What Is Happening In the Gas-Permeable Contact Lens Industry

The Gas-Permeable Contact Lens

The mainstay of treatment for our patients with keratoconus are gas-permeable lenses.  Corneal gas-permeable (GP) lenses have been the treatment of choice for over 40 years and fit approximately two-thirds the size of the cornea.  Corneal GP lenses translate and pump tears and oxygen under the lens with each blink.  Hybrid lenses have a GP center bonded to a soft skirt that cushions and centers the lens.  Scleral lenses are very large diameter lenses that completely vault the cornea and land on the relatively insensitive scleral tissue.  Whether they are corneal GP, hybrid, or scleral lenses, the commonality is that all of these strategies use the optics and rigidity of GP materials to provide the best vision and comfort for this challenging condition.

gas-permeable contact lens
Well-fit corneal GP lens with sodium fluorescein dye

The way that the GP industry works is that GP button manufacturers (there are 6 in the US) sell the raw material, or button, to independent laboratories (there are 39 in the US) who then craft the button using industrial lathes into hundreds of lens designs using their own intellectual property.   GP buttons are used to make corneal GPs, hybrid, and scleral lenses.  Doctors who are skilled in fitting and evaluating the lens designs craft custom made GP lenses for their patients for whatever purpose benefits the patient.

Not many people know that the GP lens industry is on fire right now.  The turmoil began when Valeant Pharmaceuticals purchased Boston Products.  Boston Products manufactures the raw material of GP lenses, GP buttons, and held around 80% of the US market share.

The independent laboratories have a trade association called the Contact Lens Manufacturer’s Association (CLMA) who have an educational wing called the Gas-Permeable Lens Institute (GPLI).  The GPLI is universally beloved by practitioners because its primary function is to educate doctors to become better doctors in a non-branded, good-of-the-industry format.  No lens design is favored over any other.  Education is free to all doctors and expertise in specialty lenses is stressed, so that patients are placed in skilled hands.  Jan Svochak, president of the CLMA, says, “The CLMA represents a longstanding group of Independent Contact Lens Manufacturers working collaboratively where we have shared goals. These include educational resources through the GPLI that work closely with Eye Care Practitioners and Educational Institutions as well as a dedication to protecting and advancing utilization of custom manufactured contact lenses.”

Next Valeant dropped the hammer on the industry.  Overnight and for no apparent reason, they sent a letter to all of the independent laboratories announcing that they were increasing the price on scleral lens-sized Boston buttons by an astounding 60% (and other buttons by multiples).  Simultaneously, they announced that they were dropping out of the CLMA.  This move stunned the CLMA member labs as it blocked them from supplying Paragon CRT lenses to doctors.  Being the market leading GP button manufacturer, dropping out of the CLMA essentially defunded the GPLI and ensured the immanent collapse of the CLMA.

The price increase sent shock waves throughout the industry.  There was a simultaneous but independent reaction from many of the key-opinion leading optometrists who fit GP lenses.  The problem with any increase in price on the GP button level is that these price increases are passed down the line through the laboratories, the doctors and eventually, to the patients.  Valeant saw a huge backlash from optometrists who essentially stopped prescribing their materials.  They admitted making a mistake, and lowered the cost of the buttons, but interestingly, not to the original level.  Instead, there was an average 16% increase in the cost of scleral lens buttons to the laboratories.  Similarly, Valeant did not rejoin the CLMA.  The cost increase has been reported to fund Valeant brand specific education.

The other members of the CLMA came together and saved the association and the GPLI.  Additionally, a key competitor to Valeant, Contamac, rejoined the CLMA.  Contamac is a button manufacturer who formerly held around 8% market share of GP buttons.  At present, key sources within the industry believe that the market share has essentially flip-flopped, so that now, Contamac has rapidly gained market share of the GP button space as doctors have largely abandoned Boston materials in protest of these moves.

