Jones D, MacNeil C, Pal S, Weinstein M. What Is the Best Way to Market CLs as a Great Choice for Children? Review of Optometric Business 2023, September: Video series - Part 2

Jones D, MacNeil C, Pal S, Weinstein M. What Are Your Practice’s Key Gains & Improvements in Myopia Management? Review of Optometric Business 2023, November: Video series - Part 3

Jones D, Woods J.. Workshop: Multi-function Instruments for Myopia management: A Review of Current Instruments and their Capabilities. British Contact Lens Association Clinical Conference & Exhibition, Manchester, Jun 10, 2023

Jones L. The CL Practice of the Future 47th Congress of the International Society of Contact Lens Specialists, Tucson, AZ, USA, Apr 29, 2023

Jones L. Dry Eye & Contacts: Harmony or Havoc? 47th Congress of the International Society of Contact Lens Specialists, Tucson, AZ, USA, May 1, 2023

Jones L. How well do you know your ocular lubricants? British Contact Lens Association Clinical Conference & Exhibition, Manchester, Jun 10, 2023

Jones L. Fabrication of a Microfluidic Chip for Evaluating Drug Delivery and Ocular Cytotoxicity with Contact Lenses British Contact Lens Association Clinical Conference & Exhibition, Manchester, Jun 11, 2023

Jones L. Opening Keynote - Opportunity, Opportunity, Opportunity: What you’re not seeing! 38th Congress of the Canadian Association of Optometrists, Québec City, Canada, Jul 6, 2023

Jones L. Fast Forward to the Future: Novel CL Innovations Global Specialty Lens Symposium, Las Vegas, Jan 21, 2023

Jones L. Osmolarity: Gold Standard for Dry Eye Disease Determination or Random Number Generator? XXV Biennial Meeting of the International Society for Eye Research, Feb 23, 2023 [ Show Abstract ]

The potential impact of osmolarity on dry eye symptoms dates back to the early 1970’s. The concept that tear film instability leads to hyperosmolarity and that this is a key factor in the development of dry eye disease (DED) is described in the 2017 TFOS Reports. Both aqueous deficient and evaporative DED can lead to tear hyperosmolarity, which stimulates ocular surface inflammation through increased expression and production of proinflammatory cytokines and chemokines, resulting in corneal epithelial cell death by apoptosis. Ocular surface disease and tear hyperosmolarity have also been associated with goblet cell loss, which can lead to altered mucin expression and tear film instability, further exacerbating inflammatory processes. These changes may stimulate sensory nerve fibers innervating the ocular surface, generating sensations of ocular discomfort. Although osmolarity has gained fairly widespread acceptance as a DED diagnostic, findings suggest that tear osmolarity measurements do not possess the very high sensitivity and specificity claimed by some studies and it may have limited value in the diagnosis of DED. A key factor in determining the relationship between DED and osmolarity relates to the ability to measure osmolarity, a process that is not without its challenges. The low volume of tears on the ocular surface necessitate using techniques that can estimate osmolarity using micolitre or nanolitre volumes of fluid. Clinical assessment methods typically occur through estimation of the osmolarity of the inferior tear meniscus. However, calculations using fluorescence assessments and hyperosmolar drops suggest that hyperosmolar levels in the tear film overlying the ocular surface may transiently spike during tear instability to levels far greater than that determined in the inferior tear meniscus, resulting in corneal inflammation and triggering sensory neurons. This may explain the relative disconnect between DED symptoms and osmolarity measurements.
Additonally, variability in results obtained between instruments, within-visit measures, differences between eyes and the impact
of treatments on osmolarity values over time require further examination.
In addition to DED, this review will examine other factors that may impact osmolarity values, including contact lens wear, cataract
and refractive surgery and systemic drugs. Finally, the osmolarity of ocular lubricants and contact lens blister packs and their
clinical relevance will be discussed.

Jones L, Craig J, Hinds M, Alster Y, Bosworth C, Ng A.. Sign and Symptom Improvement Rates Among MGD Patients Following 6 Months of Treatment With AZR MD 001 American Academy of Optometry, New Orleans, October 12, 2023 [ Show Abstract ]

Purpose: AZR MD 001, a topical ophthalmic ointment consisting of selenium sulfide as an active ingredient (either 0.5% or 1.0% concentration), was investigated in a Phase 2 clinical trial as a new treatment for meibomian gland dysfunction (MGD). Treatments for MGD seek to demonstrate strong efficacy, restore gland function, and improve patient symptoms. The aim of this study was to determine the responder rates for signs and symptoms in patients with MGD following 6 months of treatment with AZR MD 001.

