EyeDigest Magazine November 2019

EYE DIGEST November 2019

BCDO’S QUARTERLY OPTOMETRIC MAGAZINE

Technology

& Innovation

When Your Patient’s Smart Phone Can Prescribe Them Contact Lenses

Dr. Shaun Golemba Member Spotlight

New First Nations Health Benefits Plan In B.C. – “Works!”

info@optometrists.bc.ca 604.737.9907

BC Doctors of Optometry 121 –10551 Shellbridge Way, Richmond B.C, V6X 2W8

CONTENTS

Practice Management When Your Patient’s Smart Phone Can Prescribe Them Contact Lenses ..... 3 Financial Planning For ODs ................................................................................................... 7 New First Nations Health Benefits Plan In B.C. – “Works!” .................................. 10 The Scotia Professional Plan For Optometrists ........................................................ 12 How Sun Life Is Helping Health-Care Go Digital ...................................................... 13

Industry Alcon Canada Adds Innovative Dry Eye Treatment To Its Portfolio..................................... 15 Eye Allergy Treatment Market Size Is Anticipated To Exhibit A CAGR of 5.3% By 2023 | Growth Analysis, Future Trends And Regional Insights ............................................................................................................ 18 Blepharitis Treatment Market Analysis And In-Depth Research On Market Growth .................................................................................................................. 20

Programs Safety Eyewear Is Not Just For The Workplace .................................................................... 22 Are You Interested In Locum Work? Let Us Know! .............................................................. 26 BCDO Upcoming Events ............................................................................................................. 28

Spotlight on a Member Member Spotlight - Dr. Shaun Golemba ...................................................................... 32

Research Dry Eye Management and Omega-3 And Omega-6 Fatty Acids .................. 37 Understanding The Role Of Rheology In Determining Efficacy Of Eye Drops ................ 42

Leisure Take Technology To Another Level At Telus World Of Science! ...................... 43 Let The Holiday Spirit Surround You ............................................................................. 44

When Your Patient’s Smart Phone Can Prescribe Them Contact Lenses

By Dr. Trevor Miranda

Eye Digest Magazine | 3

When your patient’s smart phone can prescribe them contact lenses, it is time to make a shift change in the optometry profession. That time is now.

Simple Contacts is a free app available in Android and Apple app stores that allows patients to do a visual assessment test on their phone, be given a prescription and order contacts within minutes and from the comfort of their couch. The lenses will be delivered to their house within days and they can manage reordering from their phone.

The app is only available in the US and is FDA registered with the test results reviewed by ophthalmologists licensed in each state. In the US, contacts are regulated by the FDA as medical ophthalmic devices.

This is just one example and there are numerous other companies out there with similar technology that eliminates the need for an in-person optometry visit. Canada is always a few years behind with new technology, but this will soon come to Canada.

4 | Eye Digest Magazine

For now, human doctors are still reviewing the test results for Simple Contacts. The speed they are likely able to review results on a computer screen versus an in-person visit is probably in the realm of 1-2 minutes compared to a typical chair-time of 15 minutes. Within a few short years, humans won’t be doing this review as Artificial Intelligence (AI) will be faster and more accurate.

Government regulations in the US and Canada still lists contacts as a medical device that requires a doctor's prescription. However, this has been successfully challenged in the courts and entrepreneurs have found ways to work around it in countless other situations. Therefore, the courts offer no protection to the optometry profession.

In Canada, optometrists account for approximately 50% of all contact lenses sold with the other 50% coming from big box stores like Walmart and Costco and online retailers like Clearly. This shows that optometrists through government regulation control 100% of the initial market due to regulations requiring patients to first get an optometrist’s

prescription and have lost 50% to competitors once the patient has their prescription.

lenses. These big four sold through optometrists' big box stores and online retailers.

Why don’t patient’s stay with optometrists' forever? The reason is because the patient’s need of price, convenience and option is being met elsewhere. In short optometrists aren’t competitive.

Now, tech entrepreneurs in their mid-twenties without medical or eyecare experience have entered the manufacturing space to sell directly from manufacturer to consumer eliminating everyone in the middle. Hubble is one example and Kits , Waldo and Dandy are others. In the case of Hubble, they sell daily disposable contacts on a monthly subscription for $30/month ($1 a day).

Online is easier, faster and cheaper for patients with home delivery. In-person at the optometrists' office is inconvenient (scheduling weekends, after work), slower (15 minutes chair time, plus travel) and local optometrists are perceived to be more expensive.

Technology isn’t just eliminating in-person prescriptions for contacts, it's changing the manufacturing world of contacts too and how patients interact with manufacturers. The big four manufacturers (J&J, B&L, Alcon and Cooper Vision) used to be the only option for contact

Optometrists particularly see Hubble as a threat to their practice as noted in these articles: • Hubble Proof your Contact Lens Practice • Hubble Trouble • Hubble Contact Lenses - 4 Things to Consider Hubble in particular is extremely effective at marketing to patients and has really got their attention, despite the fact their lenses don’t

Eye Digest Magazine | 5

really save patients money and are made with outdated material. Hubble is able to do this because they understand patient’s preferences and are speaking their language on needs - ease of ordering, subscription services, low monthly fees, and colorful boxes.

As eyecare professionals, optometrists are conservative by nature which can make it challenging to take action when it seems like the contact lens business is shifting on all sides.

Since contacts usually make up only 10-15% of an optometry practice’s revenue perhaps it's not worth the effort?

I disagree. Contact lenses are a small but important part of an optometry practice because it can lead to other sales in drops, sunglasses, and glasses.

More importantly, it helps establish a trusting relationship with patients when they are being prescribed contacts that they are in fact medical devices and a human optometrist is concerned about the health of their eyes. This is the value that optometrists bring, and it can’t be replaced with software. Patients do value optometrists as medical professionals and feel comforted that a person that knows them by name is looking out for their eye health. An app can’t provide this and this as a profession is what we need to focus on - the human connection, empathy and trusted relationship between healthcare provider and patient.

The mistake many make is that they believe this human connection needs to only be in-person, it doesn’t. The best way to look at the situation is that your clinics need to go digital or get left behind.

That doesn’t mean compromising on eye care and patient health. In fact, digital communication with your patients can enable you to provide better patient care by no longer being restricted to speaking in person once a year.

One way, we are doing this with contact lenses is through Avocado Lenses, which I founded with a 6 | Eye Digest Magazine

group of doctors and software engineers. Avocado provides an online platform for optometrists to compete with big box stores, online retailers and startups which are taking away their patients.

Avocado provides only brand name contacts from the big 4 (J&J, B&L, Cooper Vision and Alcon) which are ordered from the optometrist and shipped directly to the patient's home. Avocado is a tool to handle the ordering and shipping process which provides no value to patients while allowing optometrists to focus their value on patient care.

Most importantly Avocado is a subscription service where patients order 6 months’ of supply but pay in monthly installments. This model has been in Europe for over a decade and 70% of contacts in Europe are sold through subscription. This is also the preferred method of payment for consumers in very successful products such as Netflix, car insurance, gym memberships etc. This eliminates the high upfront costs to patients of buying 6 months of lenses from an optometry office and now lets them get the 6 or 12 month discount pricing but pay for it in monthly installments.

Avocado is only available to optometrists and is launching in a few select cities in Fall 2019.

Related Links: Simple Contacts: https://play.google.com/store/apps/details?id=com.simplecontacts.scapp&hl=en_US Hubble: https://ownersmag.com/hubble-contacts-ben-cogan-jesse-horwitz-interview/ Kits: https://www.kits.com/ Waldo: https://www.hiwaldo.com/ Dandy: https://dandycontacts.com/ Hubble Proof your Contact Lens Practice: https://eyecarebusiness.ca/hubble-proof-your-contact-lens-practice/ Hubble Trouble: https://newgradoptometry.com/hubble-trouble/ Hubble Contact Lenses - 4 Things to Consider: https://newgradoptometry.com/hubble-contact-lenses/ Avocado Lenses: https://avocadolenses.com/

Financial Planning For ODs Financial Literacy Counsel Inc.