In a reactionary panic, Valeant has most recently written to the CLMA, asking to rejoin, but paradoxically with demands.  The CLMA is currently reviewing whether to allow Valeant to rejoin and under what terms.  Long term, it is beneficial for the industry for everyone to work together for the common good. It is unfortunate that a large company has come into the keratoconus treatment area and is raising prices without providing any real value, such as research and development into newer and better tools.  Companies like Valeant ultimately need to realize that they are not in control of an industry.  The patients and doctors are.

 

Dr. Sonsino is a partner in a high-end specialty contact lens and anterior segment practice in Nashville, Tennessee.  For over 12 years, he was on the faculty at Vanderbilt University Medical Center’s Eye Institute.  Dr. Sonsino is a Diplomate in the Cornea, Contact Lens, and Refractive Therapies Section of the American Academy of Optometry (AAO), chair-elect of the Cornea and Contact Lens Section of the American Optometric Association (AOA), a fellow of the Scleral Lens Education Society, board certified by the American Board of Optometry (ABO), and an advisory board member of the Gas Permeable Lens Institute (GPLI).  He lectures internationally, publishes in peer-review and non-peer-reviewed publications, and operates the website: TheKeratoconusCenter.org.  He consults for Alcon, Art Optical, Allergan, Johnson & Johnson, Optovue, Synergeyes, Visionary Optics, Visioneering, and formerly for Bausch & Lomb.

3/30/16

Sonsino Headshot

Jeffrey Sonsino, OD, FAAO
The Contact Lens Center at Optique Diplomate
Cornea, Contact Lens, and Refractive Therapies,

Having Trouble with Your Scleral Lenses?

Scleral lens have become very popular and while many enjoy the comfort and vision correction they provide, some find it difficult to apply (insert) and remove these large diameter RGP lenses. If you are one of the many who are having difficulty managing to get your scleral lenses in or out, there are a number of tools available to help.

The Scleral Lens Education Society website provides a wealth of information about the care and handling of these lenses trouble with your Scleral Lenses as well as an excellent video. There are photos demonstrating various ways to hold the lens while applying it …some you may not have tried! If you have trouble with your schleral lenses, see below.

Troubleshooting tips and tricks:

    • If you are unable to maintain fluid in the bowl of the lens as you bring it towards your eye, make sure that your face is fully parallel to the floor. It may seem like you are nearly standing on your head when you’re in the correct position to apply the lens.
    • Lid control is essential; use one hand to hold lids completely out of the way, and don’t release the lids until the lens is actually fully in place and the plunger (or your finger tripod) has been removed.
    • If you are unable to successfully apply a solid lens with saline, you could practice applying the lens after filling the bowl of the lens with Celluvisc™ or another non-preserved viscous lubricant. These viscous lubricants will blur your vision compared to saline, however, so you may simply want to use them to practice lens application. Once you’ve mastered this step, switch to saline to give you better vision.
    • Try to keep both eyes open as you apply your lenses. This may also help you to position the lenses correctly.
    • If you are using a bulbed (DVM) plunger, and can see the opening in the center of the suction cup, look directly at the hole as you bring the lens into position. This will help you to position the lens correctly.

    Many find the DVM plungers helpful. They are readily available at your doctor’s office and online. These are just a few of the places to find them: DMV Corp, Dry Eye Zone, and Amazon.

    trouble with your schleral lensesAnother variation to the standard lens inserters is a ring-style lens applicator by EZI Scleral Lens. It was designed by a post-transplant patient who like so many, had trouble inserting his scleral lens without getting a bubble. Read Tim’s story.

    If you have tried the above techniques and still have trouble applying scleral lenses there are a number of devices available that may help. Dalsey Adaptives has developed the See-Green devicetrouble with your schleral lenses that can be used to help successfully apply scleral contact lenses. The See-Green system comes with a stand that holds a lighted plunger (Figure 2). Using this system, you don’t hold the lens, you lower your eye onto it, which leaves both hands free for improved lid control. The light at the center of the plunger is used as a target to help you position the lens centrally on the eye. Click here to see the detailed instruction sheet.

