Fadel D.. Three of a kind: Examples of challenges presented with scleral lens patients and how to overcome them. Contact Lens Spectrum 2023;38, July: 32-36, 38-40, 51

Fadel,D. Medmont Meridia™: Much More Than a Corneal Topographer Clinical Optometry 2023;15 283-301 [ Show Abstract ]

In recent years, advanced diagnostic instruments have become widely available in optometric practices, offering various functions that optimize clinical information gathering. This article focuses on the Medmont Meridia™, a state-of-the-art multipurpose diagnostic device with corneal topography and cutting-edge features. Corneal topography is pivotal in the early diagnosis of corneal disorders, determining baseline ocular surface assessment, helping in contact lens fitting, and monitoring ocular health over time. The Medmont Meridia boasts Placido-disc-based imaging with extensive corneal coverage. Furthermore, the Meridia accurately measures the horizontal visible iris diameter, pupil diameter, and palpebral fissure width, which assists in making contact lens parameter decisions. Additionally, it offers sagittal height data for scleral lens design and first lens selection, streamlining the fitting process. Beyond its topography capabilities, the Meridia excels as a comprehensive dry eye assessment tool. With features like tear meniscus height, tear film surface quality, and meibography capabilities, it aids in diagnosing dry eye and monitoring its progression. The device also provides customizable dry eye reports with integrated grading scales and questionnaires, making dry eye management, patient education, and compliance more accessible. In conclusion, the Medmont Meridia consolidates a multitude of examination tools in a single instrument, enhancing practice efficiency and elevating patient care and communication. Its versatility and accuracy make it an invaluable asset in optometric practices worldwide.

Fadel,D., Gildea,C. Case Report: Remote Scleral Lens Fitting for High Toric Scleras in a Keratoconus Patient Optometry and Vision Science 2023;100(12):876-881 [ Show Abstract ]

SIGNIFICANCE
Technology plays a crucial role in customizing scleral lenses and improving lens alignment, especially in challenging scleral shapes. In addition, remote fitting technology allows optometrists to extend their expertise globally, empowering patients to access to customized lenses without travel expenses.

PURPOSE
The objective of this study was to document the difficulties encountered in fitting a scleral lens in a patient with keratoconus and pronounced scleral toricity. In addition, the study aimed to present the successful remote fitting achieved by using advanced technology.

CASE REPORT
An Irish male patient diagnosed with keratoconus exhibited high scleral toricity. Generally, keratoconus eyes often exhibit significant scleral asymmetry associated with cone decentration and disease severity. Improperly aligned scleral lenses can lead to regional changes in scleral shape, lens decentration, discomfort, and visual disturbances. Indeed, previous scleral lens fits were unsuccessful because of these issues. Corneoscleral profilometry was acquired in Ireland and then used in Italy to design customized lenses, which were then delivered to the patient's optometrist in Ireland. The first lenses designed and delivered demonstrated excellent overall performance without requiring adjustments.

CONCLUSIONS
This report highlights the importance of corneoscleral profilometry to increase efficiency and reduce lens reorders and chair time, and the remote fitting in overcoming barriers to accessing specialized lens fitting.

Garg P. Fast Forward to the Future: Biodegradable CLs Contact Lens Spectrum 2023;38, February:

Garg P, Wulff D, Phan CM, Jones L. Evaluation of a biodegradable bioink for the fabrication of ophthalmic devices using 3D printing The Association for Research in Vision and Ophthalmology, New Orleans, LA, USA, April, 2023 [ Show Abstract ][ PDF ]

Purpose: To develop a degradable bioink for fabricating ophthalmic devices using 3D printing.

Methods: The bioink formulation consisted of 10% gelatin methacrylate (GelMA), 0.6% lithium phenyl-2,4,6-trimethylbenzoylphosphinate (LAP), and 5% yellow dye as a light absorbing agent to improve print resolution. The bioink was used to 3D print square sheets (7x7x1 mm) using a commercial masked-stereolithography (mSLA) 3D printer at 95% humidity and 37°C temperature. The degradation of printed sheets was evaluated with different concentrations (0,25,50,100 μg/ml) of matrix metalloproteinase (MMP9) enzyme 37°C. MMP9s are naturally found in the tear film and elevated in various diseased states such as in corneal wounds and dry eye disease. The weights of the sheets were measured at t = 0,4,6,8,12,16,24 hrs. Another set of cubes (1x1x1 cm) was autoclaved and kept sealed in storage at different temperatures (4°C, 25°C, and 37°C) in phosphate buffered saline (PBS) and their weight was measured on day 10. An attempt was made to fabricate a contact lens using this bioink.

