Professor Nicola Logan of Aston University
For the first half of each Contact lens Month (CLM) webinar, an Optician-selected key opinion leader was interviewed by series host and Optician’s editor-in-chief, Chris Bennett. They then faced questions from the live audience.
The second half saw the evening’s sponsoring company field a speaker for a second presentation with the evening topped off by a second Q&A session. All of the webinars are available to watch in full, on demand at opticiancontactlensmonth.co.uk but below is a quick romp through the subjects chosen this year.
Few topics command as much interest as myopia management and CLM kicked off with a webinar on that subject sponsored by VTI through its partner Positive Impact. VTI supplies the NaturalVue Extended Depth of Focus (EDOF) lens, which has applications in both myopia management and correction of presbyopia.
The opening session took a broader look at myopia under the heading of: Everything You Wanted Know About Myopia Management But Were Afraid To Ask. In the speaker’s chair was Professor Nicola Logan of Aston University (pictured top). Prof Logan is a researcher and educator with a special interest in myopia. Her research interests span the progression, development and management of myopia and she runs a clinical service and lectures on optometry.
Bennett asked Prof Logan about the take up of myopia management services by UK practices and asked why some eye care professionals (ECPs) seemed reluctant to get involved. She said there was a growing, and regulated, body of evidence being built that would give more ECPs the confidence to get involved with myopia management as the market matured.
She suggested the multi-factorial nature of myopia would likely lead to an array of options across spectacle lenses, contact lenses, lifestyle changes, light sciences and drugs to combat myopia in the future. It was likely that ECPs would want to see evidence of how the various techniques performed.
Myopia management is, and would continue to be, a growing area of practice and there was a demand waiting to be met, she added. Research currently being undertaken at Aston showed there was an appetite among parents for myopia treatments that was not being met in the high street. Parents were actively seeking options for their child, she said.
Questions on the night for Prof Logan came thick and fast with many listeners wanting to know at what age treatment for myopia should start and end. She responded that clinical judgement would always drive this and careful monitoring was key. There were no set start and end ages for treatment but she said myopia progresses faster in younger children; so the earlier intervention the better.
Combinations of treatment options were also top of the questioners’ list with several asking if contact lenses or spectacles were better and if the two could be used together. Returning to clinical judgement Prof Logan concluded: ‘The most effective option is the one that the child is going to comply with.’
Other questioners wanted to know about NHS funding for myopia management, hyperopia options, late adopters and Prof Logan’s responses to those and many more can be viewed in the recording of the webinar at opticiancontactlensmonth.co.uk.
The second guest for the night was Dr Ashley Tuan chief medical officer of VTI (pictured below, right). Dr Tuan graduated from the Ohio State University where she received master of physiological optics and doctor of optometry degrees. She received her PhD in vision science from UC Berkeley.
Her career spans 30 years of clinical and vision research in areas such as higher order aberrations, myopia progression control, presbyopia correction and age-related macular degeneration treatments.
She provided an overview of the Extended Depth of Focus (EDOF) lens design before outlining the latest data from VTI’s trials of its NaturalVue lens in myopia management.
The Progressive Myopia Treatment Evaluation for Naturalvue Multifocal Contact Lens Trial is a multi-national, randomised, double masked, three-year prospective study. It is collecting data from different geographical areas across different ethnicities, lifestyles and living environments.
Dr Tuan provided full data on the trial, which is available in her presentation, reporting that 45% of the subjects in the trial had no myopia progression in the most recent year while 64% had progression of less than 0.25D. The full presentation can be viewed at opticiancontactlensmonth.co.uk.
The audience on the night of the webinar was keen to know the latest thinking from both speakers on start and finish times for myopia management and the relative benefits of contact lenses over spectacle options.
Dr Tuan said, as ever, professional judgement had to be exercised on start time but both speakers repeated that the earlier treatment started the better. Dr Tuan also made the point that as NaturalVue was a multifocal lens it could take care of the population from a seven-year-old to a 70-year-old.
