GlobalCONTACT - 02/2023

ISSN:1386 0194

2

2023 (94)

International News • EFCLIN Congress & Exhibition 2023

Fitting Background • The other side of myopia

History • 75 years rigid corneal lens

Business + Marketing • Recruiting

Contaflex

Clinical Guide for Scleral Lens Success

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LETTER FROM THE EDITOR

How do you know that?

From books? From publications? From your daily work in your

are key elements for new ideas and good networking for a

quiet chamber? Well, that too. But at least as important as the

successful future.

disciplined work in the office, in the lab or in the care of patients, is the exchange with colleagues and professionals in the field.

There was such a key moment a year ago when Euromcontact

These valuable experiences are inspiring and expand your

presented the issue around the use of PFAS. This brought it into

knowledge – and you can use and recycle them for your profession.

central focus in the contact lens industry. A whole morning was dedicated to the topic and there was also a very detailed update

At the end of April, the industry met again for the annual

on it at the last conference. Is a ban on PFASs really looming

EFCLIN conference and exhibition. This time, the experts

and how will it affect our industry? In this issue you can read a

gathered in The Hague, Netherlands. Attendance was as high

review of the EFCLIN conference with an interview with EFCLIN

as before the pandemic. This is despite the fact that the Corona

President Armin Duddek.

pandemic has had a significant impact on conference attendance in general. Yes, the events industry worldwide has suffered.

In addition, the question of whether orthokeratology is sustainable in everyday life is currently being discussed once again. Due to

Some of the major trade shows and conferences went into a

the change of the daily visual acuity, especially the suitability for

tailspin as a result and are still struggling. Many events were

road traffic has been questioned. We already presented a current

canceled or postponed, resulting in significant financial losses

study on this in the last issue. You can read another article on this

for event organizers, service providers and suppliers. The event

subject starting on page 38, which leads to a clear conclusion. ■

industry had to adapt quickly and find alternative solutions, such as virtual events or hybrid events. But these meetings

SILKE SAGE

always lacked the crucial factor: genuine exchange among

Editor-In-Chief

colleagues on an eye-to-eye level. Although many organizers

silke@global-cl.com

still face challenges, the trade show business is recovering.

And that's a good thing, because this intense energy kick from person to person and live presentations in front of an audience offer innovation, inspiration, and impulses. These

ONLINE VISIT OUR BRAND NEW WEBSITE WWW.GLOBAL-CL.COM GlobalCONTACT 2-23

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EUROPEAN FEDERATION OF THE

CONTACT LENS AND IOL INDUSTRIES

WHY WOULD YOU BECOME AN EFCLIN MEMBER It’s the best form of business e one on don everr d e ever ave hav g I have king ki orkin networki

A great source of information all The members understand und un nde ders ders rstta ta each other tan

Why wouldn’t you I’d pay the membership just to come to the congress

It’s run by its members, for its me

mbers

It’s like having a whole

network of experts

available at all times ustry If you can’t support your own ind who h can you support?

There is

always s omeone can contact w you ho will have e xperiience ces you can b ben ene nefi efit fit ffrom fit rom ro

The congress & exhibition is the best there is lp each other,

Everyone seems to he ng iin it’s amaz

ve body

entati It’’s our repres

If you would like to become an EFCLIN Member check out www.efclin.com and click the “Become A Member” link.

info@efclin.com

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+41(0)411279 372 315032 10 10 +44

EFCLIN, EFCLIN WINKELBÜEL 2 CH-6043 ADLIGENSWIL Bishops Stortford, SWITZERLAND CM23 9GZ, UK

Search: EFCLIN

@EFCLIN

20.06.12 17:56 31.05.16 12:39 14:33 23.05.22 13:34 31.05.23 24.06.15 00:03

CONTENT

ISSN:1386 0194

LETTER FROM THE EDITOR 3

How do you know that?

Silke Sage

2

2023 (94)

INTERNATIONAL NEWS

International News • EFCLIN Conference 2023

6

All about you & event dates

Fitting Background • The other side of myopia

10 All about markets

History • 75 Years Rigid Corneal Lens

11 All about products

Business + Marketing • Recruiting

12 All about research

Contaflex

Clinical Guide for Scleral Lens Success

16 EFCLIN Congress & Exhibition 2023 Silke Sage

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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: REM Vision Technologies SL, www.remvt.com Page 9: LAMBDA-X S.A., www.lambda-x.com Page 19: DIATEC Diamanttechnik GmbH., www.diatec-pforzheim.de Page 21: SCHNEIDER GmbH & Co. KG, www.schneider-om.com

20 EFCLIN Forum – Lean production Mike Denison

22 BCLA Clinical Conference & Exhibition

MANUFACTURING 24 Blocking tooling and process – part 2 Erik Larsen

HISTORY 26 The hard facts – The 75th anniversary of the rigid corneal lens Eef van der Worp, Patrick Caroline & Craig Norman

Page 23: OPTOCRAFT GmbH, www.optocraft.com Page 29: Larsen Equipment Design Inc., www.larsenequipment.com Page 31: DAC International, Inc., www.larsenequipment.com Page 33: AMETEK Precitech, Inc., www.precitech.com Page 43: K & Y Diamond Ltd, www.kydiamond.ca Inside back cover: Acuity Polymers, Inc, www.acuitypolymers.com Outside back cover: DAC www.dac-intl.com