Results: Samples that were exposed to MMP9 enzymes showed a time-dependent degradation with increasing enzyme concentration. The samples incubated with 100 and 50 μg/ml of MMP9 were completely degraded by the end of 12 and 16 hrs, respectively. At the end of 24 hrs, the samples incubated at 25 μg/ml enzyme showed 72.8% degradation whereas the control samples did not show any signs of degradation. Interestingly, samples that were autoclaved and kept in storage also did not show any signs of degradation at all temperatures. A 3D-printed CL with overall diameter 14mm and thickness 1mm was printed without any support structures within 1 hour.

Conclusion: This study showed GelMA-based bioink can be used to fabricate biodegradable devices such as contact lenses. The biomaterials degrade in the presence of MMP-9 and future work will work on tuning the degradation kinetics of these materials, as well as incorporating ocular drugs.

Garg P, Wulff D, Phan CM, Jones L. Fabrication of a degradable ocular drug delivery system using 3D printing CBB 2023 Conference: Waterloo for Health, Technology and Society, March, 2023 [ PDF ]

Guthrie S, Chow T, Luensmann D, Woods J, Lumb E, Orsborn G. Short term visual performance of two myopia control soft contact lenses British Contact Lens Association Clinical Conference & Exhibition, Manchester, Jun 9-11, 2023 [ Show Abstract ]

PURPOSE: To gain insights into the short-term visual performance of two myopia control contact lenses which employ different optical designs.

METHODS: Children aged 8 to 15 years, with no history of contact lens wear or recent myopia control intervention, participated in a non-dispensing, single visit, double masked trial where the study lenses were fit and worn contralaterally in randomised eyes. The myopia control study lenses were senofilcon A (AA1D, Johnson & Johnson Vision) and omafilcon A (M1D, CooperVision). After participants had worn the lenses for 1 hour, they rated their subjective experience with vision using a 0-100 scale (100 is best) and distance visual acuity (LogMAR (VA)) was measured. Lens preference was determined at the end of the wear period using a 5-point Likert scale and reasons for preference were provided.

RESULTS: Twenty-six participants completed the study (9F:17M; mean age 11.6 ± 2.1 years). Mean refraction was OD Sph -1.96 ± 0.93D (-0.25 to -3.50D), Cyl -0.34 ± 0.35D (0.00 to -1.00D) and OS Sph -1.77 ± 0.97D (-0.25 to -3.50D), Cyl -0.38 ± 0.38D (0.00 to -1.00D). Subjective ratings of distance vision at 1 hour were better (Wilcoxon matched pairs, p<0.01) with M1D (88 ± 14) versus AA1D (79 ± 18). Distance VA was also significantly better (Wilcoxon matched pairs, p<0.01) with M1D (0.02 ± 0.04 logMAR) over AA1D (0.09 ± 0.08 logMAR). When asked to provide an overall lens preference after 1 hour of wear, more participants preferred M1D than AA1D, and vision was reported as the main reason for their preference (M1D:14 vs AA1D:6, No preference:6; p=0.17).

CONCLUSIONS: When worn contralaterally for 1 hour, the different optical designs of M1D and AA1D performed significantly differently. M1D resulted in better distance vision ratings and visual acuity, and both of these differences would also be considered clinically relevant.

Guthrie S, Woods J, Luensmann D, Chow T, Lumb C, Orsborn G. Subjective Vision Experience in Soft Myopia Control Contact Lenses by Age American Academy of Optometry, New Orleans, October 12, 2023 [ Show Abstract ]

PURPOSE: To compare the short-term vision experience of preteens (PT) and teens (T) with two myopia control (MC) contact lenses of different optical designs: senofilcon A, with a noncoaxial ring-focus design (AA1D, Johnson & Johnson Vision) and omafilcon A, with a dual-focus design (M1D, CooperVision, Inc.).

METHOD: Children aged 8-15 years who had no prior history of contact lens wear or recent MC intervention were recruited for a single-visit, double-masked trial with study lenses randomly fit and worn contralaterally. Participants were separated into two age groups: PT: 8-12 years and T:13-15 years. After wearing the lenses for 1 hour, participants rated their subjective visual experience on a 0-100 scale (where 100 indicated the best experience), and distance visual acuity was measured using LogMAR (VA). At the end of the wear period, lens preference was determined using a 5-point Likert scale, and participants provided reasons for their preference.

