Developments in Contact Lenses No financial interest

Developments in Contact Lenses No financial interest

Market Developments • The European drop out rate is 30. 4% • The owner/manager of the Danish Kontaktlinse Instituttet reported that in 2011 they had 850 new fittings but 700 dropouts. • Multiples have gained 3% of the CL market share at the expense of independents.

The Internet • Prescription eyewear (PEL) which owns glassesdirect. com, lens. On, myoptique. com and Sunglass Shop. com say that 3 -4% of the European eyewear market is online. • Other high growth e-commerce categories such as fashion and apparel are closer to 10%. It is anticipated that optics will follow this. • Total loss ≈ 13%

But they still have to come to me for aftercare? • Out of 8 internet CL sites checked only 4 asked me for a copy of my Rx or my optician’s details. • When was the last time you took a call from an internet site asking to confirm a patient’s Rx? • Prosecution – get the sites closed down? – MK is 4 in 10, 000 wearers per year – Risk of loss of two or more lines of vision is 6 in 100, 000. Internet associated with a 4. 5 x greater risk. • The sale of CLs is effectively already deregulated.

What can we do? • • Charge realistic fitting fees. Offer them something new at aftercares Fit more RGPs. Ortho-K

Sclerals • Predicted to be the future of CLs • RGP lens material. • Can be divided into different types based on diameter: – Corneoscleral – 12. 9 to 13. 5 mm – Semi-scleral – 13. 6 to 14. 9 mm – Mini-scleral – 15 to 18 mm – Scleral – 18. 1 to 24+mm Image from CL Spectrum

Corneosclerals • These do not completely vault the cornea. • They are good for any patient who requires the visual correction of an RGP lens but cannot tolerate them. • The larger diameter than RGPs means less lid interaction and so less adaptation making them more suitable for part time wearers. • They can be made with or without fenestration. Image from No. 7

SOClear Lens A corneoscleral lens from No. 7 Does not require a topographer for fitting No. 7 run free training courses for fitting. Rinsed, wetted and stored with a preservative free soft CL MPS e. g. Sauflon Synergi • Cleaned with an alcohol based cleaner available from No. 7 • Protein removal can be done monthly with Menicare Progent. • • Images from No. 7

Myopia Control • Child needs regular aftercare. Less opportunity to buy lenses from the internet. • The decision to instigate anti-myopia treatment should be based on hyperopia of +0. 50 D or less at age eight, parental myopia and binocular vision status (esophores are more successful). • Can be as simple as fitting the child with a centre distance MF lens.

What’s New in Myopia Control • In Hong Kong Coopervision are trialling the Mi. Sight daily disposable lens designed for myopia control. • Alcon is conducting a multi-year clinical study in China to evaluate the efficacy of specially designed myopia-control silicone hydrogel contact lenses Image from Coopervision

What’s new now and what is coming? • In CL solutions polaroid has introduced the contactspod.

Menicon Magic

The Meibographer • Topcon make a non-contact IR device which can be attached to their slit lamps which allows visualisation of the meibomian glands.

Slit Lamp Fundus Viewing System

CL Materials: Comfort • As discomfort is No. 1 reason for CL dropout and dryness is the leading cause of discomfort manufacturers are always looking for ways to make lenses more moist.

• HPMC in packaging saline. • PEG releases early from the lens • PVA slowly releases from the lens throughout the day by blink action.

• Outer surface of the lens designed to mimic lipid layer of tear film. • Water content of lens (78%) is the same as that of the cornea but still has a DK/t of 42 even though it does not have silicone.

Antimicrobial surfaces • Ciba, Menicon & Sauflon (synergi) have a microblock contact lens case. • What about a microblock CL surface? • Contact lenses with a built in microblock have already been made in labs and tested but additional research is needed. • Their compatibility with lens care systems needs to be established along with any likelihood of allergic reaction. • Build up of endotoxins.

If successful • There would likely be an increase in extended and continuous wear lenses and a decrease in • We can avoid this the CL solutions market.

Amphibious Lens • Mini-scleral • RGP material • High powered segment centrally (for water viewing) • Peripheral distance correction for viewing in air Images from CL Spectrum

CLs for Drug Delivery

Problems with Glaucoma Drops • A 2008 Canadian study reported that over 50% of glaucoma patients surveyed were either non-compliant with drops or demonstrated improper administration. • It is thought that BAK preserved drops may be causing damage to the cornea, conjunctiva and even the trabecular meshwork. • The conjunctival damage can affect the success rate of trabeculectomies.

Drug-eluting CLs • First used in 1965. • The advantages of drug delivery via CLs are: – Lower concentrations of drugs can be used – The patient can have their vision corrected as well – The drug is in direct contact with the cornea and there is less secondary penetration through the conjunctiva

Recent trials • Silicone hydrogel lenses with timolol and vitamin E (the vitamin E prolongs the drug delivery) have been successfully shown to decrease IOP in Beagle dogs.

Challenges • There are major hurdles to commercialization including processing and storage issues, regulatory issues, high costs of clinical studies, and cost-benefit analysis. • It is also not clear whether drug-releasing contact lenses are suited to be sold in pharmacies or directly by healthcare professionals such as ophthalmologists and optometrists.

Monitoring Biomarkers • In the University of Akron they have developed a CL that detects glucose in the tears and then changes colour if there is a build up of glucose.

Augmented Reality Eyewear • Innovega are designing propriety display technology to go into contact lenses.

Applications • Soldiers can be given real time images from unmanned reconnaissance planes. • Fully immersive video games. • Augmented reality • Cheating in exams

Thank you for your attention