NAMES TO NOTE Caroline, Patrick Denison, Mike Griffith, Tom Kinder, Alina Larsen, Erik Meerding, Jennifer Norman, Craig Urschinger, Timm van der Worp, Eef GlobalCONTACT 2-23

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26 20 32 38 24 34 26 44 26

FITTING BACKGROUND 32 20 Years of “Nocturnal” night lenses Tom Griffiths

34 The other side of myopia Jennifer Meerding

38 Changes in visual acuity and spherical equivalent after corneal reshaping during the day Alina Kinder

BUSINESS + MARKETING 44 Ensuring that jobs and skills go hand in hand Timm Urschinger

NEWS 48 Yellow Pages 5

27.07.23 12:19

INTERNATIONAL NEWS

All about you Haag-Streit UK moves to new premises

more than 30 years. It is close to road and rail links, just off the M11 motorway and a stone's throw away from Stanstead airport. The new premises comprises two buildings that encourage collaborative working, improved workflow and sustainability initiatives.

The new headquarters include an open-plan office which can accommodate the HS-UK team as well as space to hold Academy courses. The logistics and service team will be located in a separate warehouse facility. The company has donated a lot of the furniture from the old office building to local Harlow schools and charities. New furniture was sustainably sourced and both new facilities will benefit from solar energy and electric car charging spaces. HS-UK has remained fully operational throughout the move process and will keep existing phone numbers, email addresses and bank details.

Dean Johnson, HS-UK Managing Director, said, “This is a very exciting time for HS-UK as we move into our new home in Bishop’s Stortford. The new offices are very well located

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Haag-Streit UK (HS-UK) has announced that they have moved

and have a more modern look and feel. We look forward to

the UK headquarters from Harlow to Bishop’s Stortford in

welcoming both customers and colleagues for meetings, as

Hertfordshire. The new site is just ten miles away from the

well as inviting delegates to attend training in our new dedicated

previous Harlow location, where the company has been for

Academy space.”

EurOK in Barcelona: Everything about Ortho-K

award was bestowed to those who demonstrated their

After a long break since 2019, the 6th EurOK took place

knowledge in this field.

in Barcelona at the Gran Hotel Rey Don Jaime from April

The meeting is held each edition in a different European

28-29. For two days, an intensive educational program

country. The last edition of EurOK was held in Cluj Napoca,

was offered, focusing on seminars as well as general

Romania at the end of 2019. The European Academy of

scientif ic lectures related to or t ho-K and myopia

Orthokeratology (EurOK) is a non-profit, independent

management. During the two days, examinations for

organization and represents the European section of the

myopia management certification were also held and an

International Academy of Orthokeratology (IAO).

Review of Myopia Management named official media sponsor of International Myopia Conference

professionals maximize the emerging field of myopia

Review of Myopia Management (RMM) has been named

management. It will work with the IMC to promote the

t he of f icia l media sponsor of t he upcoming 19t h

event to eyecare professionals and vision scientists across

International Myopia Conference (IMC)in September

the U.S. and globally. The groups plan to collaborate on

2024 in Hainan Island, China. The event will be hosted

soliciting abstracts for the conference, encouraging

by the Aier Institute of Optometry and Vision Science,

attendance, and publishing coverage of the event before,

Aier Eye Hospital Group. Review of Myopia Management

during and after it takes place.

is a leading online publication designed to help eyecare

GlobalCONTACT 2-23

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INTERNATIONAL NEWS

CooperVision to invest $500 million in Puerto Rico operations expansion CooperVision has announced a multi-year investment plan totaling $500 million to expand its operations in Puerto Rico.

The company is launching the plan to enlarge its production facilities in Juana Diaz and to establish a global manufacturing site in Ponce, further affirming its four-decade commitment to the island.

"Our $500 million investment signals a commitment to customers, to our 2,000 local employees who are part of the great CooperVision family, and especially to the people of Puerto Rico, where we have operated and prospered since

In Ponce, the company is acquiring the former facilities of

1984. The planned investments represent a significant

Roche Diagnostics, conver ting t he location into a

expansion of our global manufacturing footprint and continued

115,000-square-foot hub that expands capacity to manufacture

positive impact on the island’s economy,” said CooperVision

soft contact lenses shipped globally, including MiSight 1 day.

Executive Vice President of Global Operations Rolando Torres,

Representing approximately $100 million of the total $500

during a press conference where he was joined by Secretary

million investment, the 14-acre site—with sustainable design

of the Department of Economic Development and Commerce

and advanced technologies—is expected to employ 400 people

Manuel Cidre Miranda.

in its initial operating phase.

In Juana Diaz, the company will convert a 22,000-square-foot

“We continue to take strategic actions to maintain our global

warehouse for production use, installing new, high-volume,

success and improve our competitiveness. The growth in local

automated contact lens manufacturing cells. A second

production volumes, capital investment, and job creation have

initiative will add 120,000 square feet to the current

been constant and forceful drivers for economic development

manufacturing f loor, accommodating additional new

in Puerto Rico. Today’s announcement accelerates this trajectory

manufacturing cells for substantially increased local

and deepens our longstanding commitment to the island,”

production volumes. The third project in Juana Diaz expands

said Torres. “Puerto Rico’s selection for the CooperVision

CooperVision's main building by 100,000 square feet for

expansion followed considerable study and analysis of multiple

warehousing and new packaging lines.

options, highlighting the extraordinary talent who lives here.”