    Scleral lenses offer good vision and comfort but can be challenging to manage. Discuss these options with your eye care professional to get his or her recommendation for your specific situation.

    1/28/16


     

    CathyW headshotCathy Warren, RN
    Executive Director
    National Keratoconus Foundation

Top 10 Articles of 2015

eye facts and eye disease
In looking at the many articles we shared with you in 2015, we found that your interests were varied. From the science of vision, eye facts and eye disease to helpful suggestions to help your vision.

Here is the list of the top 10 articles you read last year. Do you have a favorite that is not on the list? Share it in the comments section below.

    1. Rods and Cones Give Us Color, Detail and Night Vision
    2. 20 Facts About the Amazing Eye
    3. Understanding and Treating Corneal Scratches and Abrasions
    4. 32 Facts About Animal Eyes
    5. 20 Facts About Eye Color and Blinking
    6. When You See Things That Aren’t There
    7. Posterior Vitreous Detachment
    8. Can Keratoconus Progression Be Predicted?
    9. Winter Weather and Your Eyes
    10. Coffee and Glaucoma: “1-2 cups of coffee is probably fine, but…”

Do you have any topics you would like to see discussed in the blog? Please leave any suggestions you might have in the comments below.

1/7/16


Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

The Importance of An Eye Exam

Why You Need An Eye Exam

The end of the year is fast approaching – when was the last time you had an eye exam? Was it a comprehensive eye exam?
eye exam
To keep your eyes healthy and maintain your vision, the American Optometric Association (AOA) recommends a comprehensive eye exam every two years for adults ages 18 to 60, and annual exams for people age 61 and older. However, if you have a family history of eye disease (glaucoma, macular degeneration, etc.), diabetes or high blood pressure, or have had an eye injury or surgery, you should have a comprehensive exam every year, unless otherwise indicated by your doctor.
Also, adults who wear contact lenses should have annual eye exams.

An important part of the comprehensive eye exam is the dilated eye exam to look inside your eye. Drops are placed in each eye to widen the pupil and allow more light to enter the eye. This gives your doctor a clear view of important tissues at the back of the eye, including the retina, the macula, and the optic nerve. This allows for early diagnosis of sight-threatening eye diseases like age-related macular degeneration, diabetic retinopathy, glaucoma, etc.

To better understand the importance of the dilated eye exam, here is a video from the National Eye Institute (NE) that explains what to expect.

At the end of your comprehensive eye exam your doctor should raise any concerns he has with you. But it is up to you to be prepared to react and ask questions for peace of mind and to help save your vision.

Questions To Ask After Your Eye Exam

It is always important to know if anything about your eyes have changed since your last visit. If the doctor says no, then the only thing you need to know is when they want to see you again.

If the doctor says the have been some minor changes, you need to know what questions to ask, such as:

  • Is my condition stable, or can I lose more sight?
  • What new symptoms should I watch out for?
  • Is there anything I can do to improve or help my vision?
  • When is the next time you want to see me?

If the doctor sees a marked change in your vision or give you a diagnosis of eye disease, you would want to ask:

  • Are there treatments for my eye disease?
  • When should I start treatment and how long will it last?
  • What are the benefits of this treatment and how successful is it?
  • What are the risks and possible side effects associated with this treatment?
  • Are there any foods, medications, or activities I should avoid while I am undergoing this treatment?
  • If I need to take medication, what should I do if I miss a dose or have a reaction?
  • Are there any other treatments available?
  • Will I need more tests necessary later?
  • How often should I schedule follow-up visits? Should I be monitored on a regular basis?
  • Am I still safe to drive?

Your vision is a terrible thing to lose, but with proper diet, exercise and no smoking, along with regularly scheduled eye exams, you improve your chances of maintaining your sight.