Methods: For this multicenter, double-masked, vehicle-controlled, parallel-group trial (NCT03652051), randomized patients (1:1:1) received AZR MD 001 (0.5% [n=82] or 1.0% [n=83]) or vehicle (n=80) twice weekly before bed for 6 months. Eligible patients were ≥18 years of age, exhibited meibomian gland obstruction (Meibomian Gland Secretion [MGS] score ≤12 for 15 lower lid glands), and were required to discontinue topical prescription ocular surface treatments for ≥2 weeks and topical ophthalmic preparations (including artificial tear substitutes). Predefined responder criteria, based on literature thresholds, were: Meibomian Glands Yielding Liquid Secretion (MGYLS) change from baseline ≥5, MGS score >12, and Ocular Surface Disease Index (OSDI) score <13. Analyses included all data through month 6.

Results: AZR MD 001 showed a higher percentage of patients with a clinically meaningful improvement of ≥5 more glands yielding meibum compared with vehicle (MGYLS: 60%, p12) as early as 14 days (20%, p=0.0380 for AZR MD 001 0.5%; 19%, p=0.0949 for AZR MD 001 1.0%; 7.6% for vehicle). Patients continued to demonstrate normal meibum at month 6 (74%, p=0.0017 for AZR MD 001 0.5%; 63%, p=0.1273 for AZR MD 001 1.0%; 48% for vehicle). By month 6, significantly more patients treated with AZR MD 001 were asymptomatic for disease (OSDI <13: 48%, p=0.0333 for AZR MD 001 0.5%; 50%, p=0.0205 for AZR MD 001 1.0%; 30% for vehicle).

Conclusion: Over 6 months, a statistically significant proportion of patients applying AZR MD 001 demonstrated a clinically meaningful response, with normalization of their meibomian gland function and the achievement of asymptomatic status for disease.

Jones L, Craig J, Wolffsohn J. Contact Lens Comfort in Practice 4th World Congress of Optometry O=MEGA23, Melbourne, Sep 8, 2023

Jones L, Jedlicka J. The Future of Contact Lenses: What does the future for contact lenses look like? Contact Lens Spectrum Livestream Series, Episode 1, Jul 21, 2023

Jones L, Maldonado-Codina C. The Future of Contact Lenses: Smart Materials and Optics Contact Lens Spectrum Livestream Series, Episode 4, Oct 5, 2023

Jones L, Stahl U, Guthrie S, Yang M, Moezzi A, Thom M. Contact Lens Compendium: Contact Lenses & Solutions Available in Canada. V49 2023.

Jones L, Stahl U, Guthrie S, Yang M, Moezzi A, Thom M. Contact Lens Compendium: Contact Lenses & Solutions Available in America. Vol 4 2023.

Jones L, Szczotka-Flynn L, Dutta D. . The Future of Contact Lenses: How does the Contact Lens Practice evolve? Contact Lens Spectrum Livestream Series, Episode 3, Sep 21, 2023

Jones L, Walsh K. TFOS lifestyle report summary & Clinical Applications Canada Dry Eye Summit, Toronto, ON, Canada, Nov 18, 2023

Jones L, Walsh K, Ng AY, Schulze M. Diagnostic Instruments In: Contact Lens Practice; 4th Ed. Elsevier, Oxford, UK. 2023.

Jones L, Wolffsohn J. CLS LIVE!: Lyndon Jones with James Wolffsohn Contact Lens Spectrum 2023;38, November: 16-17

Jones L, Wolffsohn J. The Future of Contact Lenses: The Quest for Greater Comfort Contact Lens Spectrum Livestream Series, Episode 2, Aug 3, 2023

Jones,L., Efron,N., Bandamwar,K., Barnett,M., Jacobs,D. S., Jalbert,I., Pult,H., Rhee,M. K., Sheardown,H., Shovlin,J. P., Stahl,U., Sranila,A., Tan,J. Tavazzi,S., Ucakhan,O. O., Willcox,M. D. P., Downie,L. TFOS lifestyle: Impact of contact lenses on the ocular surface Ocular Surface 2023;29(July):175-219 [ Show Abstract ]