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www.remvt.com

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INTERNATIONAL NEWS

12th Freiburg Contact Lens Forum by Hecht

forum with a total of 230 participants was dedicated to the interesting contact lens topics that are currently engaging the world of ophthalmic optics and optometry. The weekend's lectures and panel discussion addressed current marketing strategies, clinical insights into contactology, myopia prevention, and presbyopia management. Entertainment was provided by the comedy show of Dr. Oliver Tissot, cabaret artist and sociologist, with a humorous summary of the lectures of the first day and the performance of Oli Meier & Te Brothers with Fireworks of Rock.

After the event, Mario Rehnert (Marketing) at Hecht summarized: "We look back on a great 12th Freiburg Contact Lens Forum with 230 participants. In one and a half days, the participants were able to learn about the topics of marketing, clinical contactology, myopia prevention and presbyopia care in a clear and entertaining way. Also, in our following workshop on Monday some topics were deepened and intensively

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Already for the twelfth time, Hecht Contactlinsen GmbH

discussed. The participants visibly enjoyed the intensive

invited to a Forum in the Konzerthaus Freiburg, Germany,

professional exchange during the numerous breaks in a cordial

from May 6 to 7, 2023. Hecht, with its founding father Dieter

and relaxed atmosphere. At the evening event, the participants

Muckenhirn, looks back on many years of experience in the

danced and celebrated together. The forum will probably take

field of contact lenses as well as the organization of further

place every three years in the future. We are already looking

education opportunities for interested parties. The two-day

forward to the next Forum and have many ideas for it."

Bausch + Lomb launches multifocal silicone hydrogel contact lenses in the US

Bausch + Lomb INFUSE Multifocal contact lenses are made

Bausch + Lomb has announced the U.S. launch of Bausch +

combines breathability with a low modulus and high moisture,

Lomb INFUSE Multifocal silicone hydrogel (SiHy) daily

allowing the lens to maintain 96% of its moisture for 16 hours.

disposable contact lenses. Featuring a material infused with

The lens material is infused with ProBalance Technology, which

ProBalance Technology and the company’s 3-Zone Progressive

includes a combination of ingredients inspired by the Tear Film

design, the new lens is aimed at patients with presbyopia and

and Ocular Surface Society’s DEWS II report and is released

promises clear vision with seamless transitions across near,

during lens wear to help maintain ocular surface homeostasis

intermediate and distance vision while helping to minimize

and minimize contact lens dryness.

contact lens dryness.

According to a recent study, 90% of presbyopic patients surveyed

"Presbyopic patients have unique vision needs due to their age

agreed Bausch + Lomb INFUSE Multifocal contact lenses allow

and lifestyle. Our Bausch + Lomb INFUSE Multifocal SiHy

them to effortlessly move from various tasks throughout the day.

contact lenses were designed to directly address the common

In addition, eye care professionals surveyed agreed that Bausch +

problems that they experience with multifocal contact lenses,

Lomb INFUSE Multifocal lenses were easy to fit for 99% of patients.

such as contact lens dryness, which nearly 70% of multifocal

"Ocular surface changes that occur with age, as well as lifestyle

contact lens wearers report experiencing during lens wear,"

changes such as increasing digital device usage, can have an

said Yang Yang, senior vice president, Vision Care, Bausch +

impact on presbyopic patients, leading them to experience eye

Lomb. “With the prevalence of presbyopia estimated to be

strain and other eye symptoms. As a result, multifocal lens fitting

nearly 80% by age 45-55 in North America, and an increasing

can sometimes prove to be a challenge, particularly with patients

aging society in the United Statesthat spends more than nine

who express comfort and vision concerns,” said Mile Brujic,

hours a day on digital devices, we are proud to use our latest

O.D., Premier Vision Group, Bowling Green, OH. "Bausch +

science and contact lens technologies to provide eye care

Lomb INFUSE Multifocal contact lenses demonstrate consistent

professionals and their patients with this new innovative

focusing power in each zone of vision, help ensure a smooth,

multifocal lens option.”

wettable surface for patient comfort and are easy to fit."

with a SiHy daily disposable lens material (kalifilcon A) that

GlobalCONTACT 2-23

04.07.23 12:42

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INTERNATIONAL NEWS

Johnson & Johnson presented new clinical data on daily contact lens at BCLA conference

Johnson & Johnson Vision’s booth hosted a variety of interactive

Johnson & Johnson Vision has presented a range of new clinical

were invited to try the Acuvue Virtual Reality vision experience

data and learning opportunities for developments in contact

with a demonstration on fitting multifocal contact lenses. The

lenses at the 2023 British Contact Lens Association (BCLA)

new Virtual Reality vision experience is being shared by Johnson

Clinical Conference and Exhibition from 9 – 11 June in

& Johnson Vision with Eye Care Professionals across multiple

Manchester, UK. A platinum sponsor of the event, Johnson &

EMEA countries to help improve contact lens learning and

Johnson Vision had prepared two feature presentations, along

training experiences.

with a series of free papers and poster sessions available to Eye

The company also hosted multiple educational presentations

Care Professionals in attendance. New data examined the

as part of the 2023 BCLA program, with the opportunity

technological features of Acuvue Oasys Max 1-Day and Acuvue

for attendees to hear from leading experts about clinical

Oasys Max 1-Day Multifocal contact lenses, including filtering

data and guidance in contact lens innovations. As part of

high-energy visible (HEV) light designed to reduce visual

ongoing environmental sustainability efforts, the Johnson

discomfort.