Financial planning for OD’s is often two-sided: personal financial planning and planning for the practice.

OD’s could have access to financial tools that non-business owners may not have. While this can be an advantage it can also be overwhelming.

A financial plan can help ensure that the decisions you make are aligned with your financial goals.

The struggle OD’s business owners often have with managing money, is trying to save for the future, while needing to spend money today. A financial plan allows you to achieve your financial goals, as it looks at where you are today and where you want to go, personally and for your practice.

For OD’s, personal and practice finances are connected. Therefore, both sides should be addressed: Personal and Business.

Eye Digest Magazine | 7

There are 2 main areas your personal financial plan should address: Accumulation and Protection.

Accumulation: • Cash Management - Savings and Debt • Tax Planning • Investments

As a BCDO member, you now have access to: Integrated financial, tax and estate planning advice:

Protection: • Insurance Planning • Health Insurance • Estate Planning

Most importantly monitor and recommendations. Adjust, if necessary.

1. FLC is here to help you, your family and your practice create and execute a plan to achieve your financial goals throughout every stage of your career.

2. BCDO members and their partners have access to two private financial counselling sessions valued at $225 per hour.

3. t the end of the session, they will receive an integrated financial, tax and estate planning prescription to address their top financial planning priorities. review

If you have questions about your financial plan or want a second opinion or you, reach out to FLC. BC Doctors of Optometry has partnered with the FLC to help members address the financial education, financial planning, and insurance planning. FLC is committed to the financial wellbeing of Optometrists by ensuring that every BCDO member who utilizes their member 8 | Eye Digest Magazine

benefit will receive an integrated financial, tax and estate planning prescription. This prescription is customized to their unique needs and ensures that Optometrists are on track financially, are investing wisely, are maximizing tax deductions and have adequate insurance coverage.

Contact our team at the FLC for financial advice & education: Book a private consultation: Email: consultation@flci.ca Phone: 604.620.6030 Website: www.flci.ca For more information please visit Double-check your Financial Plan is in Focus at : https://www.flci. ca/blog/financial-planning-for-business-owners

Eye Digest Magazine | 9

New First Nations Health Benefits Plan in B.C. – “Works!”

First Nations Health Authority, BC It was just a few days after the First Nations Health Authority (FNHA) transferred the administration of vision care health benefits to Pacific Blue Cross, that an Indigenous mother took her two sons to the optometrist for eye examinations. “Am liking the new system of the FNHA switching to PBC,” she wrote on Facebook afterwards. “The direct billing process is so much better than sending away and waiting a couple weeks to see if you’ll get approved. [The optometrist is] told immediately of approval amounts, etc. Works!”

“Works!” is exactly what health benefits staff members at both the FNHA and Pacific Blue Cross wanted to hear after months of planning the new system to administer benefits for vision services, dental services, and medical supplies and equipment (MS&E).

It’s been a long time coming but the transfer of benefits administration from the federal government to the First Nations Health Authority has been in the works since the FNHA was created in 2013. The organization’s leaders consider the step a move towards First Nations self-governance over health services in B.C., which is exactly why the FNHA – the only health authority of its kind in Canada – was created.

Previously, approximately 144,000 First Nations people in B.C. received health benefits primarily through Non-Insured Health Benefits (NIHB) 10 | Eye Digest Magazine

– a federal program that provides coverage to registered First Nations people for a specified range of medically necessary items and services that are not covered by other plans and programs.

The first phase of the benefits transition from Health Canada to the FNHA took place in October 2017 with the transfer of non-insured pharmacy benefits to PharmaCare (Plan W – for Wellness). The second phase – of the vision, dental and MS&E benefits – took place Sept. 16 following a year-long comprehensive consultation effort with health regulators, individual health care providers, clients*, and other individuals and organizations involved with the delivery of First Nations health care.

Change was welcome on all fronts. One focus group participant last March described the way the system used to work for getting eyeglasses: “When we choose glasses, the optometrist tells us we can only get certain frames and directs us to the ‘Indian Affairs’ glasses, which are ugly. It is an embarrassing experience and makes us want to walk out of the store.”

The system wasn’t popular with health care providers either.

“I gave up on providing eyewear to First Nations people because I got so frustrated with the process and there was no one to talk to,” said one optician who participated in a provider interview

last November.

No more. Gone is the absence of program contacts. Gone is the need for pre-approvals for eye examinations and standard eyewear.

Gone is the lengthy wait for reimbursements – for both clients and health care providers. Now health care providers can register with Pacific Blue Cross – if they are not already – and readily check on client eligibility and pre-determinations; receive electronic statements and direct deposit payments; and access information resources. In addition, benefit coverage levels have increased and are not as restrictive as they were previously.

For some First Nations people, the changes to the benefit program go beyond improved coverage and convenience and go to the heart of cultural safety – a concept the FNHA aims to embed in health care so that every First Nations person feels safe and respected when they receive health services. An example of how this relates to vision care came from a poignant anecdote shared in one of the health benefits community engagement sessions.

“I was beat in the head so often in Indian Residential School that every time I can’t see now, I get terrified that someone is going to attack me again,” one man said. “That’s why when I lost my glasses, I lived in constant fear until I had coverage for new ones.”

While the new benefits program can’t take away past trauma, it can help mitigate trauma’s lasting effects, even in seemingly small ways such as eliminating the requirement for pre-approvals for standard care. The FNHA is also committed to monitoring, evaluating and adjusting the program to ensure that every client and every health care provider feels the same as that mother who took her sons to the optometrist – that the system “works!”

For more information: See https://www.pac.bluecross.ca/provider for the provider reference guide and FNHA vision fee schedule.

Send comments or questions to Connie Chong, Manager, Provider Relations, FNHA, at provider@fnha.ca “Clients” is the term the FNHA uses instead of “patients” in order to reflect the organization’s commitment to service and to a wholistic perspective to health.

The FNHA created an awareness campaign to promote the new benefits program to our clients (see advertisement).

Eye Digest Magazine | 11

12 | Eye Digest Magazine

Life’s brighter under the sun

INTRODUCING

Canada’s largest health network 150,000+ health-care providers Over 10-million ratings 4-million total searches and counting

In virtually every other industry, we have access to information about services before we use them. We can compare the ratings, services and cost for hotels, vacations and restaurants on simple easy-to-use platforms. But when it comes to finding a new health-care provider, it can involve multiple searches on the internet. And often calls to friends and family for their recommendations.

It’s time for health care to catch up. We need resources that make it easy for Canadians to connect with the right care.

How Sun Life is helping health-care go digital Sun Life has made a commitment to help Canadians live healthier lives. We saw that there was a tremendous opportunity to help health-care go digital. To make it easier for health-care providers and patients to connect. That’s why we created a powerful health network.

Our network is available to Canadians on LuminoHealth.ca and to Sun Life Clients on our app and website. It maps out over 150,000 providers and includes important Eye Digest Magazine | 13 information like phone number, location, rating and more. This information makes it easier for Canadians to search and connect with health-care providers near them.

health network.

You already have a basic profile on Sun Life’s network. It’s based on the information we

receive on submitted claims. Now you can give patients a full picture of your practice Oura network is available to Canadians on LuminoHealth.ca to Sun Life Clients with Gold Profile.

A Gold Profile subscription unlocks accessand to exclusive tools that on our app and website.