11/5/15

Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Laser Refractive Surgery: LASIK, LASEK, PRK and PTK

The introduction of the excimer laser to eye surgery in the early 1990’s represented a revolutionary innovation in the treatment of refractive errors: nearsightedness, farsightedness, and astigmatism. The development of this technology allows the safe and dependable correction of vision in many patients. For the most part, however, keratoconus (KC) patients are not candidates for such procedures for 2 reasons. First, the inherent biomechanical weakness of the keratoconic cornea could worsen if tissue is removed from the already thin cornea. Second, in addition to standard nearsightedness, farsightedness, and astigmatism, keratoconic vision is also impeded by higher order aberrations, which can be thought of as static in the eye’s optical system. However, recent advances may make variations of such procedures applicable to selected patients with KC.
Laser Refractive Surgery: LASIK, LASEK, PRK and PTK

LASIK, LASEK, PRK and PTK

Today, laser in situ keratomileusis (LASIK) is the most popular method of laser eye surgery. LASIK uses an excimer laser to correct nearsightedness, farsightedness, or astigmatism by removing a thin lenslet of tissue from the surface of the cornea (the clear, front “watch crystal” of the eye). This is analogous to removal of a “tissue contact lens”. In LASIK, which is now an “all-laser” technique, a pancake-like thin flap of the cornea is first prepared with a high speed femtosecond laser. The flap acts to preserve the surface epithelial cells (which are like tiles on a floor) to promote quick healing and recovery of vision. Next, the excimer laser is used to remove a small amount of tissue from the corneal surface beneath the flap. The excimer laser used in LASIK produces a beam of invisible ultraviolet light energy, which when applied via an eye tracking mechanism, results in meticulous removal of this “tissue contact lens”. After corneal reshaping, the LASIK procedure is finished when the corneal flap is repositioned. When the flap is replaced, it lies in the bed of excimer laser removed tissue, causing the surface to change shape with the effect of decreasing nearsightedness, farsightedness, or astigmatism.

Laser vision correction can also be performed without a LASIK flap. These procedures, which are also perfomed with the excimer laser, go by a number of names – PRK (photorefractive keratectomy), LASEK (laser epithelial keratomileusis), epi-LASIK, or ASA (Advanced Surface Ablation). Although LASEK and LASIK sound the same, unlike traditional LASIK, LASEK does not require the preparation of a corneal flap. This has two potential advantages. First, risks of making the corneal flap in LASIK are avoided. This may be important in some patients in whom there is an additional risk in making the flap, such as patients with corneal scars or irregularities. Second, since laser treatment is done on the surface, LASEK/PRK preserves more corneal tissue. In particular, patients who have thinner corneas may be more safely treated with a no flap technique rather than LASIK.

At the beginning of the LASEK / PRK eye surgery procedure, the surface cells of the cornea are loosened and removed. The laser treatment then is applied, just as in LASIK, removing the properly shaped “tissue contact lens” for the desired optical correction. At the end of the procedure, a contact lens bandage is applied. Topical drops are used for a few week afterwards to avoid infection and control wound healing.

Vision after LASEK/PRK takes a little while longer to completely improve and stabilize than after LASIK because the epithelium needs to grow and smooth. Substantial improvement usually is noticed the day after the procedure and fluctuates over the next 2 weeks. The contact lens is removed in 5 days in most patients. Driving vision in the days after the procedure can be variable and take up to 2 weeks in some patients.

For both LASIK and LASEK/PRK, there are two basic types of possible side effects. Because patients may respond and heal differently, it is possible that the entire refractive error may not be fully corrected. In this case, vision will be clearer without glasses, but may not be as good as desired. In these situations, patient often can undergo a re-treatment procedure to further improve their vision. In addition, optical side effects include halos around lights and glare, especially at night, and some patients may experience dry eye sensations. Other, more rare, complications include infection or scarring.
LASIK, LASEK, PRK, PTK
Recently, there has been much talk in the keratoconus community about combining corneal collagen crosslinking with topography-guided LASEK/PRK. Topography-guided PRK uses information gained from your corneal map to program the laser to help make your cornea more optically regular. The goal of topography-guided PRK, like Intacs, is to improve corneal contour in the KC patient to improve glasses corrected vision and contact lens tolerance. In general, you will still need contacts and glasses afterwards.

