Optometric Physician

A weekly e-journal by Art Epstein, OD, FAAO


Volume 20, Number 4

Monday, January 20, 2020


Inside this issue: (click heading to view article)
######### Off the Cuff: CES 2020
######### Corneal vs. Scleral RGP Lenses for Keratoconus and Other Ectatic Corneal Disorders
######### Rapid Healing of a Persistent Corneal Epithelial Defect with Autologous Serum Treatment
######### Bimatoprost Imprinted Silicone Contact Lens to Treat Glaucoma
######### News & Notes

Click on the image for upcoming Conferences and Meetings.


Off the Cuff: CES 2020

January 2020 started with a blast with the annual CES, the consumer electronics show held yearly in Las Vegas. This was our fourth straight year of attendance, and we’re either in better shape or just accustomed to walking the miles of exhibit halls lined with new technology. From massive high-tech juggernauts to bleeding-edge, barely funded startups, the halls were packed. However, this year, much of what we saw—even CES innovation award-winning products—were fairly pedestrian. Overall, my sense was that this rendition of the CES was more iterative than innovative, with few exceptions.

There were definitely a few show-stopping new introductions. For fans of large-screen TVs, several entire-wall-sized 8K monitors were pumping out incredibly vibrant colors and deep immersive sound. Reminiscent of the sci-fi movie-depicted TVs of a decade ago, a single humongous monitor wall with various information, background art and entertainment content concurrently running seemed not that far off. On the medical side of new things, there was lots of activity in the wearables segment, with blood pressure, pulse, EKG and noninvasive blood sugar monitoring displayed at several booths.

EyeQue, the refractionist replacement app/device that I’ve followed since my first CES, appears to be doing well—very well. Their booth has doubled in size every year. Current products EyeQue VisionCheck and EyeQue Personal Vision Tracker measure refractive error and PD. Using generated “EyeGlass numbers,” or so-called EGNs, regular glasses or EyeQue’s new “Try-On Glasses” can be ordered. Although the company goes to great lengths to state that it is not practicing optometry, the reality is that if it does what a duck does, and the duck requires a license to do it, it is a duck…or, in this case, perhaps a quack. While I still see value and possible synergy with optometry, at this point I think EyeQue has taken the concept too far and is approaching sufficient mass to attract attention from a state licensing board or face other legal or regulatory action. I guess we’ll see.

On a brighter and more positive note, we were pleased to see Zeiss exhibiting with a large and impressive booth. Demonstrating its cutting-edge lens technology from a consumer-facing perspective, the booth attracted a lot of attention and was really well done, as you can see from the photos.  


Representatives shared that this was their second year (we had missed them last year) and that the booth was always crowded. High-tech displays showed the effectiveness of high-quality UV protective eyewear as well as the effects of sun damage on the skin, which will have me using sunscreen religiously from now on. We were so impressed that we ordered one of Zeiss’ devices that will show the effects of UV damage on the skin to our patients. Kudos to Zeiss leaders for recognizing the tremendous value of sharing new eye care technology at the CES. I wish more companies would follow their lead.

Arthur B. Epstein, OD, FAAO
Chief Medical Editor


Want to share your perspective? Write to Dr. Epstein at artepstein@optometricphysician.com.

The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of the editorial board, Jobson Medical Information LLC (JMI), or any other entities or individuals.



Corneal vs. Scleral RGP Lenses for Keratoconus and Other Ectatic Corneal Disorders

Researchers compared the comfort and visual performance of corneal rigid gas permeable contact lenses (CLs) and scleral rigid gas permeable contact lenses (SLs) in participants with corneal ectasia, successfully wearing "habitual" CLs. In a randomized controlled trial (RCT) with a 2×2 crossover, 34 participants were recruited and randomized into two groups. Group 1 (sequence AB) was fitted in period 1 with new CLs, and after a four-week washout period in which habitual CLs were worn, crossed-over to SLs, period 2. Group 2 (sequence BA) was first fitted with SLs in period 1, and after a washout period of four weeks, crossed-over to new CLs, period 2. The median lengths in weeks of periods 1 and 2 were: 17.5 (IQR 12.4) and 14.5 (IQR 6.2) respectively. The outcome measures for visual performance were best-corrected visual acuity and the contrast sensitivity function. Vision related quality of life (Qol) was assessed using the National Eye Institute Visual Function Questionnaire-25, reported subjective perception of vision (SPV) and reported subjective perception of comfort (SPC) scores, recorded on a scale from 1 to 10. The final outcome measure was the selection of the preferred lens type at the completion of the RCT.

For the 30 subjects who completed the trial, significantly higher SPC scores were found for SLs compared to CLs (p=0.002). Significantly higher SPC scores for CLs were found in participants who selected CLs as their preferred lens for future use, compared with those who selected SLs (p=0.009). All other outcomes exhibited no significant difference between the experimental lenses. There was no significant difference (p=0.86) in the proportion preferring CLs (53%) and SLs (47%).

Researchers concluded that significantly better comfort was reported for SLs compared with CLs. Significantly higher comfort in CLs was found in those who preferred CLs than those who preferred SLs. Successful CL wearers whose SPC in CLs was <7 were likely to achieve better comfort with SLs. On average, successful CL wearers found SLs more comfortable, and researchers wrote that there were unlikely to be any significant visual or visual Qol advantages or disadvantages in refitting successful CL wearers with keratoconus and other corneal ectasia disorders with SLs, and vice versa.