& Johnson Vision booth at BCLA was built re-using materials

education opportunities and hands-on demonstrations. Visitors

Acuvue Oasys Max 1-Day contact lenses are designed with a

from previous events and was 100% paperless, with all

combination of two new technologies: TearStable Technology

education and marketing materials available electronically.

and OptiBlue Light Filter. TearStable Technology is designed

Every time a visitor used the digital screen to download

to maximise tear-film stability and retain moisture. The OptiBlue

material, the amount of paper saved was added to a running

Light Filter is the highest-level blue-violet filter, with 60%

total that was visualized on-site through a virtual “living

blue-violet light filtering designed to reduce light scatter.

tree” installation.

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04.07.23 31.05.23 12:42

INTERNATIONAL NEWS

ACLM honors the memory of Michael Tillotson

Michael Tillotson (Photo: Johnny Bingham)

Micky was always an adept political operator. Without appearing

Micky became secretary general of

to do so, he ensured that Euromcontact had a president who

the Association of Contact Lens

was competent and chosen from a different European country

Manufacturers (ACLM) in succession

on a rotational basis. Without exception, each president was

to a very successful and charming

delighted to have Micky at their right hand. Meetings were

former colonial administrator. There

usually held in Paris where the lunch was a joy not allowed to

was a view that a former major general

eclipse the business. There was always an annual meeting in a

might place his stamp too firmly on

smart city. During the Italian presidency, guests arrived at the

the organization. He didn’t. He

excellent Venice hotel to find a welcome gift in their room.

skillfully corralled the disparate

When unwrapped there was some disappointment to discover

membership – 30 or so, mainly

each had received a pair of rubber boots – care was taken with

managing directors of UK-based

French sensibilities by not calling them Wellingtons. The boots

contact lens manufacturers – and gave

proved invaluable as Venice was flooded.

them brilliant support and very subtle

It was over a dinner in a pleasant Venice restaurant, most diners

guidance reflecting his expertise as a

wearing said boots, that Micky showed characteristics long

staff officer. This was at a time when

admired. His liver arrived and it was not what he wanted though

the European economic community was flexing its muscles

it was precisely what he had ordered. Seeing that the dish of

and bringing in a directive that would regulate medical

the lady opposite him was more to his taste he suggested that

devices. Micky recognized that this regulation needed to be

his was such a superior dish that he felt honor bound to offer

drafted so that it did not bring a disproportionate burden on

to exchange it with hers. She read him accurately and declined

the industry that would be too much, especially for the smaller

the generous offer.

manufacturers.

Micky and Sybil moved to Normandy during Micky’s tenure at

That was the beginning of a great initiative largely led by him

Euromcontact which made for easier travel to meetings and

in which a Europe-wide federation of contact lens manufacturers,

played to his Europhile instincts. It was over a pleasant lunch

Euromcontact, was formed. Micky became its first secretary

that he and the then Euromcontact president conceived a pan-

general and brought in the ACLM equivalents from across

optical, pan-Europe cooperation which brought together five

Europe. He spent many a long day in Brussels and was very

organizations representing between them: optometrists, opticians,

influential in getting a special clause in the Directive for the

ophthalmologists, contact lens specialists and the contact lens

Contact Lens Industry – that was probably a unique achievement

manufacturers to form the European Contact Lens Forum. It,

for any device industry. Micky developed some firm friendships

like much of Micky’s legacy in the contact lens industry, lives

in the commission and was widely highly regarded.

on. An aging group of folks from the UK contact lens industry

It was probably at this time that he started to use ‘Michael’

and practice continue to lunch together each year and Micky’s

rather than ‘Micky’ largely to avoid the disappointment on the

name invariably crops up in reminiscences of a very formative

faces of senior French officials when they discovered that Micky

time for the contact lens world. Michael Tillotson died at the

was not a petite brunette but a robust British general.

age of 95 in May 17th. He will long be remembered. n

WEBINARS, CONFERENCES & TRADE FAIRS 2023

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ICSC 2023 www.icscmeeting.com

July 28-29

Ft. Lauderdale, FL (USA)

Vision By Design www.orthokmeeting.com

Sep 6-10

Chicago, IL (USA)

IOFT 2023 www.ioft.jp/en-gb.html

Oct 10-12

Tokyo (JPN)

American Academy of Optometry 2023 www.aaopt.org

Oct 11-14

New Orleans, LA (USA)

AAO 2023 www.aao.org

Nov 3-6

San Francisco, CA (USA)

GlobalCONTACT 2-23

23.06.23 12:15

INTERNATIONAL NEWS

All about products TRIOPTICS - SortStation IOL: Inspection of intraocular lenses in production OptiSpheric® IOL PRO 2 offers fully automated IOL measurement. It is completed with WorkStation IOL and integrated SortStation IOL. This workplace is the best choice when it comes to carrying out all the steps upstream and downstream of measurement in a simple, fast and safe process. It includes loading the sample holders with optimal illumination that makes it easy to ensure the ideal positioning of the lenses. The lenses can safely be sorted after the measurement: Test results are automatically transferred to the display and made visible directly at the location of the samples. The fulfillment of the pass/fail criterion is displayed in a red/green color scheme and the reliable assignment of each lens is enabled. Visit www.trioptics.com / sales@trioptics.com