Typically, LASEK/PRK procedures for keratoconus are combined with corneal collagen crosslinking, which has the goal to strengthen the weak keratoconic cornea and decrease progression of corneal mishapening over time. It is important to note that such treatments are not FDA-approved and are not generally available in the U.S. However, a number of international surgeons have been exploring the potential role of combined LASEK/PRK with crosslinking to improve keratoconus outcomes. In our practice, we have also had the opportunity to use Intacs and other procedures to further improve corneal shape in patients who have undergone topography-guided treatments with crosslinking with encouraging results.

In addition to LASIK and LASEK/PRK, the excimer laser may provide a novel therapeutic modality in the treatment of a number of superficial corneal disorders. This treatment is known a phototherapeutic keratectomy or PTK. Whether PTK eye surgery is used alone or as an adjunctive strategy in traditional corneal surgical techniques, a number of disorders affecting the corneal surface may be successfully treated by taking advantage of the excimer laser’s ability to meticulously remove superficial corneal tissue. These include a variety of corneal degenerations and dystrophies, corneal irregularities, and superficial scars, such as surface nodules found at the apex of the keratoconic cone. While some of these conditions, heretofore, could be treated by mechanical superficial keratectomy techniques, PTK may minimize tissue removal and surgical trauma.

So, for patients with keratoconus, it is important to know that, although LASIK type procedures are generally not indicated, research using these advanced technologies continues. A tailored therapeutic approach over time may combine a variety of procedures to optimize the corneal shape and ultimate visual outcome for the patient with keratoconus.

9/15/15


Peter Hersh, MD - Laser Refractive Surgery: LASIK, LASEK, PRK and PTKPeter S. Hersh, MD
Cornea and Laser Eye Institute – Hersh Vision Group
CLEI Center for Keratoconus

Which Eye Care Specialist Do You Need?

It’s time to get your eyes checked – do you go to an ophthalmologist, optometrist or optician? Your optometrist sees the beginnings of age-related macular degeneration, but is sending you to see and ophthalmologist, why?
eye care specialist
One of the most confusing things about taking care of your eyes can be differentiating between an ophthalmologist, optometrist and optician. Each eye care specialist has a very important part to play in the health of your eyes and here is a quick synopsis of what each does so you can choose the best one for your vision issues and treatment.

Ophthalmologist
These specialists are fully trained medical doctors that have completed the eight years of training beyond a bachelor’s degree. Their training has included a full spectrum of eye care, from prescribing glasses and contact lenses and giving eye injections, to carrying out intricate eye surgeries. Many doctors may also be involved eye research to better understand vision, improve eye disease treatments or potentially find a cure. They are easily identified by the MD following their name.

Optometrist
These medical professionals have completed a four-year program at an accredited school of optometry. They have been trained to prescribe and fit glasses and contact lenses, as well as diagnose and treat various eye diseases. They provide treatments through topical therapeutic agents and oral drugs, and are licensed to perform certain types of laser surgery, such as Lasik. They are easily identified by the OD following their name.

Optician
These eye care professionals are not licensed to perform eye exams, medical tests or treat patients. Their purpose is to take the prescription from the ophthalmologist or optometrist and work with you to determine which glasses or contact lenses work best for you. If you suffer from an eye disease like keratoconus, these specialists can make the difference between a relatively normal life, or one that is dictated short periods of vision because of contact lens pain. These eye care professionals may hold and associate optician degree or have apprenticed fore required number of hours.

While each one of these eye specialists has their own area of expertise, they can form a team whose only concerns are your eye health and the ability to see as clearly as possible.

