Boston XO2® is everything you love about Boston XO® lens material + hyper Dk.
At 141 Dk, Boston XO2® provides even higher oxygen delivery than Boston XO.® Having these two material choices available offers you:
More Flexibility
Accommodates lens designs for common vision conditions, as well as demanding visual needs such as keratoconus and ocular surface disease.
More Peace of Mind
Backed by the exceptional service and support you’d expect from a company that’s been around since 1853.
More Confidence
All our lens materials are precision manufactured by experienced technicians followed by rigorous quality control.
While it features even higher oxygen delivery than Boston XO®, Boston XO2® is still precision manufactured by experienced technicians and undergoes the same rigorous quality control— all backed by exceptional Bausch + Lomb service and support.
Visit www.fit-boston.eu or contact your authorized Boston® Lab.
Visit bostonlensmaterial.com or contact your authorized Boston Lab.
Last year, around 8.3% of cyber-attacks were on companies worldwide. Te largest share of phishing attacks during the period of the survey, at around 16.5%, was on global internet portals*. Attackers use the "human factor" as a gateway for attacks on companies, authorities and other institutions. Especially in the case of phishing, the human factor is the weakest link in the security chain. So, cybercriminals try to manipulate people and, in this way, install malware or gain access to sensitive data.
In addition to phishing attacks, infection with malware is the biggest threat for companies and a multitude of new malware variants are added every day. Tese are particularly dangerous because they have not yet been identifed as malicious programs and are rarely detected. Furthermore, attackers use critical vulnerabilities in sofware products, distributed denial-of-service attacks, in which the attacker foods a server with internet trafc to prevent users from accessing connected online services and sites. And of course, good old ransomware is also a threat.
Everyone knows by now that algorithms are largely responsible for search results on the world wide web. But did you know that even comments made on social media are fltered diferently depending on the user? Or that up to one in ten random posts, according to some estimates, may come from foreign governments trying to infuence our opinion?
Te increasing digitalization and use of artifcial intelligence (AI) ofers many advantages for companies and individuals. However, the networked world also has its downsides, as it ofers hackers around the world the opportunity to cause chaos and interrupt supply chains remotely. AI in particular is increasingly being used by criminals to automate attacks, disguise them and maximize their chances of success.
Stay alert
Te most frequent victims of cyber-attacks are in economically well-developed countries, particularly the United States and Western Europe, for example Germany and the United Kingdom. Tis is because of the high availability of lucrative targets such as companies, research institutions and government agencies. Emerging markets are also increasingly afected due to the inadequate security measures that are ofen in place there.
How to protect yourself against this – and why every single company should contribute to protecting the global infrastructure from hackers – is the subject of part 1 of the series on cyber security, starting at page 44.
But that's not all: in this issue, we look at the wettability of RGPs. Martin Conway and Mark Eddleston draw our attention to the various factors that need to be considered here.
One condition that will afect all of us sooner or later is presbyopia. And even if not everyone can report from their own experience yet (I can now!), the latest facts are interesting. In this issue, Eef van der Worp begins by taking a close look at the current state of knowledge on the subject.
All this and much more awaits you on the following pages. ■
*Statista
SAGE Editor-In-Chief silke@global-cl.com
In the breathtaking north we find close to Oslo together the visions of tomorrow. The 51th EFCLIN Congress & Exhibition takes place there from 10th – 12th April 2025. For an engaging lecture program, EFCLIN forum and the best trade exhibition in the business, it can’t be beaten. It’s where the Contact Lens & IOL Industry from Europe, the Far East, North America and beyond come together… will you be there?
INDEX TO ADVERTISERS
Title: Contamac, www.contamac.com
Inside front cover: Bausch + Lomb Inc., www.bausch.com
Page 27, Outside back cover: DAC International, Inc., www.dac-intl.com
Page 31: LAMBDA-X S.A., www.lambda-x.com
NAMES TO NOTE
Bischof, Uwe 32 Capasso, Domenico 50 Conway, Martin 14
Eddleston, Mark 14
Gharbieh, Nabil 44
Jonske, Corinna 32
Larsen, Erik 22
Lingelbach, Bernd 40 Petzold, Lena 24 van der Worp, Eef 28
LETTER FROM THE EDITOR
3 Stay alert Silke Sage
INTERNATIONAL NEWS
6 All about you
11 All about products
12 All about research
38 All about markets
TECHNOLOGY
14 Te wettability of RGP contact lenses Martin Conway and Mark Eddleston
18 Chemical plastics recycling
20 Spiral-shaped optics
MANUFACTURING
22 Time, errors, productivity, & proft: Decisions, decisions! Pt. 2 Erik Larsen
REPORT
24 Barcelona in focus: 42nd ESCRS Congress Lena Petzold
26 Achromatopsia on Pingelap Island Silke Sage
FITTING BACKGROUND
28 Presbyopinion: Part I: Def nition & mechanism Eef van der Worp
32 A dialogue: Mini scleral lenses Uwe Bischof & Corinna Jonske
36 Red light treatment in myopia management Rebekka Nurkanovic
VISUAL PERCEPTION
40 Te Ouchi Illusion Bernd Lingelbach
HISTORY
42 Pioneers of ophthalmic optics: Heinrich Meibom
BUSINESS & MARKETING
44 Security training in the supply chain – pt. 1
MAGAZINE
48 Yellow Pages
50 Closing words: Domenico Capasso
All about you
Wöhlk Contactlinsen receives MDR certifcate
Wöhlk Contactlinsen GmbH has received the MDR certificate. The European Medical Device Regulation (MDR; Regulation 2017/745) has been in force since May 2021, replacing the two previous European medical device directives MDD and AIMDD. The certification was a real feat of strength for the medium-sized company: The MDR requires a full recertification of all existing products (legacy products), some of which have been on the market for years, to ensure that they meet the increased regulatory requirements of this new regulation.
“The certification process was preceded by a fundamental analysis: Which products could be included in the MDR?
Which contact lenses did Wöhlk have to consolidate with a heavy heart for business reasons, even if they were niche products such as the colored Sport Contrast, which did not
exist on the market in this form a second time?” explains Dirk Reschat, Head of Quality Management and Regulatory Affairs at Wöhlk Contactlinsen. “The effort involved in obtaining this certificate was enormous: we had to expand and train our QM department, use external services such as toxicological tests in laboratories and meet various technical and administrative requirements. This can only be achieved with a good strategy and an excellent team.”
The certification has one major advantage: the contact lens manufacturer from Schönkirchen can now approve new products on the market again. “This is particularly important for our company, which has its own material production, research and development facilities,” explains Hiroko Aikawa, Managing Director of Wöhlk Contactlinsen. “We are proud and happy to be one of the first companies in our industry to receive this certificate. Our strength has always been to respond to customer wishes. Our aim is to once again present new and further developments of individual contact lenses on the market. Our customers can now look forward to new products from Wöhlk in the near future.”
Bausch + Lomb receives FDA approval for full range
of vision IOL
Bausch + Lomb Corporation has announced that the U.S. Food and Drug Administration has approved the enVista Envy full range of vision intraocular lens (IOL). According to the company, the IOL offers a continuous range of vision with excellent dysphotopsia tolerance on the enVista IOL platform.
“We’re confident that U.S. surgeons will agree with what their Canadian colleagues have already told us: enVista Envy delivers exceptional outcomes and meets cataract patients’ high expectations, as well as their own,” said Anthony Wallace, Vice President and General Manager, U.S. Surgical, Bausch + Lomb.
A multicenter, randomized and controlled clinical trial evaluating 332 subjects demonstrated excellent long-term outcomes with the enVista Envy IOL in the U.S. On average, 86% of patients reported little to no bothersomeness for dysphotopsia (glare, halo, starbursts), showing an impressive tolerance profile overall.1
In a Canadian clinical study evaluating 110 subjects, 94% of patients reported little to no difficulty viewing close objects, and
93% were completely to moderately satisfied with their vision post-surgery.2
The company says that Envy delivers outstanding performance in all lighting conditions thanks to ActivSync Optic intelligent energy distribution, which optimizes vision in many lighting conditions and that the IOL also enables surgeons to treat a wider range of astigmatic patients with more accuracy and precision with 0.5D steps (or less) throughout the cylinder range.
“I’ve long trusted the enVista platform to deliver excellent outcomes for my cataract patients,” said Alice Epitropoulos, MD, Ophthalmic Surgeons & Consultants of Ohio and principal investigator in the Phase 3 U.S. clinical trial.
The new IOLs will be commercially available in the U.S. on a limited basis in 2024 and more broadly in 2025. Bausch + Lomb is also in the process of seeking regulatory approvals for the lens in additional markets.
1 Data on fle. enVista Envy U.S. Clinical Study.
2 Data on fle. enVista Envy Canadian Clinical Study.
Investment company becomes new owner of Hecht
Hecht Contactlinsen GmbH from Au near Freiburg, Germany, which has been owner-managed for 46 years, has completed an eight-month process: In future, the manufacturer of custom-made, RGP and sof contact lenses will be majority-owned by Novum Capital, an owner-managed investment company from Frankfurt am Main, Germany. Hecht describes the change of ownership as “an important prerequisite for continuity, delivery capability, innovation and growth beyond the generational change”.
Te previous managing partner Stefan Muckenhirn (57) will retain a minority share in the company founded by his father Dieter Muckenhirn in 1978 and will remain managing director.
Bernhard Steiert (58), son of an early Hecht shareholder and
Menicon acquired shares of distributors owned by Oculus Contact Lens in Southeast Asia
Menicon announced that it acquired 100% of the shares and ownership of three distributors in Southeast Asia from Oculus Pte Ltd., a contact lens manufacturer and distributor headquartered in Singapore.
Oculus manufactures and distributes contact lenses primarily in Southeast Asia. According to Menicon, particularly, its
managing partner, is stepping down as managing director. Stefan Muckenhirn comments: “As commercial director, Bernhard Steiert has played a decisive role in shaping the great success of Hecht Contactlinsen GmbH over many years with his exceptional management expertise and in-depth industry experience and has led the company to a high level of proftability. I would like to thank him wholeheartedly for this and am delighted that he will remain associated with the company in an advisory capacity.”
Like Stefan Muckenhirn, the previous managing director Frank Widmer (63) will remain active as managing director. He comments: “I would also like to thank Bernhard Steiert very much for his outstanding and highly competent commitment over many years. Te task of the management team remains to continue to be a reliable, innovative partner for optical businesses, practices and clinics that ft individual contact lenses with our staf and our products.”
Beatrice Dreyfus, Partner at Novum Capital, says: “Hecht is a hidden champion that also has great potential in other European countries. We will support the company's growth with business expertise, fnancial resources, and genuine passion. Tis will strengthen the home base in Au as well as the subsidiaries in Germany, Switzerland, and Spain.”
Stefan Muckenhirn adds: “I am convinced that in Novum Capital, the management team has found an investment company that is ideally suited to Hecht's potential. We are delighted about this milestone in the company's history and are looking forward to a future full of new opportunities.”
FreshKon brand, which features colored contact lenses, has a high brand recognition with strong sales network of more than 2,000 stores.
Before this acquisition of shares, Menicon expanded its sales in Southeast Asia through exports and sales agents. The company reports that it has achieved establishment of both sales and production bases in Southeast Asia acquisition of shares and expects this to boost growth of the Group in this region.
New executive director at Optometry Giving Sight
Optometry Giving Sight (OGS) is pleased to announce that Donna J. Mikulecky, CPA, has accepted the organization’s executive director position. She replaces retiring executive director Lois Schoenbrun, FAAO, who has served in the role since April 2022. Mikulecky has more than 25 years of experience leading healthcare organizations, most recently as chief operating officer of Vision Source. Until her appointment as executive director, she served as treasurer of OGS’s U.S. and Canada Boards of Directors.
“I’ve had the pleasure of serving with Donna for the last several years,” says U.S. board chair, Dr. Juan Carlos Aragón. “As a board member, she has been committed to our mission and a very valued colleague. I look forward to working with her in her new role.” “She has the skills and experience to lead us forward,” adds Canada board chair Dr. Susan Cooper. “With Donna’s passion, business acumen, and industry knowledge, OGS will continue to invest in the international development of optometry to provide sustainable primary vision care to those in need.”
BostonSight held annual FitAcademy retreat
BostonSight held their annual FitAcademy retreat at New England College of Optometry (NECO) in Boston, September 13-14, 2024. This year marked the sixth iteration of the educational retreat for cornea and contact lens residents and fellows at schools and colleges of optometry and accredited fellowship sites throughout the United States and Canada.
FitAcademy was held at NECO’s Clinical Training Center, where residents learned about scleral lens fitting and assessment, how to manage and co-manage a range of corneal and ocular surface disorders, including dry eye disease and keratoconus, managing the scleral lens patient Beyond the Fit (a staple of FitAcademy programs), and scleral lens application and removal techniques. The retreat’s intimate setting also provides residents and fellows
a unique opportunity to collaborate with fellow clinicians, strengthening their professional connections as they begin their careers.