All-in-one tray-based metrology instrument for IOLs All too often, the bottleneck in IOL production is found in quality control. The NIMO MATRIX proves to be the solution for this problem by providing a quick and reliable way to measure refractive IOLs in seconds: the automated instrument measures a full tray of lenses (up to 121 IOLs) in a single click. NIMO MATRIX allows for the quality control of 200 to 400 items per hour, opening the doors to a new, more efficient production line. Based on the NIMO TR0815 technology, NIMO MATRIX is an all-in-one motorized instrument that is used for the quick, autonomous control of IOLs (monofocal, toric, multifocal, multifocal toric). The NIMO MATRIX offers the full range of capacities of the NIMO TR0815, albeit fully automated intraocular quality inspection while eliminating the manual manipulation of individual lens and potential damages. Our team of experts will gladly meet you for a demonstration of this ideal solution for quick and autonomous control. https://ophthalmics.lambda-x.com, sales-ophthalmics@lambda-x.com, +32 67 79 40 80

Global Specialty Lens Market Drives Record Year for Boston® Materials Boston® materials had a record-setting year in 2022, boosted by a 33% jump in sales of their gas permeable (GP) contact lens material Boston XO2®. The company attributes this growth to the increasing demand for specialty contact lenses worldwide, particularly in orthokeratology.

Boston XO® is also gaining popularity in Europe and Asia for its use in orthokeratology (ortho-k), the use of specially fitted contact lenses during sleep to temporarily reshape the cornea. Ortho-k is projected to increase significantly over the next several years, particularly in Europe. Myopia is also anticipated to become more prevalent among the general population due to increased exposure to digital screens after the COVID-19 pandemic. Boston® Materials are manufactured with precision by highly skilled technicians. Each products must undergo rigorous quality control, resulting in the introduction of innovative gas permeable lens materials and lens care products throughout the company’s history. For more information, visit www.fit-boston.eu

Ultra Precision Diamond Tools

CONTACT LENSES TOOLING

DAC Optoform Moore Nanotech UPL Precitech Nanoform REM Vision

News from K&Y Diamond At K&Y Diamond Ltd, we are committed to supporting an industry that has such a positive impact on the lives of people around the globe. “It is predicted that the Contact Lens industry will grow on average, + 3% per year”. The ever-increasing demand is why we have developed into one of the world’s largest manufacturers of single-crystal diamond tools used to make RGP lenses, IOL’S and optical molds. K&Y diamonds are found in both large and small labs in over 60 countries earning us a reputation for delivering a superior product at a fair price. Our focus on advancing the most efficient

lapping and polishing technology means better tool life and more consistent performance over a wide range of materials. Let our team of over 45 talented technicians and engineers help you make the best product possible! Visit www.kydiamond.ca GlobalCONTACT 2-23

11_About Products.indd 11

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23.06.23 12:17

INTERNATIONAL NEWS

All about research

Protein deposits, eye movements, brain & senses, SARS-CoV-2 test Scientists at the Centre for Ocular Research & Education (CORE) have used radiolabeled proteins to measure protein deposits on rigid gas permeable (RGP) contact lenses. A new study about the plasticity of the brain reveals that a change in the visual system also induces a modification in the hearing system.

Research led by scientists at the University of Colorado Boulder, USA, suggests that the movement of eyes may reveal information about how humans make decisions. Research led by scientists at the University of São Paulo (USP) in Brazil has found that SARS-CoV-2 can be detected in tears collected by swabbing.

By Rebekka Nurkanovic

Using radiolabeled proteins to study RGP contact lens deposition

RGP lens materials were soaked in the radioactive artificial

Historically, protein deposits on rigid gas permeable (RGP)

to a 3% one-step hydrogen peroxide (OSP) care solution to

contact lenses have been difficult to measure because of test

investigate cleaning ability. Investigators determined the

sensitivity limitations. Scientists at the Centre for Ocular

deposits were minimal, ranging from 1.2 ± 0.2 μg to 3.2 ± 0.7

Research & Education (CORE) have used radiolabeled proteins

μg per lens without use of a cleaning solution. Moreover, the

to overcome that challenge. They had used the technique for

OSP solution significantly reduced the amount of radioactive

soft contact lens deposition studies in the past and now applied

lysozyme present on the majority of RGPs after 30 alternating

it to RGPs for the first time.

incubating and cleaning cycles when compared to using

The Biosciences Group incorporated radiolabeled lysozyme

phosphate buffered saline, with measurements of remaining

into an artificial tear solution and then determined on-lens

lysozyme on cleaned lenses ranging from 1.3 ± 0.1 μg to 2.5

protein sensitively through radioactive counts. Seven common

± 0.1 μg per lens.