Several lifestyle choices made by contact lens wearers can have adverse consequences on ocular health. These include being non-adherent to contact lens care, sleeping in lenses, ill-advised purchasing options, not seeing an eyecare professional for regular aftercare visits, wearing lenses when feeling unwell, wearing lenses too soon after various forms of ophthalmic surgery, and wearing lenses when engaged in risky behaviours (e.g., using tobacco, alcohol or recreational drugs). Those with a pre-existing compromised ocular surface may find that contact lens wear exacerbates ocular disease morbidity. Conversely, contact lenses may have various therapeutic benefits. The coronavirus disease-2019 (COVID-19) pandemic has impinged upon the lifestyle of contact lens wearers, introducing challenges such as mask-associated dry eye, contact lens discomfort with increased use of digital devices, inadvertent exposure to hand sanitizers, and reduced use of lenses. Wearing contact lenses in challenging environments, such as in the presence of dust and noxious chemicals, or where there is the possibility of ocular trauma (e.g., sport or working with tools) can be problematic, although in some instances lenses can be protective. Contact lenses can be worn for sport, theatre, at high altitude, driving at night, in the military and in space, and special considerations are required when prescribing in such situations to ensure successful outcomes. A systematic review and meta-analysis, incorporated within the review, identified that the influence of lifestyle factors on soft contact lens dropout remains poorly understood, and is an area in need of further research. Overall, this report investigated lifestyle-related choices made by clinicians and contact lens wearers and discovered that when appropriate lifestyle choices are made, contact lens wear can enhance the quality of life of wearers.

Leat,S. J., Saraf,A., Rose,K., Christian,L. W., Irving,E. L., Jones, D. A., McCulloch, D. L. Measuring recognition visual acuity in young children–testability with the Waterloo Differential Acuity Test (WatDAT) Clinical and Experimental Optometry 2023;106(8):883-889 [ Show Abstract ]

Clinical relevance: Visual acuity measurement is important for the detection and monitoring of eye disorders. Developing accurate and sensitive visual acuity tests suitable for young children is therefore desirable.

Background: Recognition or form visual acuity (VA), which is measured with matching in children aged 3 years and up, is more sensitive for detecting visual deficits compared to resolution VA. The Waterloo Differential Acuity Test (WatDAT) is a proposed recognition VA test using the concept of identifying the "odd one out" among distractors. The WatDAT is expected to be cognitively easier than matching tests and therefore may be used in younger children. The purpose of this study is to investigate the testability of the WatDAT paradigm in children aged 12-36 months, and to determine the optimum format and number of distractors.

Methods: Fifty-one typically-developing children aged 12-36 months participated in the study. Data for Patti Pics (PP) and Face targets (FT) were collected for formats with 3, 4 and 5 distractors. The targets were presented binocularly on a computer touch screen at 30 cm. The task was to touch the face among identical non-faces or a house among circles. Following initial training, there were 5 presentations for each distractor format. Testability was defined as correctly identifying at least 4/5 presentations and was also determined for uncrowded PP symbols using matching.

Results: Of participants aged 18-36 months, 87% could perform the WatDAT PP targets with 3 distractors compared to 68% for the FT, while 48% could perform matching with PP. The testability for FT increased to 85% for children ≥22 months. Younger children showed lower testability. For the 3 distractor format, PP targets gave 9% testability in children 12 to <18 months, and FT gave a testability of 16% in children 12 to <22 months.

Conclusion: WatDAT testability is higher than matching VA tests. This indicates that the newly developed WatDAT has potential for measuring recognition VA in children 18 months and older.

Luensmann D, Guthrie S, Woods J, Voltz K, Vega J.. Software Guided Orthokeratology Fitting Success American Academy of Optometry, New Orleans, October 12, 2023 [ Show Abstract ]

PURPOSE: To evaluate the ease of fit and success rate of the recommended orthokeratology lens parameters as determined by the Visavyä software (CooperVision Inc.).

METHOD: This four-site prospective study recruited participants aged 6-35 years and fit them bilaterally with Paragon CRT® or Paragon CRT Dual Axis® orthokeratology lenses (CooperVision Inc.), worn every night for 1 month. Four different topographers were used in the study: Medmont E300, Oculus Keratograph 5, Oculus Pentacam or Topcon CA-800. Topography data were uploaded into the software and together with subjective refraction and white-to-white corneal diameter data, the software calculated the recommended lens parameters for the first trial lens. If fit and/or vision was not acceptable, lens modifications were permitted at the dispense visit, after the first night or after one week of wear. Best-corrected visual acuity was determined at baseline and unaided acuity was measured after one month of overnight lens wear.