It maps out over 150,000 providers and includes important includes these business-building features: information like phone number, location, rating and more. This information makes it easier forPreferred Canadiansplacement to search and connect with health-care providers them. can in the search results in your local area near so patients find you content that allows you to showcase your expertise and share what AttractCustom new patients with a Gold Profile makes your practice unique You already have a basic profile on Sun Life’s network. It’s based on the information we receive on submitted claims. Now you can give patients a full picture of your practice More ways for patients to connect with you including a ‘request an with a Gold Profile. A Gold Profile subscription unlocks access to exclusive tools that appointment’ button and your website link includes these business-building features:

Preferred placement in the search results in your local area so patients can find you

Today, Gold Profiles receive up to 10x more engagement than basic profiles. Let Canada’s health helpexpertise patients and Custom contentlargest that allows you tonetwork showcase your andfind share what with you. makes your practice connect unique More ways forLearn patients to about connect withProfile you including a ‘request an more a Gold appointment’ button and your website link

Check Gold out your profilereceive on Lumino searching by your specialty Today, Profiles up Health to 10xbymore engagement thantype basic address. profiles. Let Canada’s largestand health network help patients find and connect with you.

Learn more about a Gold Profile

Check out your profile on Lumino Health by searching by your specialty type and address.

14 | Eye Digest Magazine

MGD treatment system

OVER 6 MILLION PEOPLE IN CANADA SUFFER 1 FROM DRY EYE. 86% OF DRY EYE PATIENTS HAVE SIGNS OF MEIBOMIAN GLAND DYSFUNCTION (MGD).2 TAKE CONTROL AND TREAT MGD WITH CONFIDENCE.3 For personalized, real dry eye relief, the iLUX® device, with its advanced Smart Tip Patient Interface, gives you results you can see.

Caffery et al. Prevalence of dry eye disease in Ontario, Canada: A population-based survey. The Ocular Surface. 2019:1-6 Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012;31:472-478.

3.

Hardten DR, Schanzlin JD, Dishler JG, et al. Comparison of a Handheld Infrared Heating and Compression Device for Treatment of Meibomian Gland Dysfunction to a Thermal Pulsation Device. Presented at the Annual Meeting of the American Society of Cataract and Refractive Surgery (ASCRS); April 13-17, 2018; Washington, D.C. 1.

2.

© 2019 Alcon Inc. 07/19 CA-ILU-1900017

Eye Digest Magazine | 15

Alcon Canada adds innovative dry eye treatment to its portfolio HAVE YOU ASKED YOUR PATIENTS HOW THEIR EYES ARE FEELING TODAY? BETWEEN INCREASED SCREEN TIME AND LONGER WORKDAYS, CHANCES ARE THEY ARE AMONG THE 6 MILLION CANADIANS1 LIVING WITH DRY EYE DISEASE OR EXPERIENCING DRY EYE SYMPTOMS. According to a recent survey by research firm Leger on behalf of Alcon Canada, 85 per cent of Canadians have experienced at least one symptom of dry eye, which can include eye fatigue, watery eyes, sensitivity to light, blurred vision, eye redness, and difficulty with nighttime driving.2 Those who suffer from dry eye say activities like reading, driving and travelling can increase the problem.

Of Canadians with dry eye: 58% say they experience more dry eye discomfort depending on the season

67% say their eyes get tired when looking at computer, phone, tablet or television screens

66% say they experience dry eye symptoms when they read

i m p a c t of dry eye across the general public, Alcon Canada has added the iLux® MGD Treatment System – an innovative, handheld device for the treatment of Meibomian Gland Dysfunction (MGD) – to its robust selection of dry eye treatment options.

“Alcon Canada is continuously exploring new ways to innovate dry eye treatment, address patient needs, and broaden dry eye awareness,” said Chris Van Dyk, Country Business Head, Vision Care at Alcon Canada. “This includes making new additions to our market-leading SYSTANE® product portfolio, as well as the acquisition of the iLux® MGD Treatment System, an in-office therapy for the comprehensive treatment of dry eye.”

“Dry eye is a chronic issue for a large number of my patients, making it a challenge to treat them and achieve optimal results,” said Dr. Judy Parks, doctor of optometry at Ancaster Eye Clinic. “This can be caused by factors such as normal aging, hormonal changes, environmental exposure, medical conditions, and excessive screen time, making it important to treat the root cause of your patients’ dry eye in addition to addressing its symptoms.”

An innovative, in-office therapy

Considering the unique and prevalent

in-office.

16 | Eye Digest Magazine

More than 85 per cent of patients with dry eye have signs of MGD, making it a major cause of dry eye.3 Like other forms of dry eye, MGD is associated with a range of symptoms that can negatively affect patients, including ocular discomfort and blurry vision.4 The iLux® MGD Treatment System allows eye care professionals to directly target a patient’s blocked Meibomian glands and provide therapy

Using the iLux® MGD Treatment System, eye care professionals can warm the eyelids to alleviate blocked Meibomian glands through the application of lightbased heating. While applying the iLux® MGD Treatment System, the practitioner can view the eyelid margin and apply manually-controlled compression to express blockages, making adjustments as needed to tailor treatment to the individual needs of the patient.5 Most treatments are completed in a matter of minutes, allowing eye care professionals to take control and treat MGD with confidence.6 The streamlined nature of the treatment allows for higher potential patient volume in dry eye clinics.

“Dry eye is a large and growing market, and we anticipate dry eye devices to be the fastest growing segment of the global market through 2022,” 7 said Van Dyk. “Proactively treating dry eye can help establish or grow a dry eye specialty in-clinic.”

Robust in-clinic and at-home treatment options The iLux® MGD Treatment System has a natural synergy with Alcon Canada’s market-leading SYSTANE® portfolio, allowing Alcon to offer iLux® as an in-office treatment and SYSTANE® as an at-home solution for dry eye sufferers.

The SYSTANE® family of products includes: •S YSTANE® COMPLETE Lubricant Eye Drops, the first all-in-one drop for all types of dry eye.

•S YSTANE® Omega-3 Supplement, a source of omega-3 fatty acids that helps to relieve dry eye symptoms and maintain good overall health.8 • SYSTANE® Lid Wipes, Alcon Canada’s premium, pre-moistened and hypoallergenic eyelid cleansing wipes.

“Between crafting a personalized treatment plan with the iLux® MGD Treatment System and recommending SYSTANE® COMPLETE for use at home, I feel confident that I am providing comprehensive dry eye therapy for my patients,” said Dr. Parks.

Alongside the #1 doctor-recommended SYSTANE® family of products, the iLux® MGD Treatment System is the latest in Alcon’s robust selection of dry eye treatment options to help support or develop a clinic’s dry eye practice. To learn more, contact your Alcon Advanced Technology Sales representative

MGD treatment system

. Caffery et al. Prevalence of dry eye B disease in Ontario, Canada: A populationbased survey. Ocular Surface. 2019.

2 Vision Care Survey, Research Report, 2019.

This survey was conducted online by Leger, on behalf of Alcon Canada from May 30 until June 3, 2019, among 1,500 Canadians age 18+, using Leger’s online panel Leger Opinion. A probability sample of the same size would yield a margin of error +/- 2.5%, 19 times out of 20.

3 Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD. Distribution of aqueous1

deficient and evaporative dry eye in a clinicbased patient cohort: a retrospective study.

Cornea. 2012;31:472-478.

4 All About Vision. Meibomian Gland Dysfunction (MGD): The Cause Of Your Dry Eyes? Available at: https://www. allaboutvision.com/conditions/meibomiangland.htm. Accessed April 12, 2019.

5 iLux® Evaporative Dry Eye Treatment System: User Manual. Alcon data on file.

6 Hardten DR, Schanzlin JD, Dishler JG, et al.

Comparison of a Handheld Infrared Heating and Compression Device for Treatment

of Meibomian Gland Dysfunction to a Thermal Pulsation Device. Presented at the Annual Meeting of the American Society of Cataract and Refractive Surgery (ASCRS); April 13-17, 2018; Washington, D.C. 7 Market Scope® Charting the Course of the Eye Care Marketing. Dry Eye Products Report. Licensed to Alcon, Inc. Alcon data on file. 2017.

8 Giannaccare et al.: Efficacy of Omega-3 Fatty Acid Supplementation for Treatment of Dry Eye Disease: A Meta-Analysis of Randomized ClinicaTrials. Cornea 2019 (in press).

