Contact lens Month (CLM) featured a series of webinars on each Wednesday evening during February. The first half of each webinar saw an Optician-selected key opinion leader interviewed by series host and Optician’s editor-in-chief Chris Bennett, before facing questions from the live audience. Part two followed a similar format with a speaker provided by the evening’s sponsor.
Recordings of all of the webinars described below can be viewed at opticiancontactlensmonth.co.uk along with downloads and resource materials.
Extended Depth of Focus
Extended Depth of Focus (EDOF) featured on February 1 with optometrist Nick Dash providing an overview of EDOF designs within visual optics. Dash has been in independent practice for 30 years and more recently has branched out into the field of ophthalmology though the Matrix Eye Clinic. He is an opinion leader in myopia management and founder of the whymyopiamatters.org website.
Dash described what EDOF is, and why and where contact lenses with that design should be fitted. He continued to describe which patients might benefit from EDOF designs and how EDOF lenses could fit into a practice’s offering.
Dash faced a range of questions about EDOF designs with the live audience keen to know about adaptation times to the lenses and the visual play-offs wearers might expect. Interest from the audience spanned both myopia management and presbyopia as Dash reminded questioners that EDOF was available in two designs across a range of materials and modalities, creating a powerful suite of tools for eye care professionals (ECPs) to add to their portfolio of contact lenses.
With questions becoming ever more specific, it was timely that the second half of the webinar took a more proprietary approach. The sponsor for the evening was Positive Impact and professional services director Phil Thompson provided information on VTI’s daily EDOF lens, NaturalVue product. He outlined the powers available and also provided pointers for practitioners on getting accredited to fit the lenses. Questioners were keen to know how addition powers were included with an EDOF fit, comparisons with traditional designs and the cost of the lenses compared with mainstream multifocals and myopia management options. The optical play-offs surrounding peripheral defocus were also discussed in response to a number of queries.
Sclerals
Week two saw a change of pace with the subject of the often-overlooked scleral contact lens being explored. Optician’s key opinion leader for the evening was Nick Howard who qualified as a contact lens optician in 1984. He now works with challenging ocular conditions and complex contact lenses both in independent practice and hospital clinics.
Howard (pictured left) gave an interesting historical look at sclerals, which concluded by comparing the first, handcrafted, glass, 19th century lenses with those manufactured using today’s technologies and materials. He suggested sclerals offered solutions to a range of optical conditions encountered in practice, including dry eye. After many years of decline, sclerals had found renewed interest in the last few years and practices could benefit by brushing up their skills and getting to know sclerals better, said Howard. Given the efficacy of sclerals in visual conditions and dry eye, their use could be a case of ‘back to the future’, he ended.
Questioners on the night were very keen to know what practice equipment was necessary to fit sclerals, cost, chair time, handling and replacement cycles. Howard said, while additional equipment helped optical coherence tomography (OCT), topographers and the like were not essential. He had good news on chair time and replacement cycles, while handling was a question of teaching and practice.
Bausch+Lomb was the sponsor for the night and Pauline Bradford, product specialist for speciality vision products at Bausch + Lomb, gave an overview of the features and fitting of its scleral Zenlens.
She reiterated some of the points made by Howard about the suitability of scleral lenses in solving optical problems other lenses struggle to solve before going on to describe the basic fitting process for the Zenlens. Questions from the audience once again focused on the technology needed, chair time and cost. The audience was keen to know about the multifocal designs used and cost. Bradford alson provided some resource links, which are available along with the webinar at opticiancontactlensmonth.co.uk.
In answer to a question on whether the time invested in sclerals was worth it, Bradford explained how the lenses could act as a great practice differentiator and builder, and provided some interesting numbers on replacement cycles and the ease of getting into scleral fitting. She agreed with Howard that the cost effectiveness was good for those patients with a need for sclerals and the chair time was worth it for the professional. She also confirmed that everyone from a newly qualified eye care professional (ECP) and up could get involved with sclerals.
Dry eye or lens discomfort?
Week three saw a return to the perennial topic of comfort in an evening sponsored by Alcon, entitled Dry Eye or Contact Lens Discomfort? Heading up the night for Optician was Ros Mussa, an ECP with more than 30 years’ experience and a special interest in dry eye. She combines working in practice with a range of advisory, educational and professional services roles.
In a lively interview with Bennett, Mussa offered some practical tips on first identifying dry eye and communicating with patients to effectively gain an insight into their experience. She then suggested some of the therapies and products available to treat dry eye before deciding how to differentiate between dry eye and contact lens-related issues.
