococcus aureus was identified as the most common bacteria and Candida the most common fungus in non-contact lens-related cases.

    Omega-3s Linked to Epithelial Cell Improvement

  • Oral omega-3 fatty acids (O3FA) may have a positive impact on epithelial cell morphology and goblet cell density in contact lens-related dry eye, reports a study published in Cornea. Dry eye syndrome has previously been linked to O3FA deficiency.

    CXL: No Effect on Scleral Lens Tolerance

  • Corneal crosslinking (CXL) does not affect scleral lens tolerance in patients with progressive keratoconus, according to a small prospective study in the March 2015 Optometry and Vision Science. However, lens fit should be reevaluated after CXL, as some fitting parameters can change.

  • Check Out More Articles from the March Issue of RCCL Here!

    Have a topic you want to see discussed? Want to comment on an article? We want to hear from you! Contact us with your feedback and suggestions.


    20 Pearls on Ocular Allergy
    and Dry Eye

    Ocular allergy and dry are two of the most common ocular conditions worldwide, affecting an estimated quarter of the global population. This prevalence makes understanding their respective pathologies, symptoms and treatment options key to building and maintaining a successful practice. To help, the March issue of Review of Cornea & Contact Lenses is devoted to improving your understanding of ocular allergy and dry eye. Below are 20 great pearls shared by several experts in the field. For more detail, click through to read the original articles for each.


    1. Vernal keratoconjunctivitis presents as either limbal (Horner-Trantas dots and epithelial infiltrates), palpebral (enlarged papillae of upper tarsal conjunctiva, superficial keratitis and hyperemia) or mixed (elements of both). Superior punctate keratopathy exists in both forms of the disease. More
    2. It’s feasible to use steroids with a reduced IOP-elevation profile in ocular allergy, particularly in severe cases, but other risk factors make long-term use for non-complicated allergy questionable, so proceed with caution. More

    3. Seasonal allergic conjunctivitis patients first and foremost should reduce exposure by keeping windows closed and avoiding outside activities when pollen levels are high. When outside they should wear close-fitting, wraparound glasses, then wash hands once inside again. Allergens can also become attached to hair, so patients should wash hair prior to sleeping and change pillowcases daily. More

    4. Because VKC can closely mimic SAC, but with the potential for permanent vision loss, always test all patients who present with severe itching, stringy discharge and other signs and symptoms suggestive of VKC. More

    5. Allergic conjunctivitis may be more prevalent than you realize. A study found it in 73.2% of 258 ocular surface disease patients, either alone or in combination with aqueous deficient or evaporative dry eye. It was also the most commonly encountered unique condition (41.7%) of the three. More
    6. VKC can be treated using combination eye drops that act as both an antihistamine and mast cell stabilizer; however, in more severe cases, topical steroids may be needed instead. Topical cyclosporine may also be used to treat VKC. More

    7. While the effects of ocular cicatricial pemphigoid on mucous membranes prompts signs and symptoms of dryness that mimic true dry eye disease, it can be differentiated by observation of widespread involvement of conjunctival tissue. More

    8. Switch patients to a daily disposable contact lens to reduce contact lens-associated GPC recurrence; while symptoms of lens-induced GPC are associated with all types of contact lenses, increasing lens replacement frequency decreases incidence of GPC. More

    9. A small number of VKC patients develop reduced vision from sterile corneal ulceration and scarring. The corneal lesions (shield ulcers) appear in the superior cornea and may involve the visual axis. These lesions arise from a mix of cationic protein release and mechanical eye rubbing  that traumatizes the cornea. More

    10. Peroxide disinfection helps prevent GPC reoccurrence when the contact lens material cannot be changed, e.g., in patients with irregular astigmatism from keratoconus or penetrating keratoplasty. Also effective: use of an alcohol-based cleaner for 30 seconds daily or a two-component cleaner with sodium hypochlorite and potassium bromide for 30 minutes one to two times a week. More

    11. Signs that differentiate epithelial basement membrane dystrophy from dry eye include corneal epithelial microcysts (“dots”), whirling defects (“fingerprints”) and positive and negative fluorescin staining. Observing how inter-blink dynamic changes in the tear film impact the corneal reflection in the keratometer can also help. More

    12. If a patient’s GP lenses progressively dry out throughout the day, schedule a late afternoon exam to check the lens surface for deposits consisting of protein or lipids. If discovered, switch solutions or add a more aggressive lens cleaning regimen to help reduce deposits. More

    13. While itch is the classic, primary diagnostic factor in allergic conjunctivitis, a study found three others—burning, soreness and scratchy sensation—were just as significant in making the diagnosis. Also, intensity of burning and soreness was more statistically significant than that of itching. More

    14. To mitigate recurrence of contact lens-associated GPC, modify the lens edge and/or change the polymer, as surface deposits depend on the lens type. For example, higher water content contact lenses develop more deposits than lenses with lower water content. More

    15. When treating allergic conjunctivitis, consider dual-acting mast cell stabilizers/antihistamines. These newer agents reduce allergy-induced itching and their effects are better tolerated and longer lasting than single-action antihistamines. More

    16. If a GP lens patient experiences dry eye even with their lenses removed, the problem may be with the ocular surface itself, not the lens. Examine carefully—note the lid appearance, look for any capped meibomian glands or scalloped margins, check their tear prism and do a Schirmer’s test or the phenol thread test to determine aqueous tear production. More

    17. Examine patients for a localized area of GPC on the superior tarsal conjunctiva overlying a suture to diagnose suture-related GPC. Treatment should involve the removal of these loose, exposed sutures, with additional pharmacologic treatment as needed. More

    18. Consider changing lens type to alleviate dry eye in GP lens patients. Patients who experience dry eye symptoms may benefit from a lower dK material because of its advantageous wettability properties. Inadequate surface wettability can compromise lens wear. More

    19. In GPC related to ocular prostheses, a mucus coating may form on the device; thus, treatment should involve an increase in frequency of device removal, cleaning and polishing. Mast cell stabilizers/antihistamines may also be used, but should not be the primary treatment. More

    20. Parenteral first-generation antihistamines commonly used in systemic allergy may be counterproductive in managing ocular allergic disease because they can bind to histamine receptors in the central nervous system, causing sedation, dry mouth, dry eye and tachycardia. The overall effect is an increase in the concentration of allergens in the tears. More
    Review of Optometry® is published by the Professional Publications Division of Jobson Medical Information LLC (JMI), 11 Campus Boulevard, Newtown Square, PA 19073.

    To subscribe to other JMI newsletters or to manage your subscription, click here.

    To change your email address, reply to this email. Write "change of address" in the subject line. Make sure to provide us with your old and new address.

    To ensure delivery, please be sure to add revoptom@lists.jobsonmail.com to your address book or safe senders list.

    Click here if you do not want to receive future emails from Review of Optometry.