Optometric Physician

Vol. 21, #13   •   Monday, March 29, 2021


Off the Cuff: The Beginning

This month marks the 50th anniversary of the FDA approval of the first soft contact lens. Introduced by Bausch + Lomb in 1971, the B&L SofLens redefined the entire contact lens industry and literally transformed the practice of optometry. What started as a seemingly impossible idea in the mind of Czech polymer chemist Otto Wichterle, became one of the greatest innovations of the 20th century.

Wichterle was a true visionary who believed that plastic could be mixed with water to form a physiologically compatible hydrogel—something that was considered impossible at the time. Moreover, he had a vision for how such an invention could be used. Borrowing parts from his child’s erector set and reverse wiring a bicycle generator, he developed the first spin casting device to manufacture soft lenses. In collaboration with local ophthalmologists he used his lenses to fit aphakic pediatric patients at a local hospital.

I recall a conversation I had with George Grobe during a visit to B+L in 1999. George, who now heads B+L’s R&D, had co-developed the surface of the PureVision, the first silicone hydrogel in the US, another major B+L innovation. While patiently explaining the complex surface chemistry and talking about the science, George mentioned that he recently had the good fortune of actually meeting Dr. Wichterle. As George explained the magnitude of what Wichterle had accomplished from a chemist’s perspective, his admiration for the man was clearly evident.

Innovation continues at Bausch + Lomb, which I have had the pleasure of watching from a front row seat. Some recent notable contact lens introductions include the first multifocal toric lens that surprised me with how easily it was to fit and how well it worked and the Infuse, a novel daily disposable silicone hydrogel with built-in surface wettability enhancement specifically designed to support the ocular surface environment.

Congratulations to B+L on 50 years of soft lens innovation. I can’t wait to see what the next 50 will bring…


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 Jobson Medical Information LLC (JMI), or any other entities or individuals.



Ocular Surface Characteristics in Acne Vulgaris

Since acne vulgaris is a disease of the sebaceous glands, it may have potential effects on the ocular surface and tear homoeostasis, which are essential for good vision. Optometrists should be aware of ocular surface pathologies when prescribing glasses or contact lenses for the visual rehabilitation of these young patients. To evaluate the ocular surface features, meibomian glands and tear parameters of patients with acne vulgaris, the right eyes of 70 individuals (34 patients with acne vulgaris, 36 healthy volunteers) were evaluated. The tear break-up time of participants was measured, and the Schirmer’s test was performed. To determine ocular surface characteristics, samples were taken from the conjunctiva for impression cytology. Finally, the loss rates of the upper and lower eyelid meibomian glands were determined by taking meibography (Sirius, CSO, Florence, Italy).

Tear break-up time was significantly lower in the study group compared to the control group. No statistically significant difference was determined between the groups with respect to Nelson grade in the conjunctival impression cytology. Grade 3 cytological changes were not observed in either group. The median value of the loss rate in the meibomian glands in the upper eyelid of patients with acne vulgaris was 19.10% (IQR: 18%), while it was 8.75% (IQR: 9.53%) in the control group. The median value of the loss rate in the meibomian glands in the lower eyelid was 15.70% (IQR: 15.13%) and 7.70% (IQR: 6.53%) in the acne vulgaris and control groups, respectively.

This study showed that patients with acne vulgaris may have a predisposition to meibomian gland damage and tear instability. Researchers suggested that a more detailed ophthalmologic examination should be performed in patients with acne vulgaris.

SOURCE: Muhafiz E, Öztürk M, Erten R. Ocular surface characteristics in acne vulgaris. Clin Exp Optom. 2021 Mar 15. [Epub ahead of print].