RESULTS: Twenty-six participants completed the study (9F:17M; mean age 11.6 ± 2.1 years), 16 PT and 10 T. Mean refraction was OD Sph -1.96 ± 0.93D (-0.25 to -3.50D), Cyl -0.34 ± 0.35D (0.00 to -1.00D) and OS Sph -1.77 ± 0.97D (-0.25 to -3.50D), Cyl -0.38 ± 0.38D (0.00 to -1.00D). When participants rated their subjective experience with vision at 1 hour, both age groups reported better distance vision with M1D compared to AA1D (PT:M1D: 90 ± 15, AA1D: 82 ± 17, p<0.01; T:M1D: 85 ± 13, AA1D: 73 ± 18, p=0.02). Distance visual acuity (VA) was also better with M1D over AA1D in both groups, with the difference in the PT group being statistically significant (PT:M1D: 0.03 ± 0.04, AA1D: 0.09 ± 0.08, p<0.01; T:M1D: 0.02 ± 0.04, AA1D: 0.08 ± 0.09, p=0.07). For near VA, M1D performed better than AA1D in PT (PT:M1D: 0.07 ± 0.08, AA1D: 0.12 ± 0.08, p<0.05; T:M1D: 0.05 ± 0.05, AA1D: 0.06 ± 0.06, p=0.29). When asked to provide an overall lens preference after 1 hour of wear, more PT preferred M1D than AA1D (M1D:8 vs AA1D:4, No preference:4) and more T preferred M1D than AA1D (M1D:6 vs AA1D:2, No preference:2), with both groups reporting vision as the main reason for their preference.

CONCLUSION: When worn contralaterally for 1 hour, the different optical designs of M1D and AA1D performed significantly differently. The preteen and teen groups responded similarly, with M1D preferred by both groups for better distance vision. In addition, while teens had an equivalent vision experience to the preteens, they were overall more likely to rate that experience lower than preteens, indicating a potential difference in subjective experience between the groups and a more critical assessment of vision in teenagers.

Hiscox R, Morgan P, Jones L.. Surely that can’t be true, or can it? British Contact Lens Association Clinical Conference & Exhibition, Manchester, Jun 9, 2023

Ho B, Phan CM, Ramasamy M, Hui A, Jones L. PDMS microfluidic devices fabricated from commercial 3D printers support growth of viable HCECs and enable cell biological assays for low-cost high-throughput screening The Association for Research in Vision and Ophthalmology, New Orleans, LA, USA, April, 2023 [ Show Abstract ]

Purpose: To integrate human corneal epithelial cells (HCECs) into a PDMS microfluidic chip fabricated from a novel 3D printing method to perform cell biological assays.
Introduction: The advent of microfluidic devices has enabled tight control over the physical and chemical cellular environment in vitro, while allowing for large-scale imaging and biochemical reactions at single-cell resolution. These devices are capable of miniaturizing assays to the microliter and nanoliter range, thereby increasing assay throughput with high sensitivity, a feature that is highly advantageous in high-throughput cell-based screens. Polydimethylsiloxane (PDMS) has been widely used in microfluidics devices due to its optical clarity and non-toxicity to cells, among other desirable features. However, the fabrication of PDMS devices traditionally requires specialized facilities and instruments. Additionally, PDMS itself is highly hydrophobic and does not support mammalian cellular viability and growth.

Methods: PDMS devices were cured in 3D-printed moulds generated using the FormLabs stereolithography (SLA) printer (FormLabs 3B+, FormLabs, Somerville, MA). These devices were sterilized by autoclaving, and coated with 0.01% polydopamine (PDA) and 20μg/mL collagen. HCECs were seeded onto the device, and allowed to grow for 18-36 hours in DMEM/F12 media at 37oC. HCECs were imaged by light microscopy, and viability was assessed by alamarBlue assays.

Results: Here, we present a novel and simple method of generating PDMS microfluidic devices suitable for mammalian cell biology assays using commercial 3D printing. We show that PDMS devices coated with polydopamine (PDA) support the growth of human corneal epithelial cells (HCECs) that are metabolically active (~60-90% viability) and are comparable to HCECs cultured in standard tissue culture plastic consumables. Finally, HCECs cultured in our devices are capable of growth with fluid flow rates of up to 1mm/s.

Conclusion: Our study shows that PDMS devices manufactured through the aid of a novel 3D printing pipeline support the growth of HCECs. We aim to utilize these microfluidic devices as a tool to screen different compounds and formulations while assessing cellular viability and acquiring high resolution microscopic and fluorescence images of HCECs.