8/11/15

Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Eye Issues For Every Age Recap

Vision is something we take for granted, but when we start to have trouble seeing it is easy to panic. This blog has covered a variety of eye issues for every age, from children through older adults. Here are a few articles from leading doctors and specialists that you may have missed and might be of interest.
Artistic eye 6
Bill Takeshita, OD, FAAO – Visual Aids and Techniques When Traveling

Michelle Moore, CHHC – The Best Nutrition for Older Adults

Arthur B. Epstein, OD, FAAO – Understanding and Treating Corneal Scratches and Abrasions

The National Eye Health Education Program (NEHEP) – Low Vision Awareness
Maintaining Healthy Vision

Sandra Young, OD – GMO and the Nutritional Content of Food

S. Barry Eiden, OD, FAAO – Selecting Your Best Vision Correction Options

Suber S. Huang, MD, MBA – It’s All About ME – What to Know About Macular Edema

Jun Lin, MD, PhD and James Tsai, MD, MBA – The Optic Nerve And Its Visual Link To The Brain

Ronald N. Gaster, MD FACS – Do You Have a Pterygium?

Anthony B. Nesburn, MD, FACS – Three Generations of Saving Vision

Chantal Boisvert, OD, MD – Vision and Special Needs Children

Judith Delgado – Driving and Age-Related Macular Degeneration

David L. Kading OD, FAAO and Charissa Young – Itchy Eyes? It Must Be Allergy Season

Lauren Hauptman – Traveling With Low Or No Vision  /  Must Love Dogs, Traveling with Guide Dogs  /  Coping With Retinitis Pigmentosa

Kate Steit – Living Well With Low Vision Online Courses

Bezalel Schendowich, OD – What Are Scleral Contact Lenses?

In addition here are few other topics you might find of interest, including some infographics and delicious recipes.

Pupils Respond to More Than Light

Watery, Red, Itchy Eyes

10 Tips for Healthy Eyes (infographic)

The Need For Medical Research Funding

Protective Eyewear for Home, Garden & Sports

7 Spring Fruits and Vegetables (with some great recipes)

6 Ways Women Can Stop Vision Loss

6 Signs of Eye Disease (infographic)

Do I Need Vision Insurance?

How to Help a Blind or Visually Impaired Person with Mobility

Your Comprehensive Eye Exam (infographic)

Famous People with Vision Loss – Part I

Famous People with Vision Loss – Part II

Development of Eyeglasses Timeline (infographic)

What eye topics do you want to learn about? Please let us know in the comments section below.

7/21/15


Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Driving With Vision Loss

Challenges Faced by Individuals Driving With Vision Loss

Overview
People of all ages often view driving as the key to independence. Individuals with vision loss are no exception. Three groups of people with vision loss who wish to acquire or maintain the privilege of driving include teenagers with a congenital or acquired visual impairment who have never driven, adults with the same who have never driven, and adults with an acquired visual impairment who have driven in the past but may lose their license because of their vision loss. driving with vision lossHowever, vision standards for driving vary from state to state, and this variation persists despite decades of research demonstrating that there is no absolute cutoff criteria in visual acuity or peripheral vision for safe versus unsafe driving. The fact that states have variable standards results in people with visual impairments not being able to be licensed in some states, including perhaps their own, while being able to be licensed in a neighboring state. Clearly, the ability of these individuals to safely operate a motor vehicle does not change when they cross a state line. Yet, to maintain at least some driving privileges, they may find themselves having to move to a different state.

It is well known that many older drivers modify their driving norms to help keep themselves and others safe. For example, many older drivers voluntarily reduce or stop driving at night, in hazardous weather conditions, or on super highways. By limiting their driving, older drivers, particularly those with visual impairments, are able to continue operating their automobiles safely and efficiently in spite of reduced vision. This is important, considering the vast majority of older adults live in the suburbs or in rural areas where automobiles are required for transportation.

Maximizing Visual Capabilities
It is important for all individuals, but particularly for drivers who are visually impaired, to make sure their spectacle correction is up-to-date. Contrast enhancement and glare control with filtering lenses can also be of great benefit. Most drivers have experienced driving into the glare of the sun, while looking through a dirty windshield. Although wearing sunglasses and keeping windshields clean is not mandatory, they certainly help drivers see more easily and feel more comfortable when driving.