This year, 31 cornea and contact lens residents attended the event, which included hands-on wet lab training. Thanks to funding from BostonSight and support from sponsors, students attend FitAcademy for free. “We are incredibly grateful for our sponsors: NECO, Glaukos Corporation, Contamac, and Tangible Science,” said Karen G. Carrasquillo, OD, PhD, FAAO, FSLS, FBCLA, BostonSight’s Senior VP of Clinical and Professional Affairs and director of the FitAcademy program. “We have seen their continued support year after year and are pleased that they, too, see the value of providing scleral lens education to eye doctors seeking specialization in their careers.”
UPC EVO
MOST VERSATILE FREEFORM MANUFACTURING –POLISH-FREE
The multifunctional UPC Evo processes a variety of custom-fit premium designs for contact lenses, IOLs, and even molds with great accuracy and productivity. It off ers the highest flexibility thanks to its modular design.
It can be fitted with a fast scan-head-based CO2 laser engraving system or a milling spindle for haptics of any shape, with the highest precision. Even an integrated automation option is part of the extensive possibilities. The sophisticated design features all the key aspects to generate high form accuracy and superb polish-free results – a rigid base, fluidic bearings, smooth running motors, and high performance motion controllers. The onboard Fast Tool carries four tools and off ers the ideal conditions for freeform lens generation.
The UPC Evo meets that sweet spot where high-quality and performance is complimented by a compact design and an economic price.
Founder Dieter Muckenhirn dies at 81: Mourning for a
great personality
Dieter Muckenhirn is considered the inventor of the aspherical contact lens. Together with partners, he founded Hecht Contactlinsen GmbH in 1978. He passed away on November 5. The management and employees of the contact lens manufacturer bid him farewell in an obituary.
“It is with deep regret that we bid farewell to Dieter Muckenhirn, the founder and visionary head of Hecht, who passed away on November 5, 2024 at the age of 81. With his unique idea of the individual contact lens “Ascon”, he not only founded a company, but also shaped an industry.
He was more than just an entrepreneur; he was a passionate innovator who guided Hecht's fortunes with passion and tireless commitment for decades. His unshakeable belief in the power of ideas and his ability to inspire people made him an indispensable driving force for our company and the entire industry.
His approachability, his ability to listen and his way of leading the company made him a valued leader and mentor. With gratitude and respect, we bid farewell to an exceptional person whose vision and passion will continue to guide us.”
The management and employees of Hecht Contactlinsen GmbH
Nov 23-24 Rome (Italy)
Nov 26 online
Jan 15-18 Las Vegas, NV (USA)
Apr 10-12 Lillestrom, Oslo (Norway)
May 4-8 Salt Lake City, UT (USA),
May 16-18
Ljublijana (Slovenia)
Jun 5-7 Birmingham (UK)
Jun 20-21 Charlotte, NC (USA)
Oct 8-11 Boston, MA (US)
Oct 1-3 Tokyo (Japan)
Oct 22-25
West Palm Beach, FL (USA)
All about products
Contamac: Proven Products, Leading Brands
Contamac’s website has been updated and designed to provide customers with an enhanced user experience. With a more user-friendly interface, enriched content, and improved navigation, it provides visitors with seamless access to the resources they need. Alongside the complete range of contact lens and intraocular lens materials, the website now includes Global Insight, Contamac's digital publication. Alongside the website launch, Contamac released a refreshed look to its familiar product logos. T is transformation brings greater alignment to the Contamac brand, and to that of our industry partners. Visit www.contamac.com to see more.
All about products
Matrix: A 4-in-1 Metrology System for IOL Production by Lambda-X Ophthalmics
NIMO Matrix: A 4-in-1 Metrology System for IOL Production by Lambda-X Ophthalmics
Matrix by Lambda-X Ophthalmics is an advanced 4-in-1 metrology system streamline and enhance quality control for intraocular lenses. It integrates optical Modulation Transfer Function (MTF), dimension, and thickness measurements into a fully automated system that can test up to 300 lenses per hour. operator-independent design ensures consistent, accurate results, while signifcantly reducing costs. Fully customizable to meet manufacturers’ needs, the NIMO Matrix boosts improves production fow, enhances quality control, and ensures traceability production process.
Te NIMO Matrix by Lambda-X Ophthalmics is an advanced 4-in-1 metrology system designed to streamline and enhance quality control for intraocular lenses. It integrates optical power, Modulation Transfer Function (MTF), dimension, and thickness measurements into a single, fully automated system that can test up to 300 lenses per hour. Te operator-independent design ensures consistent, accurate results, while signi fcantly reducing inspection costs. Fully customizable to meet manufacturers’ needs, the NIMO Matrix boosts productivity, improves production fow, enhances quality control, and ensures traceability across the production process. www.ophthalmics.lambda-x.com – sales-ophthalmics@lambda-x.com
All about research
Bioplastics, healing corneal wounds
Washington University in St. Louis reports two studies on purple bacteria that can produce natural polymers. A University of Waterloo team has developed a contact lens material that could act as a bandage for corneal wounds while releasing drugs in a controlled manner to help the eye heal faster. By Rebekka
Nurkanovic
Turning bacteria into bioplastic factories
Washington University in St. Louis, USA, reports two studies on purple bacteria that can produce natural polymers. A study led by graduate student Eric Conners found that two relatively obscure species of purple bacteria can produce polyhydroxyalkanoates (PHAs), natural polymers that can be purifed to make plastic. Another study led by research lab supervisor Tahina Ranaivoarisoa showed that genetic engineering could coax a well-studied but notoriously stubborn species of purple bacteria to dramatically ramp up its production of PHAs. Conners and Ranaivoarisoa work in the lab of Arpita Bose, an associate professor of biology in Arts & Sciences and corresponding author of the new studies.
“Tere’s a huge global demand for bioplastics,” Bose said. “Tey can be produced without adding CO2 to the atmosphere and are completely biodegradable. Tese two studies show the importance of taking multiple approaches to f nding new ways to produce this valuable material.”
Purple bacteria are a special group of aquatic microbes renowned for their adaptability and ability to create useful compounds from simple ingredients. Like green plants and some other bacteria, they can turn carbon dioxide into food using energy from the sun. But instead of green chlorophyll, they use other pigments to capture sunlight. Te bacteria naturally produce
Two studies by WashU biologists shed light on purple bacteria as a potential source of bioplastics. Picture: Joe Angeles / WashU
PHAs and other building blocks of bioplastics to store extra carbon. Under the right conditions, they can keep producing those polymers indefnitely.
As the WashU biologists reported in Microbial Biotechnology1, two little-known species of purple bacteria in the genus Rhodomicrobium showed a remarkable willingness to produce polymers, especially when energized with small amounts of electricity and nourished with nitrogen. Rhodomicrobium bacteria have unusual properties that make them intriguing contenders as natural bioplastic factories. While some species foat around cultures as individual cells, this genus forms interconnected networks that seem especially well-equipped to produce PHA. Other types of bacteria can also produce bioplastic polymers with some help. As reported in Applied and Environmental Microbiology2, the WashU researchers used genetic engineering to coax high levels of PHAs out of Rhodopseudomonas palustris
Healing eyes with contact lenses
A cross-disciplinary team at the University of Waterloo, Canada, has developed a new contact lens material that could act as a bandage for corneal wounds while releasing drugs in a controlled manner to help the eye heal faster. Typically, corneal abrasion patients spend seven to ten days wearing a clear, oxygen-permeable bandage contact lens, ofen instilled with eyedrops containing antibiotics. However, the one-time antibiotic application makes it difcult to ensure enough drugs stay on the eye for sustained treatment.
“It’s a targeted-release drug delivery system that is responsive to the body,” said Dr. Lyndon Jones, a professor at Waterloo’s School of Optometry & Vision Science and director of the Centre for Ocular Research & Education (CORE). “ Te more injured you are, the more drug gets delivered, which is unique and potentially a game changer.”
Jones knew there was a market for a drug-delivering bandage contact lens that could simultaneously treat the eye and allow it to heal. Te question was how to develop it.
As the University of Waterloo has several researchers and entrepreneurs building technology to disrupt the boundaries of health, Jones was able to team up with Dr. Susmita Bose (PhD’23), Dr. Chau-Minh Phan (PhD’16) and Dr. Evelyn Yim, an associate professor of chemical engineering working on collagen-based materials. Rounding out the team were Dr. Muhammad Rizwan, a former postdoctoral fellow, and John Waylon Tse (MASc’18), a former graduate student, both with Yim’s lab.
Collagen is a protein naturally found in the eye that’s also ofen involved in the wound healing process – however, it’s too sof and weak to be a contact lens material. Yim found a way to transform gelatin methacrylate, a collagen derivative, into a biomaterial ten times stronger. One unique property of collagenbased materials is that they degrade when exposed to an enzyme
TIE-1, a well-studied species typically reluctant to produce the polymers. Several genetic tweaks helped boost the output of PHA, but one approach was especially successful. Researchers saw impressive results when they inserted a gene that increased the natural enzyme RuBisCO, the catalyst that helps plants and bacteria capture carbon from air and water. With the help of the super-charged enzyme, the usually sluggish bacteria turned into relative PHA powerhouses. Te researchers are optimistic a similar approach could be possible with other bacteria that might be able to produce even higher levels of bioplastics. Bose plans to take a closer look at the quality and possible uses of the polymers produced in her lab.
1 DOI: 10.1111/1751-7915.14552
2 DOI: 10.1128/aem.01438-24
Source: Washington University in St. Louis
called matrix metalloproteinase-9 (MMP-9), which is naturally found in the eye.
“Tese enzymes are very special because they’re involved in wound healing, and when you have a wound, they’re released in greater quantity,” Phan said. “If you have a material that can be degraded in the presence of this enzyme, and we add a drug to this material, we can engineer it so it releases the drug in a way that is proportional to the amount of enzymes present at the wound. So, the bigger the wound, the higher the amount of drug released.”
Te team used bovine lactoferrin as a model wound-healing drug and entrapped it in the material. In human cell culture study, the researchers achieved complete wound healing within fve days using the drug-releasing novel contact lens material.
Another beneft of the material is that it only becomes activated at eye temperatures, providing an inbuilt storage mechanism. Te next step is fne-tuning the material, including entrapping diferent drugs in it. Te scientists believe their material has great potential for the eye other body sites, especially large skin ulcers. A study outlining the researchers’ work was published in the journal Pharmaceutics.
DOI: 10.3390/pharmaceutics16010026
Source: University of Waterloo
(A) Growth of immortalized HCEC cells on 20% w/v GelMA+ gels, (B) Growth of immortalized HCEC cells on 30% w/v GelMA+ gels. On the 5th day, the cell growth on the respective hydrogels was observed. Picture: University of Waterloo
The wettability of RGP contact lenses
Providing comfort for the eye
In this article, we will examine the role of the polymer chemist, the manufacturing lab, the practitioner and fnally the patient, in providing the eye with the most comfortable and wettable GP contact lens possible. By Martin Conway and Mark Eddleston
Rigid gas permeable (RGP) lenses provide good visual acuity as well as being durable. Tey also are acknowledged to be the safest form of contact lens¹.
Maintaining adequate wettability can sometimes be a challenge, however, due to the hydrophobic nature of some of the monomers utilized in providing oxygen permeability. In this article, we will examine the role of the polymer chemist, the manufacturing lab, the practitioner and fnally the patient, in providing the eye with the most comfortable and wettable GP contact lens possible.
Wettability
Wettability refers to the ability of a liquid to spread and form a thin, uniform f lm on the surface.
• Comfort: Adequate wettability ensures that the lens surface remains moist and thereby prevents discomfort, dry spots, and irritation during wear.
• Visual acuity : An even tear f lm across the surface of the lens is essential for clear and stable vision.
• Deposit resistance: A well-wetted lens surface is less likely to attract and trap debris and deposits such as proteins, lipids, and other environmental contaminants, which can compromise lens performance.
The role of the polymer chemist
RGP contact lens materials and hydrophobicity
RGP contact lens materials are polymers that are typically manufactured by reacting together several diferent monomers. These monomers are carefully selected to impart desirable properties to contact lenses and to increase the safety and comfort of lens wear for patients.
All modern RGP materials contain at least one silicone monomer, primarily added to increase oxygen permeability, and at least one fluorinated monomer, added both to provide deposit resistance and to contribute to oxygen permeability.
Silicone and fuorine monomers are hydrophobic and may confer this characteristic to RGP materials, giving them a low a f nity for water, which can lead to poor wettability.
Low wettability results in liquids beading up on the surface of lenses, rather than spreading across the surface in an even f lm, leading to friction during blinking. It is therefore important that RGP materials are made more hydrophilic, especially at the lens surface, to enhance comfort.