© 2019 Alcon Inc. 08/19 CA-ILU-1900028

Eye Digest Magazine | 17

Eye Allergy Treatment Market Size Is Anticipated To Exhibit a CAGR of 5.3% By 2023 & Growth Analysis, Future Trends and Regional Insights

Abhishek Sawant Market Research Future Website: www.marketresearchfuture.com/reports/eye-allergy-treatment-market-3811

Global Eye Allergy Treatment Market Size, Growth and Share Analysis by Type (Vernal Keratoconjunctivitis, Atopic Keratoconjunctivitis, & Contact Allergic Conjunctivitis), Treatment (Medications & Allergy Shots), and End User (Hospitals & Clinics), Region and Key Players, Forecast to 2023 .

The global Eye Allergy Treatment Market size is anticipated to exhibit a strong 5.3% CAGR over the forecast period from 2018 to 2023, according to the latest research report from Market Research Future (MRFR). The report presents a detailed analysis of the global eye allergy treatment market, profiling the leading drivers and restraints operating on the market. The major economic factors operating in the market’s environment are also studied in the report to understand the market’s economic position and standing. The major players 18 | Eye Digest Magazine

operating in the global eye allergy treatment market are also profiled in the report to provide readers with a clear picture of the market’s competitive landscape.

The global eye allergy treatment market is mainly driven by the growing awareness about eye disorders and the growing demand from consumers for effective eye allergy medications. The eyes are among the most delicate organs in the human body and can be grossly affected by several factors, including imbalances in the body as well as extreme

changes in the environment. This has driven significant research and development activity in the global eye allergy treatment market in recent years, as ophthalmology has advanced significantly as a major area of medicine. The growing geriatric population is also likely to be a key driver for the global eye allergy treatment market over the forecast period. The eyes grow weak with age, leading to a higher prevalence of ophthalmological conditions among the geriatric than among younger demographics. Growing air pollution is also likely to be a major driver for the global eye allergy treatment market over the forecast period. Air pollution is a major causative agent for eye allergies, as dust, pollen and other particles are borne on air pollution and can easily reach the eyes. Growing urbanization around the world has driven the extent of air pollution, leading to a growing prevalence of eye allergies. This is likely to drive the demand from the eye allergy treatment market over the forecast period.

Competitive Analysis: Leading players in the global eye allergy treatment market include Nutra Essential OTC, Shire, Akorn Inc., Nicox, Teva Pharmaceutical Industries Ltd., Santen Pharmaceutical Co. Ltd., Bausch Health, Novartis AG, Johnson & Johnson Services Inc., and Allergan plc. Research into developing more effective formulations for eye allergy treatment is likely to remain a popular avenue among players in the global eye allergy treatment market over the forecast period. Developing formulations with safer ingredients that don’t affect the eyes adversely is also likely to be a priority for players in the eye allergy treatment market.

In October 2018, Santen Pharmaceutical launched Verkazia eye drops.

In 2017, Novartis AG launched an olopatadine hydrochloride ophthalmic solution for the treatment of allergic conjunctivitis.

Segmentation: The global eye allergy treatment market is segmented on the basis of type, treatment, end use, and region.

By type, the global eye allergy treatment market is segmented into seasonal and perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis, contact allergy conjunctivitis, and giant papillary conjunctivitis.

By treatment, the global eye allergy treatment market is segmented into medications and allergy shots (immunotherapy). The medications segment is further segmented into artificial tears, decongestants, antihistamines/mast cell stabilizers, oral antihistamines, and corticosteroids.

Theallergyshotssegmentisfurthersub-segmented into subcutaneous immunotherapy treatment and sublingual immunotherapy treatment.

By end use, the global eye allergy treatment market is segmented into hospitals and clinics, and specialty centers.

Regional Analysis: The Americas hold the largest share of more than 40% in the global eye allergy treatment market and is likely to remain the leading regional market over the forecast period. The Americas market for eye allergy treatment is mainly driven by the growing prevalence of ophthalmological conditions in North America, the growing awareness about ophthalmological conditions, and the growing geriatric population in the region. According to the National Eye Institute, about 3 million cases of conjunctivitis were reported in the U.S. in 2015.

Europe holds the second largest share in the market, followed by Asia Pacific.

Related Links: Digital Journal: http://www.digitaljournal.com/pr/4467383

Eye Digest Magazine | 19

Blepharitis Treatment Market Analysis and in-Depth Research on Market Growth Mr. Raj Shah, CEO Coherent Market Insights https://www.coherentmarketinsights.com/ongoing-insight/blepharitis-treatment-market-1761

20 | Eye Digest Magazine

Seattle, WA -- (SBWIRE) -- 10/02/2019 -Blepharitis is a chronic disorder that leads to inflammation of the eyelids. The disorder impacts the part of eyelid where eyelashes grow. The disease progresses when tiny oil glands near this area are clogged as the clogging leads to irritation and redness of the eyes. Blepharitis is evident with following symptoms: high sensitivity to light, loss of eyelashes, watery eyes, burning sensation in the eyes, greasy eyelids, itchy eyes, red and swollen eyes, flaking of skin around the eyes, crusted eyelashes after waking up, more frequent blinking, abnormal growth of eyelashes, and stinging sensation in the eyes. Blepharitis is also a cause of seborrheic dermatitis, a dandruff of the eyebrows and scalp. The condition can also lead to bacterial infection, clogged oil glands, malfunctioning of oil glands, and rosacea. Other effects include allergic reactions to eye medications, contact lens solutions or eye make-up and eyelash lice or mites.

Increasing prevalence of ophthalmic disorders among the geriatric population is expected to boost growth of the blepharitis treatment market.

For instance, according to a survey conducted

by American Academy of Ophthalmology in 2014, blepharitis usually affects people above the age of 50 years. According to the same source, blepharitis is observed in 37% male ophthalmic patients and 47% in female ophthalmic patients.

Moreover, increasing number of drugs in the pipeline is also expected to contribute to the market growth. For instance, ISV-305 sponsored

by InSite Vision is in phase 3 clinical trials, ISV-305 treats patients with early symptoms of blepharitis.

Key players in the market are focused on product development and launch in order to expand their product portfolio, thereby propelling the market growth. For instance, in 2015, BlephEx, a Franklinbased company launched Rysurg. It is used to clean eyelids and also maintains hygiene. According to a study conducted by American Academy of Ophthalmology in 2015, around 50% of ophthalmic

patients suffer from symptoms of blepharitis and dry eyes. Constant use of this device helps prevent recurrence of blephairis and the treatment is painfree. Key players in the market are also focused on adopting merger and acquisition strategies. For instance, in 2013, Shire Plc. acquired Californiabased ophthalmic company, SARcode Bioscience.

The acquisition helped Shire Plc. to add new drug – Lifitegrast— to its specialist drug portfolio. In 2016, the U.S. Food and Drug Administration (FDA) approved Lifitegrast for the treatment of signs and symptoms of dry eye and blepharitis.

However, lack of awareness regarding the treatment of blepharitis and high cost of therapies used in the treatment of the condition is expected to hinder the market growth.

For instance, in 2017, Scope Ophthalmic launched Moist Heat Mask, a device that helps in the treatment of blepharitis by loosening the oil present in Meibomian glands and allowing it to flow more freely. It helps to soften eye lash debris, prevent the evaporation of natural tear film, restores moisture to the eye and also the surrounding area, as well as improves tear film lipid quality. In 2015, MiBo Medical Group, a U.S.based company, launched MibO Thermoflo. This device helps in the treatment of blepharitis and dry eyes and is required to be gently massaged on the margins of the eyelids for a minimum of 12 minutes. In 2015, MiBo Medical Group launched Lid Pro, a device that is used to treat anterior Blepharitis. The region of Asia Pacific is expected to witness significant growth due to increasing prevalence of blepharitis. According to a study conducted by Journal of Clinical and Experimental Ophthalmology in 2016, signs and symptoms of blepharitis increased by 32% among the geriatric population as compared to 2014.