Questioners on the night were very interested in Mussa’s go-to products for dry eye treatment. She also highlighted the importance of utilising the full gamut of lens products available and ensuring patients are aware that contact lens technology may offer them a better-than-current lens.
Continuing the theme of comfort in the second half of the Alcon sponsored evening was Dr Sònia Travé Huarte, a postdoctoral researcher and optometrist at Aston University. Dr Travé Huarte specialises in dry eye diagnostics and treatments, anterior ocular surface disease management, specialty contact lenses, Meibomian gland dysfunction and corneal pain.
She gave her insights into the ideal properties a contact lens should exhibit to maximise comfort and interact positively with the tear film. This lead on to a discussion around Alcon’s Total 1 contact lens. Dr Travé Huarte described the lens’ technology, such as its water gradient and SmartTears feature, before describing the physical properties of the lens, which reduced the potential for discomfort.
Joining Dr Travé Huarte and Mussa for the Q&A was Dr Sunny Verma Mistry, professional educational and development manager at Alcon. She kicked off with a fuller description of SmartTears, which she described as an artificial lipid that is diffused from the lens to support the tear film.
Questions from the audience included the availability of different lens diameters for daily lenses, which the panel members did not see as an issue. Another viewer asked if patients with higher prescriptions were in greater danger of developing dry eye because of the thickness of their contact lenses. Dr Verma Mistry said modern materials meant that the difference in thickness was not that great, so she did not see that as a problem, and instead pointed to overwear as a more likely to be a culprit in cases of dry eye.
The panel concluded by responding to a question about the importance of solving dry eye issues in reducing dropouts. Drs Travé Huarte and Verma Mistry concurred that ECPs needed to understand what sort of dry eye was in play to ensure the right contact lens was fitted. If that could be successfully resolved, then the patient would not drop out.
Myopia
Week four took the topic of the day as its cue: myopia. Optician’s key opinion leader for the night was Dr Kate Gifford. Dr Gifford is an internationally renowned clinician-scientist optometrist and peer educator, and a Visiting Research Fellow at Queensland University of Technology, Australia. She holds a PhD in contact lens optics in myopia, professional fellowships, over 90 peer-reviewed and professional publications and has presented more than 200 conference lectures. In 2016, along with her husband Dr Paul Gifford, she co-founded Myopia Profile and moved full-time into peer education in 2020. Prior to this, she ran her paediatric, contact lens and myopia specialty practice in Brisbane for 13 years.
Bennett asked Dr Gifford about her move into myopia management and how the Myopia Profile website came about. As well as providing some background on the evolution of myopia management in practice, she provided some tips for ECPs on how to get involved and the resources provided by Myopia Profile. She also sounded a warning that practices should be offering myopia control, if they did not they might face difficult questions from patients and parents in the future.
The final night’s webinar was sponsored by CooperVision and Dr Gifford’s interview was followed by Neil Harvey, professional affairs consultant of myopia management at CooperVision. Harvey has been in practice since the early 1980s and has worked across the independent and multiple sectors.
He provided a roundup of the latest trials of CooperVision’s MiSight myopia management lens, which now has seven years of data. He first outlined the scale of myopia and the dangers of allowing youngsters to develop high levels of myopia.
In a combined Q&A session Dr Gifford and Harvey faced a blizzard of questions about the MiSight lens, but also about myopia management in general. Age proved a very popular line of questioning with the audience keen to know when MiSight wear should start and when it should finish. Harvey explained that MiSight was licensed for use between six and 18 years of age but clinical decisions had to be made on an individual basis.
Practice equipment also featured highly, with questioners wanting to know if biometry, such as axial length, had to be measured. Dr Gifford assured watchers that axial length measurement was not essential but suggested equipment such as OCT was finding its way into more and more practices.
In answer to questions on wearing times, Dr Gifford gave a comprehensive overview of wearing times per day, per week and for the duration of childhood with the expectation that wearing should be full-time to achieve good results.
Mixing and matching spectacle lenses and contact lenses, communication and managing expectations were also discussed. Both speakers agreed that myopia can be managed but not cured and results cannot be 100% guaranteed. The discussion ended with a warning from Dr Gifford that not doing anything about managing myopia was no longer acceptable and possibly negligent.
Optician would like to thank all of those who posted questions during the live webinars and apologise to those whose questions we did not have time for.
To see the full presentations and discussion go to opticiancontactlensmonth.co.uk, where all of the webinars can be viewed for free. The webinars also included downloadable resource materials and contact details.