The Effect of Daily Life Activities on Intraocular Pressure-related Variations in Open-angle Glaucoma

The recent advent of continuous intraocular pressure (IOP) telemetry has led to an increased awareness of the importance of IOP fluctuations, and theories have emerged suggesting that IOP variations could play as important a role in glaucoma progression as the mean level of IOP. The aim of the present study was to evaluate the direct effect of common daily activities on IOP-related profiles. Primary open-angle glaucoma and glaucoma suspect patients were prospectively enrolled from specialist clinics at the University of California San Diego. Patients were fitted with a Sensimed Triggerfish (TF) contact lens sensor (CLS) and were instructed to return to their usual daily activities for 24 hours. They were asked to record each specific activity or event in a diary. The protocol was repeated twice. The following events were recorded: “walking/cycling,” “resistance training,” “yoga/meditation” and “emotional stress.” CLS measurements recorded 60 to 30 minutes prior to each event were used as a baseline reference, and all IOP-related fluctuations for 120 minutes after the start of each event were reported in relation to this reference.

Forty relevant events from 22 CLS recordings in 14 patients were retrieved from the diaries. Walking/cycling (n=10) caused a small but statistically significant elevation of the IOP-related profile during the activity. Resistance training (n=11) caused a persistent elevation of the IOP-related profile from the onset of the activity through 120 minutes after the activity was stopped. Yoga/meditation (n=4) caused a sustained drop in the IOP-related profiles through to 120 minutes, although this was not statistically significant. Emotional stress (n=13) was associated with a gradual elevation of the IOP-related profile from the start of the stressful stimulus. Both early and late variations were statistically significant.

The present study suggested that emotional stress and resistance training may be associated with persistent IOP-related profile elevation.

SOURCE: Gillmann K, Weinreb RN, Mansouri K. The effect of daily life activities on intraocular pressure related variations in open-angle glaucoma. Sci Rep. 2021 Mar 23;11(1):6598.



Persistent Globe Flattening in Astronauts following Long-duration Spaceflight

Posterior globe flattening has been well-documented in astronauts both during and after long-duration space flight (LDSF), and has been observed as early as 10 days into a mission on the International Space Station.

Globe flattening (GF) is thought to be caused by the disc-centered anterior forces created by elevated volume and/or pressure within the optic nerve sheath (ONS). This might be the result of increased intracranial pressure, increased intraorbital ONS pressure from compartmentalization or a combination of these mechanisms.

Researchers reported posterior GF in three astronauts that has persisted for seven years or more following their return from LDSFs, suggesting that permanent scleral remodeling may have occurred.

SOURCE: Mader TH, Gibson CR, Barratt MR, et al. Persistent globe flattening in astronauts following long-duration spaceflight. Neuroophthalmology. 2020 Sep 3;45(1):29-35.





Industry News

Essilor Launches Vision-R 700 Refraction System

Essilor Instruments launched the Vision-R 700 refraction system, with an optical module featuring variable focus in combination with new patented technology, Digital Infinite Refraction. The simultaneous and continuous variations of the sphere power, cylinder axis and cylinder power offer a new cylinder-search method based on a vectorial approach to refraction. Other features aid “tele-optometry,” and automated Smart programs and algorithms guide the practitioner, while simulated comparisons are designed to enhance patient comfort and confidence in the prescription. Read more.




Eaglet Eye Launches Virtual Education Program

Eaglet Eye announced its new Virtual Interaction Program, a three-part virtual education series focused on profilometry-based specialty lens fitting. Together with Tom Arnold, OD; Jason Jedlicka, OD; Barry Leonard, OD; and Sheila Morrison, OD, this educational activity aims to help practitioners get more comfortable with the concept of scleral lenses and challenges, and how profilometry can make the fitting process faster and more precise. These one-hour webinars will be held on the last Thursday of the month from April through June, at 8 p.m. EST, and are complimentary to all eye care professionals. Read more.

Prevent Blindness Names April as Women’s Eye Health and Safety Month

Blindness Named April as Women’s Eye Health and Safety Month to raise awareness on the fact that women are at higher risk for most eye diseases, and provide free information on topics related to possible vision changes during pregnancy, to the safe use of eye cosmetics. Read more.



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