Related Links: Digital Journal: http://www.digitaljournal.com/pr/4462781

Eye Digest Magazine | 21

22 | Eye Digest Magazine

SAFETY EYEWEAR IS

NOT JUST FOR THE WORKPLACE

Eye Digest Magazine | 23

Phillip Trickett Manager, Eyesafe BC

“Unfortunately, most people don’t think about eye protection for the home until it is too late,” said Lynn Polonski, MD, an ophthalmologist specializing in ocular trauma at University of Arizona Medical Center.

“Don’t risk a lifetime of vision loss — use protective eyewear.”

You should wear safety eyewear whenever there’s a risk of eye or face injury. While required in many workplaces, the use of safety eyewear goes well beyond that.

In the workplace The Occupational Safety and Health Administration (OHSA) provides guidelines and 24 | Eye Digest Magazine

assistance about when to wear safety eyewear and what type of eyewear is most suitable. Unfortunately, at home and during recreation time very few guidelines exist, leaving the wearer to access eye hazards for themselves.

Regardless of the decision about when to wear safety

eyewear, it remains essential in preventing 90% of eye injuries in Canada every year. Safety eyewear is simply the best and the last line of defence for protecting your eyes whether at work, at home or during recreational activities.

Eye safety neglected at home Most people consider their home a safe environment but unfortunately the potential for eye injury is as high at the home as in the workplace. Only 35% of individuals surveyed wear protective eyewear during home projects.

Hazards exist in the home with yard work, power tools, and chemicals being the top culprits.

Common injuries from at-home hazards include: • Metal or wood splinters when using power tools • Flash injury when welding • Foreign object or blunt force trauma during yard work • Chemical splash when cleaning • Mowers and trimmers propelling dirt and debris into the air

On July 1st, 2019 we launched the BC Safety Eyewear program allowing our members to source prescription safety eyewear through the BCDO EyeSafe program for these people. It is an easy to use online ordering system offering extremely competitive prices, whilst at the same time maximizing second pair sales and increasing practice profitability.

Eyesafe carries a full range of CAN / CSA - ANSI compliant eyewear products offering traditional safety eyewear, full seal frames, nonconductive safety frames and goggles as well as a comprehensive selection of compliant ophthalmic prescription lenses.

The Eyesafe and BC Safety Eyewear Programs For over 30 years the BCDO has been successfully operating a prescription safety eyewear program for companies throughout BC and has representation on the CSA Committee (Eye and Safety Protection Z94.3) in order to address any changes or amendments regarding Eye Safety within British Columbia and Canada.

Given that one of the main directives of the Association is to promote and educate people on eye health and eye safety it was a natural move to expand the existing Eyesafe program to allow members to dispense prescription safety glasses to people who are not part of the current Eyesafe program or are just wanting to purchase safety compliance eyewear for their own personal use.

In Fall 2019 we will also be introducing a range of full prescription CSA / ANSI compliant sunglasses.

Further details will follow in the BCDO Eyeliner updates.

For further details regarding a range of Eyesafe products and services to it’s members, please contact info@eyesafebc.ca or call 604-737-9947 Eye Digest Magazine | 25

Please visit the BCDO Member website for the Locum List info: https://members.optometrists.bc.ca/bcao/BCAOMember/Optomart/Locum_List.aspx 26 | Eye Digest Magazine

Are you interested in Locum work? . . .

Let us know!

BCDO has a “Locum List� of members interested in locum opportunities to assist members looking for short term work coverage.

If you are interested in locum opportunities, please provide us with your contact information: name, email, and phone number. When an opportunity becomes available, we will email our list of locum doctors with the details and those interested can connect directly with the member who posted the ad.

Please email info@optometrists.bc.ca if you would like to be added to the Locum List or if you are looking for locum coverage.

Eye Digest Magazine | 27

BCDO Events

CONTINUING EDUCATION AND COLLABORATIVE NETWORKING EVENT Continuing Education and Collaborative Networking Event at Terminal City Club in Vancouver.

Date: Wednesday November 20, 2019 Time: 6:30 PM – 7:30 PM Location: Terminal City Club, Metropolitan ballroom 837 W Hasting St, Vancouver, BC Total COPE CE credits: 1

An opportunity to engage, collaborate and network with local Ophthalmologists and Optometrists during an evening social gathering at the Terminal City Club.

Date: Wednesday November 20, 2019.

Time: 7:30 PM – 9:30 PM Location: Terminal City Club, Metropolitan ballroom 837 W Hasting St, Vancouver, BC 28 | Eye Digest Magazine

OKANAGAN/MAINLINE REGIONAL MEETING & CE Come and network with fellow optometrists in the Okanagan, while gaining CE credits! This event will feature a presentation on the changes to the MSP Agreement for BC optometrists, presented by BCDO President, Dr. Johnathan Lam. Dr. Peter Shaw will then present on binocular vision and vision therapy, and on innovations in vision care and the patient-optometrist dynamic.

Date: Sunday, November 24, 2019 Time: 4:00 PM – 8:00 PM Location: Four Points by Sheraton, Kelowna Airport 5505 Airport Way, Kelowna, BC Total COPE CE credits: 3

Eye Digest Magazine | 29

BCDO Events

NORTH ISLAND REGIONAL MEETING & CONTINUING EDUCATION Come out and connect with fellow optometrists in the area while earning 2 CE hours! Enjoy dinner, network with fellow optometrists and discuss dry eye treatment through the interactive course, Private Eye: Connecting the Dots in Dry Eye Disease, presented by Dr. Brad Genereux, OD. This innovative program is in a "game" format, based around stimulating discussion amongst peers.

Register today to secure your place!

Date: Monday, November 25, 2019 Time: 6:00 PM - 8:30 PM Location: Mahle House Restaurant 2104 Cedar Rd, Nanaimo, BC Total COPE CE credits: 2

30 | Eye Digest Magazine

GVOS/FVOA REGIONAL MEETING & CONTINUING EDUCATION Come out and connect with fellow optometrists while earning 1.5 CE hours! Enjoy dinner, network with fellow optometrists, and discuss dry eye treatment through the course, Envision: Treating Dry Eye Disease - New Solutions for the Present, presented by Dr. Matthew Bujak, MD. Space is limited, so register today to secure your place!

Date: Tuesday, November 26, 2019 Time: 6:00 PM - 8:00 PM Location: Tap Restaurant 101-15350 34 Avenue, Surrey, BC Total COPE CE credits: 1.5

BCDO 2020 ANNUAL CONFERENCE BC Doctors of Optometry’s 2020 Annual Conference & OPTOFAIR is a three-day continuing education, networking and professional development event for doctors of optometry and optometric staff. This is your opportunity to gain valuable and relevant insight and education into the optometric field.

Date: February 28 – March 1, 2020 Location: Hyatt Regency - 655 Burrard Street Vancouver, BC Eye Digest Magazine | 31

Dr. Shaun Golemba Member Spotlight 32 | Eye Digest Magazine

Eye Digest Magazine | 33

Dr. Shaun Golemba Port Alberni, BC BC Doctors of Optometry member Valley Vision Optometry 4009 Redford Street Port Alberni, BC V9Y 3R9

My educational path started at the University of Regina where I pursued a double major in Biology / Biochemistry. After three years, I gained admittance to the optometry program at the University of Waterloo. In my final year at UW, I had an invaluable externship experience at the Houston Eye Associates, a four-story private practice with 21 ophthalmologists and surgical centre. After convocation, I moved to Victoria to work as an associate in a private practice. Three months after that, optometry was de-insured

by MSP which sharply curtailed the available patients for me to see as the third and newest OD in my practice, so I had to be innovative. In the next four-year span, I built a practice from scratch with 3 other ODs and did locum work in Smithers, Cranbrook, and Prince George. I 34 | Eye Digest Magazine

enrolled in business classes at UVIC and learned Simply Accounting from my aunt, a bookkeeper for several dental practices in Regina. As much as I loved Victoria, my wife is a teacher, and there were no teaching jobs available. Literally a day after stating we needed a change, I got a call out of the blue from an OD in Port Alberni who had been practicing there since 1960. He was more than ready to move on. My wife and I decided to take a drive up and see what Port Alberni was all about. To our surprise, my wife was immediately hired by the school district and we fell in love with the city. Back in the 1970s, it was difficult to attract workers to the community, so the big employers of the day created incredible sporting facilities to attract families. This is why Port Alberni has so much more than cities of comparable size. Real

estate prices were so much lower than Victoria that we were able to buy a house 2.5x as large as our Victoria condo and have money left over for a down-payment on the practice. Since that time, we have created a dream practice, modelling a combination of the Houston Ophthalmology practice and the Smithers optometry practice, with four initial diagnostics rooms, four exam lanes, scribes, and maximum delegation. We have every optometric toy one could want and get daily referrals from local physicians, the urgent care clinic, and the emergency department from West Coast General Hospital. With a higher income and lower cost of operation, I no longer have to see patients 6 days/week and we have been able to enjoy life more: travel, hiking, cycling, motorbiking, snowboarding, surfing, and just hanging out with our kids and two pugs.