In reply to a number of questions coming in from the audience on astigmatism Dr Tuan confirmed that NaturalVue could correct around 1.5D of astigmatism with reports from ECPs of up to 2.75D being corrected. Prof Logan made the point that there were other options for myopia correction with soft toric contact lenses using traditional design.
Dr Tuan also responded to a question on atropine with her thoughts from the experience in the US where the drug is used by ophthalmologists. She said there was evidence of an additive effect where soft lenses and atropine could be used together.
Prof Logan reiterated that atropine was not licensed in the UK but any myope would need optical correction alongside atropine treatment so why not use an optical correction, which is also a treatment such as a myopia management contact lens?
The issue of mixing myopia management contact lenses and spectacles was again raised by several of the audience. Prof Logan said the data to support this was only now being collected. Clear evidence did not exist but if the parent could afford both: ‘We think it’s a good option.’ She said, for short term wear, such as a football match, a single vision contact lens would normally be sufficient.
Dr Tuan said, as there were currently no myopia management spectacle lenses available in the US, this was not something she had experience of. The speakers’ response to questions on a possible rebound effect after ceasing treatment, education and others can be viewed in the recording of the webinar at opticiancontactlensmonth.co.uk.
More on myopia
Myopia management was also the topic of conversation for the webinar on March 19 in an evening sponsored by CooperVision. Optician’s key opinion leader for the night was the president of the BCLA, Rakesh Kapoor (pictured below, right).
He is a partner in four Specsavers practices in London and teaches contact lens practice to Specsavers trainees in preparation for professional exams.
During a 30-year career Kapoor has been a NHS ophthalmic adviser, GOC committee member, a university lecturer and a College of Optometrists examiner councillor.
Kapoor gave an insight into his presidency plans for 2024 before moving on to give his experience of myopia management in practice. A self-professed advocate for growing the contact lens market, Kapoor said the fundamental goal was for the BCLA to educate ECPs.
He said practitioners were isolated so having a point of reference for education was essential. Transforming a patient into a contact lens wearer often boiled down to recommendation from the clinician and ECPs needed the confidence to suggest contact lenses to their patients.
Giving his experience of Specsavers’ approach to offering myopia management he said practitioners were required to undergo compulsory training. Education would be essential regardless of the practice setting and Specsavers was now seeing growth in the myopia sector.
He also expected to see growth in myopia management more generally as Specsavers raised the level of awareness of the technique among parents and patients in the general public.
In a wide-ranging discussion, Kapoor also spoke about the potential dangers of not offering myopia management, education, how myopia management can grow the contact lens market and how practitioners can be encouraged to get involved. A recording of the interview can be found at opticiancontactlens month.co.uk.
The speaker for the second half of this CooperVision-sponsored evening was Nicky Latham (pictured below, right). She qualified as an optometrist in 1990 and completed an MSc in children’s vision and contact lenses in 1995. She has worked in a number of practices in the multiple sector as well as delivering training across all optical job roles.
During that time she has been a clinical governance optometrist involved in driving practice standards and delivered peer review before moving into a professional services role. Latham moved to CooperVision in 2023 as the professional affairs lead for myopia management and is a holder of a certificate in the principles of myopia management from the BCLA.
In a presentation; Myopia Made Easy With MiSight, Latham talked about why myopia management is so important, why all ECPs should get involved, the importance of adherence to wearing times and MiSight as a solution to those points.
She opened by explaining that half of the world’s population will be myopic by 2050 and 90% of ECPs agree that offering a management option to combat it is crucial for the future eye health of their patients.
Providing seven-year data from its MiSight randomised controlled trial she said 59% of those taking part saw a slowing of myopia while one in four saw the progression of myopia halted. The full evidence can be seen by watching the webinar opticiancontactlensmonth.co.uk.
Latham was joined by Kapoor for the Q&A at the end of her presentation with many questions following the theme of wearing start and finish times, cyls and late emerging myopes. The audience also asked about instrumentation and if cycloplegic refraction was essential. For full explanations on all of these points log on to watch the webinar.