Maximizing Visual Attention
Human factors research has found that inattention blindness and the cost of switching contribute to or directly cause automobile mishaps. Inattention blindness refers to when a person’s attention to one activity undermines his or her attention to other activities. For example, when drivers focus on directional signs, their attention is not on what is happening on the road in front of them. The cost of switching refers to the time it takes a person to switch attention between different activities. A common example that causes driving mishaps is when drivers text while driving. When people focus on texting while driving, their response to the traffic around them is delayed.

Useful Field of View testing research has shown that the time it takes a person to process visual information, especially the complicated visual environment experienced each time a person drives, increases with age. With this in mind, decreasing or eliminating the time it takes older drivers or drivers with visual impairments to look for and visually process signage should help them maintain their concentration on the road ahead and the traffic around them.

A simple way to reduce or eliminate the need to look for directional signage is with the use of a Global Positioning System (GPS) device that uses spoken directions. Older drivers and drivers with visual impairments in particular should consider using a GPS device with spoken directions so that they are freed from the distraction of looking for/at road signs and can keep their attention on the traffic around them.

Finally, with the technology, such as adaptive cruise control and lane alert warnings, currently available in cars, it is expected that all drivers will be safer behind the wheel.

Final Considerations
A good driver is someone who has the ability to perceive change in a rapidly changing environment; the mental ability to judge and react to this information quickly and appropriately; and the motor ability to execute these decisions, along with the compensatory skills to compensate for some loss of ability in the other areas. Additionally, a driver’s familiarity with the driving environment and his or her past driving record should be taken into account when considering limiting driving activities or retiring from driving altogether.

For many drivers with vision loss, a limited driver’s license that allows them to drive during daylight hours, within a restricted radius of their home, and at lower rates of speed may be all they desire. However, there are times when an individual will need to retire from driving altogether because of vision loss or a combination of vision and cognitive changes. When this time comes, the individual needs to understand that retiring from driving is for his or her safety and the safety of others.

Finally, it is well known that vision loss in general, as well as the loss of driving privileges, can lead to feelings of hopelessness and depression. Fortunately, there are many things that can enhance the functional abilities of individuals with vision loss. To learn about available resources for individuals with vision loss, visit the National Eye Health Education Program low vision program page at www.nei.nih.gov/nehep/programs/lowvision.

7/9/15

Dr. Wilkinson - driving with vision lossMark Wilkinson, OD
University of Iowa Carver College of Medicine
Chair of the National Eye Health Education Program Low Vision Subcommittee

Scleral Lens Education Society

Scleral Contact Lenses have taken over a century to evolve into one of the best options for managing eye diseases such as keratoconus. This evolution began in the late 1800’s, with blown glass lenses. However, until the advent of highly oxygen permeable plastics, scleral lenses had very limited application. Now, with current technology and materials, scleral lenses have become a mainstream and rapidly growing lens option.
SLES_Logo_final
Scleral lenses are becoming more popular due to the exceptional comfort they can provide even to the most unusual eye shape. This comfort is attributable to their large size that allows them to tuck behind the eyelids, their relative lack of movement with eye blinks, and their fluid reservoir that keeps the cornea hydrated and does not actually touch the fragile corneal tissue in individuals with keratoconus.

As utilization of and demand for scleral lenses began to grow last decade, it became apparent that there was a need for more professionals trained in fitting scleral lenses, as well as someone to provide a consensus opinion for the eye care world on what the standard of care should be for these lenses. In addition, a process for providing a credential for those that attained a level of expertise in scleral lens fitting would allow those seeking experts in the field of fitting sclerals to find an experienced professional.

The Scleral Lens Education Society (SLS) was established in 2009 as an organization to help bring professional consensus to the suddenly rapidly growing area of scleral lenses. The mission statement of the SLS reads: “The Scleral Lens Education Society (SLS) is a non-profit organization 501(c)(3) committed to teaching contact lens practitioners the science and art of fitting all designs of scleral contact lenses for the purpose of managing corneal irregularity and ocular surface disease. SLS supports public education that highlights the benefits and availability of scleral contact lenses.”