How do you define success?

Success means something totally different to each of us. To some, success may mean becoming a millionaire. It may mean a house in the country, or a 4-day work week, or staying healthy. Maybe it is retiring at age 55 - success is a personal thing. We all have to define what is important to us, create a goal, then work towards realizing those goals.

Who inspires you?

There are so many people I draw inspiration from – these are the first 4 I thought of:

• My wife, Shannon – she has been completely

selfless since I met her – offering unconditional love and support as I’ve worked on my professional growth. Once I get an associate, I plan to return the favour and give her the runway to work on her Masters in Education.

• My Director of Operations, Anita. She is currently being treated for a rare, aggressive form of breast cancer. She has maintained her positive, playful self and has taught me the importance of living in the moment and being

with family.

• My high school football coach, Kevin. He believed in me when I was nothing but a shy, scrawny Grade 8. Coached me on lifting weights and diet which lead to my big break in Grade 10 becoming the defensive captain.

• Steve Jobs. No personal connection, LOL, but I had to throw someone in here from pop culture. Despite being a total jerk, Steve had the uncanny ability to create the “Reality Distortion Field” – the ability to convince anyone of practically anything. He could see the future and get everyone else to see it too. Imagine what we could create in optometry with that ability.

What is something about you (a fun fact) that not many people know?

I am a classically trained pianist. In Grade 12, after obtaining my grade 8 examination in piano from the Royal Conservatory of Music, I had to decide whether to pursue an education in music or go for optometry. I chose the easy route and went for optometry.

What inspired you choosing optometry as your profession?

I had my first exam when I was 8 years old. As a typical 8 year old boy, I was fascinated by all of the opto-gadgets and coloured lights. That fascination never waned.

Why is being a member of BCDO important to you?

Optometry in BC would not exist in its current form if it were not for the dedicated ODs who have served for the BCDO. The financial benefits alone cover the costs of membership. Every OD in BC should be a member of the BCDO. Period.

What would you like to see BCDO accomplish in the next few years?

Eye Digest Magazine | 35

Just as we can bring up [programs] on the [Find a Doctor] section on the website, I would like to see the ability to bring up specialties: who can I refer to for scleral lenses? Vision Therapy? Low Vision?

teal – I remember tossing the package in the garbage and saying “there’s no way I’m going to move to the middle of nowhere to practice in Barbie’s Dreamhouse”.

What are the most rewarding aspects of your job?

After studying and practicing VT since 2006 and LV since 2015, I enjoy helping those patients who have been told by others “Nothing more can be done”. A couple months ago, I saw a fellow in my LV clinic who was hunched over, clutching to his cane on one side and his wife on the other. His wife had to physically take his hand to show him where the armrest was for the examination chair to get him seated. At the end of the exam, with his LV device, he got up out of his chair, stood upright and walked all around our office. It was a moment that induced tears – I love those moments.

Fast forward 14 years later and ironically, I now own that practice and working with Barbara Wright Design, have transformed Barbie’s dreamhouse into an office recognized by Review of Optometry for Best Renovation of an Existing Large Office. I have had the opportunity to speak all over Canada and five other countries, I own my own building, and have been able to create a practice I never could have had in a large city. I don’t get caught in the trap of keeping up with the Jones’ with things such as a $100,000 sports car because I commute to work on my bicycle through the rainforest. To fulfil my desire to drive fancy cars, I just rent them when I travel. I’m looking forward to driving the Tesla 3 I reserved for my trip to Nashville in November. Even if you don’t plan to stay in the rural community for the rest of your life, consider working there when you finish optometry school to accomplish two goals: 1) pay off your student loans quicker with the extra income and lower cost of living and 2) build the skills you will need to compete in the larger center you wish to eventually settle in. However, I think once you make the leap, you’ll realize there is a higher quality of life in the rural community.

What are 3 pieces of advice you have for New Grads entering the workforce?

1. You have to be prepared to pay the price if you want to succeed: I recently interviewed a potential associate who expected 8 weeks off and didn’t want to commit to more than a one-year contract. In Malcolm Gladwell’s The Outliers, he proposes that for anyone to become an expert, they need to put in 10,000 hours. For an Optometrist working 8 hours/day, 5 days/week, 48 weeks/year, that works out to just a little over 5 years.

Joining an established OD can help you get to that expert level. Once you have “paid the price” of your 10,000 hours and are making meaningful contributions to the practice, then it is appropriate to start making demands.

2. Consider moving to rural BC: I recall in my 4th year, feeling like quite a hot shot after returning from Houston, receiving a package in the mail for the Port Alberni practice I now own. At the time, the practice was pink & 36 | Eye Digest Magazine

3. Become Financially Literate: Read Rich Dad, Poor Dad, The Wealthy Barber, and Kevin O’Leary’s 3 books. Work hard, eliminate personal debt, buy investments to create passive income, repeat.

Dry Eye Management: Omega-3 & Omega-6 Fatty Acids Nature's Way Canada Background: In 2014 the National Dry Eye Disease Guidelines for Canadian optometrists included essential fatty acids as a long term management strategy for chronic dry eye alongside topical cyclosporine1.

More recently the Tear Film and Ocular Surface Society published the 2017 Dry Eye Workshop II (DEWS II)2. Their Management and Therapy report included a review of the research on the omega-3 fatty acids EPA and DHA as well as the omega-6 fatty acids GLA2. DEWSII listed oral essential fatty acid supplementation in Step 1 of their Staged Management & Treatment Recommendations for Dry Eye Disease further solidifying supplementation with essential fatty acids as an effective treatment management strategy2.

What are essential fatty acids?

Essential fatty acids are comprised of omega-3 and omega-6 fatty acids, which are physiologically distinct groups of fatty acids that are deemed “essential” – meaning we have to get them from

the diet for good health, as our bodies lack the enzymes to produce them3. Both omega-3 and omega-6 fatty acids are important components of the phospholipid bilayer of cells and compete for incorporation into the cellular membrane3.

Of the omega-3 fatty acids, there are 3 that stand out.

• ALA (alpha-linolenic acid) • EPA (eicosapentaenoic acid) • DHA (docosahexaenoic acid) ALA is found in greater quantities in green leafy vegetables and plant oils, including nuts and seeds such as walnuts and flaxseeds. While ALA is an omega-3 and technically the essential omega3, to provide the health benefits commonly associated with omega-3 it must be converted into the longer-chain EPA or DHA omega-3 fatty acids. Unfortunately, the human body isn't very efficient at converting ALA. Studies estimate that the conversion rate of ALA into EPA and DHA is about 5%4,5. This means that while foods Eye Digest Magazine | 37

like green leafy vegetables, nuts and seeds are healthy foods and sources of ALA, they are not very efficient at providing EPA and DHA due to this limited enzymatic conversion.

Direct sources of the omega-3 EPA and DHA include marine oils, such as fish oils and algal oils.