Combatting discomfort
For the final webinar of Contact Lens Month, the focus fell on comfort in a session sponsored by Bausch + Lomb. The key opinion leader for the night was Neil Retallic, an optometrist with experience of working within practice, education, industry and professional services roles (pictured below, right).
Retallic is currently the head of professional development at Specsavers and a College of Optometrist assessor and examiner. He has been involved with numerous organisations as a council and committee member across the sector and is the immediate past president of the BCLA and part of the GOC Education Committee.
Using his experience of delivering lectures and interpreting clinical findings into daily practice Retallic revealed up to 80% of contact lens wearers have comfort issues. This figure translates into 500,000 drop outs a year.
He went on to describe the ‘beautiful structure’ of the tear film and the role it plays in contact lens comfort and what happens when things go wrong. Alongside discomfort, vision also suffers so it is no surprise that drop out from contact lenses can follow.
Maintaining homeostasis was the key and Retallic outlined some of the strategies ECPs can employ to support their patients’ tear film. With over 2,000 proteins and 700 receptors per square millimetre the tear film is complex, said Retallic, but drops, gels, supplements and foods could support the tear film’s needs.
A discussion between Bennett and Retallic then followed on the properties a contact lens should possess to maintain comfort. This included interaction with the tear film but also the modulus of the lens and its design and interaction with the lids.
This segued neatly into a presentation by the evening’s sponsor, Bausch + Lomb, on its Ultra One Day lens. Delivering the presentation was Rakhee Thakrar, senior professional affairs associate with Bausch + Lomb (pictured below, right). Thakrar qualified as an optometrist in 2009 and has worked in numerous practices as a locum optometrist in the corporate and independent sector.
She said patients unnecessarily compromise their contact lens wearing experience by accepting dryness and discomfort as normal and often blame their own lifestyle, not their lenses. ECPs often remain unaware as patients do not complain about their wearing experiences, she said.
Her presentation outlined a lens she said had been designed to address this patient need; Bausch + Lomb Ultra One Day. She described this as a lens employing the next generation, silicone hydrogel contact lens material offering breakthrough moisture and comfort technologies.
In her presentation, which can be viewed at opticiancontactlens month.co.uk, she described how these technologies are embedded within the lens and how they enrich and stabilise the tear film.
The presentation went on to share details of Ultra’s visual optics and the findings of research showing patients’ dissatisfaction with their lenses. Most said they endured discomfort to be able to wear their lenses longer but would be interested in exploring a more comfortable lens.
She also confirmed patients did not share this discomfort with their ECP and blamed their own lifestyles. Unfortunately, Thakrar was not available for the Q&A so she shared reference points for further information on the webinar with the audience.
Answering questions from the audience, Retallic returned to talk through some of the comfort issues raised. Webinar watchers on the night were keen to learn more about measurable assessment of discomfort in practice. Retallic said staining, irritation and lid wiper epitheliopathy or inflammation caused by mechanical interaction, were useful places to start.
However staining did not always mean discomfort so, as ever, professional judgement and a thorough investigation and patient questioning were key. Wearing times also came under the spotlight and Retallic suggested changes in patients’ wearing habits were a useful indicator. Patients often independently reduce wearing times and this could be a precursor to action to combat discomfort, he said.
With the relationship between dry eye and contact lens discomfort so closely linked, Bennett asked Retallic how the two could be separated. Retallic suggested the obvious solution was to take the lens out and see if issues resolved. A more likely scenario is where a lens irritates an existing dry eye problem. This could be established and action taken to mitigate the symptoms.
A final question on the effects of handling and care systems on drop outs prompted Bennett to ask if any research had been undertaken in that area. Retallic responded that handling was more of an issue for new wearers and there were simple tips to help with that.
Passing those on should be part of the teach. These are as simple as hand washing and thorough drying, having the right modulus of lens for the individual. He was not aware of anything in the literature about issues such as long nails making handling less successful.
He said with the right instruction most people can successfully handle their lenses and that should not be a problem. Hygiene and lighting also had to be right. ‘It all goes back to best technique and training,’ he concluded.