Enhancing wettability during manufacture of the polymer Incorporating water miscible monomers such as methacrylic acid, hydroxyethyl methacrylate (HEMA) and N-vinyl pyrrolidone
(NVP) into the lens material’s polymer matrix increases the overall hydrophilicity of the lens, ofsetting the hydrophobic nature of the silicone-containing monomers.
Careful balancing of the ratios of silicone monomers, fuorinated monomers, and hydrophilic monomers by material designers, produces a material that is not only permeable to oxygen, but that also wets well.
To maximize the hydrophilic aspects of the material it is essential that lenses are prepared carefully prior to dispensing, and that lens surfaces are maintained free of deposits and scratches during wear and handling.
When RGP lenses are dispensed to the patient, it is essential that the surface quality of the lens is maintained by the patient to retain its wettability.
The role of the contact lens laboratory
Raw material polymers arrive at the contact lens laboratory as pre-formed buttons which, for a corneal lens, are typically 12.7 mm in diameter and 4.7 mm in thickness. Te button comprises a polymer which contains a mixture of both hydrophobic and hydrophilic monomers, randomly spread throughout the matrix of the button.
Fig.1: Various stages of contact angles formed by a liquid drop with the surface of a solid.
Fig.2: Contact angle measurement in laboratory conditions.
Fig.3: Contact lens manufacturing.
To maximize the hydrophilic aspects of the material it is essential that lenses are prepared carefully prior to dispensing, and that lens surfaces are maintained free of deposits and scratches during wear and handling.
Te polymer manufacturer will have provided recommendations to the laboratory for each material’s lathing characteristics, and these will include speed of rotation and depth of each cutting pass of the lathe to avoid the generation of excessive heat on the fnished surface of the fnished lens.
Te laboratory machines the button to produce the lens and in doing so will need to secure the button in place during the lathing process. Wax is used to mount the button in place for machining. Tis wax is hydrophobic and is removed from the fnished lens, along with any other contaminants. Any microscopic residues lef on the surface of the lens may be removed by further treatment in a plasma chamber. Te type of plasma treatment used in a normal specialty contact lens laboratory should really be viewed as an additional intensive cleaning step, and though the plasma treatment will also activate the surface of the treated lens and make it more wettable, this efect is temporary and will dissipate within a week.
At the end of the lens’s journey through the laboratory, it will be fully formed, and the surfaces will have been thoroughly cleaned to remove any residual waxes that might inhibit wettability. At this point, the polymer chains at the surface of the fnished lens will consist of a mixture of hydrophobic and hydrophilic monomer species that will compete for their efect on the overall wettability of the surface. Although the surface may appear to be inert, at a molecular level the polymer chains are capable of reorganization. By soaking the lens in a conditioning solution before shipping, the laboratory can start a process that will gradually improve the wettability of the lens surfaces over the following week. Te presence of the soaking solution at the surface of the lens will attract hydrophilic components of polymer chains to the surface of the lens and repel hydrophobic species. Over time, this efect will alter the surface characteristics of the lens and will continue for approximately a week afer manufacture. Te chart (Fig.4) indicates the reductions in wetting angle that take place using four diferent materials from various manufacturers. For this reason, it is recommended that lens manufacturers ship lenses to practitioners in a soaking/conditioning solution in order that this process may take place.*
Although it may take up to seven days for the surface to reach optimal performance, the majority of the efect occurs within the frst 2-3 days, and this can take place during shipment.
Fig.4: The contact angle of gas permeable materials over time.
Fig.5: Slit-lamp inspection of the anterior segment of the eye.
The role of the practitioner
It is important that the practitioner insists that GP lenses are shipped from the laboratory in a soaking solution for this surface conditioning process to begin. Although it may take up to seven days for the surface to reach optimal performance, the majority of the efect occurs within the f rst 2-3 days, and this can take place during shipment.
The role of the patient
When RGP lenses are dispensed to the patient, it is essential that the surface quality of the lens is maintained by the patient to retain its wettability. Te process of conditioning outlined above is reversible. If the lens surface is not cleaned properly afer wear, any lipids remaining on the surface will reverse the process described. Te hydrophobic nature of lipid at the surface will repel hydrophilic species and attract hydrophobic elements. Tis will eventually result in a dry spot on the surface of the lens if allowed to continue. Te importance of digital cleaning with an appropriate surfactant cleaner should be stressed at dispensing and every afercare visit.
Should a patient present with wetting issues, then a poor cleaning regimen is likely to be the cause. It is not enough for the practitioner simply to demonstrate cleaning at this stage, as it is likely that the surface has been re-conditioned by the presence of lipids on the surface for some time prior to the visit. Te lens needs to be removed, cleaned, and then soaked in an appropriate conditioning solution for at least 48 hours in order that the surface can be returned to somewhere near its optimal wettability. n
* It is important to ensure all local regulatory requirements are being complied with when shipping contact lenses in solution.
References : 1 Ophthalmology. 2008 Oct;115(10):1655-62. doi: 10.1016/j.ophtha.2008.04.002. Epub 2008 Jun 5. The incidence of contact lens-related microbial keratitis in Australia.
Martin Conway has over 40 years’ experience in the contact lens feld as a qualifed contact lens optician. He is registered with the UK General Optical Council on the Speciality Contact Lens Register. Martin is a fellow of the British Contact Lens Association (FBCLA), and the International Association of Contact Lens Educators (FIACLE). He has served in the professional services role as an educator and clinical adviser on behalf of both Saufon and CIBA, and now acts as professional services consultant for Contamac. Martin has lectured extensively in Europe, Asia, Russia, North and South America and the Middle East.
Mark Eddleston received his PhD from the University of Cambridge in 2012 and has subsequently enjoyed several busy, but rewarding years working as a project leader within the R&D team at Contamac.
Chemical plastics recycling is ready to go
New mathematical formula describes entire process
Hundreds of millions of tons of plastic waste are generated worldwide every year.
Scientists are working tirelessly on new methods to recycle a large proportion of this waste into high-quality products and thus enable a genuine circular economy. However, current recycling practices fall short of this goal. Most plastic waste is recycled mechanically: shredded and then melted down. Although this process does result in new plastic products, their quality deteriorates with each recycling step.
is then introduced into the molten plastic. A crucial step involves adding a powdered catalyst containing metals such as ruthenium. By carefully selecting a suitable catalyst, researchers can increase the efciency of the chemical reaction, promoting the formation of molecules with specific chain lengths while minimizing byproducts such as methane or propane.
Rotational speed and geometry are key
An alternative to this is chemical recycling, which avoids loss of quality. Tis method involves breaking down long-chain plastic molecules (polymers) into their fundamental building blocks (monomers), which can be reassembled into new, high-quality plastics, creating a truly sustainable cycle.
Fuels from plastic waste
As the approach of chemical recycling develops, the initial focus is on breaking down these long polymer chains into shorter-chain molecules that can be used as liquid fuels, say, or lubricants. Tis gives plastic waste a second life as petrol, jet fuel or engine oil.
Scientists at ETH Zurich have now laid down important foundations for developing this process. Tese enable the global scientifc community to engage in more targeted and efective recycling development work.
Researchers in the group led by Javier Pérez-Ramírez, Professor of Catalysis Engineering, investigated how to break down polyethylene and polypropylene with hydrogen. Here, too, the frst step is to melt the plastic in a steel tank. Gaseous hydrogen
“ Te molten plastic is a thousand times thicker than honey. Te key is how you stir it in the tank to ensure the catalyst powder and hydrogen get mixed right through,” explains Antonio José Martín, a scientist in Pérez-Ramírez’s group. Trough experiments and computer simulations, the research team demonstrated that the plastic is best stirred using an impeller with blades parallel to the axis. Compared to a propeller with angled blades or a turbine-shaped stirrer, this results in more even mixing and fewer fow vortices. Te stirring speed is equally crucial. It must be neither too slow nor too fast; the ideal speed is close to 1,000 revolutions per minute. Te researchers successfully developed a mathematical formula to describe the entire chemical recycling process with all its parameters. “It’s every chemical engineer’s dream to have a formula like this at hand for their process,” Pérez-Ramírez says. All scientists in the research feld can now precisely calculate the efect of the stirrer’s geometry and speed.
With this formula, future experiments can focus on directly comparing diferent catalysts with the infuence of mixing under control. In addition, the principles developed here are central for scaling up the technology from the laboratory to large recycling plants. “But for now, our focus remains on researching better catalysts for the chemical recycling of plastics,” Martín says. n
Source : ETH Zurich
References: Jaydev, S.D., Martín, A.J., Garcia, D. et al. Assessment of transport phenomena in catalyst efectiveness for chemical polyolefn recycling. Nat Chem Eng 1, 565–575 (2024). https://doi.org/10.1038/s44286-024-00108-3.
Most drink bottle caps are made of polypropylene. Along with polyethylene they account for 60 percent of all plastic waste. Picture: Shibashish Jaydev / ETH Zurich
Next level innovation
Larsen Equipment Design Introduces the Auto-Transfer Blocking System
Te folks at Larsen Equipment Design, Inc. were pleased to introduce the ATB-203 Auto-transfer blocking system at the EFCLIN Congress at Vilamoura Resort (Portugal) in April of this year. “While most of the industry has our established blocking system in use, we felt it was time to take the industry to the next level in lens blocking technology in keeping with our culture of innovation.” Says President and Founder, Erik Larsen. He added “While it is always exiting to create new products and processes, gratifcation for us is seeing those eforts accepted by industry as they have been over the last four decades.”
Larsen displayed the full line of lens fabrication machinery and tooling in addition to the new blocking system. We received comments like: “We’re happy with our existing system but, Oh! Self-calibration in 15 seconds!?”; “ Tere IS no dispenser? Tat’s clever.” Te wax pool arrangement with no internal moving parts greatly reduces maintenance.
“We never liked the practice of dropping hot wax into a pristine base curve. Te thermal shock has to have a detrimental efect on the material and thus the optics. Dipping the arbor in hot wax enables it to form a perfect shape centered on the arbor, then cool
before being laid into the BC. When the diameter of the arbor determines the amount of wax, no precision metering is needed.”
Erik goes on to say, “You can block a 17 mm scleral BC and know the large arbor diameter arbor will have the correct amount of wax, then block a 10 mm BC with a corneal arbor with the correct amount of wax. Tat is unprecedented!”
“ Te new blocking system retains our unique Wax Tickness Control so both corneal and scleral BC’s can be blocked with no mechanical adjustments required (no fddling by the operator).”
Te new system is housed within a safety shroud in compliance with health and safety regulations.
“Upon returning with orders for the new system, we undertook refning of the design and human/machine interaction. We are now “cutting metal” in anticipation of the frst deliveries.”
Larsen Equipment Design is the leading manufacturer of state of the art contact lens blocking and polishing machines enabling labs to reach their highest productivity levels.
For more information, please contact Larsen Equipment Design, Inc. at Erik@larsenequipment.com.
Researchers have developed a new type of lens that uses a spiral-shaped surface to maintain a clear focus at diferent distances in varying light conditions. Picture: Laurent Galinier
Spiral-shaped optic
Developed for clear focus at diferent distances
French researchers have reported the development of a spiral-shaped optic that maintains clear focus at diferent distances in varying light conditions. They say that the new lens works much like progressive lenses used for vision correction but without the distortions typically seen with those lenses. It could help advance contact lens technologies, intraocular implants for cataracts and miniaturized imaging systems.
“Unlike existing multifocal lenses, our lens performs well under a wide range of light conditions and maintains multifocality regardless of the size of the pupil,” said Bertrand Simon from Photonics, Numerical and Nanosciences Laboratory (LP2N), a joint research unit between the Institut d'Optique Graduate School, the University of Bordeaux and the CNRS in France.
“For potential implant users or people with age-related farsightedness, it could provide consistently clear vision, potentially revolutionizing ophthalmology.”
In Optica, the researchers describe the new lens, which they call the spiral diopter. Its spiraling features are arranged in a way that creates many separate points of focus which makes it possible to see clearly at various distances.
Creating a vortex of light
Te inspiration for the spiral lens design came when the paper’s frst author, Laurent Galinier from Spiral SAS in France, was analyzing the optical properties of severe corneal deformations in patients. Tis led him to conceptualize a lens with a spiral design that causes light "to spin", like water going down a drain. Te researchers explain that this phenomenon, known as an optical vortex, creates multiple clear focus points, which allow the lens to provide clear focus at diferent distances. “Creating an optical vortex usually requires multiple optical components,” said Galinier. “Our lens, however, incorporates the elements necessary to make an optical vortex directly into its surface. Creating optical vortices is a thriving feld of research, but our
method simplifes the process, marking a signifcant advancement in the feld of optics.”
Te researchers created the lens by using digital machining to mold the spiral design with high precision. Tey then validated the lens by using it to image a digital ‘E,’ much like those used on an optometrist's light-up board. Te authors observed that the image quality remained satisfactory regardless of the aperture size used. Tey discovered that the optical vortices could be modifed by adjusting the topological charge, which is essentially the number of windings around the optical axis. Volunteers using the lenses reported noticeable improvements in visual acuity at a variety of distances and lighting conditions.
Crossing disciplines
Bringing the new lens to fruition required combining the intuitively crafed design with advanced fabrication techniques through a cross-disciplinary collaboration. “ Te spiral diopter lens, frst conceived by an intuitive inventor, was scientifcally substantiated through an intensive research collaboration with optical scientists,” said Simon. “ Te result was an innovative approach to creating advanced lenses.”
Te researchers are now working to better understand the optical vortices produced by their lens. Tey also plan to perform systematic trials of the lens’ ability to correct vision in people to comprehensively establish its performance and advantages in real-world conditions. In addition, they are exploring the possibility of applying the concept to prescription eyeglasses, which could potentially ofer users clear vision across multiple distances.
“ Tis new lens could signifcantly improve people’s depth of vision under changing lighting conditions,” said Simon. “Future developments with this technology might also lead to advancements in compact imaging technologies, wearable devices and remote sensing systems for drones or self-driving cars, which could make them more reliable and efcient.” n
Source: Optica
References : Laurent Galinier, Philippe Renaud-Goud, Jean Brusau, Lucien Kergadallan, Jean Augereau, and Bertrand Simon, "Spiral diopter: freeform lenses with enhanced multifocal behavior," Optica 11, 238-244 (2024).
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Time, errors, productivity and proft
Decisions, decisions! Part 2
This article is a follow-up to the last one in GlobalCONTACT No 97 in which I talked about how the number and types of decisions that a lab tech needs to make afects productivity and rejects caused by wrong decisions. In the article, I alluded to how machines and processes can reduce the number of decisions needed. Here is how you can do this to make your lab more efcient and more proftable. By Erik Larsen
An example is the bladder polishing system. Into to the 90s, pitch and hard polishing tools were utilized to polish spheres. Special f xtures were utilized to polish torics. T is process required either forming the pitch to the lens or picking the correct polishing tool to ft the curve. Te peripheral curves had to be formed and polished separately. Te bladder polishing system eliminated all these tasks, with the proviso that the curve was turned on an air-bearing lathe. T is process has become the norm for all back surface geometries including scleral lenses.
Another example of reducing the number of decisions is changing from holding the lens blank directly in the lathe collet to blocking the lens blank. Again, with the pitch polishing (lapping) method, the geometry off the lathe would be “corrected” to a sphere. But with CNC lathes adding toric, aspheric, and free-form capability, pitch or hard tool polishing is not possible because it will drive the curve to a sphere. If you turn a base curve (BC) in a deformed state, the resulting curve will not be what you need. Bladder polishing will not correct that. So, blocking the lens blank ensures that the BC will yield
what the lathe turned and the bladder polisher will polish that surface. Again, the current process eliminates many decisions on the part of the lab tech. T is is because the surface geometry is generated by the lathe and a single bladder tool polishes it; the lab tech doesn’t need to choose the polishing tool. Te same polishing tool can stay on the machine all day.
The processes I mentioned above are standard operating procedures for most labs around the world. What other advances reduce the reliance on good decisions in the manufacturing process? In answering this question, the production manager can wander around the lab and look at each task to see what motions the lab tech is making.
Options for lens blank blocking
An example is the lens blank blocking procedure. As I mentioned in the previous article, the center thickness control needs to be addressed. If the blank thickness needs to be measured, that can be done for each job, or the bag of lens blanks can be sorted upon receipt at the lab, so that blanks with the same thickness can be stored together. A time study will determine which
approach is faster. If the lens blank is blocked on a hollow arbor, then the center thickness of the BC is directly measured. Te next step is to block the lens blank to the arbor. Tere are several blocking methods in use. T is is partly because high precision is not required at this point in the manufacturing process. Below are options for corneal lens blanks (12.7 mm diameter).
1. Hand blocking using tape or wax and blocking guide or f xture.
2. Manual blocking machine.
3. Dual purpose auto-blocker.
4. High production lens blank auto-blocker.
Option 1 may be hard to believe, but for low volume it works f ne.
Option 2 would utilize an old blocking machine you have in storage.
One advantage to options 1 and 2 is that you have a separate workstation next to the lens blank inventory that does not interfere with the precision transfer blocking station.
Option 3 requires the operator to switch the transfer blocker to lens blank blocking several times per shi f T is may not seem to be an issue, but the decisions and time delay add up. Option 4 is for high production up to 3000 lenses per shi f Again, there would be a separate workstation next to the lens blank inventory. Also, having pre-measured lens blanks would be good here (if this is your process).
Scleral lens blank blocking can be done utilizing the above options, but some of the industry holds the scleral lens blank directly in the lathe collet against the face of the collet. T is method can yield good results because the scleral lens blank is massive enough to withstand the collet force. However, there are a few problems that can arise with this method.
1. Te face of the lathe collet may not be perfectly square to the bore which may tilt the lens blank. So, the shoulder on the lens blank would be against the tilted face of the collet. New lathe collets have the bore and face ground at the same time, so inherently they are square, but over time and if a crash happens, there may be a defect on the face of the collet which will tilt the lens blank.
2. Te face of the 12.7 mm diameter of the lens blank may not be parallel to the shoulder. T is could cause alignment problems in front blocking because blocking machines usually register of the 12.7 mm face of the lens blank.
3. Holding the scleral lens blank directly in the lathe collet means that lathe probing needs to accommodate the diferent location from the front cut probe position which may be over 10 mm di ference. T is wastes time.
Another method is to block the scleral lens blank in a cupped holder. Te advantages of this method include:
1. Easily done by hand (high precision is not needed).
2. No collet force is transferred to the lens blank.
3. Te cupped arbor is a precision tool, so the lathe collet clamps on it the same every time.
4. Te face of the lens blank is approximately at the same position from the lathe spindle to reduce the probing range which saves time.
It should be apparent that I’m talking about transfer blocking by the comments I made about lens blank blocking. We did not invent transfer blocking, but in the last few decades we have championed that process and built machines and tooling around it. In summary, the process involves blocking a convex arbor to a blocked concave surface. Te result is two arbors with a f nished BC between them. T is applies to both corneal and scleral lens blocking. Te goal is to mount an un-strained BC to the convex arbor with high precision in both radial and tilt. T at means a blocking machine needs to be able to be aligned in both radial and tilt axes. I’ll leave it to the reader to see if their blocking system has that lab capability. Once the BC is transfer-blocked, a separating device removes the f rst arbor, then the blocked BC is ready to turn the front surface.
Back to decision making: In one type of blocking machine, you need to set up the machine for front blocking (from blank blocking), set the blocking height for the particular center thickness, and set the amount of wax to be dispensed. Tat is at least three decisions on the part of the technician. In another blocking system those decisions are automatic. Te majority of labs utilize the later system.
Looking to the future
Looking to the future holds some interesting possibilities in the context of decision making. Robots do not make many decisions, the fewer the better. With the advent of machines and processes that require few decisions, these tasks are an obvious application for robot machine tending. While fully automated lens production systems are operating in a few labs around the world, the norm is a mixture of manually loaded machines and autoloaded lathes. Expect to see more workstations with a robot tender in the future. T is trend also fts well with LEAN processes. n
Erik Larsen graduated from the University of Washington with a Mechanical Engineering degree in 1981 and started Larsen Equipment Design later that year. Erik Larsen has industry awards from CLMA and EFCLIN.
Barcelona in focus
– a brief report from the 42nd
ESCRS Congress
¡Hola! and welcome to a long weekend packed with the most interesting topics currently occupying ophthalmologists. We are talking about the 42nd Congress of the European Society of Cataract & Refractive Surgeons – or ESCRS for short.
From September 6 to 10, 2024, the congress invited like-minded people to exchange knowledge at the Fira de Barcelona in Spain. By Lena Petzold
Te ESCRS was founded in 1991 to promote education and research in the feld of implant and refractive surgery and to advance the study and practice of ophthalmology. Te European association now has over 7,000 members from 130 countries. In the following article, we will guide you through the 42nd congress, which attracted a total of 16,735 participants from 126 countries.
“We have strengthened ties with ophthalmological societies around the world, creating a collaborative environment that benefts everyone.” – Filomena Ribeiro, ESCRS President.
The opening
Te frst day of the congress kicked of with the opening ceremony, during which the “2024 Ridley Medal Lecture” was given by Indian ophthalmologist Dr. Abhay Raghukant Vasavada. He discussed the post-operative decentration of IOLs. Tis is also known as “dead bag syndrome”. Te results of a study by the Iladevi Cataract and IOL Research Centre and Raghudeep Eye Hospital in India showed that more than 50 percent of the patients examined had a decentration of the IOL. Tis occurred in 75 percent of the patients more than ten to twenty years afer surgery. In one third of the patients examined, the decentration occurred
bilaterally. Risk factors in this context were male gender and the presence of myopia. How can this be treated? Only a second operation can improve the dislocation. Option one is repositioning of the IOL, whereas the second option is a complete replacement of the IOLs. Dr. Vasavada recommends the Yamane technique with intrascleral fxation.
The BOSS
From September 6, the f rst sustainable, integrative society (BOSS), which was founded this year by ESCRS President Filomena Ribeiro, also started. BOSS is designed to give young ophthalmologists the opportunity to interact with more than 40 experts in ophthalmology and discuss professional development in the form of speed mentoring sessions. Te mentors are well-known ophthalmologists or decision-makers at ESCRS. One session ofers participants the option of engaging in a one-hour discussion with a total of six mentors, with each mentor receiving a ten-minute slot. Te main topics of these sessions included, for example, research advances in ophthalmology, career opportunities and stays abroad. Te work of BOSS continues even a fer the congress. A year-round
program has been developed to enable participants to network with each other at future events as well.
History
Another networking opportunity with both familiar and new participants was the museum celebrating the 75th anniversary of the frst IOL implantation. Te IOL in question was performed by the British ophthalmologist Sir Harold Ridley on 29 November 1949. During this exhibition, Ridley's ofce and operating room were open to visitors, allowing them to immerse themselves in the development of the IOL and the associated implantation process. At the same time, there was an insight into the further development of IOL and cataract surgery up to possible future innovations. In the adjacent tunnel museum, selected museum pieces were on display. Multimedia presentations were also set up in other sections of the congress halls to provide insights into the day-to-day practice of cataract surgery. And not to be forgotten are the escape rooms. One room consisted of various areas, such as an operating table, a gallery of former and current ESCRS chairs, and chests that could be opened by solving puzzles. Te aim of the room was to correctly calculate an intraocular lens to be used with the help of the ESCRS IOL calculator. Te parameters eye length, K1 and K2, anterior chamber depth, etc. had to be determined in the puzzles in order to calculate the IOL to solve the riddle of the escape room.
The present
An insight into current topics was provided by: five main symposia, four research symposia, 393 poster presentations, 80 wet labs and eleven dry labs. In the laboratories, those who wanted to expand their knowledge and skills were able to perform (virtual) operations on the anterior segment of the eye under the supervision of experts. Tere was an opportunity to perform the surgical procedures using a slit lamp or virtual reality glasses. During the poster presentations, participants had fve minutes each to present the results of current studies in a rapid-fre session. Te topics included, for example, cataracts, surgical operation methods or the testing of new IOL developments. The lecture by Eleonora Bianchi (England) dealt with the development of a contrast sensitivity questionnaire for the classifcation of existing lens opacities and for the surveyed patients on a waiting list for cataract surgery. Te questionnaire was sent by post to 233 patients (divided into age groups, gender and socio-economic status). Te costs amounted to around 3 £ (~ 3.60 €) per patient surveyed. However, it should be noted that different lighting conditions lead to different results. Furthermore, the flexibility of the questionnaire could be exploited by patients, who could artifcially lower the results in order to get an appointment for surgery faster. Ultimately, the questionnaire is a practical and cost-efective way of prioritizing patients on the waiting list for surgery.
More than 300 exhibitors from the ophthalmologic and optical industry participated in the ESCRS industrial exhibition, ofering 24 independent symposia, which were attended by a total of 10,000 participants.
Other interesting facts from various industry and research symposia: When performing LASIK on hyperopic patients, attention should be paid not only to the keratometry values, but also to the epithelial thickness. Artifcial intelligence (AI) will play an increasingly important role in ophthalmology and will be used for diagnostics and screening, especially on the retina (glaucoma, lesions or diabetic retinopathy). AI can determine the patient's gender based on the foveal refex. AI can also be used in patient care, continuing education, and research. Filomena Ribeiro summed up the congress as follows:
“Your expertise and insights, presented with clarity and enthusiasm, have enriched scientifc discourse and fostered a collaborative environment.”
The future
Next year, the annual winter meeting will take place in Athens, Greece, from February 28 to March 2, 2025. Around six months later, the association invites you to the 43rd ESCRS Congress in Copenhagen, Denmark, from September 12 to 16, 2025. n
Lena Petzold graduated from high school in 2018 and began her bachelor's degree in ophthalmic optics/optometry at the Ernst Abbe University of Applied Sciences in Jena, which she completed in October 2021. She started the subsequent Master's programme in the same month. In 2022, she had the opportunity to present her bachelor's thesis at the American Academy of Optometry. She has been working part-time at JenVis Research since 2021.
ESCRS Industrial exhibition.
Did you know...
...that there is a small island in the Pacifc where a signifcant percentage of the population lives in a world without colors?
Pingelap, a remote island in Micronesia, is known worldwide as the “Island of the Colorblind”. This description is to be taken literally, as a signifcant number of the islanders sufer from the rare genetic disorder achromatopsia. This disease leads to total color blindness, meaning that those afected see only gray scales and have no color vision. In addition to color blindness, visual acuity is limited and sensitivity to light is greatly increased, making it considerably more difcult to see in daylight. By Silke Sage
Te story behind the high prevalence of achromatopsia on Pingelap goes back to a “genetic bottleneck” that occurred in the 18th century. In 1775, the island was hit by a devastating typhoon that wiped out almost the entire population. Only about 20 people survived, and genetic testing showed that one of them carried a mutation responsible for achromatopsia. Due to the island's isolated geographical location and small population, this mutation spread over generations. Today, an estimated 5-10% of the island's inhabitants su fer from this disorder, while worldwide it a fects only about one in 30,000 people.
Te interesting story of Pingelap and its inhabitants has been frequently featured in scienti fc papers and books. One of the most well-known contributions comes from neurologist and author Oliver Sacks. In his book “ Te Island of the Colorblind,” Sacks describes his trip to Pingelap to learn more about the effects of this unusual genetic disorder. He describes the challenges the islanders face, such as their di fculty seeing in
bright daylight. Many of them wear widebrimmed hats and sunglasses to protect their light-sensitive eyes. At the same time, however, Sacks emphasizes the remarkable adaptability of the people. They have developed a life that is attuned to their circumstances, and they navigate their environment remarkably well despite their limited vision.
Interestingly, there is no social stigma associated with color blindness on Pingelap. Because so many people are affected, achromatopsia is considered normal there. Unlike in other parts of the world, where such impairments can ofen have an isolating efect, the community on the small island is an example of how a society can adapt to and integrate genetic peculiarities.
Te story of Pingelap also raises important questions about genetic diversity and isolation. Pingelap is an example of the so-called founder efect, in which a small number of individuals found an isolated population whose genetic traits can be reinforced over generations. T is efect can, as in the case of Pingelap, lead to the spread of a genetic mutation that rarely occurs under normal circumstances.
For scientists, the isolated island is not only a place of special interest due to the prevalence of achromatopsia, but also a key example for understanding how genetic diseases can develop in small, isolated populations. Research on the island helps to better understand the mechanisms behind the inheritance of genetic disorders and to develop possible approaches for treatments.
Overall, Pingelap is a fascinating example of the complexity of human genetics and how humans adapt to extraordinary circumstances. In “ Te Island of the Colorblind,” Oliver Sacks not only presents the scienti fc facts about this island, but also a deep understanding of the cultural and human aspects of life in a world without color. n
Left, Fig. 1: Visual impression of a person with normal vision. Right, Fig. 2: Simulation of achromatopsia: complete color blindness with a glare component from daylight and greatly reduced visual acuity. The view can only be approximated. It is intended to illustrate that this type of visual impairment is more signifcant than a color vision defciency such as red-green color defciency. (Photos: Silke Sage + AI)
CASE STUDY:
Fitting a highly toric and asymmetric ocular surface using current lathe technology
BACKGROUND
A 25-year-old female with history of severe aqueous deficiency dry eye and f lamentary keratitis following numerous ocular reconstruction surgeries since infancy for excision of benign neoplasm of lacrimal gland and coloboma of lid repair presented for a PROSE scleral lens consultation. Te patient complained of ocular discomfort and poor vision, recalcitrant to all prior therapies including periodic amniotic membranes. ODsc: 20/150 (PH 20/60) OSsc: 20/30-2 (PH 20/25+2)
PLAN
Improve vision, comfort, and support the ocular surface with a scleral lens. To ft around the temporal conjunctival obstacle, the diameter of the lens must be either small enough to avoid the anatomical obstacle entirely (and likely necessitating a notch) or be large enough to cover the obstacle. A larger diameter design was pursued to ft over the anatomical obstacle and allow better coverage of the desiccated ocular surface.
TRIAL LENS SELECTION
• 18.5mm/2.88 sag/8.0 BC/+0.25 sph/0.35mm bitoric
• VA: 20/80+2
• Over-refraction: +3.00 sphere; 20/40-2
an 8-meridian toric design was pursued. Sagittal depth was reduced by 300 microns and additional haptic adjustments were made to address areas of edge li f
LENS DESIGN # 1
• 18.5mm/2.58 sag/ 8.0 BC/ +3.25 sph/ 8-meridian 1.12mm toric (steepest meridian at 7:30)
• VA: 20/40-2, without improvement with over-refraction
• Residual compression over the temporal elevated conjunctiva was evident. Centration of the lens greatly improved. Tere was adequate and improved corneal clearance, with resolution of the inferior tear prism. Residual inferior temporal edge li f was noted.
LENS DESIGN #2
• 18.5mm/2.58 sag/8.0 BC/+3.25 sph/ 8-meridian 1.32mm toric (steepest meridian at 7:30/ custom temporal channel (135 – 190^, 250 microns of depth)
• VA: 20/30-1, without improvement with over-refraction
• A channel was added to the temporal aspect and the inferior temporal edge was steepened.
RESULTS
Te patient continued with daily scleral lens wear, with signifcant improvement in comfort and vision, with resolution of flamentary keratitis. Given the highly toric and asymmetric nature of the ocular surface, necessary lens adjustments could only be achieved with access to advanced high precision FT3 technology provided by our lathe vendor. With appropriate precision lathe technology, the range and customization of ftting is boundless.
Te initial trial lens was applied and demonstrated a poor ft. Necessary adjustments to obtain an optimal ft were implemented with utilization of thorough slit lamp evaluation and implementation of PROSE scleral lens customizations. Tere was notable compression overlying the temporal elevated conjunctiva with associated inferior temporal edge li f . Mild edge li f was also noted nasally, inferiorly and superiorly. Te apical vault was also over 500 microns and demonstrated inferior decentration as evident by the inferior tear prism. Two scleral lenses were designed. T e highly irregular ocular surface and focal signi f cant inferior temporal edge li f necessitated at least 1 mm of steepening. To achieve this in this oblique meridian,
Dr. Bita Asghari, OD, FAAO, FSLS
PROSE Provider and Associate Director of Clinical Education
Presbyopinion
Part I: Defnition & mechanism
Everyone has an opinion on presbyopia. But let’s stick to the facts and fnd out: What is presbyopia exactly? Using an evidencebased approach with information from recently published review papers, this article explores the ins and outs of presbyopia and its correction methods. By Eef van der Worp
Te claimed inventor of bifocal glasses, although there are some questions regarding the exact nature of that claim, is Benjamin Franklin – a founding father of the US and one of the architects of the Declaration of Independence in 1776. Franklin was a fervent reader and the founder of the frst public library in the US; he was myopic, and as he got older, like anyone else, he became presbyopic (he passed away at the respectable age of 84). Carrying around two pairs of glasses was a big nuisance to him; he writes in letters to a friend. He asked a local glass grinder to cut the lenses of both glasses in half and mount them both in one frame. He calls these ‘double glasses’ in a letter, with a drawing, to the mentioned friend in 1785. Besides maybe the frst description of bifocal glasses, Franklin was known for a number of interesting quotes, of which this one seems quite appropriate for the topic of presbyopia: ‘Life’s tragedy is that we get old too soon and wise too late.’
CLEAR
Back to the mentioned review papers, these were generated by the British Contact Lens Association (BCLA). During 2024, eight reports in the Contact Lens Evidence-Based Academic Reports (CLEAR) series focused on presbyopia; in total, more than 175 pages published in eight ‘chapters,’ if you will, in the peer-reviewed journal Contact Lens & Anterior Eye. The publication is a consensus paper that involved close to 100 experts from around the world and numerous references to back up all the information generated. Contact lenses are of course part of the series, but the papers certainly are not limited to that; they cover everything from defnition to mechanism to intervention methods besides glasses and contact lenses, such as intraocular lenses, corneal surgical techniques, pharmaceutical solutions, and even scleral technology.
One of the frst take-home messages is: Presbyopia correction involves much more than providing ‘just a near add.’ Te term 'presbyopia management' is quite appropriate, because if we want to take our presbyopic patients seriously, we must take a more holistic approach and consider and inform all options available to patients today.
It also seems appropriate to think in line with ‘myopia management’: with presbyopia too, there is a big task for eye care practitioners (ECPs) to inform and provide all types of intervention. Besides that, the potential for our (specialty) lens industry with presbyopia correction is probably at least as big as it is for myopia, although the latter gets a lot more attention lately.
‘Tell me and I forget. Teach me and I remember. Involve me and I learn.’ – Benjamin Franklin
By definition
Of course, it makes sense to start with determining an accurate defnition, which is something the frst CLEAR paper does. Te international consensus is this: 'Presbyopia is defned as occurring when the physiologically normal age-related reduction in the eye’s focusing range reaches a point that, when optimally corrected for far vision, the clarity of vision at near is insufcient to satisfy an individual’s requirements.'
Interestingly, despite all our recent research and innovations, we don’t fully understand accommodation completely.
A couple of things can be taken from this. Presbyopia is not something that suddenly happens at the age of 45 or thereabout; it is a life-long process that starts at birth pretty much – but only manifests around the age of 45 because we read at a certain distance. In essence, it is related to the length of our arms. Tis is obviously an anatomical feature, and it at least partly explains the diferences in various regions and the (minor, but still) diferences between men and women.
Regional diferences are quite large. Te prevalence of functional presbyopia in 2015 was 24,9% of the entire population –accounting for 1,8 billion people. However, the percentage of people who get a presbyopic correction difers greatly, partly because of income, partly because of near task demands. Te CLEAR paper diferentiates high-income countries from other regions; in the frst, uncorrected presbyopia is close to zero percent, while in parts of the sub-Saharan region, it can be about 90%. So, it is good to keep in mind that presbyopia primarily is a near-vision demand condition (with emphasis on ‘demand’).
Many risk factors for presbyopia are explored in depth in the papers, including the infuence of UV light, nutrition (diet), stress, sleep, etc. on accommodation. Some may have a potential infuence, but at the end of the day there is no strong evidence for a clear contribution of any single variable. Te number one variable is age, together with vision demands (e.g., reading distance).
It’s getting personal
Just like the theme of the upcoming Global Specialty Lens Symposium in Las Vegas (US), ‘It’s Getting Personal,’ presbyopia management is also all about getting personal. Presbyopia and the CLEAR papers are also prominent on the program of GSLS 2025.
Te one and only question we really should ask our presbyopic patients is ‘What do you need?’ And accordingly, we should try to mimic or defne the near tasks as ‘real-life’ as possible.
Tis means for sure that ECPs should work with a trial frame (not the phoropter!) so that patients can hold their near work at their desired distance and use real-life reading tasks, such as smartphones, e-readers, sheet music – whatever it is they want/need/desire.
One thing ECPs and patients need to understand is that if a myope goes from glasses to contact lenses at an early-presbyopia age, this can lead to higher accommodation/convergence
demands – meaning they would need a near correction sooner or a higher near addition. For hypermetropia, it is the reverse (the near add can be postponed a bit, or lowered, when switching from glasses to contact lenses).
The elderly eye
What happens to the eye as we get older? A few things, but they are not in the cornea. Te cornea stays relatively stable throughout life, which is a good thing as the cornea represents by far the highest optical value of the entire human optical system (the total optical power of the eye is 60D, of which the cornea is responsible for about 40D; for the rest, the crystalline lens is responsible). Astigmatism changes a tad throughout life, but mostly it is crystalline lens-related (not cornea).
So, it’s the crystalline lens that undergoes major changes throughout life and is almost solely responsible for the reduction in accommodation. A common myth in the public, but even in the eyecare world, is that the crystalline lens’ eye muscles degenerate with age and that this process is responsible for the reduction in accommodation. Te CLEAR publication is pretty clear about that: it is the lens itself, not the muscles. Te lens gets more rigid with age. It consists mostly of proteins; in fact, the crystalline lens has the highest concentration of protein anywhere in the human body (300 mg/ml). And proteins change with age. To make things a bit more complex, the crystalline lens can be seen as similar to an onion. Diferent parts of the lens show diferent alterations. In general, the lens changes in overall thickness, and the curvatures of the outer surfaces change; there is a steeping of both the anterior and the posterior surface (but not in the same amount; anterior more than posterior, giving the lens a more hyperbolic shape). To fnish this part up: the zonulae (the strings attaching the crystalline lens muscle to the lens capsule) also change: their innervation on the lens capsule becomes more anterior with age. Tis partly causes a ‘shif’ forward of the crystalline lens, which also contributes to the change in optical power (e.g., change in accommodation). Interestingly, despite all our recent research and innovations, we don’t fully understand accommodation completely. All the
changes described here cause a reduction in accommodation … but according to scientists, they cannot 100% predict the total change in accommodation. Tis is called the ‘presbyopia paradox.’ Additional changes may be found in the alteration of index of refraction of the proteins in the crystalline lens, but this fnding has not fully crystallized yet.
Intervention methods
In line with myopia management terminology, what are the intervention methods for presbyopia? Apart from glasses and contact lenses, there are corneal inlay techniques, intraocular lens implantation with several lens design options, laser refractive surgery, pharmaceutical solutions and more. Part 2 of this series will focus on all these in the next GlobalCONTACT. Te technical aspects will be covered as well as considerations in choosing one option over another. Te latter may be as important as the frst – as the choice for one technique over another is ofen a personal one. Presbyopia is not an opinion. It is real and can be explained in an evidence-based manner (and no, exercises do not help and neither does postponing getting a reading device). But the choice of management for presbyopia is highly personal, the patient’s opinion is crucial, and the choice should be based on a wellinformed presentation of all options by the eyecare provider. n
References :
1 Wolfsohn JS, Naroo SA, Bullimore MA, Craig JP, Davies LN, Markoulli M, Schnider C, Morgan PB. BCLA CLEAR Presbyopia: Defnitions. Cont Lens Anterior Eye. 2024 Aug;47(4):102155.
3 Markoulli M, Fricke TR, Arvind A, Frick KD, Hart KM, Joshi MR, Kandel H, Filipe Macedo A, Makrynioti D, Retallic N, Garcia-Porta N, Shrestha G, Wolfsohn JS. BCLA CLEAR Presbyopia: Epidemiology and impact. Cont Lens Anterior Eye. 2024 Aug;47(4):102157.
4 Wolfsohn JS, Berkow D, Chan KY, Chaurasiya SK, Fadel D, Haddad M, Imane T, Jones L, Sheppard AL, Vianya-Estopa M, Walsh K, Woods J, Zeri F, Morgan PB. BCLA CLEAR Presbyopia: Evaluation and diagnosis. Cont Lens Anterior Eye. 2024 Aug;47(4):102156. doi: 10.1016/j.clae.2024.102156. Epub 2024 Apr 18. PMID: 38641525.
5 Tm4 Podcast series (Dutch) Presbyopia Management – sponsored by Bausch+Lomb Benelux.
Eef van der Worp, BOptom, PhD, FAAO, FIACLE, FBCLA, FSLS is an educator and researcher. He received his optometry degree from the Hogeschool van Utrecht in the Netherlands (NL) and has served as a head of the contact lens department at the school for over eight years. He received his PhD from the University of Maastricht (NL) in 2008. He is a fellow of the AAO, IACLE, BCLA and the SLS. He is currently adjunct Professor at the University of Montreal University College of Optometry (CA) and adjunct assistant Professor at Pacifc University College of Optometry (Oregon, USA). He lectures extensively worldwide and is a guest lecturer at a number of Universities in the US and Europe.
Letter by Benjamin Franklin describing the frst ‘double glasses’ or bifocals in 1785 (Image: library of congress USA)
Innovative Metrology for Myopia Control in Spectacle Lenses
Lambda-X Ophthalmics, a global leader in advanced optical metrology systems, is announcing the release of the NIMOevo-SPL, an innovative metrology instrument designed to simplify the measurement of myopia control spectacle lenses featuring complex microstructures.
Innovative Metrology for Myopia Control in Spectacle Lenses
Innovative Metrology for Myopia Control in Spectacle Lenses
Key Benefts
Measuring spectacle lenses with intricate designs and microstructures has traditionally been a complex and labor-intensive process. Operators needed to carefully align lenses and navigate through cumbersome procedures, o f en requiring highly specialized skills and it o f en result to low quality results. T e NIMOevo-SPL instrument is changing that by taking advantage of Lambda-X’s high-precision wavefront measurement technology, to provide accurate and simple procedure to achieve reliable optical performance results.
Lambda-X Ophthalmics, a global leader in advanced optical metrology systems, is announcing the release of the NIMOevoSPL, an innovative metrology instrument designed to simplify the measurement of myopia control spectacle lenses featuring complex microstructures.
KEY BENEFITS
Lambda-X Ophthalmics, a global leader in advanced optical metrology systems, is announcing the release of the NIMOevo-SPL, an innovative metrology instrument designed to simplify the measurement of myopia control spectacle lenses featuring complex microstructures.
Measuring spectacle lenses with intricate designs and microstructures has traditionally been a complex and labor-intensive process. Operators needed to carefully align lenses and navigate through cumbersome procedures, o f en requiring highly specialized skills and it ofen result to low quality results. Te NIMOevo-SPL instrument is changing that by taking advantage of Lambda-X’s high-precision wavefront measurement technology, to provide accurate and simple procedure to achieve reliable optical performance results.
Measuring spectacle lenses with intricate designs and microstructures has traditionally been a complex and labor-intensive process. Operators needed to carefully align lenses and navigate through cumbersome procedures, o f en requiring highly specialized skills and it o f en result to low quality results. T e NIMOevo-SPL instrument is changing that by taking advantage of Lambda-X’s high-precision wavefront measurement technology, to provide accurate and simple procedure to achieve reliable optical performance results.
T e system’s powerful SPL-Mentor so f ware enables seamless work f ows with customizable features for speci f c testing needs. With its automated processes and intuitive interface, NIMOevo-SPL allows even non-experts to operate the instrument e f ciently while maintaining the highest level of measurement accuracy.
T e system’s powerful SPL-Mentor so f ware enables seamless work f ows with customizable features for speci f c testing needs. With its automated processes and intuitive interface, NIMOevo-SPL allows even non-experts to operate the instrument e f ciently while maintaining the highest level of measurement accuracy.
Key Benefts
• Precision Measurement: Delivers high-accuracy power mapping and microstructure analysis using advanced wavefront measurement technology.
• Precision Measurement: Delivers high-accuracy power mapping and microstructure analysis using advanced wavefront measurement technology.
• Precision Measurement: Delivers high-accuracy power mapping and microstructure analysis using advanced wavefront measurement technology.
• Measures All Microstructures: Capable of analyzing all type microstructures in myopia control lenses.
• Measures All Microstructures: Capable of analyzing all type microstructures in myopia control lenses.
• Measures All Microstructures: Capable of analyzing all type microstructures in myopia control lenses.
• Auto-Detection: Automatically identi f es and measures each microlens, ensuring thorough and accurate characterization.
• Auto-Detection: Automatically identi f es and measures each microlens, ensuring thorough and accurate characterization.
• Auto-Detection: Automatically identi f es and measures each microlens, ensuring thorough and accurate characterization.
• Custom Work fows: Te SPL-Mentor sof ware ofers customizable work fows, enabling users to tailor the solution to their specifc testing needs and simplifying the process.
• Custom Work f ows: T e SPL-Mentor so f ware o f ers customizable work f ows, enabling users to tailor the solution to their speci f c testing needs and simplifying the process.
• Custom Work f ows: T e SPL-Mentor so f ware o f ers customizable work f ows, enabling users to tailor the solution to their speci f c testing needs and simplifying the process.
T e NIMOevo-SPL is designed to bene f t both R&D and production, o f ering faster, more reliable lens measurement. By reducing complexity and manual adjustments, it ensures consistent, repeatable results for advanced lens designs, enhancing the quality of lenses for the myopia control market.
T e NIMOevo-SPL is designed to bene f t both R&D and production, o f ering faster, more reliable lens measurement. By reducing complexity and manual adjustments, it ensures consistent, repeatable results for advanced lens designs, enhancing the quality of lenses for the myopia control market.
Wavefront Measurement - Sphere Power Map
Mini scleral lenses
– when are they benefcial? A dialogue
At the last conference of the Association of German Contact Lens Specialists (VDCO) Uwe Bischof and Corinna Jonske of the Müller Welt contact lens institute in Stuttgart held a critical technical discussion. Read the transcript here to fnd out what it was about:
Corinna Jonske: We are meeting today to discuss the topic of mini-scleral lenses and when ftting these contact lenses really makes sense for us.
Uwe Bischof : Lately, I have ofen been annoyed by this topic and how it is currently positioned in the market ...
Corinna Jonske: What do you mean? We ft mini-scleral lenses almost every day. Have you suddenly lost your conviction?
Uwe Bischoff: That's not the point. Of course, I'm happy about every patient that we can help significantly by fitting these lenses. But I also belong to the generation that experienced the “extinction” of scleral lenses in the 1990s. These lenses disappeared from the market for good reasons,
because the oxygen supply to the cornea was really limited with the materials used at the time and the changes caused to the eye by wearing the lenses were not tolerable. And even though we have better materials available today, a sense of scepticism remains with me when I see how mini-scleral lenses are hyped today.
Corinna Jonske: You mean that because many ftters are too careless with the modality “mini-scleral”, because you hear about it everywhere, and it is advertised as “easy” and without problems? Are you worried that some people don't realize the efects?
Uwe Bischof : Tat's right, and actually even more than that: at every contact lens conference, mini scleral lenses are one of
Uwe Bischof, Managing Partner at Müller Welt Kontaktlinsen, Stuttgart, Germany (left) and contact lens specialist at the contact lens institute
Corinna Jonske (right)
Mini-scleral
15.0 to 18.0 mm
Large-scleral
18.0 to 25.0 mm
Almost
the main topics, and the trade press also mainly covers the possibilities ofered by scleral lenses. Almost every manufacturer now has its own product, and optometrists are led to believe that ftting them is easy and can be done at the push of a button in some cases. But what happens then? If a contact lens ftter has little or no experience with GP contact lenses, will changes to the cornea caused by scleral lenses always be detected early and correctly on the slit lamp? What does he do when difculties arise? Does he then have the know-how and experience to assess the situation correctly?
Corinna Jonske: Tat's right, but we all don't have that many years of experience with these lenses yet. Even in practice, we occasionally see phenomena with these lenses that we didn't know about with corneal treatments. Just think of the epithelial vesicles that we have already seen under scleral lenses in severely damaged corneas, or the phosphate deposits that appear in some people. We always have to approach these cases cautiously and consult with the treating ophthalmologist.
Uwe Bischof: Te question is: how ofen are such changes also triggered in healthy eyes that would not necessarily have to wear scleral lenses?
Corinna Jonske: I see what you mean, if you haven't tried all the corneal RGP contact lens options before resorting to a scleral lens.
Uwe Bischof: Right! Our clear strategy is to only ft scleral lenses when all corneal options have been exhausted. As a rule, only those customers who have no viable alternative wear mini scleral lenses. If there are changes or difculties, then at least we know that we have already tried everything else that might have been healthier.
Corinna Jonske: Even with clear indications such as keratoconus, a f er keratoplasty, etc., we always try to f nd a corneal lens before resorting to a scleral lens. Because we know that this usually works for decades!
Uwe Bischof: For the practitioner and the patient, mini-scleral lenses initially ofer many advantages that are quickly visible and noticeable: there is hardly any familiarization time, they can quickly be worn all day, and the adaptation by bridging the entire surface is initially stress-free and easy. No wonder that many practitioners may no longer take the supposed detour via the corneal contact lens, even if it would actually be better and healthier for the eye.
Fig. 1: When ftting mini scleral lenses, it is not only the size that matters, but also the sagittal height.
Fig. 2: Defnition of mini scleral lenses for bridging ftting. Source: Scleral lens guide, Eef van der Worp
Fig. 3: Epithelial vesicles on a previously damaged cornea, occurring under the scleral lens, are tolerated and observed by the ophthalmologist.
Recently, we had a special case: we provided a customer with a lens a fer leukemia and severe gra f-versus-host disease. We had to perform the ftting completely in the dark because the man was so blinded by the open and scarred cornea that he experienced severe pain in normal daylight. Under such conditions, you need much more time for the ftting, let alone for teaching how to handle the lenses.
Corinna Jonske: It took four training sessions before the customer was able to put in the lenses with the help of his wife. Tis is almost impossible to calculate and can hardly be refected in the bill with a German health insurance company.
Uwe Bischof: It is also worth taking a look at physiology: What is the situation of the eyes a fer 20-30 years of wearing these lenses? We don't know that yet.
Corinna Jonske: Especially when I think of keratoplasties, we see neovascularization and changes to the cornea much more ofen, which we did not know from corneal care in this form. I am concerned that a keratoplasty under scleral lenses could decompensate earlier than if such a patient had a corneal treatment, which would mean an earlier re-keratoplasty, which one would actually like to avoid!
Uwe Bischoff: Exactly, and that's why it's important that experienced specialists deal with these lenses and can recognize changes early on and, if necessary, f nd solutions to avoid such
a situation. T is requires perfect mastery of the slit lamp, experience and further training.
Corinna Jonske: And especially with follow-up care, you occasionally face completely di ferent challenges when a lens that has worked perfectly so far is reordered with the same speci fcations and then no longer wets. In this case, it is also helpful to have experience with reworking and to be able to remove manufacturing residues (block wax) from the lens surfaces by polishing, for example.
Fig. 4: Phosphate deposits in the cornea under scleral lenses, often in connection with vitamin D intake, cause not yet verifed.
Fig. 6: Tilted keratoplasty with pronounced step.
Fig. 7: Extensive pterygium.
Fig. 8: Advanced keratoconjunctivitis sicca.
Fig. 5: Severe deep-seated keratoconus.
Uwe Bischof : In general, it is also very helpful to know the geometric structure of the lenses used well and to be able to optimize comfort by making targeted modi fcations when ftting them.
Corinna Jonske: My advice: anyone who wants to get started with the topic of mini-scleral lenses should defnitely get training from the manufacturer or ideally even do an internship at a specialist institute where many such contact lenses are ftted. T is also shows the importance of trying out all the other
contact lens variants and not simply dismissing corneal care as “antiquated”. It is still fully justi f ed and should not be forgotten in all this hype!
Uwe Bischof : My conclusion: Whenever the conditions in the eye do not allow the use of corneal solutions, we can ft scleral lenses meaningfully and then we can really help many people with these lenses without having to worry in the long term about perhaps making the wrong decision regarding the health of the eye.
Corinna Jonske: An additional comment on this: compliance plays a very important role in the success of these adjustments. In addition to being informed about the recommended maximum wearing time, the customer must also receive instruction in how to care for the lenses. In this context, the sensitivity of the filling solution is extremely important. We recommend mechanical cleaning, disinfection with a hydrogen peroxide system and a saline solution without any additives such as buffers or similar as the filling solution (under no circumstances the saline solution from the bottle!), and these solutions are not that easy to find on the market.
Uwe Bischof : Even though it is a challenge, with this concept we have now been able to help a great many people with miniscleral lenses not only to better vision but also to a completely new quality of life, and that even makes up for the annoyance I mentioned at the beginning of this article. n
Fig. 10: Signifcant blanching when blood fow is interrupted by the vessels. This is not acceptable!
Fig. 11: Conjunctival fap; the loose conjunctiva is pulled under the scleral lens, impairing oxygen supply.
Fig. 12: Midday fogging; the tear flm under the scleral lens becomes cloudy, impairing vision.
Fig. 9: Comparison of two 20-year-old keratoplasties, both treated with a corneal lens. This shows the diference in aging depending on the quality of the transplant, regardless of the lens worn.
Red light treatment in myopia management
First results and outlook
A question mark would have been a good ft after our headline, because in recent years, low-level red light treatment has received attention in connection with myopia management. However, in addition to success stories, there are also warnings about this form of treatment. We have looked at the studies. By
Rebekka Nurkanovic
Several studies on myopia management using low-level red light (LLRL) have already been published in China. In April 2023, for example, JAMA Network Open presented the results of a 12-month, school-based, randomized, parallel-group clinical trial conducted between April 2021 and August 2022 in ten primary schools in Shanghai, China. Te study aimed to evaluate the efcacy and safety of a repeated LLRL intervention for the prevention of myopia in children with pre-myopia. Te study included 278 children with pre-myopia (spherical equivalent refractive error of -0.50 to 0.50 dpt in the more myopic eye) and at least one parent with ≤-3.00 dpt, in grades 1 to 4.
Te children were randomly assigned to two groups. Te children in the intervention group received three-minute red light therapy twice a day, fve days a week. Te children in the control group continued their usual activities. At the fnal examination, a distinction was made in the intervention group between children who had an interruption of treatment due to the COVID 19 pandemic and those who did not. Te data of the more myopic eyes were analyzed. Te authors report that their results show
that red light therapy is an effective measure for myopia prevention, with good user acceptance and a reduction in myopia in children with pre-myopia of up to 54.1% within twelve months when comparing the group without interruption of treatment with the control group.1
In January 2024, an optometry researcher at the University of Houston, USA, warned against the use of LLRL therapy. Lisa Ostrin, a professor at the UH College of Optometry, reported in the journal Te College of Optometrists that measurements in her laboratory indicate that clinicians should reconsider use until safety standards can be confrmed and it is ensured that the retina cannot sufer photochemical and thermal damage.
Te researcher explains that thermal eye injury from a laser can occur at any wavelength if the temperature change of the retina is more than 10°C, which leads to protein denaturing. In the case of thermal damage, the size of the injured area is usually smaller than the beam diameter, and the resulting scotomas (weakening in part of the visual feld) are permanent. Te study
was published in Ophthalmic & Physiological Optics (OPO)2. Te publication of this study was followed by an objection from a company whose product was mentioned in the article but was not among the devices tested. Te company felt that its device was misrepresented and criticized the application of ANSI (American National Standards Institute) regulations in the study. The objection and the researchers' response to it were also published in OPO.3+4
At the EAH Jena (Germany), where clinical studies on the topic of red light in myopia management are in progress, a class 3R laser power was confrmed for a commercially available device during the measurement. Josefne Dolata, lecturer in the SciTec faculty, faculty of ophthalmic optics/optometry/ophthalmic technology/vision science, as well as a doctoral candidate at the TU Ilmenau and the EAH Jena, explained to GlobalCONTACT that the Occupational Safety and Health Ordinance on artifcial optical radiation OSTRV/2006 and the DIN EN 60825-1 (safety
of laser equipment – part 1: classification of systems and requirements) provide guidance. For example, DIN EN 60825-1 states that laser class 3R has a wavelength between 302.5 nm and 700 µm and an output of 1 to 5 milliwatts. According to the DIN standard, Class 3R laser radiation is potentially dangerous to the eye and special protective measures must be taken during operation, including the wearing of protective goggles, the appointment of a laser protection ofcer and the reporting of the use of this equipment.
Until further study results are available, it is up to the user to carry out a thorough risk/beneft assessment. n
A web survey conducted in August 2024 reveals that worries about climate are present in Gen Z’s future outlooks, with the results showing that 36% percent of Gen Z worry at least somewhat that they will need to move from where they currently live due to climate change and its impacts on water.
Source:TheWaltonFamilyFoundationandGallup
According to forecasts, the global market for ophthalmic devices could reach a volume of USD 55.47 billion by 2029. One reason for this expected market growth is that the prevalence of eye diseases is increasing as the global population ages and the demand for ophthalmic devices is rising accordingly.
Source:Statista
Global growth
The International Monetary Fund’s October 2024 World Economic Outlook summary states that global growth is expected to remain stable yet underwhelming and that fve years from now, global growth should reach 3.1% , a performance that is described as mediocre compared with the pre-pandemic average.
Source:IMF
Items sold on Amazon
71% of the products that wholesalers and retailers sell on Amazon are produced in China, according to a survey conducted by Jungle Scout and published by the ECDB.
Larsen Equipment
In 2004, Keith Parker and I opened Advanced Vision Technologies (AVT). At that time, the economy was going through a very bad recession and as a result, it was impossible for a new business starting up to get a loan. We immediately reached out to Erik and Pam at Larsen Equipment to get refurbished equipment to use in our Laboratory. As AVT’s business grew, we invested in many diferent pieces of new equipment from Larsen Equipment and this helped us grow into one of the Premiere Labs in the United States. Our success is due in part to Erik and his Team with their state-of-the-art equipment and maintenance of their products. AVT is forever grateful for Larsen Equipment’s support of AVT. It is great to know AVT is working with Industry leaders with the Larsen Equipment and their Team!
Janine Bungo, VicePresident
QUALITY MANAGER: RANDY MINGOY
I have known Erik Larsen since 1992. Since then I have used just about every piece of equipment his company has built. My experience with Erik and the Larsen team has been one of great appreciation as they have always helped me in my needs of fully understanding equipment used to manufacture quality contact lenses. Erik has also been able to engineer any part needed for me even it was a custom part. Erik (Larsen Equipment) has been and still is a pioneer in the contact lens and optical industry, and I am thankful to him for his support over the years.
Randy Mingoy
Quality Manager
Advanced Vision Technologies
DIRECTOR OF OPERATIONS: JORDAN GOBEL
Tere can be a lot of moving parts when it comes to managing operations, so it is key to have reliable precision equipment that assists in overall efciency. Larsen Equipment delivers just that! I have been utilizing Larsen manufacturing equipment for over 15+ years and have yet to run into an issue they could not resolve. I am a satisfed owner of bladder polishers, edge roller’s and auto-blockers etc. Each one of these units greatly assists in the reduction of rejects and manufacturing waste. Teir ability to customize and retroft speci fc tools certainly sets them apart from the competition. Larsen stands behind their equipment with a knowledgeable staff that provides exceptional service. Simply put, we are a better laboratory because of our relationship with the folks at Larsen.
Jordan Gobel Director of Operations/Consultant
Advanced Vision Technologies
PRESIDENT: KEITH PARKER
I have had the pleasure of working with Erik since the beginning of Larsen Equipment. Te f rst piece of equipment, a 6 spindle horizontal arm polisher revolutionized our production of GP contact lenses. T rough the years, I watched his business grow as he and his team listened to our Industry needs and developed now numerous products not only simplifying many tasks of manufacturing but improving the consistency of quality in our finished products. Innovation has been an ongoing experience of our Company only made possible through the innovation of necessary equipment developed and made available by the Larsen team.
Larsen Equipment is a family owned business hosting a team of willing Staff all having the attitude of serving their Customer’s needs. As a Customer, we are made to feel like we have a friend in the business helping us develop a more e f cient process allowing our Company to deliver better products for our Customers. Our success of AVT simply could not have been possible without the help, assistance and dedication of Larsen Equipment. I will be forever grateful for my opportunity to work with Erik and his very capable Sta f
Keith Parker President
The Ouchi Illusion
From the series “Visual Perception”
It is a book of “Designs for Artists and Craftsmen” that was published as early as 1977 under the title “Japanese Optical and Geometrical Art”. When the designer and artist Hajime Ouchi visited the psychologist Dr. Walter Ehrenstein jr.* (1950-2009) in 1986, he brought him his book as a gift. Walter Ehrenstein leafed through it and in the 746 patterns he saw on page 75 (Fig. 2) at the top left, an incredible picture: the inner circle seemed to move within the outer circle! By Bernd Lingelbach
Before this incident, no one had ever noticed this apparent movement in the pattern, not even Hajime Ouchi. Walter Ehrenstein also had an explanation ready. Te inner and outer circles are separated by the diferent directions of the “tiles” for the perception.
The peripheral and central visual fields are “processed” diferently by the neurons. Te peripheral visual feld remains
largely stable despite small eye movements. Tis is not the case with central vision. If, as in fgure 1, there is already a separation of center and periphery in the image itself, then the inner part can also be separated from the outer part in perception. Te inner circle takes on a life of its own and follows the eye movements. This leads to the apparent movements of the inner circle.
Fig 1: Ouchi illusion
Walter Ehrenstein knew immediately: he should publish the efect as soon as possible. It turned out diferently.**
Akiyoshi Kitaoka's version of the Ouchi illusion.
Te optical illusion “Rotating Snakes” made Akiyoshi Kitaoka world-famous more than 20 years ago. But he is also known for creating a stronger version of almost every illusion. In figure 3, the well-known researcher of optical illusions strengthens the separation of the periphery and the center by adding a red ring and a shadow. Both are slightly ofset to the side. Tis also creates an enormous sense of space. Te inner circle seems to foat above the periphery.
Spine-Drift Illusion by Akiyoshi Kitaoka
Akiyoshi does not seem to have been completely satisfed with the result of fgure 3. He experimented further and then carried out a consistent separation of center and periphery in the picture. For this he used his “spines”, which he had also used to explain other phenomena. In fgure 4 the inner square seems to be detached from the periphery. Even if you try to concentrate on keeping it fxed, it will make small movements. Basically, we “see” our spontaneous eye movements. n
Dr. Bernd Lingelbach was a professor at Aalen University in the Ophthalmic Optics degree programme. He was and is regularly present at international conferences with his own contributions. Lingelbach's barn in Leinroden is known far beyond the borders of Germany. Many examples of visual perception and a large collection of various items illustrating optical phenomena can be found here.There have been a whole series of television programmes about the barn.
References :
* Walter Ehrenstein Jr., hereinafter referred to as Walter E., is the son of the psychologist Walter Ehrenstein (1899 - 1961), the discoverer of the “Ehrenstein Pattern”.
** The pattern became known worldwide in 1986 as the “Ouchi-Spillmann Illusion.” It was only in 2016, seven years after the death of Walter Ehrenstein Jr., that Spillmann mentioned that Walter Ehrenstein had given him access to the book (https://journals. sagepub.com/doi/pdf/10.1177/0301006616637433 ).
Fig 2: Ouchi's book contains 746 patterns in this and similar styles. On page 75, right page, top left, Walter Ehrenstein discovers the apparent movement of the inner circle.