The vast majority of clinical research investigating supplementation with omega-3 fatty acids in dry eye use fish oil as the source for EPA and DHA in the intervention.

When it comes to omega-6 fatty acids, a common source is vegetable oil (eg. corn, sunflower, safflower) which contains linolenic acid (LA) which is then converted, through a number of steps, to arachidonic acid (AA)6. Eggs and animal fats are direct sources of arachidonic acid.

Gamma-linolenic acid (GLA) is a unique omega-6 fatty acids which is an intermediate between LA and AA. GLA is predominantly found in evening primrose, borage and black seed oils1.

The role of omega-3 and omega-6 fatty acids in the body: Omega-3 fatty acids (specifically EPA) and the omega 6 fatty acid arachidonic acid (AA) are parent compounds in the production of eicosanoids7.

The dietary intake of omega-3 and omega-6 fatty acids impacts the type of eicosanoids produced, with those resulting from the omega-3 being associated with an anti-inflammatory effect and those from AA being associated with a pro-inflammatory effect7. It is important to note that both omega-3 and omega-6 are essential, thus both are required, and it is the balance of the two that plays a role in which state predominates.

Nutritional research suggests that a dietary ratio of omega-3 to omega-6 is 1:1 to 1:4, which is believed to be what historically was consumed dating back to paleolithic times is thought to be ideal7.

The Western diet has changed significantly from 38 | Eye Digest Magazine

the diet of our ancestors with significantly higher amounts of omega-6 being consumed leading to estimates of an omega-3 to 6 ratio today that is 15- 20 : 1 instead of the more ideal 1:1 or 1:67.

Because of this it has even been suggested that the Western diet is “deficient” in omega-3 fatty acids78. This is why much research focuses on the supplementation of the omega-3 fatty acids EPA and DHA to help restore this systemic balance and ultimately impact the physiological state from the downstream effects of these essential fatty acids, this premise also applies to dry eye6.

What about the dry eye recommendations for essential fatty acids, including omega-6?

Given the above synopsis of omega-3 and omega-6 fatty acids it may seem counterintuitive that the National Dry Eye Disease Guidelines as well as DEWSII recommends essential fatty acids, which include omega-6 as management strategies for dry eye.

As highlighted in the National Dry Eye Disease guidelines, a specific omega-6 fatty acid stands out, gamma-linolenic acid (GLA)1. What makes this omega-6 fatty acid unique is that like the omega-3 fatty acids EPA and DHA it can elicit anti-inflammatory properties which in fact are different than those from EPA and DHA and can have positive effects in the body, including in dry eye19. The recommendations go further to highlight that GLA be combined with a minimum ratio of 1:1 with the omega-3 fatty acids EPA and DHA1. Clinical research showed that when the three fatty acids (EPA and DHA and the omega-6 GLA) were combined, the combination “ may be utilized to reduce the synthesis of proinflammatory AA metabolites, and importantly, not induce potentially harmful increases in serum AA levels (which was seen when GLA was administered on its own)”9. The mechanism of action that has been suggested for this by in vivo and in vitro studies is that EPA may act as an inhibitor of delta-5 desaturase enzyme, thereby reducing the

production of AA9.

There have been numerous clinical studies conducted investigating the omega-6 GLA in dry eye, with dosages ranging from 15 to 420 mg 10–15.

As highlighted in the National Dry Eye Guidelines: “In the presence of EPA/DHA, GLA has been shown to have significant anti-inflammatory properties and to be effective in dry eye with an inflammatory component”1. Clinical research has investigated its effect with promising results in contact lens associated dry eye, post refractory surgery dry eye, dry eye associated with Meibomian gland dysfunction, keratoconjunctivitis sicca (KCS) associated with sjorgens syndrome and improve the signs and symptoms of moderate to severe KCS with inflammatory components1,10,13,14,16–18 A recent (2017) systematic review and meta-analysis on the efficacy of nutritional supplementation with omega-3 and omega-6 fatty acids in dry eye syndrome concluded, similarly to the National Dry Eye Guidelines, that while omega-3 fatty acids should be the main component of oral supplements it may be combined with lower amounts of omega-615.

Given the significant increase in research showing positive results with supplementation of essential fatty acids in dry eye and their inclusion in dry eye management guidelines, while there is still more research to be done to determine an ideal dosage ranges and ratios there is little doubt that essential fatty acids (including the omega-3 fatty acids EPA and DHA and the omega-6 fatty acid GLA) are now an accepted and effective mainstream management option for dry eye.

References: 1. Prokopich L. National Dry Eye Disease Guidelines for Canadian Optometrists. Can J Optomtry. 2014;76(Suppl. 1):131. https://opto.ca/sites/default/files/resources/documents/ cjo_dry_eye_supplement_2014.pdf.

2. Jones L, Downie LE, Korb D, et al. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017;15(3):575628. doi:10.1016/j.jtos.2017.05.006.

omega-6/omega-3 ratio and the brain. Mol Neurobiol.

2011;44(3):203-215. doi:10.1007/s12035-010-8162-0.

4. Plourde M, Cunnane SC. Extremely limited synthesis of long chain polyunsaturates in adults: implications for their dietary essentiality and use as supplements. Appl Physiol Nutr Metab. 2007. doi:10.1139/H07-034.

5. Thomas Brenna J, to Brenna CJ. Efficiency of conversion of a a-linolenic acid to long chain n-3 fatty acids in man. 1363.

6. Jones L, Downie LE, Korb D, et al. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017;15(3):575628. doi:10.1016/j.jtos.2017.05.006.

7. Simopoulos AP. The importance of the ratio of omega-6/ omega-3 essential fatty acids. Biomed Pharmacother.

2002;56(8):365-379. doi:10.1016/S0753-3322(02)00253-6.

8. Barabino S, Horwath-Winter J, Messmer EM, Rolando M, Aragona P, Kinoshita S. The role of systemic and topical fatty acids for dry eye treatment. Prog Retin Eye Res. 2017;61:2334. doi:10.1016/j.preteyeres.2017.05.003.

9. Barham JB, Edens MB, Fonteh AN, Johnson MM, Easter L, Chilton FH. Addition of eicosapentaenoic acid to gammalinolenic acid-supplemented diets prevents serum arachidonic acid accumulation in humans. J Nutr. 2000;130(8):1925-1931. http://www.ncbi.nlm.nih.gov/pubmed/10917903. Accessed December 21, 2017.

10. Brignole-Baudouin F, Baudouin C, Aragona P, et al. A multicentre, double-masked, randomized, controlled trial assessing the effect of oral supplementation of omega-3 and omega-6 fatty acids on a conjunctival inflammatory marker in dry eye patients. Acta Ophthalmol. 2011;89(7):591-598. doi:10.1111/j.1755-3768.2011.02196.x.

11. Jackson MA, Burrell K, Gaddie IB, Richardson SD. Efficacy of a new prescription-only medical food supplement in alleviating signs and symptoms of dry eye, with or without concomitant cyclosporine A. Clin Ophthalmol. 2011;5(1):12011206. doi:10.2147/OPTH.S22647.

12. Barabino S, Rolando M, Camicione P, et al. Systemic linoleic and gamma-linolenic acid therapy in dry eye syndrome with an inflammatory component. Cornea. 2003;22(2):97-101. doi:10.1111/j.1467-8470.1988.tb00584.x.

13.

Aragona P, Bucolo C, Spinella R, Giuffrida S, Ferreri G. Systemic omega-6 essential fatty acid treatment and PGE1 tear content in Sjögren’s syndrome patients. Investig Ophthalmol Vis Sci. 2005;46(12):4474-4479. doi:10.1167/ iovs.04-1394.

14.

Kokke KH, Morris JA, Lawrenson JG. Oral omega-6 essential fatty acid treatment in contact lens associated dry eye. Contact Lens Anterior Eye. 2008;31(3):141-146. doi:10.1016/j.clae.2007.12.001.

15.