Hui A. Sustained Drug Delivery Devices for the Eye American Academy of Optometry, New Orleans, October 14, 2023 [ Show Abstract ]

This presentation will detail the barriers to effective pharmacokinetics for drug delivery to the eye with currently available therapies such as eye drops, and provide supportive evidence for the need for sustained drug delivery in appropriate instances. Commercially available, drug releasing devices will be presented, and their indications and experience when used clinically will be discussed. How ocular sustained drug delivery devices may be incorporated into the practice of today as well as the practice of the future will also be presented and discussed within the context of currently available and developing devices.

Hui A. Recent Strategies to Manage CLD Contact Lens Spectrum 2023;38, July: 10-11

Hui A. Commercialized Ocular Drug Delivery Devices XXV Biennial Meeting of the International Society for Eye Research, Feb 21, 2023 [ Show Abstract ]

The goal of creating a sustained drug delivery device for the anterior or posterior segment has been approached from numerous avenues, from inserts to contact lenses and punctal plugs. The utility of a device which can sustain drug release allows for the potential to increase patient compliance as well as improve clinical outcomes, as agents are able to be maintained at appropriate concentrations for desired periods with less administration. This presentation will discuss drug releasing devices for the eye which have reached commercialization. The indications for these devices, their reported effectiveness and known adverse reactions will be discussed. The experience on the use of the devices after they have been released on to the market will also be discussed, as well as their current clinical usage in contemporary eye care management.

Hui A, Heynen M, Chan V, Mirzapour P, Enstone D, Saad M, George M, Ngo W, Jones L. The impact of RGP care solutions on ISO measured lens parameters and the protein deposition on RGP lenses when managed with a hydrogen peroxide care solution Global Specialty Lens Symposium, Las Vegas, Jan 20, 2023 [ PDF ]

Huynh,C. B., Nagaarudkumaran,N., Kalyaanamoorthy,S., Ngo,W. In Silico and In Vitro Approach for Validating the Inhibition of Matrix Metalloproteinase-9 by Quercetin Eye & Contact Lens 2023;49(5):193-198 [ Show Abstract ]

Purpose:
To validate the mechanism and inhibitory activity of quercetin against matrix metalloproteinase-9 (MMP-9) using a hybrid in silico and in vitro approach.

Methods:
The structure of MMP-9 was obtained from the Protein Data Bank, and the active site was identified using previous annotations from the Universal Protein Resource. The structure of quercetin was obtained from ZINC15. Molecular docking was performed to quantify the binding affinity of quercetin to the active site of MMP-9. The inhibitory effect of various concentrations of quercetin (0.0025, 0.025, 0.25, 1.0, and 1.5 mM) on MMP-9 was quantified using a commercially available fluorometric assay. The cytotoxicity of quercetin to immortalized human corneal epithelial cells (HCECs) was quantified by obtaining the metabolic activities of the cells exposed to various concentrations of quercetin for 24 hr.

Results:
Quercetin interacts with MMP-9 by binding within the active site pocket and interacting with residues LEU 188, ALA 189, GLU 227, and MET 247. The binding affinity predicted by molecular docking was −9.9 kcal/mol. All concentrations of quercetin demonstrated significant inhibition of MMP-9 enzyme activity (all P0.99).

Conclusions:
Quercetin inhibited MMP-9 in a dose-dependent manner and was well-tolerated by HCECs, suggesting a potential role in therapy for diseases with upregulated MMP-9 as part of its pathogenesis.

Jin Y, Jones L, Gorbet M. Investigation of the Circadian Recruitment of Tear Neutrophils to the Ocular Surface and Their Phenotypes  The Association for Research in Vision and Ophthalmology, New Orleans, LA, USA, April, 2023 [ Show Abstract ]

Purpose: Hundreds of thousands of leukocytes (with approximately 60% of the population being polymorphonuclear neutrophils (PMNs)) can be collected from the ocular surface immediately on waking, while only a few are harvested during the daytime. To better understand their role in ocular surface homeostasis and inflammation, this study aimed to investigate potential factors contributing to the circadian infiltration of tear PMNs and changes in phenotype across different time points in a 24-hour cycle.

Methods: Tear leukocytes were collected from 30 participants using a gentle eyewash after 2-hr and 7-hr of sleep at night, after 2-hr sleep during the day, and towards the end of the day (around 5 pm). Cell count and morphology were determined using a Moxi Z cell counter and May-Grunwald stain, respectively. Cells were stimulated by fMLP. Changes in the degranulation (lactoferrin, CD66b, CD63) and cell aging state (CD184) of PMNs were measured via flow cytometry. Neutrophil extracellular traps (NETs) were also identified by flow cytometry and microscopy following staining with myeloperoxidase, citrullinated histones, and CD15.