Beginning with the founding board which included world renown experts in scleral lens fitting such as Greg DeNaeyer, OD, Christine Sindt, OD, and Bruce Baldwin, OD, PhD, the SLS has worked to spread the word about the potential benefits of scleral lens wear to both providers and patients alike. Professional education has included scleral lens webinars, workshops, and lecture series that are always standing room only events.

Currently, the SLS has over 2000 member contact lens practitioners as well as over 50 fellows, or certified scleral lens fitters that have demonstrated their expertise through a peer reviewed process of case reports, publications, and lectures. Many of these members and fellows are international, with SLS fellows from 11 countries, 5 different continents, and 20 different states in the US. Members hail from all 50 states, 6 continents, and over 40 countries.

In addition, the SLS has numerous industry sponsors that support the mission of the society to provide patient access to experienced fitters across the world. The sponsors provide the resources that allow the educational opportunities for practitioners as well as the website and patient resources that are available.

SLS board members are elected to serve in various capacities, including fellowship, public education, and international relations, and are elected to one year terms. The current board consists of:
President, Muriel Schornack, OD, Mayo Clinic, Rochester, MN
Vice President, Melissa Barnett, OD, University of California, Davis
Secretary, Michael Lipson, OD, University of Michigan
Treasurer, Mindy Toabe, OD, Metrohealth, Cleveland, OH
Immediate Past President, Jason Jedlicka, OD, Indiana University
Fellowship Chair, Pam Satjawatcharaphong, OD, University of California, Berkeley
Public Education Chair, Stephanie Woo, OD, Havasu Eye Center, Lake Havasu, AZ
International Chair, Langis Michaud, OD, University of Montreal

For more information about scleral lenses and the Scleral Lens Education Society, please visit the website at www.sclerallens.org. If you or someone you know might benefit from scleral lenses, you can locate a fitter in your area through the website as well. If you are unable to locate a fitter near you on the website, please contact the SLS and we will try to locate options in your local area.

7/2/15


Dr. JedlickaJason Jedlicka, OD
Clinical Associate Professor, Chief of Cornea and Contact Lens Service
Indiana University, School of Optometry

Vision Recap Of Previous Articles of Interest

Besides the comments that we get, one of the best parts of putting together this blog is the wonderful group of guests who share their expertise and personal stories. I want to thank all of the eye care professionals and friends that have contributed to make this blog a success.
Vision Recap
Here is a quick vision recap of some of the articles we had in the past that you may have missed.

Jullia A. Rosdahl, MD, PhDCoffee and Glaucoma and Taking Control of Glaucoma

David Liao, MD, PhDWhat Are A Macular Pucker and Macular Hole?

Kooshay MalekBeing A Blind Artist

Dan Roberts15 Things Doctors Might Like Us To Know

Jennifer VilleneuveLiving With KC Isn’t Easy

Daniel D. Esmaili, MDPosterior Vitreous Detachment

Donna ColeLiving With Dry Age-Related Macular Degeneration

Pouya N. Dayani, MDDiabetes And The Potential For Diabetic Retinopathy

Robin Heinz BratslavskyAdjustments Can Help With Depression

Judith DelgadoDrugs to Treat Dry AMD and Inflammation

Kate StreitHadley’s Online Education for the Blind and Visually Impaired

Catherine Warren, RNCan Keratoconus Progression Be Predicted?

Richard H. Roe, MD, MHSUveitis Explained

Sumit (Sam) Garg, MDCataract Surgery and Keratoconus

Howard J. Kaplan, MDSpotlight Text – A New Way to Read

Gerry TrickleImagination and KC

In addition to the topics above, here are few more articles that cover a variety of vision issues:

If you have any topics that you would like to read about, please let us know in the comments section below.

6/23/15


Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation