GlobalCONTACT - 01/2022

ISSN:1386 0194

1

2022 (90)

Anniversary • 30 years GlobalCONTACT

Fitting Background • Ultra-Dk contact lenses

TRANSFORMING LIVES From lens materials to industry support, we see the importance of working together to deliver products and expertise that truly transform patients’ lives.

Technology • Freeform lenses made by liquid polymers

Business + Marketing

Full Range of Products

Educational Initiatives

• Self-determined salaries

Report • Global Specialty Lens Symposium

NOW AVAILABLE AT YOUR APP STORE 01_Titel.indd 1

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09.03.22 12:21

LETTER FROM THE EDITOR

90th Edition of GlobalCONTACT Today we celebrate our 30th anniversary of GlobalCONTACT

Now, a lmost 14 years later, I sti l l come to work on

and you have the 90 issue in front of you. We take this as an

GlobalCONTACT every day with the same enthusiasm as I

opportunity to look back and review the beginnings and

did on my very first day.

th

development of GlobalCONTACT. For page 32+33, I went through the archive of my photos of The magazine has had three publishers and has been a close

GlobalCONTACT from over the past 14 years. During that

witness to all the ups and downs in the contact lens industry.

time, I have accompanied the magazine, the industry and the

In 1992, 'Contact' (as it was aptly named at the time) was

people involved. Many of them have become friends; some

published as the journal of the European association EFCLIN.

have unfortunately already left us over the years.

However, it only appeared nine times under this flag before being handed over to EPS and Wim Aalbers who published it

We would like to thank you very much for this trusting

from 1995 to 2008. Chance and the firm resolve of Wim Aalbers

cooperation and your loyalty! So let’s look forward with

and Jörg Spangemacher who wanted this magazine to continue

optimism to the next 30 years! Whenever you have an idea,

to exist and genuinely foster Contact within the industry, led

something to share or even some criticism, please go ahead

to GlobalCONTACT passing into our hands in Germany in

and let us know. It is very much appreciated.

the autumn of 2008. May we introduce ourselves?

However, let us not forget one thing during this time: The As our reader, you are of course familiar with this trade magazine

war in Ukraine is an immense tragedy for all people who live

for the contact lens industry and the unique media mix with

or have lived in Ukraine and are now on the run. The whole

the digital edition in the GlobalCONTACT app. The Eyepress

world, and Europe in particular, is watching anxiously for

Publishing House, which gives GlobalCONTACT its home,

any further developments – and so are we at GlobalCONTACT.

publishes a wide range of trade journals for experts from various

In the next issue, we would like to address the consequences

disciplines in optometry, optics and ophthalmology. The

for our industry as they may occur: The shortage of raw

portfolio includes five German and English language journals

materials but also how business relations with Russia and the

as well as six indices. They are published as print products as

people and employees in the respective countries are affected.

well as online and in their own app. There are editorially

We would therefore like to hear your opinion. Please write

designed websites for all magazines.

to me directly: silke@global-cl.com ■

So, in 2008 another publication was added to the existing ones. But it is much more than that: The contact lens business is a remarkable and committed industry built on longtime

SILKE SAGE

friendships and a tightly woven network. I count myself as

Editor-In-Chief

fortunate to have been involved from day one, even though

silke@global-cl.com

as an optometrist initially I found it challenging. For me it was important to find out how this industry ticks, who does what, and which topics could be of particular interest to the readers.

GlobalCONTACT 1-22

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48th

EFCLIN

EUROPEAN FEDERATION OF THE

CONTACT LENS AND IOL INDUSTRIES

CONGRESS EXHIBITION

28TH – 30TH APRIL 2022 BARCELONA/SITGES, SPAIN

A WORLD OF OPPORTUNITIES 2022

Spanish culture combined with ancient and modern science has found Sitges/Barcelona to be the perfect location for business and leisure time as well.

The 48th EFCLIN Congress & Exhibition takes place there from 28th – 30th April 2022.

For an engaging lecture program, manufacturer’s 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?

REGISTER NOW

www.efclin.com/congress or e-mail us on info@efclin.com Comsy_Ins_EFCLIN_2022_A4.indd 1 !AZ.indd 4

MORE INFORMATION WEB www.efclin.com MAIL info@efclin.com PHONE +41 41 372 10 10 FACEBOOK search: EFCLIN TWITTER @EFCLIN#efclincongress ADDRESS EFCLIN | Winkelbüel 2 | CH-6043 Adligenswil | Switzerland

27.04.21 14:22 25.02.22 12:25

CONTENT

ISSN:1386 0194

LETTER FROM THE EDITOR 3

90th Edition of GlobalCONTACT Silke Sage

1

2022 (90)

Anniversary • 30 years GlobalCONTACT

Fitting Background • Ultra-Dk contact lenses

INTERNATIONAL NEWS

TRANSFORMING LIVES

6

10 All about markets

From lens materials to industry support, we see the importance of working together to deliver products and expertise that truly transform patients’ lives.

12 All about research

Technology • Freeform lenses made by liquid polymers

Business + Marketing

Full Range of Products

All about you & Event dates

16 All about products

Educational Initiatives

• Self-determined salaries

ANNIVERSARY

Report • Global Specialty Lens Symposium

20 30 years in the contact lens industry Impressions and opinions NOW AVAILABLE AT YOUR APP STORE

24 Something else in retrospect INDEX TO ADVERTISERS Title: Contamac, www.contamac.com

Inside front cover: Bausch + Lomb Inc., www.bausch.com Page 4: Efclin, www.efclin.com Page 7, 31: OPTOCRAFT GmbH, www.optocraft.com Page 9: Misupco, Inc., www.misupco.com Page 11: AMETEK Precitech, Inc., www.precitech.com Page 15: Schneider GmbH & Co. KG, www.schneider-om.com Page 17: Rotlex, www.rotlex.com Page 28, 55: K & Y Diamond Ltd, www.kydiamond.ca Page 29: DIATEC Diamanttechnik GmbH, www.diatec-pforzheim.de Page 30, 49: Larsen Equipment Design Inc., www.larsenequipment.com Page 31, 41: Optimec Systems Ltd., www.optimecsystems.com Page 47: LAMBDA-X S.A., www.lambda-x.com Inside back cover: Acuity Polymers, Inc, www.acuitypolymers.com Outside back cover: DAC International, Inc., www.dac-intl.com

NAMES TO NOTE Aalbers, Wim Frumkin, Valeri Hein, Jessica Hoy, Lachlan Larsen, Erik Meegan, Millie Müller, Leonie Urschinger, Timm van der Worp, Eef GlobalCONTACT 1-22

05_Content.indd 5

24 34 48 44 37 44 48 52 38

Wim Aalbers

TECHNOLOGY 34 Freeform lenses made by liquid polymers Interview with Valeri Frumkin by Hanna Diewald

MANUFACTURING 37 Lab consultation Erik Larsen

FITTING BACKGROUND 38 Safety in sclerals Eef van der Worp

44 Ultra-Dk contact lenses Lachlan Hoy & Millie Meegan

48 Imaging techniques – case study Jessica Hein, Leonie Müller

BUSINESS + MARKETING 52 Self-determined salaries Interview with Timm Urschinger

REPORT 18 Global Specialty Lens Symposium (GSLS) Silke Sage

43 Expert talk on MDR 50 Euromcontact market data report 2021 NEWS 56 Yellow Pages 5

25.03.22 09:10

INTERNATIONAL NEWS

All about you Samsara Vision awarded NUB status 1 reimbursement designation for SING IMT

possible and realistic

Samsara Vision announced that the German Institute for Hospital

commit to working

Remuneration (InEK) has granted NUB (Neue Untersuchungs-

with their ophthalmo-

und Behandlungsmethoden) Status 1 reimbursement designation

logical team to use

for the SING IMT (smaller-incision new-generation implantable

visual techniques and

miniature telescope). The SING IMT is approved for people

exercises to maximize

living with late-stage, age-related macular degeneration (AMD)

the effectiveness of

who are 55 years of age or older in CE referenced countries since

SING IMT. Patients

May 2020.

The NUB process allows negotiations between participating

must also meet age, SING IMT, a Galileo telescopic implant vision, cornea health, designed to improve visual acuity and quality

hospitals and health insurance providers regarding supplemental

and other require-

reimbursement of new medical treatments with the potential to

ments noted in the

improve the standard of care for patients in Germany.

patient information booklet to determine if they are a candidate

Nearly invisible inside the eye, the tiny SING IMT is a Galilean

for the SING IMT.

telescope implant designed to improve visual acuity and quality

The telescopic implant is not a cure for late-stage age-related

of life for patients with late-stage, age-related macular

macular degeneration (AMD). It will not return vision to the

degeneration. Comprised of ultra-precision micro-optics, the

level a patient had before AMD, nor will it completely make up

SING IMT is implanted during typical, out-patient cataract

for vision loss. The most common risks of the SING IMT surgery

surgery. After recovering from surgery, the patients work closely

include inflammatory deposits or precipitates on the device and

with a low vision specialist and occupational therapists to learn

increased intraocular pressure. Significant adverse events include

how to use their new vision.

corneal edema, vision-impairing corneal edema, corneal

Because AMD is a progressive disease, over time, patients have

transplant, and decrease in visual acuity. There is a risk that

adapted with the loss of vision in the central field of vision.

having the telescope implantation surgery could worsen vision

Before receiving the SING IMT, patients must understand the

rather than improve it. Individual results may vary.

outcomes post-op and

of life for patients with late-stage age-related macular degeneration. Source: Samsara Vision

addition to Dr. Stefan Krey and Joern Luethje, who have already been appointed as the CTO and CFO respectively, the new Trioptics management board was completed by Kristin Holzhey (CEO) and Simon Zilian (CSO) on January 1, 2022. Eugen Dumitrescu, who founded the company in 1991, will remain with the company until March 31, 2022, as an active managing director and then as a member of the advisory board. Since September 2019, Trioptics has been a member of the Jenoptik Group, which is based in Jena.

Kristin Holzhey has been the managing director of Otto Vision Technology GmbH since 2019 and has been directing the integration of the Trioptics Group into the Jenoptik Group since 2020. Since Dr. Stefan Krey, Simon Zilian, Kristin Holzhey, Jörn Lüthje (f.l.t.r.) Source: Trioptics

Change at the top of Trioptics

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January 1, 2022, Kristin Holzhey is the vice president in charge of the “Optical Test & Measurement” strategic business unit at Jenoptik and has taken on her new role as the CEO of Trioptics.

The other new addition to the management team is Simon Zilian,

On April 1, 2022, Eugen Dumitrescu will be stepping down

who has been with Trioptics since 2005 and has played a key

from his executive position after 30 years at the helm of the

role in driving the company’s growth over the past 16 years.

Wedel-based German company as he hands over t he

Since January 1, 2022, he is the CSO responsible for sales,

responsibility to a new and extended management team. In

marketing, service and customer care within the Trioptics Group.

GlobalCONTACT 1-22

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INTERNATIONAL NEWS

Johnson & Johnson Vision Care receives FDA approval for Acuvue Theravision with Ketotifen

Canada, where patients already have access to the new lenses.

Johnson & Johnson Vision Care, Inc. recently announced that

with Ketotifen showed a clinically and statistically meaningful

the U.S. Food and Drug Administration (FDA) has approved

reduction in itchy allergy eyes as quickly as three minutes after

Acuvue Theravision with Ketotifen (etafilcon A drug-eluting

lens insertion and lasting up to twelve hours; however, the lens

contact lens with ketotifen). Each lens contains 19 mcg ketotifen.

may be worn for longer than twelve hours for vision correction.

Ketotifen is a well-established antihistamine.

“Ocular allergic itch in contact lens wearers may soon be an

Acuvue Theravision with Ketotifen are daily disposable contact

issue of the past thanks to the decision of the FDA in approving

lenses indicated for the prevention of ocular itch due to allergic

Acuvue Theravision with Ketotifen,” said Brian Pall, OD, MS,

conjunctivitis and provide vision correction in patients who

FAAO, Director, Clinical Science, Johnson & Johnson Vision

do not have red eyes, who are suitable for contact lens wear

Care. “These new lenses may help keep more people in contact

and who do not have more than 1.00D of astigmatism.

lenses, since they relieve allergic eye itch for up to twelve hours,

Within the U.S., approximately 40 percent of contact lens

without the need for allergy drops, and provide vision

wearers suffer from itchy eyes due to ocular allergies, and nearly

correction.”

eight out of ten contact lenses wearers with eye allergies agree

“At Johnson & Johnson Vision, we are committed to bringing

that they are frustrated when allergies interfere with their

forward new technologies and innovations that can improve

normal contact lens wear. While allergy eye drops are a very

vision and overall eye health,” said Thomas Swinnen, President,

common treatment, one in two contact lens wearers say that

North America, Johnson & Johnson Vision Care, Inc. “This

the drops are inconvenient to use.

approval marks another significant milestone in Johnson &

The announcement follows positive phase 3 clinical studies

Johnson Vision’s legacy of rethinking what’s possible with

published in the journal Cornea and regulatory approval by

contact lenses to meet the visual and eye health needs of people

the Japanese Ministry of Health, Labor and Welfare, and Health

around the world.”

According to the phase 3 clinical studies, Acuvue Theravision

Advertisement

Let‘s meet again!

Come and see our news at the EFCLIN congress, 28.04. - 30.04.2022 in Barcelona.

Know your quality!

Metrology for contact lenses and intra ocular lenses.

Tel. +49 9131 69 15 00 email sales@optocraft.de !AZ.indd 1 06_about_you.indd 7

16.02.22 21:22 08:05 24.03.22

INTERNATIONAL NEWS

CooperVision plastic neutral contact lens program posts first-year results

Currently, 18 CooperVision subsidiaries in Europe and North America

One year after CooperVision established the first plastic neutral contact

slated to join this year. With this expanded scale, the program is expected

lens through a partnership with Plastic Bank the program has made a

to prevent the equivalent of nearly 90 million plastic bottles from reaching

are participating with nine more in Asia, South America, and Europe

significant environmental and social impact worldwide:

oceans in 2022 – more than three times the amount collected in 2021.

• The equivalent of nearly 28 million plastic bottles have been prevented

“We are constantly striving to identify novel solutions that not only address

from polluting the oceans.

key sustainability challenges but also create new opportunities,” said Dan

• 171 coastal communities have directly benefited from exchanging

McBride, Executive Vice President (EVP), Chief Operating Officer of

ocean-bound plastic for necessities such as clean water, groceries,

CooperCompanies. “By reexamining our relationship with plastic, we can

cooking oil, school tuition, and even health insurance.

help protect the world’s oceans and transform waste into a resource.”

According to CooperVision, their partnership with Plastic Bank, a social

“There is no single approach that achieves sustainability, so we need

enterprise that builds ethical recycling ecosystems in coastal communities

to manage plastic use on many fronts,” McBride continued. “There is

and reprocesses the materials for reintroduction into the global supply

no finish line either, so we invite contact lens wearers and the rest of

chain, is the largest plastic neutrality initiative in the contact lens industry.

the eye care industry to join us.”

30 years Trioptics

Driven by the idea to significantly develop and lead the field of computer

On December 1st, 2021, the optical metrology specialist Trioptics

controlled optical metrology, Eugen Dumitrescu founded Trioptics on

celebrated its 30 anniversary in business. The company, headquartered

December 1st, 1991, in Wedel with two partners. The company states

in Wedel near Hamburg, Germany, is one of the world’s leading

that their primary focus has always been the customer-oriented

companies in the field of optical measurement and manufacturing

development of optical measurement systems, later expanding to include

technology with subsidiaries and sales partners around the world.

manufacturing instruments. Early on, they opened subsidiaries in Asia

With their products and systems they aim to accompany and improve

and the USA to quickly provide on-site support to their customers.

the development, production, and quality control of optical components,

Over the years, Trioptics has consistently expanded its product

lenses, camera modules, and sensor systems worldwide.

portfolio, continuously improved established measurement methods,

th

and placed a significant focus on the automation of its systems. Large international and interdisciplinary customer projects are seen as just as important as the continuous development of the standard portfolio of products. The company serves the entire optical production value chain as one of the leading suppliers of optical measurement and manufacturing systems.

In 2018, they moved to the new headquarters in Wedel, just a few hundred meters from the founding address. Today, roughly 500 Source: Trioptics

employees worldwide work towards the success of the company. In 2020 Trioptics was integrated into the Jenoptik photonics group.

Euclid Systems names key leadership hires and announces major facility expansion

Boorady. “We’re pleased to welcome Greg Endicott and Mark

Euclid Systems Corporation, a global leader in advanced orthokeratology

in fast-paced healthcare environments. Their knowledge and

and proactive myopia management, announced two additions to its

leadership, as well as the brick-and-mortar expansion of our facilities,

leadership team as well as the expansion of its manufacturing facility

help fortify Euclid’s growth as a cutting-edge world leader in myopia

in Sterling, Virginia, USA.

management technologies.”

Space at the Euclid facility in Sterling, Virginia, has now been expanded

As Chief Information Officer (CIO), Greg Endicott will lead Euclid’s

over 40%. Additions include larger manufacturing space, quality assurance

strategic technology program and drive business initiatives in collaboration

labs, offices, and engineering/R&D space.

with global business leaders, including exploration of emerging

“With the launch of our game-changing Euclid Max Ortho-K lens

technologies and new strategies. Previously, Mr. Endicott had a leadership

this year, we have entered a very exciting time at Euclid. But our

role at Baxter Bioscience and was inaugural CIO of two scientific research

steadfast commitment to innovation is not taking a break. We’ve

companies. New Senior Director of Operations is Mark Mercier, a

just expanded our manufacturing space and employee resources

transformation specialist with decades of experience in contact lens

for the second time in three years and continue to grow our leadership

manufacturing at Bausch+Lomb. Mr. Mercier will drive efficient

team for future expansion,” said Euclid Systems CEO, Joseph

methodologies throughout Euclid’s manufacturing and fulfillment.

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Mercier, who bring decades of experience, innovation, and results

GlobalCONTACT 1-22

24.03.22 21:22

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INTERNATIONAL NEWS

New free form lens design feature

practitioners with more

BostonSight announced their new free form lens design feature,

fitting options for their

Smart360, for the BostonSight Scleral product.

patients, and ultimately

Using Smart360, practitioners can design a free form lens

better patient satisfaction.”

from 16 mm to 19 mm, giving them ultimate flexibility. The

“Smar t360 is simply

organization was one of the first to introduce empirical fitting.

another way to create a

In 2019, they introduced Scleral-IG, an image-guided fitting

customized lens using the

system for the BostonSight Scleral lens using Eaglet ESP. This

sa me great data-driven

year, the organization collaborated with a team of beta testers

design technolog y t hat

from the BostonSight Scleral network to evolve the technology,

BostonSight is known for,”

resulting in Smart360. Practitioners send a 360-degree scan

said Karen Carrasquillo,

of the eye directly to the organizations’ manufacturing lab

OD, PhD, FA AO, FSLS,

via the practitioner’s FitConnect account. Smart360 currently

FBCLA, Vice President of

integrates with the Oculus Pentacam CSP and CSP Pro and

Clinical and Professional

the Eaglet Eye ESP.

Affairs. What makes Smart360 unique in the empirical

“Our ongoing commitment to research and achieving optimal

fitting market is that practitioners can continue to tailor

patient outcomes drives our innovations in scleral lens design,”

the lens with BostonSight Scleral’s suite of smart features,

said Sara Yost, BostonSight’s President and CEO. “Data analysis

including SmartChannel technology to vault anatomical

from over 20,000 patient eyes, combined with our research,

obstacles and minimize suction and SmartSight technology

is used to improve our products and features, providing

to reduce higher order aberrations.”

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06_about_you.indd 9 !AZ.indd 6

24.03.22 11:52 21:22 09.03.22

INTERNATIONAL NEWS

All about markets Laser vision correction procedure volume for Q4 2021 The Refractive Surgery Council (RSC) reported laser vision

Contact lenses revenue Ukraine and Russia

correction procedure volume for Q4 2021 at 190,509, marking a year-to-date increase of

32%

According to the Contact Lenses Report 2020, Statista Consumer Market Outlook, revenue in the contact lenses segment of the eyewear

over 2020. The total procedure volume for 2021 topped 833,000

market was expected to amount to USD 15m in the Ukraine and to

for the first time since RSC began tracking LASIK, SMILE,

USD 485m

and PRK procedures in 2015, demonstrating a significant

in Russia in 2022. In global comparison, most revenue was expected to

consumer shift toward refractive surgery options

be generated in the United States (USD 5,326m in 2022).

to glasses and contacts.

www.statista.com/outlook/cmo/eyewear/contact-lenses/ukraine, www.statista.com/outlook/cmo/eyewear/contact-lenses/russia

Contact lens wear in European countries Euromcontact’s 2021 market data report states

that of the 21.7 million wearers in the 34 countries covered,

56%

use daily disposable, 43.9% weekly/bi-weekly and monthly replacement lenses, and 0.07% conventional soft lenses.

China is Russia’s most important trading partner, accounting for 13% of the country’s exports in 2019. The world’s largest exporter is even more important as a supplier of goods for Russia, accounting for 22% of the country’s goods imports in the same year.

Source: www.statista.com/ chart/26973/russias-most-important-import-partners

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24.03.22 21:26

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WEBINARS, CONFERENCES & TRADE FAIRS 2022 (due to the corona crisis, please check via the websites whether the event takes place)

EFCLIN 2022 www.efclin.com

Apr 28-30

Barcelona/ Sitges (Spain)

ARVO 2022 www.arvo.org

May 1-4

Denver, CO (USA)

EAOO & ECOO General Assembly www.visiondublin2022.com

May 12-15

Dublin (Ireland)

BCLA Focus www.bcla.org.uk

June 11-12

Hybrid: online, Birmingham (UK)

NCC 2022 www.contactlenscongress.com/?lang=en

June 26-27

Veldhoven (NL)

ICSC 2022 www.icscmeeting.com

July 29-30

Fort Lauderdale, FL (USA)

ECLSO Congress 2022 www.eclso.eu

Sep 2-3

Paris (France)

Vision By Design www.orthokmeeting.com

Sep 28 - Oct 2

Bellevue, WA (USA)

AAO 2022 www.aao.org

Sep 30 - Oct 3

Chicago, IL (USA)

IOFT 2022 International Optical Fair Tokyo www.ioft.jp/en-gb.html

Oct 18-20

Tokyo (JPN)

Advertisement

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20.03.20 21:26 17:54 24.03.22

INTERNATIONAL NEWS

All about research

Bionic eye, handheld autorefractor measurements acceptance, mechanism for AMD, contact lenses with gold nanoparticles After studying a bionic eye using a sheep model, researchers are confident it is safe for human trials. A paper found that eyeglasses made from QuickSee handheld autorefractor measurements were accepted equally to those made from subjective refraction measurements. A team from the University of Maryland School of Medicine has identified a new potential mechanism for age-related macular degeneration.

Researchers reported infusing contact lenses with gold nanoparticles to create a safer way to see colors.

Study identifies new mechanism that may cause blindness in older adults

targets to treat the disease. It was published in the Proceedings

Using laboratory-grown roundworms, as well as human and

Several years ago, researchers had identified genetic mutations

mouse eye tissue, University of Maryland School of Medicine

in the protein complement factor H as a contributor in a large

(UMSOM) researchers have identified a new potential

number of macular degeneration cases. Complement factor H

mechanism for age-related macular degeneration – the leading

marks cells in the body as self and protects them from attack

cause of blindness among older adults. The UMSOM

by the immune system, whose job it is to eliminate invading

researchers say that the findings suggest a new and distinct

pathogens and cells that do not belong. As a result, due to

cause that is different from the previous model of a problematic

complement factor H’s role in this process, it was thought that

immune system, showing that the structural organization of

macular degeneration was likely due to the immune system

the eye’s light-detecting cells may be affected by the disease.

attacking its own body’s cells that were not marked properly

The discovery offers the potential to identify new molecular

as “self.”

12

12_about_research.indd 12

of the National Academy of Sciences (PNAS).

GlobalCONTACT 1-22

23.03.22 10:16

INTERNATIONAL NEWS

According to Dr. Vogel, since identifying effective new therapies for the disease has been slow, he wanted to see if his team could find new insights from studying the disease components in his laboratory model of the roundworm, C. elegans.

Glowing sensory cells in the worm that make complement factor H protein. Photo: PNAS

Dr. Vogel’s team found a worm version of complement factor H protein located in the sensory neurons that help the worms

samples. Yet in people with complement factor H mutations

detect chemicals, food, touch, and temperature. The protein

(i.e. people genetically predisposed to macular degeneration),

appeared specifically in the middle region of the sensory

they found the inversin spread around, no longer restricted

neuron’s little antennas, known as cilia (that do the work of

to its neat banding pattern on the antenna.

sensing the environment), just next to another known

“Our findings suggest that complement factor H plays a role

important antenna protein called inversin. However, in worms

in maintaining the organization of photoreceptor cilia, and

bred to lack complement factor H, they found the inversin

this process may be defective in age-related macular

spread throughout the antennas rather than remaining in the

degeneration,” says Vogel. “We plan to continue this work to

middle of the antennas.

determine how this structural disruption affects vision and to

Next, the researchers confirmed their results in the light-

determine whether we can reverse the disruption and restore

detecting cells in tissue from human retinas. Complement

photoreceptor function.”

factor H and inversin had the same positioning next to each other in the antenna of light-detecting cells from healthy GlobalCONTACT 1-22

12_about_research.indd 13

Sources: UMSOM [1] 13

23.03.22 10:16

INTERNATIONAL NEWS

Bionic eye study paves the way towards human trials

as retinitis pigmentosa. The device has two main components which

A bionic eye being developed by a team of biomedical

communication module positioned under the skin behind the ear.

researchers at the University of Sydney and UNSW has shown

Published in Biomaterials, the researchers used a sheep model

to be safe and stable for long-term implantation in a three-

to observe how the body responds and heals when implanted

month study, paving the way towards human trials.

with the device, with the results allowing for further refinement

The Phoenix99 Bionic Eye is an implantable system, designed to

of the surgical procedure. The biomedical research team is

restore a form of vision to patients living with severe vision

now confident the device could be trialled in human patients.

impairment and blindness caused by degenerative diseases, such

The team will now apply for ethics approval to perform clinical

need to be implanted: a stimulator attached to the eye and a

trials in human patients, as they continue to develop and test advanced stimulation techniques.

The Phoenix99 Bionic Eye works by stimulating the retina – a thin stack of neurones lining the back of the eye. In healthy eyes, the cells in one of the layers turn incoming light into electrical messages which are sent to the brain. In some retinal diseases, the cells responsible for this crucial conversion degenerate, causing vision impairment. The system bypasses these malfunctioning cells by stimulating the remaining cells directly, effectively tricking the brain into believing that light was sensed.

“Importantly, we found the device has a very low impact on the neurons required to ‘trick’ the brain. There were no unexpected reactions from the tissue around the device and we expect it could safely remain in place for many years,” said Mr Samuel Eggenberger, a biomedical engineer who is completing his doctorate with Head of School of Biomedical The ocular and subcutaneous implant components of the Phoenix99.

Photo: University of Sydney

Engineering, Professor Gregg Suaning.

Sources: University of Sydney [2]

Color blindness-correcting contact lenses

To make the contact lenses, the researchers evenly mixed gold

Researchers reported infusing contact lenses with gold

nanoparticles into a hydrogel polymer, producing rose-tinted gels

nanoparticles to create a safer way to see colors in ACS Nano.

that filtered light within 520-580 nm, the wavelengths where red

Some daily activities, such as determining if a banana is ripe,

and green overlap. The most effective contact lenses were those with

selecting matching clothes or stopping at a red light, can be

40 nm-wide gold nanoparticles, because in tests, these particles did

difficult for those with color blindness. Most people with this

not clump or filter more color than necessary. In addition, these

genetic disorder have trouble discriminating red and green

lenses had water-retention properties similar to those of commercial

shades, and red-tinted glasses can make those colors more

ones and were not toxic to cells growing in petri dishes in the lab.

prominent and easier to see. However, these lenses are bulky

Finally, the researchers directly compared their new material to two

and the lens material cannot be made to fix vision problems.

commercially available pairs of tinted glasses, and their previously

Thus, researchers have shifted to the development of special

developed hot-pink dyed contact lens. The gold nanocomposite

tinted contact lenses. Although the prototype hot-pink dyed

lenses were more selective in the wavelengths they blocked than the

lenses improved red-green color perception in clinical trials,

glasses. The new lenses matched the wavelength range of the dyed

they leached dye, which led to concerns about their safety. Gold

contact lenses, suggesting the gold nanocomposite ones would be

nanocomposites are nontoxic and have been used for centuries

suitable for people with red-green color issues without the potential

to produce "cranberry glass" because of the way they scatter

safety concerns. The researchers say that the next step is to conduct

light. So, Ahmed Salih, Haider Butt and colleagues wanted to

clinical trials with human patients to assess comfort. The paper is

see whether incorporating gold nanoparticles into contact lens

freely available as an ACS AuthorChoice article.

material instead of dye could improve red-green contrast safely and effectively.

14

12_about_research.indd 14

Sources: American Chemical Society GlobalCONTACT 1-22

23.03.22 10:16

RZ_AZ !AZ.ind

INTERNATIONAL NEWS

Autorefractor measurements accepted by patients

researchers at the Massachusetts

A paper published by researchers at the Aravind Eye Institute

collaboration with the Regional

in India, Johns Hopkins University, and the Massachusetts

Government of Mad rid. T he

Eye and Ear Institute found that eyeglasses made from

development was supported in part

QuickSee handheld autorefractor measurements were

by grants from the National Eye

accepted equally to those made from subjective refraction

Institute of the National Institutes

measurements. The study authors suggest that QuickSee,

of Health.

due to its accuracy and portability, could be used to radically

In wealthy nations where patients

expand access to eyeglasses in remote and low resource

have access to licensed health care

settings which lack professionals and clinical equipment to

providers, the technology has also

provide accurate prescriptions.

helped eye doctors provide on-site care, such as in nursing homes,

The paper in Ophthalmology, "Investigation of the accuracy

correctional facilities, and community health centers. Even large

of a low-cost, portable, autorefractor to provide well-tolerated

eye health centers are using the device to manage large patient

eyeglass prescriptions: a randomized crossover trial," concluded

volumes efficiently. To date, QuickSee has been used to measure

that patients accepted eyeglasses made from QuickSee

over three million people in 45 countries, and was found in prior

measurements equally to those made from subjective

peer-reviewed studies to produce measurements that strongly

refraction. PlenOptika, the maker of the device, assisted in

agree with subjective refraction.

I n s t it ut e of Te c h nolo g y, i n

QuickSee handheld autorefractor in use in India.

Photo: PlenOptika

study design but its execution, analysis, and reporting was independent of the company.

Shivang Dave, PhD, CEO of PlenOptika and one of QuickSee's inventors, and his colleagues Daryl Lim, PhD, Eduardo Lage, PhD, and Nicholas Durr, PhD, invented the technology while

Sources: PlenOptika Referenzen: [1] www.medschool.umaryland.edu [2] www.sydney.edu.au Advertisement

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Complex freeform Silicone Hydrogel and GP surfaces for OrthoK, Scleral and Keratoconus designs with control for myopia, astigmatism and presbyopia, can be easily produced ‘polish-free’.

The UPC nano is the most economic and compact machine, with on-board freeform capabilities and an optional laser engraver, for manufacturing high-quality specialty contact lenses ready for polishing with minimal lens production costs.

Both machines can be easily automated with the SCHNEIDER automation options.

RZ_AZ_UPC100 V_UPCnano_Global-Contact_02_2022_210x149mm_4c_engl.indd 1 !AZ.indd 2 12_about_research.indd 15

15.02.2022 09:08:39 16.02.22 10:16 08:17 23.03.22

INTERNATIONAL NEWS

All about products Transforming Lives Together When we work together as an industry, we can deliver products and expertise that truly transform patients’ lives.

Full Range of Materials Led by industry insights, Contamac offers a complete range of contact lens materials to suit all indications. From our signature Optimum family of gas permeable materials, to Definitive silicone hydrogel materials and Contaflex hydrophilic soft lens materials, each with their own unique properties to benefit machinability, comfort and corneal health.

Educational Initiatives We also believe that by investing in the professionals of our future, we can ensure they are fully equipped to transform the lives of patients. Whether it is through publications, videos or industry events, Contamac is proud to support an exchange of knowledge with the industry. Find out more: www.contamac.com, sales@contamac.co.uk

QualiLENS®100 for Automation The new QualiLENS®100 for automation is a global and option-based solution, for R&D and production inspection machines, with a built-in fanless computer and PLC for Cleanrooms.

At V-OPTICS, we believe that handling lenses is tricky, risky, and burdensome. That’s why we have reflected on an all-in-one machine, able to embed any line of production, to be duplicated at will, for any type of inspection machines (contact lenses, IOL, ICL or semi-finished).

In 2021, we launched add-ons of new increasingly optic controls such as 2D dimensions, engraving reading and QC, automated cosmetic inspection, and advanced optical power.

Machine-side, high resolution cameras and illumination are used to complement our patented technology: the “Phase shift Deflectometry and computations”. Software-side, we developed software package according to manufacturers and current equipment’s requirements. More is to come.

V-OPTICS, your partner “outside of the box”. info@v-optics. fr, www.v-optics.fr/en/automatic-lens-defect-control/

Optimizations for IOL production testing OptiSpheric® IOL PRO 2 is TRIOPTICS’ fully automated optical IOL test stand. Developed for use in production, it provides a throughput of up to 100 lenses per batch.

The ISO-compliant measurement of hydrophobic and hydrophilic lenses in air or in-situ can be performed with an accuracy of 0.3 % (power) for all types of intraocular lenses (incl.

EDOF, multifocal and trifocal).

With the latest software module, the system can be connected to your database in accordance to FDA 21 CFR PART 11. This allows you to retrieve sample-specific data and measurement scripts from the server as well as to archive your measurement results in conformity with the standards. www.trioptics.com, info@trioptics.com 16

16_about_products.indd 16

GlobalCONTACT 1-22

24.03.22 21:28

!AZ.ind

INDUSTRY NEWS

The Non-Paraxial Model Eye opens the doors of EDoF IOL metrology As the complexity of IOL designs increases, metrology tools must become more powerful and effective to overcome new challenges, especially with the rise of Extended Depth of Focus (EDoF) IOL. Until recently, the Model Eye historically available in NIMO (mathematical model base on the summing of the wavefront of the IOL and the wavefront of a synthetic cornea) was perfectly appropriate. However, this method faces limitations for larger apertures and when the IOL and synthetic cornea show aberrations. LambdaX’s new Non-Paraxial Model Eye overcomes these issues by accounting for the focusing effect of the model eye and therefore the incident light entering the IOL not being collimated.

The patent pending Non-Paraxial Model Eye implemented in IOL-MENTOR® opens way to more efficient measurements of complex refractive optics with wavefront sensors in IOL metrology for both R&D studies and production quality check. Since the model has been fully validated for measurements of lenses in-air and in-situ, the operation is simpler, more consistent, beneficial to IOL manufacturers and ultimately contributes to a better vision for the patient. www.lambda-x.com , sales-ophthalmics@lambda-x.com

Advertisement

Complete Metrology Solutions for contact lenses and IOL's

Metro cell

16_about_products.indd 17 !AZ.indd 12

V-pro-GS3

24.03.22 09.03.22 21:28 14:17

REPORT

GSLS Free Paper Session: (from left). Drs. Mari Fujimoto, Erin Tomiyama, Juan Gonzalo Carracedo RodrÌguez, and Jaume Paune. Standing: Dr. Ed Bennett (moderator). Photo courtesy of Dr. Jaume Paune

Global Specialty Lens Symposium (GSLS) A look back Despite difficult circumstances due to the Corona pandemic, the Global Specialty Lens Symposium (GSLS) took place in Las Vegas from January 19 to 22 in presence. For those who could not attend the event, however, the organisers have a special ace up their sleeve. In the summer, the symposium will get an additional online-only extension. Special speakers and an interesting lecture programme will be included.

By Silke Sage

But first, a look back to Las Vegas. In total, the GSLS featured

we all have to live with at the moment, we consider it a very

around 30 educational workshops, general lectures and sessions

successful event," says co-organiser Professor Dr. Edward

on all specialty lens topics with a focus on myopia management,

Bennett of the Missouri-St. Louis College of Optometry, adding:

scleral lenses, irregular cornea management, dry eye, multifocal

"There were also some last-minute cancellations among the

contact lenses and specialty lens practice management. There

exhibitors, but most of them came. I was able to make sure

were also more than 120 scientific posters, several free lectures

through personal conversations that they were very pleased,

presenting the latest research findings, and nearly 40 sponsored

both with their decision to participate and with the attendance."

presentations where attendees could learn about new specialty lens designs.

18

18_GSLS.indd 18

HIGHLIGHTS 2022

In conversation with GlobalCONTACT, the organisers were

Edward Bennett complimented the high standard of the lectures

quite satisfied with the conference and exhibition, although

offered. He reports: "I always give our lectures chair, Jason

with just over 600 participants, only about half the usual number

Nichols, my summary of positive and constructive thoughts

of visitors showed up in presence. "Considering the circumstances

about the meeting, and it was difficult to find any negatives. ­ GlobalCONTACT 1-22

24.03.22 22:31

REPORT

Dr. Edward S. Bennett (right), Thomas E. Anastor GPLI Distinguished Service Award 2022 and Jan Svochak

Kenneth W. Leonhard (left). Winner of the Honorary Recognition Award 2022 and Chris Pantle

Naomi “Jo” Svochak GP Practitioner of the Year Award 2022: Dr. Stephanie L. Woo (right) and Dr. Bennett

GSLS Education Committee: Karen DeLoss OD, Patrick Caroline FCLSA, Jason Nichols OD, PhD (Chair), Lynette Johns OD, and Ed Bennett OD, MSEd. Photo: GSLS

A highlight in my opinion was the presentation ‘Myopia control:

more about this: "We have planned four lecture series co-

treatment showdown 2.0’, moderated by Jeff Walline with an

organised by international special lens organisations from

excellent panel consisting of Pauline Cho, Kate Gifford, Sally

Asia-Pacific, Europe and Latin America. We believe this will

Dillehay and Ashley Wallace-Tucker. A series of seven practice

be the most international GSLS we've ever had!"

cases were presented and each panel member spoke in favour

The preliminary programme is something to be excited about.

of a different treatment option: 1) orthokeratology, 2) soft

You can follow the link directly in our GlobalCONTACT app

multifocal lenses, 3) myopia control with spectacle lenses and

or find it here: www.clspectrum.com/gsls-virtual/agenda n

4) low dose atropine. The audience was then asked which modality they thought was indicated in this particular case."

VIRTUAL GSLS

Mark your calendars:

From June 9 to 11, the classic symposium will be expanded for

The next classic GSLS will take place again

the first time with an additional purely virtual version of the

from January 18 to 21 in Las Vegas, Horseshoe

GSLS-V. Jason Nichols, who is the programme chair, told us

(at the old Bally's Hotel & Casino).

GlobalCONTACT 1-22

18_GSLS.indd 19

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24.03.22 22:31

ANNIVERSARY

30 years in the contact lens industry Memories, impressions and opinions Three decades are a long time – for a magazine, for an industry and also for the people who fill it with life. On the occasion of GlobalCONTACT's 30th birthday, we asked seven well-known personalities in our industry to take a look back and continue some strands of thought for us: on their first encounter with the contact lens industry, significant innovations of the past, challenges of the present and visions for the future. Read their memories, impressions and opinions here.

Edward Bennet

The most significant innovations during this

O.D., M.S.Ed., F.A.A.O., F.S.L.S., Executive Director and President,

period were in my opinion...

GP Lens Institute, Professor Emeritus University of Missouri-St. Louis

without a doubt the introduction of

College of Optometry

scleral lenses. They allowed for excellent vision and good initial comfort, allowing

30 years ago I was ...

a significant percentage of irregular cornea

developing video programs for the GP Lens Institute at a time

patients to avoid surgery while also enhancing the quality

when this was new and innovative. I was also beginning a 22

of life of those with pathological dry eye. Secondly, we

year labor of love with the Academy of Optometry Cornea,

experienced a tremendous increase in our understanding

Contact Lenses & Refractive Technologies Section leadership.

of the importance of myopia management and developed innovative GP and soft lenses to help slow the progression

I had my first encounter with the contact lens industry...

of this condition.

in 1978. I was a beginning 4 year optometry student and had th

developed a tremendous interest in contact lenses. My optometry

The greatest challenge at the moment is...

program (Indiana University School of Optometry) had just

effective communication to the consumer that contact lenses

started a contact lens research clinic under the direction of

are health care devices.

Drs. Irvin Borish and Sarita Soni. I literally talked my way into this rotation which changed my life as I was able to perform

In 10 years, the industry will...

clinical investigations on the first soft extended wear, gas

continue to play an important role in refractive correction.

permeable, and soft toric lenses. The first study was the D3X4

Myopia management will become standard of care, and lenses

soft toric which – although it resulted in discomfort, edema,

for drug delivery, as well as smart auto-focus lenses for

and inconsistent vision – impacted my life significantly in

presbyopia will be available.

three ways: 1) the funding I received from Wesley-Jessen funded my tuition for the year; 2) I reported to Alan Tomlinson who

If I could wish for one innovation it would be...

then became a good friend and my research mentor until he

a way to make corneal lenses more initially comfortable, so

became ill; and 3) one of the subjects was a second year student

that astigmats, presbyopes, children, and those with corneal

who I ultimately married.

disease have a truly exceptional initial experience.

20

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GlobalCONTACT 1-22

24.03.22 21:30

ANNIVERSARY

Erik Larsen

It would never have been possible without...

President Larsen Equipment Design

support and collaboration from our customers.

30 years ago I was...

The greatest challenge at the moment is...

in our tenth year of the founding of

global unrest.

Larsen Equipment Design and was just entering the international market.

In 10 years, the industry will... be dependent on global stability.

I had my first encounter with the contact lens industry... in 1973 in a small shop owned by an ophthalmologist

If I could wish for one innovation it would be....

which did general machining and made machines to

peace.

make CL. The most significant innovations during this period were in my opinion...

CNC CL lathes.

Eef van der Worp

It would never have been possible without...

Optometrist PhD, Eye-Contact-Lens Research & Education

enthusiasm. The scleral lens arena is such a fun one, with so many people together working on

30 years ago I was ...

this. I think, because it has been so much pioneering

a student! But I was actually not at the optometry school in Utrecht

since the very first days of scleral lens fitting, that it

in the Netherlands, but in Manchester (UK), doing an externship at

feels like we are in this together: industry, researchers,

Eurolens Research, Department of Optometry and Vision Science

educators, practitioners, etc. Love that.

UMIST under supervision of Professor Nathan Efron. Magical times!

Phil Morgan was there too, doing his PhD. I am pretty sure my

The greatest challenge at the moment is...

enthusiasm for research and education sparked right there and then.

to make the next move. We know so much about the optics side of the eye and aberommetry – now it is time to implement that in

I had my first encounter with the contact lens industry...

practice. This is true for specialty soft lenses too, and myopia

My first encounter with contact lenses as a wearer of rigid lenses,

management applications: there are so many opportunities, it

in the late 1980s: with the contact lens industry as such – about

almost drives me nuts. But practitioners need to embrace it and

30 years ago actually. I remember doing another externship for

exploit it.

my education at NKL (back then) in Emmen in the Netherlands.

And the Director Henk van Bruggen invited me personally for

In 10 years, the industry will...

a dinner at a fancy restaurant (at least for a poor student!). We

be a much better place as we will be starting to apply big data to

talked about the contact lens industry all night and ate fresh

our patients’ eyes. Trial sets will be obsolete (in any type of lens

asparagus from the region. I will never forget.

probably) by then. Like what we see with corneal rigid lenses in parts of the world and orthokeratology increasingly: you take the

The most significant innovations during this period were in my opinion...

topography and create the best possible lens for that individual

Corneal topography really has been quite instrumental. But

eye from that. Whether it be a corneal lens, corneal remodeling,

in the end, it must be the resurgence of scleral lenses: that

scleral or soft specialty lens: that’s the way forward!

really had a significant impact on the industry. (See my article in this edition of GlobalCONTACT.) What a great journey,

If I could wish for one innovation it would be...

and how beautiful to be part of that ride. I can only feel

soft specialty lenses to mature, and to individually design better

gratitude being included in that and making so many great

soft lenses if desired because of shape or optics. I think there is

friends on the way.

so much to gain here in terms of myopia control, improved comfort, better visual performance and reduction of dropout.

GlobalCONTACT 1-22

20_QA_30years_GC.indd 21

21

24.03.22 21:30

ANNIVERSARY

Marion Beeler

of gas permeability measurements of contact lens materials, in

Dipl. Ing. (FH) Augenoptik SBAO, Association Manager

1993, when he said "vision is an island in the sea of blindness,

VMI, EFCLIN Executive Director

and our job is to prevent that island from sinking."

30 years ago I was...

The greatest challenge at the moment is...

a contact lens specialist in a renowned contact lens practice

besides world peace, which seems threatened to me at the moment, climate change and environmental protection. In

in Lucerne, Switzerland.

our industry it is to continue to encourage and support the I had my first encounter with the contact lens industry...

innovative minds. We still need RGP lenses to provide good

in 1980 when I met the specialists from Wöhlk-Contactlinsen

care for people with special vision problems. This must not

and Titmus Eurocon (now Alcon) for the first time.

be sacrificed on the altar of making a quick buck with disposable lenses, which of course have their justification

The most significant innovations during this period were in my opinion...

and clientele. The market needs both.

the silicone hydrogels, the more gas-permeable RGP materials,

Another challenge is the heavy regulation of the medical

the quadrant-specified RGPs and the restart of Ortho-K. A lot

devices market, which includes IOLs, contact lenses and care

also happened in terms of measurement technology 30 years

products as well as spectacle lenses and frames. In addition,

ago, the first autorefractometers came on the market, measurement

under the EU's "Green Deal", certain substances are to be

of the corneal periphery became a huge topic, fundus photography

banned from contact lens materials and care products. These

and other things came up. Socially, the spread of the world-

demands are challenging the contact lens industry, as it takes

wide-web and mobile phones changed our lives.

10-15 years to develop and test new materials until they are ready for the market.

It would never have been possible without... all the fantastic innovative women and men in science and

In 10 years, the industry...

research and in the many small contact lens practices and

of this sector will continue to stand together and, in healthy

optometry shops where practitioners have tried to develop new

competition with each other, bring further top products to the

devices or techniques for their needs. The dialogue between

market for the benefit of better vision.

research, practice and industry has taken the contact lens so far.

Here in Europe we have had so many bright minds that I cannot

If I could wish for one innovation it would be...

list all the names. We also always looked to the USA and Australia.

the accommodative IOL or contact lens or the breathable lens

I still think of a formative meeting with Irving Fatt, the pioneer

material.

Robert McGregor

It would never have been possible without...

Managing Director Contamac

exceptional chemists and corporations who understood the benefits this technology can

30 years ago I was…

provide to patient health.

still dreaming of becoming a professional footballer with Manchester United, I remain baffled how Utd’s scouting

The greatest challenge at the moment is...

system missed me!

the external environment.

I had my first encounter with the contact lens industry...

In 10 years, the industry will...

when supplying a glass of Whisky to my father in the Garden

remain buoyant whilst embracing many new technologies

Shed. (See GlobalCONTACT 2020-3 and 2016-1)

and innovations to ensure all companies continue to thrive, delivering products that enhance or change people’s lives.

The most significant innovations during this period were in my opinion...

If I could wish for one innovation it would be...

the invention and launch of silicone hydrogels, a significant

environmentally friendly and sustainable unleaded fuel.

chemistry milestone.

22

20_QA_30years_GC.indd 22

GlobalCONTACT 1-22

24.03.22 21:30

ANNIVERSARY

Ken Payne

It would never have been possible without...

President DAC International

innovators, technological advancement and incredible peers that saw far beyond their time

30 years ago I was... building DAC International’s European business, establishing

The greatest challenge at the moment is...

sales and service for contact and intraocular lens manufacturers

pandemic and conflicts aside, the medical device regulation

throughout West and East Europe and the Middle East.

and continued downward lens price pressures.

I had my first encounter with the contact lens industry...

In 10 years, the industry will...

in 1984 as an engineer at Hydron (later, Allergan Hydron)

still be here! Will be subject to increased regulation. More

based in Farnborough, UK.

widely automated vision solutions (closed-loop) from practice via manufacturing and back to patient. The awakening of

The most significant innovations during this period were in my opinion...

disruptive technologies in vision correction techniques.

the introduction of CNC machinery and manufacturing technologies such as ‘fast-tool-servo’ systems for complex

If I could wish for one innovation it would be...

(non-axisymmetric) lens geometries and the automation

How to make an inflatable high precision fully automated lens

of manufacture of individual/prescription contact lenses. Ortho-K

manufacturing process  No, but really – A lab-in-a-box!

modality advancement and multi- and tri-focal IOL’s.

Wim Aalbers

it workable and improved the quality of the industry. Also monitoring new

30 years ago I was ...

rules was very helpful.

45 years old, executive director of EFCLIN and had just started as publisher of this magazine.

The greatest challenge at the moment is...

Exciting time, in which we revitalized EFCLIN with a great

to maintain the professionalism of the contact

team of enthusiastic board members and developed a

lens practitioners at a high level. In several countries

magazine that still exists and still is very successful.

(soft) lenses are sold in drugstores and on the internet without any guidance. Lenses with only an indication

I had my first encounter with the contact lens industry...

of the power on the packaging. No diameter, thickness,

In 1972 I became Benelux area manager for Bausch & Lomb.

curvature, material, geometry. That is dangerous and

We introduced the first soft contact lenses in Europe. In

we see the results around.

1975 I started my contact lens practices. In the 90’s I started with Procornea in marketing and sales.

In 10 years, the industry will... be partly based on disposables and prices. But we also see

The most significant innovations during this period were in my

a very specialized professionalism. Think of myopia

opinion...

management, scleral lenses etc. Also, lenses as part of

In Europe that was no doubt the introduction of the CE

medical treatment will get more important, as production

marking. A lot of struggling and resistance in the beginning,

techniques will increase even more.

but we ended up with a better industry.

If I could wish for one innovation it would be...

It would never have been possible without...

3D printing of lenses and better quality of online

The rules came from Europe. But the efforts of the industry

communication.

and organizations like EFCLIN and Euromcontact made

GlobalCONTACT 1-22

20_QA_30years_GC.indd 23

23

24.03.22 21:30

ANNIVERSARY

Something else in retrospect Looking back at the beginnings of GlobalCONTACT When I was asked to write an article for this magazine about the magazine, I did not realize how much fun, and at the same time how much work, it would involve. All together it was great to do. This is how I approached it. By Wim Aalbers In my office I have six books in which the first 50 magazines are

In this first issue there was, of course, an introduction by the

neatly bound, weighing 12 kg (26.5 lb). For this assignment: great

president of EFCLIN, Toni Koller, since EFCLIN was

material to do some research. Flicking through all those past

responsible for the magazine. I had the honor of writing the

issues, many memories came back to me. It took me and my wife,

first version of ‘From the editor’. And thus we started our

Kitty, three full days to go through all the pages.

journey into history.

But before I share some of this past information, let me first

A few facts that place the first issue in the context of 1992:

explain why this magazine was founded in the first place.

Because we wanted to be as European as possible, all prices and

In 1991 EFCLIN was in a bad situation. There were only a few

rates were given in ECU, the currency that preceded the euro.

members left and there had not been any congress or meeting for

It is also striking that there was a fax form included in the

a few years. The initial launch (by George Nissel) in 1972 was

magazine. Looking back now, it makes you realize the internet

followed by fifteen successful years. But by 1991, it looked as if

and e-mail did not yet exist.

EFCLIN was doomed to end their activities.

The column ‘Something Else’ was already in issue 1, a column

A board meeting held in Spain, just before I was asked to join

I wrote for many years and with much pleasure. Looking at

the board, had just two items on the agenda:

that picture of myself, it is evident that my weight at the time

1. End EFCLIN or 2. Continue and how.

was 140 kg (300 lb). Kitty didn’t fail to notice…

We chose the second option and set out an ambitious plan to revitalize the organization.

RELAUNCH IN 1992

THIS SPOOKY CE THING AND OTHER CHALLENGES In that first issue there were several articles about the CE marking. In October 1992 we organized the first seminar for

One of the tools we chose was to start a comprehensive newsletter

contact-lens manufacturers on this topic. And many were to

in the form of a magazine. And that’s exactly what we did, and

follow all over Europe. There was a lot of incomprehension by

I was the one assigned by the board to start such magazine. The

most manufacturers who felt threatened, even though they

name we chose was ‘Contact’, that was the basis of the great

knew it would take another six years before the regulation on

magazine you are now holding! In 1992 the first issue (500 copies)

medical devices would come into force. Still, the magazine

was distributed to all members and potential members in Europe.

published as much news as possible on the topic.

24

24_Wim_30 years GC_v2.indd 24

GlobalCONTACT 1-22

24.03.22 22:29

ANNIVERSARY

By the end of 1992 I was invited to join the Board of Euromcontact.

Looking through the back numbers, Kitty and I were amazed

In the run-up to this spooky CE thing, Euromcontact was able

how many advertisements there were in those issues, and indeed

to influence the upcoming regulations. That was necessary

still are in the present issues. This confirms the viability of the

because some rules were not reasonable for our industry.

concept over many years.

Medical devices were classified in four classes. Class one was for

In 1993 we also introduced ‘searchers’. Small ads, free of charge,

‘high risk’ products like heart valves, etc. Such products could

offering assistance, courses, second-hand goods, etc. It all

and can only be prescribed and dispatched by qualified specialists.

worked out very well.

At that time there was the enormous problem of mad cow

In issue no. 8, 1994, there was an ad that we just have to mention:

disease. The result was that a definition of medical devices in

for Larsen Equipment. Erik Larsen was not only present with

class one was that, if any product contained any part of animal

an ad in that issue, but still is today. Sometime along the way,

tissue or if animal tissue was used in the production, by

he also started to contribute interesting articles to each issue,

definition they were class one products. At the time in the

and I know these articles have been greatly appreciated by many

production of contact lenses bee wax and silk were used for

readers over the years.

polishing. So they were Class one!

Without Euromcontact (led by Micky Tillotson) contact lenses

TRANSFER OF RESPONSIBILITY

would completely have lost their existing distribution channels.

Since 1995, the magazine has no longer been published under the

There are many such examples, and that is why the

responsibility of EFCLIN but directly by EPS. The reason was that

magazine consistently reported extensively on the CE

the magazine with a relatively low circulation was very costly. EPS

and Euromcontact.

(my company) had the ambition to expand the readership by

THE EARLY YEARS

offering the magazine to manufacturers all over the world. The result was that the circulation went up from the original 500 to

The first three issues had so called ‘narrow pages’. Between

almost 2.500 copies in over 50 countries.

every two pages, there was a ‘flap’ with a short introduction

During that period, we published the first reports from the UK

about the content. It looked good, but it was rather expensive,

on myopia control, while continuing to warn manufacturers to

so in the end we had to scrap it. However, the narrow page

be prepared for the upcoming CE marking. The final Medical

remained on the cover till 1996, issue 13.

Device Directive (93/42/EEC) was published on January 1st, 1995,

In 1993 we reported on a special congress in October in Prague,

still a few years before the legislation finally came into force.

held to celebrate the birthday of Otto Wichterle, the founder

At the request of several readers, we started to publish a list

of the soft contact lens. David Walker started an interesting

of addresses of suppliers and organizations, with their fax

series of articles about quality management.

numbers but still no internet or e-mail addresses.

Also in that year, we reported on an extraordinary experiment

At the end of 1995 we reported on the few companies who had

carried out by Paragon. They sent equipment into space with

received their CE approval and corresponding certificates.

a space shuttle and investigated the way polymerization worked

Many advertisements show pictures of people but one of them

in such a situation.

deserves special mention. The ad from EPT shows a young man

GlobalCONTACT 1-22

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ANNIVERSARY

– a boy actually – working at a lathe. This was Edwin Fierkens.

all advanced practices. Not only that but manufacturers, too,

I have known Edwin since the early 1990s and we used to

increasingly became involved in the new measurement methods.

meet regularly at congresses. But his picture in this ad shows

In this picture from 1997 I weighed 103 kg (207 lb), 37 kg less

him at a very young age. There was no mirror available during

than in 1992, which just goes to show how hard it is to work

my research, so I could not make a comparison to myself.

for this magazine.

NEW NAME, NEW LAYOUT

In 1998 more and more enthusiastic reports came in on monovision. In issue no. 18 we reported on using this approach

In 1996 (issue no. 13) the design and the name of the magazine

for golfers. Reports of contact lenses being fitted to babies

was changed. From then on, the name became GlobalCONTACT.

also became more frequent.

And the design changed too. The narrow page on the cover

In that year we introduced the GlobalCONTACT award. For

disappeared and a new layout was adopted.

many years this award was presented during the EFCLIN congress.

An alarming article under the title “Contact lenses will soon

The award was presented to the person who had published the

become obsolete”, written by David Burns, an optometrist from

most interesting or innovative article of the past year, and a jury

the UK, raised eyebrows. Had this prediction come true, the

panel was set up to judge it.

title GlobalCONTACT might have changed again to GlobalLASIK.

What happened to this award? Why not reintroduce it?

YES! The first website we published. In 1996 the CLMA proudly

In 1998 the euro became an official currency.

announced their new website: http://www.contact.inter.net.

Odd but true. (Today: https://www.clma.net/)

APPROACH OF THE NEW MILLENNIUM

Just one issue of GlobalCONTACT later we started publishing

After the stressful previous few years, in the run up to the

more websites and e-mail addresses. In many advertisements

introduction of the new CE regulations, we now had to start

from then on, this data was included as standard. In 1997 we even

worrying about the millennium bug. Horror stories about how

started publishing a separate list with new websites in our industry.

computers would no longer work after January 1st , 2000,

The first article on corneal topography was published in 1996.

abounded everywhere. Although we took it serious, we tried

From then on, as we all know, the development of this technique

to avoid real panic and concentrated on publishing reasonable

proceeded rapidly, until nowadays it is a method used in almost

information only – although we were worried too.

26

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ANNIVERSARY

name Eyepress Fachmedien GmbH. Silke Sage, who has been involved with the magazine since issue no. 28, is the leading lady now, and as editorin-chief she is doing a great job.

And our team? Well, Kitty is still my wife, Paula Bouwens, Renée Ong and their spouses are still good friends and we still get to meet regularly.

This is probably the best article I have ever written for GlobalCONTACT… I do not know where to start thanking people that made the first 16 years of GlobalCONTACT such a great experience for us. Advertisers, writers, organizations and all those who helped produce the magazine.

Our sincere thanks to everyone for these exciting 16 years. But also On August 18 , 1998, Otto Wichterle died. Brien Holden, who

to everyone who made it possible to continue and complete a total

had known Otto very well, wrote a warm and moving appreciation.

of 30 years. The magazine has changed a great deal, but who and

And so the new millennium 2000 finally arrived and, to everyone’s

what has not changed in 30 years?

relief, planes did not fall out of the sky, no important data was

GlobalCONTACT remains a magazine that is fit for its time,

lost, and no atomic bomb was launched automatically by mistake.

and still fulfills an important role in global communication

The first GlobalCONTACT in 2000 was issue no. 24.

for the contact lens industry.

Eight hectic years concerning the contact lens industry had

I wish the publishers every success in the coming years, and I

been covered in 24 issues (weighing a total of 12 kg!). Next to

hope they will have as much fun in making the magazine as

the serious stuff, we always tried to bring a smile to our readers’

we had over the course of 50 issues.

faces as well, not least through the cartoons by Mike Flanagan,

And I hope, and expect, that in 2042 Silke Sage will sit down

but also by some nonsense articles like these:

and write an article in GlobalCONTACT issue no. 150, looking

th

THE SHOW GOES ON We (Kitty, Paula and Renée) continued enthusiastically making “our” GlobalCONTACT, and 27 issues followed until issue no. 50 was the end. The end for us, but a new beginning for the team

back on 50 successful years of GlobalCONTACT! n Wim Aalbers was Executive Director of EFCLIN until 2011.

He wrote the columns "Something Else" since 1992. Active in the industry since 1972. He writes for GlobalCONTACT since it was founded in 1992.

at Mediawelt led by Jörg Spangemacher. After Jörg retired, a new young team took it over and continues the good work under the

GlobalCONTACT 1-22

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ANNIVERSARY PR-Advert

WHAT ABOUT YOU KY DIAMOND

CONGRATULATIONS TO

GLOBAL CONTAC T MAGAZINE! Your commitment to the contact lens and IOL industry has been a valuable resource for the many labs and clinicians that depend on your reporting to keep up to date on current trends and technology.

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First employee

Watch Case Tools

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We’ve evolved into one of the world’s largest producers of ultra-precision diamonds used to make many types of optical products for a wide variety of industries. To meet the ongoing demands from our customers who want to make the highest quality lenses available, we also had to develop better processes and tools designs. We’ve come a long way!

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24.03.22 21:36

PR-Advert ANNIVERSARY

WHAT ABOUT YOU DIATEC DIAMANTTECHNIK Specialized High-precision Diamond Tools for Turning and Milling DiaTec Diamanttechnik GmbH is the leading producer of high-precision diamond tools in the high-end sector. With the machines that we have

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As an experienced producer, we make diamond tools with tolerances in

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the μm range and roughnesses in the nanometre range. With gap-free

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TOOLS WITH CONTROLLED WAVINESS DiaTec offers tools with controlled waviness for machining lenses on CNC 2-axes lathes. The definition of waviness is the amount of

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deviation from a true circle. As tools with controlled waviness are

• • • • • • •

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considerably more expensive, it is important to also be able to measure

engraving milling cutters from Ø 0.05 mm

the specified waviness. Using the latest generation of measuring

radius milling cutters from Ø 0.10 mm

equipment, DiaTec can guarantee the specified waviness. The tools

end milling cutters from Ø 0.10 mm

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configuration for diamond material, radius, clearance, rake and

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waviness. DiaTec offers service of polishing for all kind of tools on

germanium, silicon, aluminium, copper and bronze GlobalCONTACT 1-22

Jubi_Indu_Komplett.indd 29

the market.

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ANNIVERSARY PR-Advert

WHAT ABOUT YOU LARSEN EQUIPMENT DESIGN

State of the art Polishers and Polishing Processes for Industrial Lens Manufacturing

steel construction, clear machines settings) as in our proven smaller machines. The RP-232 is a “bridge” type radial arm machine using the upper spindle to follow the rotation of the

Larsen Equipment Design was established in 1981 by a mechanical

lower drive spindle. The RP-231 is a “T” type radial arm machines

engineer with experience in optics manufacturing. The mission was

using the top driven counter-rotating hex spindles to drive the

to provide reliable optical fabrication machinery using readily

lens/lap. This is an aggressive machine offering reduced cycle

available components, metric bearings, and redundant features to

times.

ensure reliability, accuracy and repeatability.

Larsen Equipment Design was founded on the development of Starting with the development of polishing machinery for single

product and processes exclusively associated with lens manufacturing.

point diamond turned optics, the goal was to offer easy to set

Over the years our processes and equipment, as well as our distilled

up machines that yielded predictable results. These were

knowledge of the Industry have made us a valuable resource for lens

primarily used on steep optics. In the mid 80’s when precision

manufacturers worldwide.

optics manufacturers started using our polishers, it was conf irmed that our design actually produced f igures of lambda/10 right out of the crate. That capability prompted a long standing relationship with several companies who make mini and micro optics (1-20 mm). “Compact, predictable, and easy to set up and maintain” is an ongoing refrain from our customers . Lens manufacturers look to us for tooling assistance and appreciate our “can do” approach as well. We have continued

ADVANTAGES OF LARSEN EQUIPMENT DESIGN • • • • •

Focus on polishing technologies Access to problem solvers Fast from R&D to Production Leadership in Product/Process Development

to support the small optics niche with these bench-top machines.

Interestingly, our 1, 2, and 6 spindle polishers find applications in all processes. Some companies use multiple one spindle machines while others use our six spindle units. Of course, we adapt the easily modified spindles to customer requirements, or advise them as to the best approach.

With the advent of CNC lens generating, the polishing task has become easier. The predictable results from our polishers (they

RANGE OF PRODUCTS • • • • • •

Polishers Beveling machines Tooling Custom Equipment Process Development Automated Blocking systems

polish the generated figure) makes them easy to set up and capable of a high level of precision with a minimum amount of adjustment.

Our success with small optics polishers led to the development of 20-80 mm capacity machines. Two dual spindle polishers are now available. These share the same design features (stainless

30

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24.03.22 21:36

PR-Advert ANNIVERSARY

WHAT ABOUT YOU OPTOCRAFT

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Since then, OSL has gone from strength to strength, enhancing the capabilities of the is830 product line and achieving ISO9001 accreditation, demonstrating OSL’s commitment to the highest quality products and services.

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GlobalCONTACT 1-22

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30 years of G ­ lobalCONTACT! Without you as readers, authors, advertisers, this would not have been be possible.

Thank you for your trust and loyalty!

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24.03.22 21:43

TECHNOLOGY

Source: Technion – Israel Institute of Technology

Freeform lenses made by liquid polymers An Interview with Dr. Valeri Frumkin Researchers at Technion (Israel Institute of Technology) have developed an innovative method for producing high-quality optics using liquid polymers. The technology has several conceivable applications. It can potentially be used to produce spectacle lenses – from single vision to progressives – but also telescopes in future. The process was developed by Prof. Moran Bercovici and Dr. Valeri Frumkin.

.

Dr

Va

as

MAFO spoke with the latter about the potential of the new process. By Hanna Diewald

le r

i Fr

u m k i n . S o u rc e :

34

34_liquid lenses.indd 34

.

Ms

M

You were the person who first developed the method

polymer is determined by the shape of the bounding frame

to produce freeform optical lenses with liquids.

and the volume injected.

Can the technology actually be used to produce

The good thing is, the optical surfaces never get in contact with

freeform lenses in future?

any mold or frame. There is no issue with removing them from

Yes, we hope so. We are an academic lab and

walls or designing molds. We just get this perfectly smooth

obviously still in the development process, all

surface – with a surface roughness consistently of sub nanom-

the demonstrations that have been presented

eter – without any effort.

in the papers are done manually.

What are the advantages of your technology?

How does your invention work exactly?

One advantage of this method – even if we just look at the simplest

Instead of using mechanical processing, the standard way of

spherical and cylindrical surfaces – is the fact, that we can process

fabricating lenses today, we do not process anything. We

it in seconds. Another advantage is that there is almost no infra-

define geometrical boundary constraints for something we

structure necessary – no heavy, expensive machinery, no pollution

call a “bounding frame” and then inject a liquid polymer into

and nothing is going to waste. The only issue that we are currently

an immersion liquid. This liquid cancels gravity and gravi-

working on is reproducibility. For example, if I want to create a

tational effects, wherefore the polymer itself neither sinks

specific type of lens and want to be able to make, let us say 50,000

nor flows to the surface – it just stays there. The shape of the

of these lenses, this obviously requires automation.

GlobalCONTACT 1-22

23.03.22 09:14

TECHNOLOGY

Are there any limitations on the product side. For example, will you be able to produce progressive lenses?

We showed in our paper that we can make freeform optics. We can produce a very smooth and infinite range of optical surfaces that can be quite complex but there is one important thing: we cannot create any optical surface! We can design and fabricate our own progressive lenses precisely, based on the functions given by the physics of liquid interfaces. In our opinion, the smartest way to progress is not to try to approximate designs of other optical engineers, but rather design our own lenses based on the needed functionality.

Are transparency and image quality comparable to those of conventional lenses?

Deployment of a liquid lens. Source: Technion – Israel Institute of Technology

There are some aspects to this question. The optical quality in principle is comparable, in some cases even better. You will not be able to see a difference, as our eyes are very good at correcting various defects. If you measure the optical quality, you will see a difference. This difference comes down to the fact that this is an industry that already exists for hundreds of years, it is very developed, and we are just in our infancy. It will take a while to catch up.

Furthermore, the quality depends on the material used. We can use anything that is liquid and can be solidified. It does not even have to be a polymer. If we use UV curable polymers or thermosetting polymers, each of them has their own challenges.

UV curable polymers are extremely easy to polymerize as they polymerize very fast, but if the polymerization is not uniform, you can induce variations in refractive indexes or variations

Polymerization process. Source: Technion – Israel Institute of Technology

in the shapes. Another aspect is the shrinkage of polymers.

Major shrinkage can cause deformations, which also affect the properties, but as we can work with a very wide range of polymers, we are searching for the best candidates.

And you can use thermosetting polymers also, just mix them with a crosslinker. The polymerization will be perfect in the sense that it is always uniform. It really comes down to materials when speaking about optical quality.

Is the process also suitable for mass production in the future?

In principle, there is no limitation but currently everything is done manually. However, a precise fabrication requires repeatability. The injection process must be automated and the specific frames need to be identical to one another. There are lots of

Mor Elgarisi presenting a huge lens. Source: Technion – Israel Institute of Technology

small technical engineering issues. Those are small issues when you are a company but they are not so small when you are an

an industrial scale. The advantage of the latter is that you do

academic lab, because everything requires a lot of work and

not have anything else to do. You can hire engineers, developers,

there is a limited bandwidth in terms of time and people. It

chemists, put everyone on the desk and that will be the fastest

takes time to get to the point that we can consistently produce

way to solve the problem, obviously.

lenses, on the level that is required by the industry.

The good thing of being in academia is that we are just scientists.

Everybody is very willing to collaborate and show us what they

How long will it take to optimize your process for industrial production?

are doing. This is great because we are learning a lot and it

It depends. There are some advantages of being in the academia

allows us to improve the method significantly. If we were a

and other advantages of starting a company and doing it on

company, nobody would let us walk through their factory.

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TECHNOLOGY

F.l.t.r.: Omer Luria (lab engineer and leader of the NASA collaboration), Mor Elgarisi (PhD student currently leading this project at the lab), Prof. Moran Bercovici (head of the Fluidic Technologies laboratory at Technion). Source: Technion – Israel Institute of Technology

So at least for now, we are trying to leave it in the academia,

to a bounding frame. The device creates the bounding frame,

until we feel that the method is mature enough and we under-

injects the polymer and you have the testing component.

stand all the technical difficulties. We are sure that there are

However, what actually started the idea of trying to create

many challenges we are not even aware of now.

optics was a conversation with other scientists about a huge problem. There exists a major challenge in the developing world

Is this technology also applicable to the contact lens or IOL industry?

of having access to affordable eyewear. We found this report

In principle, yes – at least as far as we can tell. We can make

from the World Economic Forum that 2.5 billion people do

very very large lenses for telescopes, for example, or very small

not have access to eyewear. This is a huge problem for the

ones – the physics is the same. However, the current technology

economy and the people. You can send cheap glasses in a

used to make contact lenses seems to me to be very efficient.

container to a country but this is not really a long-term solution.

The question that arises here is: Does our technology have an

Instead, you need to provide the capabilities to produce on-site

advantage over the existing technology?

in good quality.

Our method might be perfectly suited for that because you do

Do you already have a major target audience in mind?

not need a factory. This is something we are very interested in,

We do not know yet… The lowest hanging fruit is to create

in terms of doing something good.

simple spherical-cylindrical corrections and you still save this entire array of machines. That would already be a major im-

Thank you for the interview. n

provement for the industry and it is relatively easy to get to that stage. From there, we can build on that. We can start thinking about injecting directly into eyewear frames, so you do not need to cut the lens and you can think about doing progressive lenses.

Very interesting for us are also freeform optics and rapid prototyping as many people in the industry told us that even if we do not produce a perfect lens but one that shows the functionality and allows them to test the design within minutes, it would be a very interesting direction. You can imagine having a device – equivalent to a 3D printer – and you enter a CAD file and design some plugins that connect our method 36

34_liquid lenses.indd 36

Liquid optics in space The researchers also collaborate with NASA as the method relies on the fact that it eliminates gravity. In space, microgravity conditions can be achieved without using an immersion liquid and polymerization is unnecessary. This allows producing huge liquid mirrors using the same physics. The method will be much cheaper than whatever is done today, as it allows creating the optics in space instead of sending it there.

GlobalCONTACT 1-22

23.03.22 09:14

MANUFACTURING

Lab consultation Working together We are assisting a start-up lab with developing their process to make contact lenses, both corneal and scleral. The owner does not have a manufacturing background and has a local optometrist who is advising her on the blocking and finishing aspects of contact lens manufacturing. The optometrist has a one-person lab in his office and has fitted lenses for over five decades.

By Erik Larsen

On a recent call, the optometrist and the new lab owner were

TOOLING OPTIONS

placing an order for a lens modification (beveling) machine,

We also discussed the blocking tooling (arbors) they wanted

diamond coated tooling, and brass tooling. We discussed the

for scleral lens production. After a few minutes, I realized that

various radii of the tools and the relative merits of the options

they planned on using corneal (12.7 mm diameter) radiused

of the blocking tooling and related process. Personally, I was

arbors to block the scleral base curves up to 19 mm. That meant

thinking that the use of diamond coated tools on the CNC

that the part of the lens bigger than 12.7 mm diameter would

turned geometry was a bad idea. Why? First off, how do you

be unsupported by the arbor; the PC would be sitting on a large

know what the modified geometry is in case you need to do

volume of blocking compound. I ended up sending a few samples

a re-fit? Second, why wasn’t the original design “correct”?

of corneal and large diameter scleral arbors for them to try

Third, diamond grinding the PC requires significant post

out. In recent years, we have offered a variety of colored arbors

polishing. Fourth, the procedure requires a highly skilled

that can serve as a color code for a narrow range of lens posterior

technician for a successful outcome.

geometries in order to maintain an approximate uniform wax

We have been building beveling and modification machines

thickness. The various arbors are to be turned to roughly match

since we started in business 40 years ago. In the last decade,

the back geometry.

the sales of the models of multi-spindle units (used in-lab)

In early 2015 I submitted an article called “The Legacy Lab”.

have fallen by about 90%. Sales of clinic one-spindle units

It discussed the difference between two start-up labs: One set

have stayed fairly steady. Sales of diamond modification

up by an “old school” manager and the other by a manager

tools have fallen off along with the in-lab machines. Sales

who understood and embraced the full capabilities of state-of-

of sponge tools for cleaning, power changing, and edging

the-art machines and processes. (This article can be viewed

have remained steady.

on our website or in the GlobalCONTACT-App.) Although, I did not specifically discuss lens modifications, I think that it was implied that modern methods and instrumentation resulted in lenses that did not require modifications. The reduction of sales of modification tooling and machines supports this notion.

So, what is the solution for the lab owner we are working with?

The key part is “we are working with”. We will continue to provide the products and services requested and make suggestions along the way to make their endeavor successful. 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.

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23.03.22 10:54

FITTING BACKGROUND

Going backstage with scleral lenses – a star is born A trilogy on specialty contact lens safety – part 1 Looking back 30 years, it is no secret that probably one of the biggest surprises in our industry has been the re-emergence and development of modern scleral lenses. The surge of scleral lens publications demonstrates their incredible increase in the recent peer-reviewed literature. Truly, ‘A Star Is Born’, like in the 2018 American romantic drama with and by Bradly Cooper and featuring Lady Gaga. Interestingly, though, this is the fourth filmed version of that story after the original 1937 and 1954 American musical (starring Judy Garland) and another 1976 musical. By Eef van der Worp

The comparison with scleral lenses is striking: after small

TIP OF THE EYESBERG

successes in the 1960s and 1970s, modern scleral lenses have

The success of the modality in large part has to do with a better

now made their great comeback too – with bells on and to

understanding of ocular surface shape. Optical coherence

never go away again, it seems. What has caused this surge, and

tomography (OCT) turned out to be an extremely helpful tool,

how safe is scleral lens wear?

as it soon was discovered that the transition zone from cornea

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24.03.22 21:45

Photo: Silke Sage

FITTING BACKGROUND

to sclera was ‘not all that curved at all’ but rather tangential in

like that knows that it can be somewhat messy and chaotic there.

shape (a straight transition in many parts of the globe at least).

Let’s see how messy it is with sclerals and where we stand.

Traditional textbooks had to be rewritten. In addition, although known through clinical wisdom by some, it was found that the

OXYGEN DEBATE

ocular surface beyond the corneal borders was quite irregular

Since the introduction of scleral lenses, there always has been

(and increases in irregularity toward the periphery). And the

a debate about suboptimal physiological conditions beneath

term ‘height’ has since been used increasingly in the contact lens

the lens and the potential for inflammation and infection with

industry to replace ‘curvature,’ which is a game changer. Today,

the modality, as first, the oxygen delivery to the cornea is

we can classify the sclera into different categories based on

hampered by the fact that the scleral lens is much thicker than

shape [1]. It can quite easily be assessed now when to start using

a rigid corneal lens (by a factor of about three), and second,

back-toric-haptic scleral lens designs and more complex back-

the fluid layer behind the lens works as an extra filter (with

surface designs. Clinicians around the world agree that if you

an estimated Dk of 80). In essence, therefore, scleral lens wear

align the scleral lens better with the ocular surface, fewer problems

can be likened to a piggyback system with two barriers

arise and the chance of scleral lens success increases.

Furthermore, there seems to be hardly any tear film exchange

So, while the surface of the eye is quite well understood now – and

possible behind a scleral lens, which obviously is different

this part of the puzzle is practically ‘solved’ – this was, literally,

from tear exchange with a rigid corneal lens.

just the tip of the "eyesberg" regarding scleral lens wear. What is

Only recently, with the surge in scientific publications, has

next is: What is happening behind the scleral lens during wear?

this topic been well documented. Work by Damien Fisher

Let’s go backstage on the set of ‘A Star Is Born,’ the scleral lenses

BAppSc, PhD, presented in the scleral lens supersession at the

edition. Everybody who has been backstage at a concert or anything

Global Specialty Lens Symposium (GSLS) and in the

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[2]

.

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FITTING BACKGROUND

surface disease including allergies and dry eye disease and use a more viscous application fluid. And if all of this fails, then lens removal and reapplication once or sometimes twice daily is recommended. A nuisance for sure, but it does not pose any additional risk. It does show that tear replenishment behind the lens is minimal, though.

As a little side-step: conjunctival prolapse is another adverse event that is new and unique to scleral lens wear. The conjunctiva is ‘sucked under’ a portion of the haptic portion of the lens.

Recent studies from Queensland University of Technology in Brisbane (AU) found that ten participants showed conjunctival prolapse 22 times (37%) [6]. All participants were asymptomatic, with no signs of ocular redness/irritation. Nasal prolapse was more prominent than temporal, and the prolapse had a mean Fig. 1: history of peer-reviewed scleral lens publications: courtesy of Rute Juliana Ferreira Macedo de Araújo.

elevation of ~71 μm. While, again, this is not the biggest concern in our practice, it surely is a nuisance as well, and the flap can adhere to the cornea in some cases (in which case it does become

International Forum for Scleral Lens Research (IFSLR) 2022

a serious adverse event). As with fogging, one of the proposed

in Las Vegas, showed that, contrary to previous beliefs, if the

mechanisms to prevent this from happening is to improve

Dk of a scleral lens exceeds 100 units, then the oxygen delivery

landing zone alignment.

to the eye needed for normal functioning in daily wear is met in most cases. Lens thickness and lens reservoir variations

INFLAMMATION

help in providing more oxygen, but only if those variations

What if there is tear stagnation behind a scleral lens? Is that

are significant. [3] Lens fenestration, although potentially helpful

worrisome? Investigators from Spain and Portugal conducted

in other ways, does not add much in terms of oxygen delivery

two important studies to investigate this. Gonzalo Carracedo

to the cornea. Only in cases of compromised corneas (such as

et al

post-corneal transplant, post-radial keratectomy, etc.) can

during scleral lens wear in keratoconus patients. With

oxygen issues arise, but typically not in normal corneas.

inflammation, an increase in temperature can or should be

WHAT (ABOUT) THE FOG?

[7]

measured the ocular surface temperature on the eye

observed. But no such thing was found: the patients wore the scleral lenses for six to nine hours, and scleral lens wear did

A nuisance at best for sure is a phenomenon that is unique to

not seem to modify the ocular surface temperature despite the

scleral lens wear: midday fogging (MDF) [4]. It deserves a place

presence of the tear film stagnation. Rute Macedo-de-Araújo

in this overview; however, it does not seem to pose any risk with

et al [8] looked at the differences between inferior and superior

regard to safety. It is a risk, however, for scleral lens failure in

bulbar conjunctiva goblet cells in scleral lens wear. Scleral

terms of dropout. Maria Walker in her PhD work – also presented

lenses rest on the scleroconjunctival region, which could result

at both the GSLS and the IFSLR – showed a couple of things:

in a mechanical impact on the bulbar conjunctiva that can

there seems to be hardly any difference between the observance

hypothetically modify some properties of conjunctival cells.

of MDF at day one in subjects versus at day four. In other words

But they didn’t: there were no differences in goblet cell count

and to simplify things, ‘you have it or you don’t’, in a manner

or in goblet cell density, and it seems that scleral lens wear does

of speaking. She also looked at subjective versus objective MDF

not affect the density and secretion of goblet cells.

scores and found the two to be highly correlated. What this means is that if patients complain of MDF, we can also see it

MICROBIAL KERATITIS

behind the lens. The ‘seeing’ is best documented using OCT if

What about the most important potential adverse event in contact

available, as this instrument can show the particle density

lens practice: microbial keratitis (MK)? The topic of safety in

behind the lens . The correlation between objective and

specialty lens practice was part of a large session at GSLS, with

subjective scores was highest, though, for the low grades of

coverage of that in the April edition of Contact Lens Spectrum [9].

MDF; for the higher grades of 4 and 5 (out of 5), that correlation

In essence, a keratitis is an inflammation of the eye, but in this

was much weaker.

case some type of micro-organism is the cause. Only 15% of the

[5]

The British Contact Lens Association (BCLA) CLEAR paper

eyes developing an MK in contact lens wear (any type of lens)

(Contact Lens Evidence-Based Academic Report) on sclerals

will experience permanent vision loss, but depending on the

advises to manage MDF as follows: decrease corneal clearance,

condition and the type of micro-organism, an MK can have

improve landing zone alignment, treat underlying ocular

quite a devastating outcome for the cornea and patient.

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FITTING BACKGROUND

Scleral lenses do not seem to pose an exceptionally large risk of corneal infections, Melissa Barnett OD, FAAO, FSLS, FBCLA, reported at the GSLS, quoting from the CLEAR paper on scleral lenses. [10] It is not easy to put a hard number on the incidence rate of MK in scleral lens wear, no matter how much we would like to communicate that to patients in practice. Despite the success of scleral lenses, the vast sample sizes needed to provide any serious numbers on incidence rates – which involve hundreds of thousands of lens wear years – are simply not available. And a complicating factor with this category is that underlying pathology is often present. Even in standard keratoconus, the epithelium is thinned and the cornea is more

CLINICIANS AROUND THE WORLD AGREE THAT IF YOU ALIGN THE SCLERAL LENS BETTER WITH THE OCULAR SURFACE, FEWER PROBLEMS ARISE AND THE CHANCE OF SCLERAL LENS SUCCESS INCREASES.

vulnerable than in the normal eye, but this vulnerability increases with different diseases, dystrophies and certainly with ocular surface disease conditions— and the risk of MK

IOP Finally, there is the concern about a potential increase in

may also be increased. found the risk of MK with

intraocular pressure (IOP) with scleral lens wear. Again, this

scleral lens wear in ocular surface disease to be 33 per 10,000

concern has been raised since the first reports on scleral lenses

patient years, but with a large 95% confidence interval between

in the 1960s. In the previous edition of GlobalCONTACT, an

5.8 to 182. However, the balance of risks versus benefits in scleral

entire article titled ‘Under Pressure’ was devoted to this topic.

lens wear almost always turns out in favor of the modality—as

To summarize, there is a beautiful but delicate balance between

patients simply have inferior vision without scleral lens wear.

the amount of fluid that is produced by the ciliary body (which

As stated in the April 2022 Contact Lens Spectrum article on

is located at the base of the crystalline lens) and the amount

lens care in specialty lens practice, while special attention to

of drainage at the trabecular meshwork (located at the base of

One 2014 paper by Shorter et al

[11]

lens care seems to be warranted for any lens modality, special

the iris anteriorly, in the corner that the iris forms with the

lens care for scleral lenses must be advised. In other words,

cornea). Could scleral lens wear impact this delicate balance?

hygiene with lens handling is crucial to improve scleral lens

The take-home message for clinical practice is that scleral lenses

safety, perhaps even more so than material Dk considerations.

could alter IOP to some degree. But definite conclusions cannot

Barnett at GSLS also reported that difficulty with lens handling

be drawn at this point based on the current evidence, the

is greater with scleral lens wear (63%) compared to with rigid

CLEAR paper states. Avoiding scleral lenses in patients who

corneal lens wear (40%) and that handling issues are the primary

have progressive glaucoma seems to make sense but is not

reason why scleral lens wearers drop out. [12, 13, 14]

always easy. Sclerals are typically not worn ‘for fun’: there is

Advertisement

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FITTING BACKGROUND

usually a major indication to wear these lenses, and the benefits

References

should be weighed against the risks – while monitoring visual

[1] DeNaeyer G, Sanders D, van der Worp E, Jedlicka J, Michaud L, Morrison

fields and optic nerve head changes. But in some other cases,

S. Qualitative Assessment of Scleral Shape Patterns Using a New Wide

alternatives, including corneal GPs, hybrids or soft custom

Field Ocular Surface Elevation Topographer. JCLRS. 16 Nov 2017

lenses, can potentially be considered. Whether lens design

[2] Van der Worp E. Safety First. Contact Lens Spectrum. April 2022;..-..

options, including non-symmetrical lens design, are beneficial

[3] Fisher D, Collins MJ, Vincent SJ. Fluid Reservoir Thickness and Corneal

and could alleviate the problem remains to be seen.

IN CLOSING It has been quite a journey with scleral lenses over the last couple of decades, but it seems clear that ‘A Star Is Born’ in our specialty lens arena: scleral lenses. While the ocular surface shape issues ‘have been solved’ to a large degree, safety issues remain an important point of focus. Going backstage with scleral lenses, it seems like some of the bigger obstacles, including the oxygen debate, have now settled. Other problems such as MDF and conjunctival prolapse are a nuisance, but there are options to try to alleviate this; for example, aligning the scleral lens better with the ocular surface could alleviate those problems

Edema during Open-eye Scleral Lens Wear. Optom Vis Sci. 2020 Sep;97(9):683-689. doi: 10.1097/OPX.0000000000001558. PMID: 32932398.

[4] Walker MK, Bergmanson JP, Miller WL, Marsack JD, Johnson LA. Complications and fitting challenges associated with scleral contact lenses: A review. Cont Lens Anterior Eye. 2016 Apr;39(2):88-96. doi: 10.1016/j.clae.2015.08.003. Epub 2015 Sep 2. PMID: 26341076.

[5] Skidmore KV, Walker MK, Marsack JD, Bergmanson JPG, Miller WL. A measure of tear inflow in habitual scleral lens wearers with and without midday fogging. Cont Lens Anterior Eye. 2019 Feb;42(1):36-42. doi: 10.1016/j.clae.2018.10.009. Epub 2018 Nov 16. PMID: 30455083; PMCID: PMC6340712.

to some degree, but they cannot always be solved. Regarding

[6] Fisher D, Collins MJ, Vincent SJ. Conjunctival prolapse during open

MK – which is our biggest concern in contact lens practice,

eye scleral lens wear. Cont Lens Anterior Eye. 2021 Feb;44(1):115-119.

including scleral lens practice – as with any lens modality, that

doi: 10.1016/j.clae.2020.09.001. Epub 2020 Oct 2. PMID: 33012674.

should have our greatest attention. Thicker lenses and an added

[7] Carracedo G, Wang Z, Serramito-Blanco M, Martin-Gil A, Carballo-Alvarez

(stagnant) fluid tear layer behind the lens are unavoidable and

J, Pintor J. Ocular Surface Temperature During Scleral Lens Wearing

may be disadvantageous in this regard. But most important

in Patients With Keratoconus. Eye Contact Lens. 2017 Nov;43(6):346-

seems to be compliance and hygiene, including proper cleaning

351. doi: 10.1097/ICL.0000000000000273. PMID: 27203795.

of the lenses, the lens cases and the lens applicators as well as

[8] Macedo-de-Araújo RJ, Serramito-Blanco M, van der Worp E, Carracedo

avoiding any tap water use in the care regimen to avoid an

G, González-Méijome JM. Differences between Inferior and Superior

infection and to provide the safest scleral lens wearing

Bulbar Conjunctiva Goblet Cells in Scleral Lens Wearers: A Pilot Study.

environment as much as possible. We can really make a

O p t o m V i s S c i . 2 0 2 0 S e p; 97( 9 ) :726 -731. d o i: 10 .10 97/

difference as a joint responsibility: of the patient, the practice (eye care practitioner and staff) and the industry together.

In the next ‘episode’ in the trilogy on specialty lens safety, overnight orthokeratology will be highlighted. Stay tuned.

Stay safe. n

OPX.0000000000001575. PMID: 32941332.

[9] Van der Worp E. Safety First. Contact Lens Spectrum. April 2022: 28-33 [10] Barnett M, Courey C, Fadel D, Lee K, Michaud L, Montani G, van der Worp E, Vincent SJ, Walker M, Bilkhu P, Morgan PB. CLEAR - Scleral lenses. Cont Lens Anterior Eye. 2021 Apr;44(2):270-288. doi: 10.1016/j. clae.2021.02.001. Epub 2021 Mar 25. PMID: 33775380.

[11] Shorter E, Schornack M, Harthan J, Nau A, Fogt J, Cao D, Nau C. Keratoconus Patient Satisfaction and Care Burden with Corneal Gaspermeable and Scleral Lenses. Optom Vis Sci. 2020 Sep;97(9):790-796. doi: 10.1097/OPX.0000000000001565. PMID: 32941334.

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 Pacific 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.

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38_Eef_Article Safety1.indd 42

[12] Schornack MM, Pyle J, Patel SV. Scleral lenses in the management of ocular surface disease. Ophthalmology. 2014 Jul;121(7):1398-405. doi: 10.1016/j.ophtha.2014.01.028. Epub 2014 Mar 14. PMID: 24630687.

[13] Kreps EO, Pesudovs K, Claerhout I, Koppen C. Mini-Scleral Lenses Improve Vision-Related Quality of Life in Keratoconus. Cornea. 2021 Jul 1;40(7):859-864. doi: 10.1097/ICO.0000000000002518. PMID: 32947413.

[14] Macedo-de-Araújo RJ, van der Worp E, González-Méijome JM. A one-year prospective study on scleral lens wear success. Cont Lens Anterior Eye. 2020 Dec;43(6):553-561. doi: 10.1016/j.clae.2019.10.140. Epub 2019 Nov 14. PMID: 31734087.

GlobalCONTACT 1-22

24.03.22 21:46

REPORT

Expert talk on MDR Appeal for a rapid European solution The application of the MDR is mandatory as of May 26, 2021. The issue still poses challenges for companies and many still need clarification on how the requirements can be implemented without harming their business. This is nicely illustrated by the fact that EFLCIN offers yet another workshop on the topic of MDR preparation at their 2022 congress. At a recent panel, it was expressed how severe the consequences of MDR could be, not only for the companies involved, but also for the patients, in the worst case scenario.

"Brussels – we have a problem!" Corinna Mutter, Regulatory

for action that show how the implementation of the MDR can

Affairs Manager at the German industry association Spectaris,

succeed. Part of these recommendations is to support those

summed up the event with these urgent words. Organized by the

companies that manufacture indispensable medical devices

Baden-Württemberg Ministry of Health and Economics, the

and whose loss threatens or has already caused gaps in supply

Brüsseler Gespräche (Brussels talks) gathered voices from the

due to a lack of alternatives.

medical device industry, EU and state policy makers, and industry associations. The search for the best solutions to overcome the

DISCONTINUATION OF IMPORTANT MEDICAL DEVICES

implementation difficulties of the MDR was thus given new

The burdens are not only momentous for the manufacturers

impetus and at the same time concrete recommendations for

of medical devices. Mutter emphasized in her presentation

action were contributed.

that the MDR-related discontinuation of important medical

In the course of the debate, industry and state politicians

devices contradicts the goals explicitly formulated in the

appealed to the EU Commission for a rapid European solution,

regulation of ensuring a high level of safety and health

because as Mutter emphasized, we are only seeing the tip of

protection while promoting innovation. Both goals are

the iceberg of product discontinuations due to the MDR.

inextricably linked and must be pursued with equal priority

However, these are already having a tangible impact on patient

and in parallel so that patients can continue to receive optimal

care. The question is how the worst consequences for all those

care in the future. The urgent plea towards Brussels and the

affected can still be prevented.

member states is therefore to act now. Seeking a solution via

The MDR entails far-reaching changes for all economic actors

national special approvals is not viable, Mutter said. This is

and especially for manufacturers of medical devices. Every

because these are neither designed for the long term nor for

single medical device must be completely re-evaluated for

EU-wide or global marketing, and they also do not enable any

compliance under the MDR – the majority of which are long-

innovative new developments.

established and safe existing products. This increase in

Spectaris takes a positive view of the fact that the European

certification effort presents companies with enormous challenges

Commission has set up a task force. However, the association

that are not always feasible in practice, exacerbated by often

emphasizes that little is yet known about the exact scope and

rising costs. The Baden-Württemberg state government has

its work assignment and that its focus must be to ensure the

therefore commissioned experts to develop recommendations

supply of existing and niche products even after 2024. n

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23.03.22 12:12

FITTING BACKGROUND

Fig. 1: Acuity GP contact lens material prototypes.

Image courtesy of Acuity Polymers.

Ultra-Dk contact lenses The role of the Dk value The market for contact lenses is ever growing and the requirements and demands from the users and clinicians are extensive; disposable, comfortable, increased wear time, overnight wear, corneal reshaping, handling (cleaning, ease of use), cost, geometric and optical properties, and high oxygen permeability. While Efron wrote an obituary for rigid gas permeable (RGP) lenses over a decade ago, the use, applications, and design technologies of RGPs has continued to grow and expand. [1]

By Lachlan Hoy and Millie Meegan

The evolution of hard/rigid contact lens material started with

Dk is the permeability of a material to oxygen, and coupled with

glass in 1887, non-gas permeable polymethyl methacrylate

lens thickness (t), it determines how much oxygen reaches the

(PMMA) in the 1940’s, and the first rigid gas permeable material

cornea through a specific contact lens (Dk/t). [2] Insufficient oxygen

in the 1970’s. Although Efron’s prediction may not have come

to the cornea creates both short- and long-term physiological

to pass, there has been a lack of material innovation for RGP

changes, such as endothelial blebs, oedema, limbal injection, and

lenses over the past decade. It has taken industry veterans, Dan

corneal vascularisation. [3] To avoid corneal oedema, a Dk/t of 24

Bell, Jim Bonafini and Jonathan Jacobson combining to form

for daily wear and 87 for extended wear has been proposed. [3] To

Acuity Polymers, Inc., to deliver the world’s first ultra-Dk gas

avoid anoxia, this DK/t value is 35 during open eye and 125 during

permeable material Acuity 200 (fluoroxyfocon A).

closed eye. The Acuity 200 ultra-Dk polymer is of particular

Material innovation considers factors such as the mechanical

interest in the overnight orthokeratology due to closed eye overnight

properties, lens thickness, wettability, water content, and oxygen

wear, scleral contact lenses due to the increased lens thickness of

permeability. To deliver the desired properties material scientists

the lens and increased tear fluid reservoir thickness, corneal graft,

innovate more than just the polymer itself, rather the refinement

and the correction of extreme ametropia.

of the polymerisation recipe (e.g. temperature, initiator type, vessel used). The team at Acuity Polymers have delivered not

ORTHOKERATOLOGY

only ultra-Dk, but a material with exceptional wettability,

Because the cornea is an avascular site, it relies on atmospheric

stability, durability, and deposit resistance.

oxygen to maintain normal metabolic activity. In orthokeratology,

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FITTING BACKGROUND

there are reduced levels of oxygen available to the cornea while

therefore more likely to take the desired shape.

the eyes are closed. [4] This is exacerbated by the use of a contact

relatively low levels of central corneal oedema occur in overnight

lens, which acts as another barrier between the cornea and its

orthokeratology lens wear (probably due to competing hydrostatic

oxygen supply. Though Holden and Mertz defined the minimum

forces – tear film pressure anteriorly and intraocular pressure

oxygen transmissibility for overnight contact lens wear to be 87,

posteriorly), what corneal oedema does arise can be minimised

recent studies suggest that this value was underestimated. [5] The

by using higher Dk materials. [7] In fact, Lum & Swarbrick found

typical thickness of an orthokeratology lens is 0.2 mm, hence

that lenses made from higher Dk material acting on the same

to avoid corneal oedema with closed eye overnight wear, the Dk

cornea had a tendency to overcorrect by an average of +0.50D

of the material would need to be greater than 174.

in comparison to lenses of the same design made of lower Dk

It’s critical that an orthokeratology lens allows as much oxygen

material. [8] Wearers of orthokeratology lenses made of materials

[8]

Although

to pass as possible to prevent hypoxia, and the Dk value chosen

with Dk 100 and Dk 163 consistently improved unaided visual

should therefore be based not on this minimum oxygen

acuity, refractive error and apical flattening to a greater degree

transmissibility value, but on a maximum.

than those wearing lower-Dk materials of 58 and 85 on each

When the cornea doesn’t receive enough atmospheric oxygen,

review, with one study finding a statistically significant

a number of physiological changes occur, including corneal

improvement in VA persisting over the two weeks. [8, 9]

oedema. [6, 7] A cornea with less swelling is more responsive to surface hydrostatic forces induced by orthokeratology and

SCLERAL LENSES Modern scleral lenses have contributed to a resurgence in rigid gas permeable material use through the therapeutic treatment of the ocular surface, visual restoration of the irregular cornea and the correction of astigmatism. [10] While scleral lenses are life-changing for many wearers, they generate hypoxic stress as the contact lens

Fig. 2: Orthokeratology lens on eye.

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Fig. 3: OCT of scleral contact lens.

45

25.03.22 10:32

FITTING BACKGROUND

and the underlying tear reservoir act as barriers to atmospheric oxygen. [11] Unlike corneal RGPs, no further oxygen is transmitted by movement of the tear film, as the tear reservoir is fairly stagnant. [12] Furthermore, most of the therapeutic and visual restoration indications are in eyes with compromised cornea and ocular surface that often cannot tolerate oxygen deprivation (e.g. corneal graft, Stevens-Jonson syndrome, corneal ectasia). [12–14] Scleral lens wearers with keratoconus and corneal graft tend to experience an increase in corneal thickness due to oedema by an average of 2-4% throughout the day. [15, 16] This may seem insignificant as the cornea swells by 4.5% overnight with eye

Fig. 4: A corneal Acuity 200 +18.00D for aphakia.

closure but recovers once awake over the course of the next hour.

However, the hypoxia-related stress secondary to

discussed above, thick lenses reduce oxygen permeability,

scleral lens wear occurs rapidly, within the first 45 mins and

and therefore should be made of the highest Dk possible to

[15]

can last for up to 150 mins after removal.

[17]

Furthermore, as

scleral lenses are worn to reduce ocular pain and in visual restoration unachievable with spectacles, wearers have a

minimise any hypoxic stress.

CORNEAL GRAFT

tendency to wear their lenses for long hours, often inserting

While the most obvious sign of hypoxia is in the stroma

straight after waking and only removing the lenses just before

(corneal oedema), oxygen deprivation also occurs at the

bed. As a result, there is little time for the cornea to recover

epithelial and endothelial levels. [20, 21] While the epithelium

from the physiological oedema it endures overnight before

is able to regenerate and recover from hypoxic stress, the

lens-induced oedema begins. While the scleral lens induced

same cannot be said for endothelial cells. This is particularly

oedema is low grade, the long-term physiological effects are

pertinent for corneal graft recipients (PK and DALK). The

unclear. [12]

average age of corneal graft donors is 65, a demographic that

It has been observed that scleral lenses with Dk values >163

is vulnerable to endothelial cell dysfunction and dystrophies. [22]

minimise oxygen depletion in the cornea, and theoretical models have approximated that to minimise hypoxic stress, scleral lenses should be manufactured from materials with Dk ≥150, lens thickness ≤250 um and tear reservoir 100150 um. [11,18,19] The evidence is clear that the highest Dk material available should be used when possible.

CORNEAL RIGID GAS PERMEABLE As disposable contact lenses dominate the correction of most ametropia, corneal RGP lenses are typically reserved for extreme ametropia, and irregular cornea. The correction of extreme ametropia requires high BVP thick lenses. As

Fig. 5: Vascularisation of a corneal graft.

Hypoxia serves to exacerbate the endothelial disease process and drives neovascularisation and inflammation, increasing the likelihood of graft rejection and ultimately shortening

DK IS THE PERMEABILITY OF A MATERIAL TO OXYGEN, AND COUPLED WITH LENS THICKNESS (T), IT DETERMINES HOW MUCH OXYGEN REACHES THE CORNEA THROUGH A SPECIFIC CONTACT LENS (DK/T).

46

44_AP_Gas Permeables.indd 46

the lifespan of the graft. Unfortunately, many corneal grafts have resulting major and irregular astigmatism and require contact lenses to restore visual quality. Every effort must be made to minimise any hypoxic or inflammatory stress on these eyes by using the highest Dk material possible and using corneal RGP lenses where possible. However, sometimes the irregularity reaches a point where corneal lenses are unable to be fit and a scleral lens is the only option precluding regraft.

Using an ultra-Dk material allows scleral lenses to be fitted in the application of corneal graft with greater confidence in the long term health and survival of the tissue.

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FITTING BACKGROUND

Fig. 8: Horizontal and vertical B-scans from the anterior OCT of the scleral lens vaulting over the corneal graft.

EyeSpace Scleral Fig. 6: Topography showing corneal toricity measuring 23.98D.

9.0/4150 μm/39°/17.5 7.0/4550 μm/40° BVP: +6.00D / -10.50D x 180.0 ° The lens provided excellent vision, the cornea remains clear, and there has been no evidence of advancing neovascularisation.

The graft continues to survive and she remains happy wearing contact lenses. n References and sources can be found in the GlobalCONTACT app and on request in the editorial office.

Fig. 7: Corneal graft shows signs of rejection including opacification and neovascularisation.

CASE REPORT A 76-year-old female had penetrating keratoplasty in 1976 for keratoconus. While the central cornea was clear, there was 24D of corneal astigmatism, and the junction of the graft was cloudy with existing neovascularisation superior and nasal. She was

Lachlan Hoy BAppSc(Optom)Hons GCOT FCCLSA FIAOMC Optometrist and Director Innovative Eye Care Director and Founder Innovative Contacts Director and Co-Founder EyeSpace Millie Meegan BVisSci/MOptom Optometrist Innovative Eye Care

fitted with a scleral lens made of Acuity 200 material in 2018.

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25.03.22 25.02.22 sales-ophthalmics@lambda-x.com - www.lambda-x.com

FITTING BACKGROUND

Imaging techniques Photo presentation: HFAK Students present their findings

Photograph

Jessica Hein & Leonie Müller Professional School for Optometry in Cologne (HFAK)

1

What can be seen here?

Vascularisation after prolonged wear of silicone hydrogel contact lenses.

Imaging technique:

Image 1: General overview of the right eye (6.3x magnification) Image 2: Visualisation of vascularisation with diffuse illumination (25x magnification) Image 3: Visualisation of ghost vessles with regredient illumination (25x magnification) Image 4: Visualisation of receding blood, regredient illumination (25x magnification)

2

Finding:

During a routine follow-up of a test person (female, 24 years) wearing soft, silicone hydrogel daily lenses, the right eye looks inconspicuous at first glance (image 1). At higher magnification, vascularisation becomes visible in the right eye (superior 2 o'clock).

Characteristics:

During corneal hypoxia, vascularisation occurs to provide additional oxygen supply. This is probably due to the tight fit of the silicone hydogel contact lens (image 2).

3

Further procedure:

In order to prevent further progress of the vascularisation, the test person was ordered to immediately abstain from contact lenses for four weeks. Already after two weeks, the blood vessels were seen to be only partially filled. What remains are bloodless capillary vessels called ghost vessles (image 3).

Image 4 clearly shows that lens abstinence is still recommended, as the blood has not yet retreated.

Subsequently, a new fitting of the contact lenses is recommended. A fitting of RGP contact lenses is advantageous here in order to minimise the risk of renewed vascularisation.

48

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48

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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 different 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!

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PR_Larsen.indd 25

969 S. Kipling Parkway, Lakewood, CO 80226 Phone: 303-384-1111 888-393-5374 Fax: 303-384-1124 www.AVTLENS.com 49

19.11.21 15:45

REPORT

Euromcontact market data report 2021 Soft contact lens and lens care markets in Europe The European federation of national associations and international companies of contact lens and lens care manufacturers, Euromcontact, has released their new market report. The statistics report covers 34 countries in 2021, in comparison to 32 countries reported in 2020. Since 2003, the federation has provided the framework for statistics on market data and analysis based on a collection and compilation of data using an independent company.

Euromcontact collected data for daily disposables (DD), weekly/ bi-weekly and monthly (W/B&M) and conventional soft (CS) CLs in 34 countries. Four are in pairs (Belgium with Luxemburg and UK with Ireland), this makes for 32 countries/clusters in total. Not all countries had data in all segments for 2021 and/or 2020, though, mainly in CS. All countries had data for weekly/ bi-weekly and monthly and daily disposables in both years.

Contributing companies (2021) ALCON

Avizor

Bausch & Lomb

CooperVision

Johnson & Johnson Vision Care mark’ennovy Menicon (Europe) Tab. 1: Contributing companies (2021)

DATA COLLECTION

replacement CL market in the covered countries. The coverage

The headquarters of the participating companies submitted each

of the conventional lenses was not so great anymore, as this

quarter the numbers of lenses sold (units) and their market value

market is mainly served by local/regional manufacturers.

(lenses and lens care products) at ex-manufacturers’ prices (sum of the invoiced prices, so called shipping or sell in data) to an

WEARER BASE

independent company. This company then removed manufacturer-

The number of people who wear CLs within a market is called

specific information and returned the aggregated numbers by

the ‘wearer base’ and is presented in the report as the fraction

country, segment, sub-segment etc. for each country to

of CL wearers within the 15 to 64 years old segment of the

Euromcontact and the participating companies. The collection

population. The report calculated the number of soft CL wearers

covered all soft lens and lens care market segments. For non-Euro

using the 2021 units (one CL) sales divided by an assumed

currency countries, the year’s exchange was fixed on 2nd January

annual consumption. The wearer base was calculated for daily

for the whole year. Past years’ values were adjusted to the current

disposables, weekly/bi-weekly and monthly replacement lenses

(2021) exchange rate of the Euro. The participating companies

(W/B-W&M) and conventional soft lenses (all other replacement

believe they cover around 80% to 90% of the disposable/planned

frequencies, CS).

Country / Region

Daily disposable (DD) ‘21

Weekly/Bi-weekly (W/B-W&M) ‘21

Conventional Soft (CS) ‘21

All types (Total) ‘21

Change from 2020 for Total

Sweden

6.16%

6.00%

0.00%

12.17%

-0.58%

Norway

8.61%

3.52%

0.00%

12.12%

-1.94%

Switzerland

4.65%

4.20%

0.00%

8.86%

4.03%

United Kingdom & Ireland

5.24%

3.24%

0.01%

8.49%

7.30%

Netherlands

2.37%

6.00%

0.00%

8.36%

0.33%

Belgium & Luxembourg

2.52%

4.25%

0.03%

6.81%

30.07%

France

1.65%

3.24%

0.01%

4.90%

8.99%

Italy

3.13%

1.74%

0.00%

4.86%

24.34%

Spain

1.03%

3.26%

0.00%

4.29%

22.06%

Germany

1.12%

3.07%

0.01%

4.21%

10.04%

Total11

2.81%

3.21%

0.01%

6.03%

8.05%

T 32

1.32%

1.97%

0.00%

3.29%

10.28%

Tab. 2: Wearer penetration by segment for population 15-64 years of age 50

50_Euromcontact.indd 50

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25.03.22 10:28

REPORT

2021 Market size (in '000 EUR)

Contact lens market (value) in the eleven assessed markets (Tab. 2)

Split of market (all 34 collected, value, in %) 2021

For each lens category and for each country, the number of

for the reported countries grew by 10.8%, to € 1,499 million.

wearers was calculated by taking the yearly figure of units sold

In the eleven markets daily disposables grew by 13.3% and

and dividing them by an assumed annual ‘consumption’ rate

weekly/bi-weekly and monthly by 8.6%, CS declined (-62.9%).

per wearer. For consistency reasons, these values were kept

The CL market for all 32/34 markets showed daily disposables

constant at 350 CLs per year for daily disposables, 26 CL per

growing at 16.6%, W/B-W&M at 12.5%, and CS declining at

year for W/B-W&M CLs and 2.7 CLs per year for CS CLs.

-81.4% (-63.0% on a comparable basis, i.e. only looking at

The number of wearers for each category and country was then

markets that had data in both years).

divided by the population of 15- to 64-year-olds for each country or

The split between segments (by value) for the total 34/32 markets

region, to provide a wearer base value as a proportion of the population

is 56.0 % for daily disposables, 43.9% for W/B-W&M and 0.07 %

of 15-64-year olds (in %) per country and in total. The eleven countries

for CS. For the eleven it is 59.1% for daily disposables, 40.8%

and regions evaluated in this article are listed in table 2.

for W/B-W&M and 0.09% for CS.

Across all 34 markets there are 21.7 million wearers (+10.3%).

With a total of 13.6% (-0.6%) of the 15-64 years old population

56% of them use daily disposables, 43.9% weekly/bi-weekly and

wearing CLs, Denmark is leading the penetration ranks, ahead of

monthly replacement lenses, and 0.07% conventional soft lenses.

Sweden (12.2%, -1.9%) and Norway (12.1%, +4.0%). Lowest among

GROWTH IN SOFT CONTACT LENSES MARKET In 2021, the market value of soft contact lenses (SCLs) at industry to eye care professionals (ECPs) level grew by 14.3% to € 1,991

the eleven is Germany (4.2%, +10%), next is Spain (4.3%; +22.1%).

HIGH SHARE IN SIHY AND DECLINE IN LENS CARE MARKET

million. The comparable total (data in ’21 & ’20) is the same,

Silicone Hydrogels (SiHy) are now at 84.6 % value share in the

€ 1,991 million, but shows a growth of 14.6%.

W/B-W&M segment (across all 34 countries/32 clusters) and

The eleven countries reported here (Tab. 2) represent 75.3%

range from 79.3% in Italy up to 95.2% in Norway in the reported

(comparable basis) of the2:total collected.

The CL market eleven countries.

Figure Splitvalue of Market (all 34 collected, value, in %) 2021 The total lens care market declined by 0.04% to € 198 million for all 34 countries/32 clusters. All countries but Egypt and the Kingdom of Saudi Arabia had total data for 2021, but not all had data for all segments in one or both years (2021/2020). Total value grew 0.8%, when looking at the total where data was available in both years. In the eleven countries, the total care market was € 138 million (-4.0%).

Figurewearers 3: DD-W/B&M-CS in population 15 -vs.

642020 years(for of values age 2021 vs. 2020 DD-W/B&M-CS in populationwearers 15-64 years of age 2021 of 2020 see also values of 2020 see also tableassessed, 5) table 2). Soft lens wearer base(for values for each country or region presented by lens category lens(with wearer base values for each countryexpressed or region as assessed, presented by lens andSoft in total comparison to 2020).

Penetration % of total. category and in total (with comparison to 2020). Penetration expressed as % of total

GlobalCONTACT 1-22

50_Euromcontact.indd 51

The report can be found on the Euromcontact webpage.

51

25.03.22 10:28

BUSINESS & MARKETING

Self-determined salaries – crazy or a viable concept?

Interview with Timm Urschinger The topic of salaries for employees, civil servants or even income for the self-employed is – quite apart from the discussion about the minimum wage or fair gender pay – a sensitive issue. In some countries and companies it is taboo to talk about it – as well as among friends or family – in other countries or companies people talk very openely about it and/or the salaries are transparent. And then there are a few companies where employees can even determine for themselves how much they earn. Like at Livesciences, a 17-member consulting team that not only takes innovative approaches with clients, but is also willing to experiment in its own organization – with regard to structures and strategies. We asked co-founder and CEO Timm Urschinger about their experience in the team and what he would recommend to companies.

Mr. Urschinger, a few years ago you started to look closely at self-

all my colleagues had previously been at home in more

determined salaries and introduced them in your company. How did

traditional organizations. So, as consultants, in our previous

this “crazy” idea come about?

lives before Livesciences, salaries were set in a more traditional

From the very first moment, we as a company focused on

way by management. Of course, there were always discussions,

self-organization, based on Frederic Laloux's book “Reinventing

but by defining a lot of KPIs as well as clear documentation,

Organizations” and the “Teal principles” described there. Of

most people at least had the impression that it really was a more

course, I have not always worked in such an environment – and

or less fair remuneration.

52

52_variables_gehalt.indd 52

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23.03.22 12:33

BUSINESS & MARKETING

EVEN IF I HEAR POSITIVE FEEDBACK THROUGHOUT THE YEAR, I PROBABLY WON'T BE ABLE TO LET GO OF MY NEGATIVE THOUGHTS IF APPRECIATION ISN'T REFLECTED IN MY REMUNARATION.

The other reason is, of course,

ing

and my colleagues. Even if I hear positive

co

, er

whether I feel valued by the company

rs c h

of the biggest components that affects

feedback throughout the year, I probably won´t be able to let go of my negative thoughts

- fo

ce

s.

the work I do. Salary is probably one

Ti m m U

recognition and appreciation for all

un

der

a n d C E O o f LI

After setting up Livesciences in a self-organized way, we felt

if appreciation isn´t reflected in my remunaration. Because

that this was not the right approach. We met with other self-

we are not immune to such thoughts either, we wanted to avoid

organized companies (Holacracy, Sociocracy, et al.) and tried

this dilemma and use our principles as a “Teal” company for

to learn from them how they approached the difficult and

salary definition as well: self-organized, self-responsible and

thorny issue of salaries and remuneration. Back in 2016 and

self-determined. Our corporate philosophy Liveline states anyway

2017, we had a “big” round of discussions – four of us at

that everyone acts as an entrepreneur and so the decision was

Livesciences at the time – and found a first viable path. But as

quickly made in one of our governance meetings. What wasn´t

early as around the turn of 2018/19, with eight people, we felt

so easy was discussing the extent to which we would dictate what

like we needed to do something different that was really more

the “consulting process” should look like or even how our

self-organized and less consensus-driven. What we learned

remuneration should be defined.

from the other self-organized companies is that there is no

Base salaries only? Bonuses calculated based on KPIs?

“one size fits all'” approach to salaries and remuneration. It

Discretionary calculated bonuses? Dynamic salaries based on

was and still is a hotly debated topic across all networks. No

hours worked or something else? Finally, here's what we decided:

one seems to know the secret formula.

• Everyone decides on their own salary -> self-determined

ci V Es

en

salaries.

But why are salaries so critical and sensitive? After all, we all have

• The “consulting process” is defined for remuneration in such

to earn a living.

a way that you have to get advice from everyone in the

In organizations – regardless of the industry and size – I have

company (i.e. seven other people) on what they think you

made the experience that it is usually not so much about the

should earn.

actual amount of money that ends up in my private bank account, but rather about subjectively perceived fairness. “My

• Building on the “everyone is an entrepreneur” principle, remuneration should consist of base salary + risk bonus.

colleague who works much less, earns more money than I do,

• The risk bonus should not be calculated based on individual

that's not fair!” Such thoughts can probably never be completely

KPIs, but based on individual risk tolerance and company-

avoided, but at least you do not want them to have a negative

wide success for the year. (We are all in the same boat, so

impact on the company.

why have different bonus levels).

GlobalCONTACT 1-22

52_variables_gehalt.indd 53

53

23.03.22 12:33

BUSINESS & MARKETING

And what did that look like in practice?

How could I give meaningful advice to someone I haven´t

How did you implement the whole thing in concrete terms?

worked with much in the past year? Nevertheless, we thought

At Livesciences, we have said consultation process that we always

it was a good idea to do it this way. Subjectively perceived

follow when making decisions. For the salaries we set ourselves,

fairness is also more emotional than rational.

we agreed that it makes sense (at least at the time with eight

The second step in our “consulting process” was a meeting

people) to define that everyone asks everyone else for advice – and

where we proceeded according to the speed dating principle.

we agreed to make this completely transparent.

In our case, we “met” with everyone who gave advice and to whom I gave advice. In doing so, I told them how I arrived at

SIMPLY ASKING QUESTIONS TO CREATE UNDERSTANDING RATHER THAN DEBATING IS AN EFFECTIVE METHOD IN MANY CONSTELLATIONS.

the number, which I entered into the sheet.

My counterpart would try to understand my motives – without discussing whether they thought they were reasonable or correct. And vice versa. Simply asking questions to create understanding rather than debating is an effective method in many constellations.

In a third step of the process, I spent another week thinking about what felt right for me personally in terms of salary, and then made a decision that we all shared with each other at a short meeting the week after our speed dating. Transparency, to me, is a critical factor in the successful setup of a self-

So we created a Google sheet with an 8x8 matrix where I would

organized team.

make suggestions to everyone else and myself. This is a number that represents the monthly salary of the person in question.

And what have you learned in the team so far in this process?

This means that I enter a number for myself (my salary, just

Or rather, where is the journey going in the future?

for reference and to make sure I´m not biased to only think

The fear of giving advice to people I hadn´t worked with much

about my salary when I get everyone else´s input), and then for

before quickly faded. “Just do it” is probably a good tip for this

everyone else. This already caused some turmoil and discussion.

part of the process as well. Interestingly, we didn´t and don´t

54

52_variables_gehalt.indd 54

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23.03.22 12:33

!AZ.ind

BUSINESS & MARKETING

have a wide range in our numbers. The proposals were all pretty close, but the reasons were often very different.

I think this simply reflected our different values, experiences and preferences. This is something that was not transparent in our company before, but has been a source of many good discussions and insights for us so far.

Even today with a few years of experience, the risk-based bonus is always a special challenge. For this, the consulting process has clearly proven itself and we are coming to good decisions more and more quickly compared to the past. Incidentally, this

EVEN TODAY WITH A FEW YEARS OF EXPERIENCE, THE RISK-BASED BONUS IS ALWAYS A SPECIAL CHALLENGE.

also applies to new employees.

Nevertheless, we check from year to year whether we keep the process or whether there are tensions and we discard the process again or try something completely different. Finally, “Teal” also means being f lexible and open to new creative and innovative solutions. That´s why I´m always interested in other people´ experiences with salaries and remuneration to learn more for our setup and approach for the next years.

Timm Urschinger is co-founder and CEO of Livesciences (livesciences. com). After his studies and several years with a well-known pharmaceutical company in Switzerland and in consulting, he decided to start his own company. His experience in managing global programs and transformation has awakened in him a passion for developing pragmatic and innovative solutions – for his own company and for customers. New organizational models like Teal play just as big a role as self-leadership and that people finally experience meaning and fun in their professional lives again. Feel free to reach out at timm.urschinger@livesciences.com

Thank you for the interview. n

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GLOBAL CONTACT The Website and the Magazine: The complete communication system for the contact lens industry. The magazine, 2,500 copies, is distributed to contact lens laboratories, wholesalers and other organizations active in the contact lens and IOL industry.

The website www.global-cl.com is free for all industry related professionals PUBLISHERS ADDRESS Eyepress Fachmedien GmbH Saarner Str. 151, D-45479 Mülheim a. d. Ruhr Tel.: +49-208-306683-00 Fax: +49-208-306683-99 Website: www.global-cl.com E-mail: info@global-cl.com CEO Petros Sioutis E-mail: p.sioutis@eyepress.de PUBLISHER Silke Sage, Efstathios Efthimiadis, Petros Sioutis EDITOR-IN-CHIEF Dipl.-Ing (FH) Silke Sage E-mail: silke@global-cl.com EDITOR Britta Laupichler E-mail: britta@mafo-optics.com TRANSLATIONS John Saniter, Bopfingen, Germany EDITORIAL BOARD Wim Aalbers, Erik Larsen, Eef van der Worp PRODUCTION & LAYOUT Efstathios Efthimiadis DISTRIBUTION PressUp GmbH, Postbox 70 13 11, D-22013 Hamburg Tel.: +49-40-386666-308, Fax: +49-40-386666-299 MEDIA CONSULTANT Constanze Classen Tel.: +49-208-306683-20 Fax: +49-208-306683-99 E-mail: constanze@global-cl.com ADVERTISING AGENT GREAT CHINA Beijing FOCUS Optics Culture Commnication Co. Ltd. Room 319, Building 2, Nr. 1, Northbank 1292, Nr. 15 Jianguo Eastroad, Beijing 100024 (Chaoyang), P.R. China Mrs. Jian Wang Tel.: +86-10-8537-6529 Email: jennywang_focus@126.com Skype: jennywang611 ADVERTISEMENT RATES Price list No. 11, valid from January 01, 2022 Publication Schedule 3 issues 2021: March, July, November

FREE ACCESS

SUBSCRIPTION COSTS PER YEAR European Union 80,00 € (plus VAT for German companies), Overseas Seamail 90,00 €, Overseas Airmail 110,00 €, United States Seamail 95,00 €, United States Airmail 125,00 €, Single issue 20,00 € (plus mailing costs) The Publisher requires three months written notice on cancellation. Subscribers please note that proof of notice may be required.

BANK DETAILS Bank account: Sparkasse Aachen IBAN: DE21 3905 0000 1073 3925 06 SWIFT: AACS DE 33XXX PRODUCTION & PRINT Kollin Mediengesellschaft mbh, Neudrossenfeld The publisher takes no responsibility for unsolicited manuscripts. Please note also that photographs submitted for use in GlobalCONTACT cannot be returned. The publisher's written permission is required for any reproduction, translation or recording of material published in GlobalCONTACT, including extracts of such material. Permission will normally be given, subject to the usual acknowledgement. Copies made of published items must be limited in number and for personal use only.

PHOTO CREDITS P.12: apinan, P.20: ink drop, P.25: MicroOne, P.32: shumo4ka, P.52: Minerva Studio /stock.adobe.com

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GlobalCONTACT App is now available GlobalCONTACT 1-22

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ABOVE

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The First Ultra Dk* GP Material Finally.

A new material breakthrough for today's specialty contact lenses.

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