Results: Significantly more cells were collected from the nighttime compared to the daytime (p<0.001). There was a positive correlation between IL-8 concentrations and PMN numbers, but not with C5a, suggesting that the recruitment of tear PMNs to the ocular surface may be driven mainly by IL-8. 2hr-sleep-derived tear PMNs were less degranulated than 7hr-sleep-derived tear PMNs (p<0.03) and possessed a larger functional activation potential in response to stimulus (p<0.03). Furthermore, 7hr-sleep-derived tear PMNs exhibited hyper-segmented nuclei and were prone to aggregation, when compared to 2hr-night-derived tear PMNs, suggesting an aged and activated phenotype. A significantly increased number of NETs were present in 7hr-night-derived tear samples (p<0.05).

Conclusions: The diurnal-nocturnal recruitment pattern of tear PMNs may be driven by the increase in IL-8 in nighttime tears. Higher levels of degranulation and NETs indicate that tear PMNs become more activated on the ocular surface during prolonged eye closure at night. This PMN inflammatory response must then be balanced by other anti-inflammatory processes to prevent ocular surface damage.

Jones D. The Role of Biometry in Myopia Management https://contactlensupdate.com/2023/04/25/the-role-of-biometry-in-myopia-management/ 2023;71

Jones D. Myopia Control is the Standard of Care! 47th Congress of the International Society of Contact Lens Specialists, Tucson, AZ, USA, Apr 30, 2023

Jones D. Axial Length - The Final Piece of the Puzzle 47th Congress of the International Society of Contact Lens Specialists, Tucson, AZ, USA, Apr 30, 2023

Jones D. State-of-the-art instrumentation for myopia management THE Myopia Meeting, Toronto, Canada, Dec 2, 2023

Jones D. Optical Biometry - The long and the short of it Global Specialty Lens Symposium, Las Vegas, Jan 19, 2023

Jones D. Optical Biometry - The Long And The Short Of It 4th World Congress of Optometry O=MEGA23, Melbourne, Sep 10, 2023

Jones D, Guthrie S, Woods J, Nguyen M, Chamberlain P, Hammond D. . Young Adult Acceptance of Dual Focus Myopia Control Soft Contact Lenses British Contact Lens Association Clinical Conference & Exhibition, Manchester, Jun 10, 2023 [ Show Abstract ]

Purpose: Myopia can continue to progress during early adulthood and previously observed acceptance of dual focus contact lenses in adolescents does not verify that progressing young adult myopes will similarly accept potential minor vision compromises when achieving the desired myopia control effect. This study assessed acceptance of dual focus myopia control contact lenses by myopic young adults.

Methods: Habitual single vision (SV) contact lens wearers (age 17-25) were dispensed MiSight 1 day (M1d, omafilcon A, CooperVision, Inc.) for 3 months. The Quality of Vision (QoV) questionnaire (McAlinden, 2010) was performed at baseline, 2 weeks, 1, 2 & 3 months. Frequency, severity and bothersome scores were summed for each vision symptom (e.g. glare) to give a combined metric (Best:0/Worse: 9). Non-parametric repeated measure ANOVA with Wilcoxon post-hoc analysis was used to determine how visual experience in M1d changed over the duration of the study and compared to SV at baseline.

Results: 27/29 of participants completed the study (23F:4M; age 22.5±1.7; SERE -3.55D±1.55D). Subjects self-reported that M1d was worn at least 6 days per week and this wear pattern was sustained over three months, averaging >12h per day (2w: 12.5±1.9h, 1M: 12.6±2.0h, 3M: 12.2±1.7h). Perception of starbursts, hazy vision, blurred vision, distortion, and fluctuating vision were not significantly different in M1d than SV. While glare, haloes, focusing difficulties, depth perception and double vision summed symptom scores at all timepoints were significantly increased compared to SV (range between 2-4 points higher, p<=0.002), 70% of subjects responded that they were likely to continue M1d wear given the likely myopia control benefits.

Conclusion: Full day wear of MiSight 1 day soft contact lenses was well tolerated in young myopic adults with mild increases in a limited number of vision symptoms that had no impact on wear time.

Jones D, Luensmann D, Alton K. The prevalence of refractive error in children in a Canadian rural, First Nation Community 4th World Congress of Optometry O=MEGA23, Melbourne, Sep 8, 2023

Jones D, MacNeil C, Pal S, Weinstein M. Unmet Market Needs of Children in Contact Lenses Review of Optometric Business 2023, July: Video series - Part 1