Fig 3: Akiyoshi Kitaoka emphasizes the separation of the periphery and the center in this version. The inner circle seems to foat in front of the outer level.
Fig 4: Spine-Drift Illusion by Akiyoshi Kitaoka. The inner square seems to “foat”. Depending on the distance, it may even appear that the outer square moves a little.
Heinrich Meibom. (Picture in frame: Herzog August Bibliothek Wolfenbüttel: Portr. II 3479a)
Pioneers of ophthalmic optics
Heinrich Meibom
Anyone who deals with contact lenses today or is increasingly concerned with the topic of dry eyes cannot avoid his name: Heinrich Meibom. He was an important German scientist and physician of the 17th century who is best known for his discovery of Meibomian Glands, which are named after him. These small glands, which ends are located at the rim of the eyelids, play an important role in the health of the eye, particularly in the production of the lipid part of the tear flm. By Silke Sage
First a few key facts: Heinrich Meibom, born on June 29, 1638 in Lübeck, Germany and died on March 26, 1700 in Helmstedt, came from an academic family. His grandfather, also a Heinrich Meibom (the Elder), was a professor of history and poetry, and his father was a well-known historian. Meibom initially received private tuition, but then studied medicine at the University of Helmstedt and later also in the Netherlands in Groningen and Leiden. In 1663, he received his doctorate in France at the University of Angers. Meibom undertook numerous educational trips throughout Europe, including to Italy, France and England.
Broad scientific sphere of activity
Afer his return to Germany, Meibom began his academic career at the University of Helmstedt, where he worked as a professor of medicine. His scientifc interests were initially wide-ranging. His ability to combine these diferent disciplines contributed signifcantly to his scientifc success.
His work, particularly on the anatomy of the eye, and the scientifc signifcance of his fndings have endured to this day.
Te "discovery" of Meibom's glands took place in 1666, when Meibom carried out detailed studies on the anatomy of the eye. He frst described these glands in his work "De vasis palpebrarum novis epistola", in which he detailed the structure and function of these previously unknown glands. Te Meibomian glands are small sebaceous glands at the rim of the eyelids that produce an oily secretion that prevents the tear fuid from evaporating too quickly. Te secretion also lubricates the rim of the eyelids, which prevents the tear fuid from "overfowing" beyond the rim of the eyelid. Meibom's discovery was a signifcant contribution to ophthalmology and is still appreciated in medical circles today. In the same year, he also discovered the "blind hole of the tongue" (Foramen Meibomii). In addition to his medical research, Meibom was also active in academic administration and served as rector
of the University of Helmstedt. In 1678, he also became professor of history and poetry. He held these positions until his death in 1700. Meibom's involvement in the academic world and his contributions to medicine and science made him an infuential fgure of his time. His marriage to Anna Sophia produced seven children. His son Brandanus Meibom (1678-1740) became professor of pathology, semiotics, botany and medicine.
Meibom's legacy
His work, particularly on the anatomy of the eye, and the scientifc significance of his findings have endured to this day. Every optometrist is familiar with the meibomian glands (also known as the tarsal glands) and they are assessed in particular when dealing with the tear flm and contact lenses. Te condition of the gland function has a decisive infuence on modern contact lens ftting and on the quality of the tear flm. Both underproduction and overproduction of the meibomian glands can cause difculties. Overproduction leads to deposits and a greasy flm on the contact lens surface. Underproduction can lead to dry eye symptoms. Meibom's life and work provide an inspiring example of the power of curiosity and scientifc discovery that still resonates in the medical community today. n
The meibomian glands, clearly recognisable here as light-coloured structures in the upper and lower eyelid. Picture: Dr. Stefan Bandlitz / HFAK
Security training in the supply chain
Cyber security series | Part 1
In an increasingly interconnected global economy, companies must recognize the critical importance of protecting their data and knowledge. The supply chain is a vital component of our economic infrastructure, and its security directly impacts our national security, economic stability, and competitive edge. Everyone must take responsibility and do their part. In part 1 of this serial about cyber security you will fnd a high-level overview of why it is important to protect yourself and, in turn, protect the entire chain. By Nabil Gharbieh
Te Vision Council came to me to create this cybersecurity series as a result of increasing requests from their members and a very direct call out by the United States Trade Representative (USTR) in their “Four Year Review of China Tech Transfer Section 301,” released in May of this year.
Specifcally, in the report, the USTR stated: “U.S. companies should prioritize cyber defenses, invest in the necessary infrastructure and services, and take appropriate actions to remediate vulnerabilities and prioritize strengthening cyber defenses. Greater transparency by U.S. companies on the extent, type, and investment in cyber defense would permit market investors to support U.S. companies taking appropriate steps to protect their technology, IP, trade secrets, and confdential business information from China’s cyber espionage.”
Essentially, the government is advising industry to work together and prioritize cyber security. Te Vision Council’s Government Regulatory Afairs team fagged this immediately, and saw an opportunity to educate the vision industry on steps that they can take to protect their businesses and work together to fortify the industry.
A collective approach to business intelligence security
Pardon the cliché, but we are stronger together. Just as a chain is only as strong as its weakest link, the security of our supply chains depends on each company's ability to protect their data. Working together ensures that vulnerabilities are addressed collectively, reducing the risk of breaches.
By collaborating, companies can share insights on emerging threats, efective security practices, and successful mitigation strategies.
A coordinated approach to security incidents allows for faster and more efective responses, minimizing the impact of breaches.
Te protection of all is therefore based on three pillars:
1. Collective defense
2. Shared knowledge and best practices
3. Unifed response to threats
Examples of technology incidents in the supply chain: Target
During the holiday season of 2013, shoppers were flling Target stores while a signifcant data breach was unfolding behind the scenes. One that would impact millions and changed how we think about cybersecurity.
A small subcontractor named Fazio Mechanical Services handled refrigeration, heating, and air conditioning for Target. Unfortunately, their security defenses were not as strong as they needed to be. Hackers saw an opportunity and sent a phishing email to Fazio, tricking an employee into downloading malware. Tis malware opened the door for the hackers to access Fazio’s network. But they did not stop there. Tey used the credentials they found to break into Target’s main network. Once inside, they placed more malware on Target’s point-of-sale systems the very machines that read our credit and debit cards when we
make purchases. For weeks, every card swiped at Target was silently recorded by the hackers.
Te attackers were a group of skilled cybercriminals operating out of Eastern Europe, primarily from Russia and Ukraine. Tey were known for their expertise in exploiting weaknesses in large organizations and had carried out similar attacks before.
Te breach was detected by FireEye, a security frm monitoring Target's network. Tey saw the malware and sent alerts, but these warnings were not acted on quickly enough. It was not until the U.S. Department of Justice alerted Target that the company took signifcant steps to stop the breach.
Te fallout was severe. Over 40 million credit and debit card numbers were stolen, along with personal information from 70 million customers. Target faced lawsuits, huge fnancial losses, and a tarnished reputation. Tey had to spend millions on legal
Fig. 1
fees and security upgrades. This breach highlighted the importance of strong cybersecurity measures and the risks posed by third-party vendors.
Lessons learned
So, what can we learn from this?
Tird-party risk management: It is crucial to ensure that any company you work with has strong security practices. Regular audits and strict security requirements for vendors can help prevent similar breaches.
Phishing awareness: Te breach started with a simple phishing email. Educating employees about the dangers of phishing and how to spot suspicious emails is essential.
Prompt response to alerts: When security alerts are ignored or delayed, it gives hackers more time to cause damage. Having a robust incident response plan and acting on alerts promptly can limit the impact of breaches.
Network segmentation: By segmenting networks, companies can prevent attackers from moving freely within the system. Tis means even if one part is compromised, the rest remains secure.
Continuous monitoring and detection: Regularly updating security tools and ensuring they work efectively can help detect threats early. Continuous monitoring is key to staying ahead of cyber threats.
Vendor and supply chain risks
Tere are many risks to vendors and the supply chain when it comes to the security of our operations, data, devices, and business partners. Hardware, sofware, networks, data or service providers are all potential entry gates for hackers. Talking about hardware, servers, A/Cs, appliances or machines for example can become a target. Regarding sofware, those responsible should be able to answer the following questions: Who owns it? Who owns the data? Who is protecting it? Who has access? Te network can be hosted in-house, by third-parties or the data is stored on the cloud. In the last case, be aware that everything is everywhere all at once. Tese risks can generally be categorized at a high level as follows:
Compromised devices: For example, copiers can be hacked. Cloud solutions: Services like Ofce 365, Dropbox, and other solutions you might not even realize are within your reach can pose risks.
Incident investigation: I ofen encounter security scares with clients, and my frst job is to determine whether the issue is on our end or the vendor’s. Tis is why someone in the organization must vet all companies you do business with, as those not in IT might not ask all the necessary questions regarding IT security. Vendor engagement: It is challenging when, every other day, I hear, “Oh, I am talking to this salesperson about sofware we may buy.” You do not know how much we just love to hear those words on the security side of things.
Practical IT steps for securing the supply chain
With a few important but efective steps, the vast majority of attacks can be avoided. Te following rules provide clarity and ofer a simple guideline that every company can follow.
1. Conduct regular security audits
Regularly assess the security posture of your systems and those of your supply chain partners. Periodically hire independent auditors.
2. Implement Multi-Factor Authentication (MFA)
Enhance security by requiring multiple forms of verifcation before granting access to your systems. Let a risk registry highlight your weak points.
3. Use end-to-end encryption
Protect data in transit and at rest with robust encryption methods.
4. Monitor network trafc
Employ advanced monitoring tools to detect unusual activity and potential breaches in real-time.
5. Patch management
Ensure all sofware and systems are up-to-date with the latest security patches to close known vulnerabilities.
6. Relationships
Manage them! Be picky!
Create or use existing third-party risk management cycle relationships with your employees!
Cybersecurity training for employees
At least once a year every company should conduct a security refresher for the entire team. Part 2 of Te Vision Council serial of cyber security presentations can be implemented as a required training for your team, eliminating the need to organize or hire a separate company to conduct one.
And do not forget: your security is as strong as your weakest link and your weakest link tends to be coworkers. Ask yourself: how confdent are you with your coworker’s security knowledge? Especially four aspects are crucial to make your team ft for cyber security:
Phishing Awareness: Train employees to recognize and report phishing attempts, which are common vectors for cyber-attacks. Incident response training: Develop and drill incident response plans to ensure quick and efective action in the event of an incident. Data handling & privacy: Educate staf on best practices for handling sensitive data and complying with data protection regulations
Tird-party risks: Train employees to assess and manage risks associated with third-party vendors and partners.
If you do not have internal guidance, the government provides well-drawn-out guidelines on cybersecurity for businesses. Tese guidelines are widely adopted by government agencies and larger companies.
Here are some of the main ones if your IT team does not cover security: U.S. Cybersecurity and Infrastructure Security Agency
(CISA), Information Sharing and Analysis Centers (ISACs), Professional Cybersecurity Organizations like ISACA and ISC2 and the National Institute of Standards and Technology (NIST).
Recently NIST has released the 'Risk Management Framework (RMF) Small Enterprise Quick Start Guide,' which I highly recommend for small businesses seeking a comprehensive, fexible, risk-based approach to managing information security and privacy risk.
When choosing sofware or a third-party vendor, make sure to include the IT team so they can help assess IT risks. Here is a third-party risk management life cycle (Fig. 2) that you can copy. While it is not an ofcial version, as those are more detailed, this is a good starting point.
Issues can arise when you do not manage this efectively. For example, employees might use services like Dropbox or bring in vendors to discuss sofware without IT assessing how it will integrate with existing systems. I have had instances where an employee created a Google Drive or Dropbox account, then lef the company, and nobody could access the account because nobody had the password. Tis also becomes a problem as you continue to move towards AI. AI quality depends on the data it receives, so the experience you get is infuenced by the data you input. Te more tools you have scattered across diferent platforms, the more you will need to integrate them with add-ons, increasing security vulnerabilities. Terefore, it is crucial to get a handle on it.
Outlook
Tis article should provide a good basis for raising awareness on good cyber security strategies and the importance of protecting your supply chain. In the second part of the series, I will focus on employees. Te article will teach employees how to be more vigilant when working with computers and “all of the things”. In part 3 of this article series, we will discuss essential policies and procedures, such as business continuity plans and backup plans, that you need to establish and review annually. n
Nabil Gharbieh is an IT-expert and currently leads The Vision Council´s webinar series about cyber security strategies. As an Information Technology Advisor at Dataprise, Nabil provides quality management services to clients across various industries and sectors. With over 17 years of experience in IT, he has developed expertise in program management, technical account management, customer success, sales, and technology advisory. Nabil is certifed in Microsoft Technologies, AI, Health Care IT Security, ITIL, Google Cloud, and Apple/ Mac Integration.
This topic was frst addressed in a lecture, presented by The Vision Council
Fig.2: Risk management life cycle
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