Molina-Leyva I, Molina-Leyva A, Bueno-Cavanillas A. Efficacy of nutritional supplementation with omega-3 and omega-6 fatty acids in dry eye syndrome: a systematic review of randomized clinical trials. Acta Ophthalmol.

2017;95(8):e677-e685. doi:10.1111/aos.13428.

16. Pinna A, Piccinini P, Carta F. Effect of Oral Linoleic and γ-Linolenic Acid on Meibomian Gland Dysfunction. Cornea.

2007;26(3):260-264. doi:10.1097/ICO.0b013e318033d79b.

17. Macrì A, Giuffrida S, Amico V, Iester M, Traverso CE. Effect of linoleic acid and γ-linolenic acid on tear production, tear clearance and on the ocular surface after photorefractive keratectomy. Graefe’s Arch Clin Exp Ophthalmol.

2003;241(7):561-566. doi:10.1007/s00417-003-0685-x.

18.

Sheppard JD, Singh R, McClellan AJ, et al. Long-term Supplementation With n-6 and n-3 PUFAs Improves Moderate-to-Severe Keratoconjunctivitis Sicca. Cornea.

2013;32(10):1297-1304. doi:10.1097/ICO.0b013e318299549c.

3.

Simopoulos AP. Evolutionary aspects of Diet: The

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40 | Eye Digest Magazine

Eye Digest Magazine | 41

Understanding the Role of Rheology in Determining Efficacy of Eye Drops

Fig. 1 - Graphical Representation of Newtonian and Non-Newtonian Fluids*

Fig. 2 - Actual Measurements of Commercially Available Artificial Tears*

The most effective and longest-lasting artificial tears exhibit Non-Newtonian behaviour as illustrated above in Figure 1. Non-Newtonian behaviour depends heavily on the composition but also on the chain length of the biopolymer in the solution that is delivered to the surface of the cornea. Practically, this means that tears with the same concentration (i.e. 0.15%) of a biopolymer, such as hyaluronan, can result in products of greatly varying efficacy.

is because products that exhibit Newtonian behaviours require more frequent applications, cause blurring at increased concentrations and cause discomfort for the patients. They will also be eliminated quickly from the corneal surface by the blinking action of the eye lids.

There is ample scientific literature that proves that artificial tears exhibiting a high η0 and low η∞ of Non-Newtonian fluids, will provide the longest lasting, most comfortable and most effective relief for patients suffering from the symptoms of dry eye disease (DED). This

It is clear from these rheological profiles of the five (5) commercial products presented in this graph that both I-DROP® MGD and I-DROP® PUR exhibit Non-Newtonian behaviours which will translate to more comfort, fewer applications and more effective relief from symptoms of DED than Thealoz®, Thelaoz® DUO and Hyabak® which exhibit Newtonian behaviours.

I-DROP® MGD • I-DROP® MGD is a premium, preservative-free, artificial tear that helps relieve symptoms associated with evaporative dry eye. It is the most advanced eye drop for hydrating and lubricating the cornea.

• The formulation contains superior osmoprotectants that stabilize and enhance the lipid layer, while reducing evaporation of the tear film.

• This unique formulation offers the patient unparalleled ocular hydration and comfort. It is a long-lasting artificial tear that re-coats the the eye with every blink, resulting in a lower therapy cost to the patient with fewer daily applications.

42 surface | EyeofDigest Magazine • I-DROP® MGD is available in a sterile, multi-dose bottle with a sophisticated one-way valve and air-return system that delivers one sterile-dosed drop at a time.

Take

technology to another level

at Telus World of Science!

Take a flight with Birdly features an amazing virtual reality experience that will keep you wanting more. This flight sensory simulator will electrify your body’s sensation as you fly through the skies.

Time: Mon–Fri: 2pm–5pm Sat–Sun: 10am–6pm Location:

147cm tall, and have a wingspan of 53” or 134cm. Check your wings here before purchasing a flight.

• Birdly is able to support up to 180kg/395lbs for a safe flight.

• Please do not use Birdly if you have any medical issues that could pose a risk to your health. Flying can result in dizziness and discomfort for those not accustomed to flight.

• A parent or guardian must be present for their child to fly.

1455 Quebec St, Vancouver, BC Website: Flight rules: • To fly safely, fledglings must stand 58” or

https://www.scienceworld.ca/take-flight-birdly®

Eye Digest Magazine | 43

44 | Eye Digest Magazine

Holiday To Do’s 2019 Let the holiday spirit surround you…

The seasonal celebrations across British Columbia are wonderful ways for families to make memories. Whether you’re seeking festive events or other ways to have fun in the cold, we’ve got you covered with our neat winter list. Check out all these incredible seasonal celebrations.

Visit each venue’s website for more information, travel directions, hours of operation, ticket prices, accessibility, and other amenities.

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Greater Vancouver & Fraser Valley 1. Holiday at the Elbow Room Café Date: December 10-29, 2019 Location: Zee-Zee Theatre - 1895 Venables St, Vancouver Website: https://thecultch.com/events/holiday-at-the-elbow-room-cafe/ 2. Vancouver Christmas Market Date: December 14th, 2019 Location: Jack Poole Plaza - 1055 Canada Pl, Vancouver Website: https://www.vancouverchristmasmarket.com/-2019/ 3. A Traditional Christmas Date: December 22, 2019 Location: Orpheum Theatre - 601 Smithe St. Vancouver Website: https://www.tourismvancouver.com/event/a-traditional-christmas/19693/ 4. Disney on Ice: Mickey’s Search Party Date: November 28 to December 1 Location: Pacific Coliseum - 2901 E Hastings St. Vancouver Website: https://www.vancouver-theatre.com/index_disney.php 5. Cirque Du Soleil – Luzia in Vancouver Date: Ongoing until December 29, 2019 Location: 88 Pacific Boulevard, Vancouver Website: https://www.cirquedusoleil.com/luzi

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Greater Vancouver & Fraser Valley 6. Whistler Holiday Experience Date: December 21, 2019 – January 5, 2020 Location: Whistler Conference Centre - 4010 Whistler Way, Whistler Website: https://artswhistler.com/event/whistler-holiday-experience 7. Art After Dark: Carr Trees for the Holidays – Glass Etching Date: December 20, 2019 Location: Audain Art Museum – 4350 Blackcomb Way, Whistler Website: https://artswhistler.com/event/art-after-dark-carr-trees-for-the-holidaysglass-etching?instance_id=87061 8. Whistler Pride and Ski Festival Date: January 26 – February 2, 2020 Location: Aava Whistler Hotel – 4005 Whistler Way, Whistler Website: https://www.whistlerpride.com/events-whistler-pride-and-ski-festival/

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Lower & Upper Vancouver Island 9. Vancouver Island Market Date: December 12 to December 15 Location: Nanaimo North Town Centre - 4750 Rutherford Road, Nanaimo Website: https://www.vancouverislandmarket.com/ 10. The Magic of Christmas Date: December 1 to January 6, 2019 Location: Butchart Gardens – 800 Benvenuto Avenue, Brentwood Bay Website: https://www.butchartgardens.com/christmas/ 11. Yellowpoint Christmas Spectacular Date: December 14 to December 15 Location: McPherson Playhouse - #3 Centennial Square, Victoria Website: http://www.yellowpointchristmasspectacular.ca/

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Northern & Interior 12. The Nutcracker Date: December 19 to December 22 Location: 2901 Griffiths Ave., Prince George Website: https://tourismpg.com/events/judy-russell-presents-thenutcracker-6856 13. Celebration of Lights 2019 Date: December 18 to December 23 Location: Central BC Railway and Forestry Museum – 850 River Road, Prince George Website: https://tourismpg.com/events/celebration-of-lights-4542

Central Okanagan & Kootenay 14. Holiday Artisan Market Date: December 7, 8, 14 and 15 Address: The Sun Peaks Grand and Conference Centre – 3240 Village Way, Sun Peaks Website: https://www.sunpeaksresort.com/events-things-to-do/ events/holiday-artisan-market-1

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