RESULTS: 54 participants (33F:21M), mean age 17.5±7.4 years [7 to 35 years] were included in the analysis. An additional 8 participants were successfully screened and dispensed but exited the study early for lens related and other reasons, they are not included in the analysis. The mean subjective refraction (OU) of all completed participants was Sph -2.60±1.30DS [-5.75 to 0.00] and Cyl -0.50±0.47DC [-1.75 to 0.00]. The software recommended either CRT or CRT Dual Axis lenses depending on the corneal toricity: • Medmont: 13 CRT, 17 Dual Axis • Oculus Keratograph 5: 10 CRT, 28 Dual Axis • Oculus Pentacam: 11 CRT, 9 Dual Axis • Topcon CA-800: 13 CRT, 7 Dual Axis Only four eyes (<4%) involving 3 different participants required a lens parameter change from the initial lens recommendation by the fitting software (all CRT Dual Axis) and involved two different topographers. For the cohort, the best-corrected visual acuity (logMAR) prior to lens wear was -0.07±0.11 (-0.30 to 0.14) and unaided vision after 1 month of lens wear was -0.03 ± 0.15 (-0.30 to +0.38) (p<0.01). Remaining refraction after 1 month was Sph –0.04 ± 0.34 DS. (-1.25 to +0.75). The 1-month unaided vision by lens type was: • CRT: -0.07 ± 0.12 (-0.30 to 0.14) • CRT Dual Axis: -0.01 ± 0.16 (-0.30 to 0.38) There were no significant or serious ocular adverse events in this study.

CONCLUSION: The Visavy™ software successfully integrated data from four different topographers and provided a >96% first fit success rate for Paragon CRT® and Paragon CRT Dual Axis®. This predictable outcome makes the Visavy™ software a valuable tool for eye care professionals when fitting these lenses to minimize chair time and optimize wearer satisfaction.

Luensmann D, Guthrie S, Woods J, Voltz K, Vega J.. Orthokeratology fitting success using a new software British Contact Lens Association Clinical Conference & Exhibition, Manchester, Jun 9-11, 2023 [ Show Abstract ]

PURPOSE:
To determine vision outcome after orthokeratology (Ortho-K) lens wear when using the new Visavy software (CooperVision Specialty EyeCare) to determine the recommended lens parameters.

METHODS:
This multisite (3) prospective study recruited participants aged 6-35 years and fit them with Paragon CRT or Paragon CRT Dual Axis Ortho-K lenses (CooperVision Specialty EyeCare), worn every night for 1 month. Topography images (Oculus Keratograph 5, Medmont E300, or Topcon CA-800) were uploaded in the software and together with entries for subjective refraction and white-to-white corneal diameter, the software provided the recommended lens parameters. If fit and/or vision was not acceptable, lens modifications were permitted at the dispense visit, after the first night or after one week of wear. Best-corrected visual acuity was determined at baseline and unaided after one day, one week and one month of Ortho-K wear. Subjective comfort was collected after the first lens application and after one month (0-10 scale, 10=very comfortable).

RESULTS:
Thirty participants (19F:11M), mean age 13.6±5.9 years [7 to 35 years] were included in the analysis. The mean refraction of all 60 eyes was Sph -2.98±1.27DS and Cyl -0.54±0.43DC. Best-corrected visual acuity (logMAR) prior to lens wear was -0.01±0.04 and unaided vision was +0.30±0.33 after the first night, +0.05±0.13 after 1 week and +0.06±0.10 after 1 month of Ortho-K lens wear. Remaining subjective refraction after 1 month was Sph –0.37±0.82DS. Only two eyes (<3%) required a lens parameter change after the initial lens recommendation by the fitting software. Comfort ratings were significantly better after 1 month (7.8±1.6) compared to the dispense visit (5.6±2.2)(p<0.01). There were no ocular adverse events in this study.

CONCLUSIONS:
The software provided a 97% first fit success rate for Paragon CRT and Paragon CRT Dual Axis. This predictable outcome makes the Visavy software a valuable tool for ECPs when fitting Ortho-K lenses.