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tear solution for 16 hours, followed by eight hours of exposure

GlobalCONTACT 2-23

23.06.23 12:25

INTERNATIONAL NEWS

“Renewed interest in RGP lenses around the world, sparked by the rise in their use for myopia management, has subsequently increased the desire for more advanced research. CORE has built a reputation for discovering new ways to precisely assess ophthalmic devices and pharmaceuticals, and this radiolabeling technique has strong potential for other applications,” said Alex Hui, OD, PhD, FAAO, head of Biosciences at CORE. The work was first presented as a scientific poster,’ The impact of RGP care solutions on ISO measured lens parameters and the protein deposition on RGP lenses when managed with a hydrogen peroxide care solution, Hui, et al.’, at the 2023 Global Specialty Lens Symposium. CooperVision provided study funding support.

Source: Centre for Ocular Research & Education (CORE)

3D illustration of a molecular model of lysozyme protein found in tears, saliva, human milk and mucus.

New insights into the interaction of brain and senses

a short period of monocular deprivation – the occlusion of

Researchers know today quite well that the brain has the critical

auditory processing. In particular, we observed a very selective

ability to adapt to different sensory experiences and, in some

increase of neural response to sounds,” says Alessandra Federici,

ways, to “compensate” for the lack of one sense or the other.

a researcher in cognitive neuroscience at the IMT School, and

one eye with an eye patch for about two hours – also affects

In a recent study, a group of researchers

first author of the paper. In other words,

from the IMT School for Advanced

even a small perturbation of visual

Studies Lucca (Italy), in collaboration

experience is enough to induce a change

with a group from the University of Ulm

in the balance between vision and

(Germany), added new insights on how

aud it ion. Indeed, t he ef fec ts of

the brain manages to adapt to changes

monocu lar deprivation were

in the flux of information coming from

paradoxical: after patch removal, the

eyes and ears.

brain became more sensitive to the

Several studies have already shown that

visual information provided by the eye

the lack of sight, even for a short period

that was occluded, as if the lack of input

of time, for example through the occlusion

led to an increase in neural excitability.

of one eye for a few hours, is sufficient to

The brain also became more susceptible

induce a temporary change in how the

to auditory input, but selectively when

brain processes visual information. Yet,

the environment was monitored with

it was unknown whether these plastic

the other, non-patched, eye. "While

effects have an impact on other senses

many studies have demonstrated the

beyond vision and influence their activity.

For this new study, the researchers from t he MOM i L ab (Molecu la r M i nd L ab or ator y) of t he I M T S c ho ol

The illustration wants to suggest that the brain continuously adapts to cope with available visual inputs. Due to the strict interdependence between vision and audition, a change in the first affects the second, keeping the equilibrium between them. Picture: Carlo Gazzi

blindfolded the eye of 20 participants

plasticity of the senses after prolonged sensory deprivation, as in the case of blindness and deafness, these findings unveil the high degree of plasticity and interdependence of the senses and the

of the experiment and asked them to look and count simple

profound impact that sensory experience continuously exerts

flashes of light while sound beeps were also presented. During

on our brain," says Davide Bottari, researcher at the IMT

the experiment, the activity in the brain was registered with

School and principal investigator of the study. The study was

millisecond precision with the electroencephalogram. The

published in the journal NeuroImage.

researchers observed that neural activity in response to visual and auditory input was altered following the eye patch removal.

DOI: 10.1016/j.neuroimage.2023.120141

“In this research, we demonstrated for the first time that even

Source: IMT School for Advanced Studies Lucca

GlobalCONTACT 2-23

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INTERNATIONAL NEWS

Eye movements give insight into decision making

high-speed, camera-based device that tracked their eye

Research led by scientists at the University of Colorado

options, getting four seconds to pick between two choices

Boulder, USA, suggests that the movement of eyes may reveal

represented by icons: Did they want to walk for two minutes

information about how humans make decisions.

at a 10 % grade or for six minutes at a 4 % grade?

The scientists asked 22 human subjects to walk on a treadmill

As the subjects considered their options, they flitted their

then choose between different settings displayed on a

eyes between the icons, first slowly and then faster. Once the

computer screen: a brief walk up a steep grade or a longer

subjects decided on their pick, their eyes slowed again.

walk on f lat ground. The Researchers observed that the

The researchers think that apart from giving valuable insight

subjects’ eyes tended to move their eyes faster when they

into the workings of the brain, tracking eye movements could

looked toward the options that they ended up choosing. The

also be useful as a diagnostic tool for certain diseases where

more vigorously their eyes moved, the more they seemed to

slowed movements are a symptom, e.g. Parkinson’s. The

prefer their choice.

research was published in the journal Current Biology.

movements. While at the screen, they pondered a series of

Qu Qu Q

In the study, the team set up a treadmill on the CU Boulder campus. Study subjects exercised on various inclines for a

DOI 10.1016/j.cub.2022.10.053

period of time then sat down in front of a monitor and a

Quelle: University of Colorado at Boulder

COVID-19 virus can be detected in tears sampled by ocular swab

18.2% of the samples, suggesting this method could be an

Research led by scientists at the University of São Paulo

combination of the factors more comorbidities and a higher

(USP) in Brazil has found that SARS-CoV-2, the coronavirus

mortality rate among patients whose tear samples tested

that causes COVID-19, can be detected in tears collected by

positive suggests that this method of detection of the virus

swabbing. The researchers analyzed samples from patients

could be a prognosis predictor. The findings suggest that

diagnosed with the disease by conventional methods and

the probability of detecting the virus in tears is greater when

admitted to the Hospital for Rehabilitation of Craniofacial

the patient has a high viral load.