SOURCE: Levit A, Benwell M, Evans BJW. Randomised controlled trial of corneal vs. scleral rigid gas permeable contact lenses for keratoconus and other ectatic corneal disorders. Cont Lens Anterior Eye. 2020; Jan 7. [Epub ahead of print]..

Rapid Healing of a Persistent Corneal Epithelial Defect with Autologous Serum Treatment

Autologous serum drop (ASD) reportedly is a safe and efficient treatment option for most ocular surface diseases. Investigators reported a case of a persistent corneal epithelial defect in a patient treated by ASD.

A 28-year old male patient presented to the investigators’ clinic with eye pain and blurry vision in his left eye. Best-corrected visual acuity (BCVA) was 20/20 in the right eye and 20/200 in the left eye. Slit-lamp examination revealed a central corneal epithelial defect on the left eye, and the right eye was normal. The defect appeared after left upper eyelid chalazion surgery and persisted for two months without any response to treatment with eye patching, bandage contact lenses and artificial tear eye drops.

Researchers started treatment with ASD six times daily and preservative-free netilmicin drops four times daily to prevent infection. The drops were used simultaneously with patching for the first two days. The eye was left unpatched after the second day. The corneal epithelial defect resolved after 48 hours. Investigators did not detect a new epithelial defect in the follow up visits. As such, they concluded that ASD was a quick, safe and effective treatment option in persistent epithelial defect cases.

SOURCE: Akagun N, Ozer PA, Gazyagci S. Rapid healing of a persistent corneal epithelial defect (PCED) with autologous serum treatment. Niger J Clin Pract. 2020;23(1):123-5.



Bimatoprost Imprinted Silicone Contact Lens to Treat Glaucoma

Bimatoprost is widely used for the management of glaucoma. Currently, it is delivered via an eye drop solution, which is highly inefficient due to low bioavailability. To control the release of ocular drugs, contact lenses are used by scientists. However, the conventional soaking method has exhibited a high burst release due to absence of any efficient controlling membrane. Researchers aimed to apply a molecular imprinting technology to improve the loading of bimatoprost from the soaking solution and to sustain the release of drug from the contact lens. The bimatoprost was loaded by conventional soaking method (BT-SM) and compared with the molecular imprinted contact lenses (BT-MP).

The loading of bimatoprost by molecular imprinting technology affected the swelling of the contact lens; however, the batch BT-MP-10 did not showed significant alterations. The uptake study showed improvement in bimatoprost loading by molecular imprinting technology in comparison with the conventional soaking technology. The in vitro bimatoprost release data showed improvement in the bimatoprost release rate profiles with BT-MP contact lenses (up to 36 to 60 hours) in comparison with BT-SM contact lenses (up to 24 to 36 hours). The in vivo rabbit tear fluid data with BT-MP batch showed improvement in the bimatoprost retention time in comparison with BT-SM contact lenses and eye drop solution. The rabbit model failed to respond to bimatoprost; thus, researchers suggested the efficacy studies should be conducted on canines or human primates.

These findings revealed the potential of using molecular imprinting technology to improve the uptake of bimatoprost and to achieve sustained release kinetics without altering the swelling, transmittance and folding endurance properties of contact lenses.

SOURCE: Yan F, Liu Y, Han S, et al. Bimatoprost imprinted silicone contact lens to treat glaucoma. AAPS PharmSciTech. 2020;21(2):63.

News & Notes
MacuLogix Introduces AdaptDx Pro, Guided by “Theia”
MacuLogix announced the next generation of dark adaptation functional testing with the introduction of AdaptDx Pro, guided by “Theia.” A new headset, custom-designed and tested for patient comfort, includes all of the functionality and accuracy of the company’s table-top dark adaptometer, the company says. As a self-contained wearable headset, the AdaptDx Pro requires no darkroom or external computer, and features an artificial intelligence-driven onboard technician named Theia. After the in-office technician selects the testing protocol and places the device on the patient’s head, Theia takes over to facilitate the testing experience by using automated instructions and adaptive feedback spoken directly to the patient. Theia’s A.I. helps ensure consistent, reliable testing results, and frees up the technician to focus on other tasks, MacuLogix says. The system will make its debut at the SECO (booth #838) and Vision Expo East (booth #MS4733) meetings, the company says. Read more. Read More.

Oyster Point’s OC-01 Nasal Spray Meets Primary Endpoint
Oyster Point Pharma announced positive top-line results from its Phase II MYSTIC study in dry-eye disease. Results showed a statistically significant improvement in Schirmer’s scores from baseline at day 84 in both doses compared with the control, the company says. Read More.




Optometric Physician™ Editorial Board

Chief Medical Editor
Arthur B. Epstein, OD, FAAO

Journal Reviews
Shannon Steinhäuser, OD, FAAO

Contributing Editors
• Katherine M. Mastrota, MS, OD, FAAO
• Barry A. Weissman, OD, PhD, FAAO (Dip CL)

Editorial Board
• William Jones, OD, FAAO
• Alan G. Kabat, OD, FAAO
• Bruce Onofrey, RPh, OD, FAAO
• John Schachet, OD, FIOS
• Joseph Shovlin, OD, FAAO



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