Anomalies (HRAC) run by the Bauru Dental School (FOB-

The study cohort comprised 61 hospitalized patients, with

USP) in the first half of 2021. SARS-CoV-2 was detected in

28 testing negative and 33 positive for COVID-19 by

14

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En Enh En au aut au

alternative to nasopharyngeal swabbing. Moreover, a

GlobalCONTACT 2-23

23.06.23 12:25

• • • •

And An A And

Your You Yo You

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INTERNATIONAL NEWS

The scientists collected samples by conjunctival swab (left) and Schirmer strip, normally used to determine whether the eye produces enough tears. Picture: Luiz Fernando Manzoni Lourençone/USP

RT-qPCR via nasopharyngeal swab. Tears were analyzed

dying compared to patients with a negative result. Those

from all 33 positives and from 14 of the 28 negatives. In

patients also had other factors that could contribute to death,

addition to collection by conjunctival swab, the scientists

such as a poor ten-year survival rate based on CCI. The

also used the Schirmer strip test, in which a strip of filter

study also included demographic, clinical and ocular

paper is placed for five minutes inside the lower eyelid.

symptom data. The main diagnostic test used was real-time

The samples were analyzed between July and November

quantitative PCR (polymerase chain reaction). Innovating

2021. SARS-CoV-2 was detected in 18.2% of the samples

in comparison with previous research, in this study viral

collected by conjunctival swab and 12.1% of those collected

RNA positivity was determined much more precisely by

by Schirmer strip. As expected, none of the patients who

analyzing the nucleocapsid (N), envelope (E) and RNA-

tested negative for the virus via nasopharyngeal swab had

dependent RNA polymerase (RdRp). The study was reported

tears that tested positive.

in an article published in the November 2022 issue of

The Charlson Comorbidity Index (CCI) was used to predict

the Journal of Clinical Medicine.

risk of death within a year of hospitalization for patients with 20 specific conditions. Patients with SARS-CoV-2

DOI 10.3390/jcm11236929

particles in tear samples had an almost sevenfold chance of

Source : Fundação de Amparo à Pesquisa do Estado de São Paulo

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CONTACT LENS+EYECARE

Photos: Silke Sage

Eef von der Worp

Welcome Reception Sponsors: Erik Larsen (LED), Dr. Johannes Pfund (Optocraft), Silke Sage (GlobalCONTACT), Felix Lopez (REM), Jonathan Jacobson (Acuity Polymers)

49th EFCLIN Congress Association of Contact Lens Manufacturers met in The Hague The EFCLIN Congress, held April 20-32, 2023, welcomed more than 300 attendees to The Hague in the Netherlands this year. For many of the industry representatives attending, the transition from MDD to MDR continues to be an important topic and was addressed accordingly. This year, the regulation or impending ban of per- and polyfluoroalkyl substances (PFAS) also played a significant role, with Laure-Anne Copel of EUROMCONTACT presenting new information. Innovations in contact lens and IOL design, new technologies in manufacturing, metrology and software applications were further important lecture topics. By Silke Sage

When the upcoming location of the congress was announced

showcased all areas of the contact lens manufacturing industry

last year, the war in Ukraine had started only a few weeks

and its suppliers. Thus, the leading material manufacturers

before. Budapest as a venue felt wrong to many participants.

for RGPs, custom soft contact lenses and intraocular lenses

The organizers showed flexibility and therefore complied with

were present, as well the machine manufacturers currently

the members' request and moved the conference quite a bit

active on the market and the most important suppliers of

further west: In The Hague a successful EFCLIN conference

met rolog y i nst r u ments a nd systems. T he d ia mond

could take place with 333 international participants from 32

manufacturers for tools, manufacturers of blockers and

countries. In addition to an excellent program of presentations,

polishing systems and suppliers of consumables and software

the event was, as always, f lanked by an exhibition that

were not to be missed.

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CONTACT LENS+EYECARE

The EFCLIN Board: Martina Clifford, Gareth Browne, Alan Bennett, Marion Beeler, Armin Duddek, Marc Botticella, Dr. Johannes Pfund, Dr. William Lee

Brought new insights on PFAS: Laure-Anne Copel from EUROMCONTACT.

Randy Kojima (r.)

EFCLIN President Armin Duddek and Executive Director Marion Beeler.

PFAS BAN AS A THREAT TO CONTACT LENS CARE

problem for contact lens manufacturers mainly of RGPs. In

The EFCLIN Forum kicked off at noon on Thursday with a

early February 2023, the European Chemicals Agency (ECHA)

well-attended panel. On Friday morning, shortly after the

published a proposed ban on all PFASs. This is the most

welcome by EFCLIN President Armin Duddek, Laure-Anne

comprehensive restriction proposal of its kind.

Copel from EUROMCONTACT addressed the topic that is

ECHA has now published a public consultation to gather

currently keeping the association and its members on their

additional information on the use of PFAS in order to consider

toes: The impending ban on per- and polyf luoroalkyl

whether exemptions from the PFAS ban can be granted for

substances – PFAS for short.

certain uses. This could then apply to contact lenses. There are currently no alternatives for three PFASs used in the manufacture

The background:

of dimensionally stable contact lenses. These include:

These chemical substances are viewed very critically; they are

Fluoropolymers and Perfluoropolyethers. While a possible

by now everywhere and can hardly be removed from the

exemption could be justified here, the evidence needs to be

environment or organisms. However, they play an important

supported with numbers. Additional information from

- if not central - role in many products. Some provide comfort

manufacturers is urgently needed here - and as quickly as

or improved product properties, for example, as anti-fogging

possible by September 2023, because that is when the consultation

agents in eyeglass lenses, as non-stick coatings in pots or serve

period ends, during which evidence of the use of certain PFASs

as rain protection in breathable clothing. The use of the

can be submitted to the responsible EU body.

approximately 10,000 different chemical compounds known

Currently, there are only two options for manufacturers: Obtain

by the collective term PFAS in the products we use every day

an exemption for contact lenses, or develop new materials and

is almost as varied as their number.

surfaces without the use of PFASs within a transition period of

Five countries from the EU have spoken out in favor of a ban

12 years. We talked about this and other topics with EFCLIN

on PFASs, setting a ball rolling that could become a major

President Armin Duddek in The Hague.

GlobalCONTACT 2-23

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CONTACT LENS+EYECARE

Interview with Armin Duddek, EFCLIN President GlobalCONTACT: Another position has just been added to the EFC-

the aim to vote against this motion in this form.

LIN Board with Marc Botticella. What are the reasons behind this?

We can live with the full ban of PFAS if necessary if there is

Duddek: When planning the conference, we keep coming

the transitional arrangement of up to 12 years. The material

across topics where we realize we need more input. So, we

manufacturers, as far as I am informed, do not currently have

agreed that we needed more minds on the board.

an alternative, but this would buy them time to develop new

This will bring new perspectives and

materials. Then the industry could actually look well into the

suggestions to the organizing team.

future. Now, it would be not good for us if the EU governments

With Marc, we have an expert with

really decided on a total ban without PFAS exemptions.

a l a rge ne t work a nd a go o d

Ar mi

n D ud de k

professional background.

GlobalCONTACT: For exemptions that can be requested, appropriate

Moreover, the board is not limited

cases must be documented. Qualitatively and quantitatively, for

to a certain number of people. Thus

how many this medical device has an important function and how

we have extended it by a new

many people have no alternative. Who would be questioned about

position. This ensures the quality

this? Only the industry or also eye care practitioners?

and will help to keep the level on a high level in the future.

Duddek: I also work as an optometrist and fit contact lenses.

In that capacity, I have already received questionnaires from ECCO and VDCO asking about the number of fittings. One

GlobalCONTACT: What are the most pressing issues for the association

tries to get some overview of the numbers probably in

at the moment?

preparation for the EU Commission. Currently we get figures

Duddek: After the Covid epidemic and the cancellation of the

via EUROMCONTACT, but there are rather the big

conference twice, we focused on the financial status. Fortunately,

companies organized and there it is mainly about soft lenses,

the association did not lose any money due to Covid and the

which are partly also affected by the PFAS issue. But we

conference could take place as usual. Nevertheless, we are trying

must prove how many patients are affected in Europe to

to get new members. Content-wise, still a big issue is the

show the EU Commission how many jobs in the industry

transition from MDD to MDR, with the first companies having

depend on it – and how many patients' jobs depend on it,

successfully completed their audits and being MDR certified.

too. If they no longer have their sight, they can no longer

Some others only need to rework small corrections in their files.

do their jobs.

At the end of the day, this is also a matter of health policy,

GlobalCONTACT: The PFAS issue is an important topic for many

and I think we should also receive reasonable figures from

industries right now. For the contact lens industry, it can become a

EFCLIN and EUROMCONTACT, from the entire industry.

D fo

for and

serious problem. What is the background?

Duddek: Yes, since this year, everything around PFAS is

GlobalCONTACT: If you look at it more closely, with custom lens

an extremely important topic at EFCLIN, which admittedly

users, it mostly affects people who sometimes can't switch to glasses,

caught us cold. The topic was not present for us until the

for example, when using scleral lenses for the severe form of dry eye

push came from the five countries in the EU Parliament

or keratoconus or other irregular corneas....

to ban PFAS. At the moment, we cannot yet estimate what

Duddek: Exactly, among our members it concerns many labs

this means for us. We are working with EUROMCONTACT

that manufacture specialty lenses. Their patients have no

and other stakeholders to lobby and inform in the EU with

alternative to oxygen-permeable form-stable contact lenses.

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CONTACT LENS+EYECARE

They can't wear soft lenses, they can't wear glasses, these

GlobalCONTACT: The CLMA (Contact Lens Manufacturers

Patients are just too unwell. So, we need the arguments to

Association, USA) has collected statistics which, with a participation

delay the transition period as long as possible to develop

rate of 95%, allow very good conclusions to be drawn about the

alternatives that have the same purpose and have the same

fitted RGP contact lenses. Could a similar procedure be applied to

oxygen permeability.

the European market?

Duddek: I was contacted by the previous president of the

GlobalCONTACT: Is the 12-year transition period already fixed or

CLMA, Josh Adams. He showed me his figures and presented

can it be extended?

the study. There, within 1.5 years, with the help of a neutral

Duddek: The EU Commission's proposal was 5-12 years for

institute, they managed to obtain data via a questionnaire.

this transition. So, we are already at the back end there. Whether

The data is so precise that it is possible to extract meaningful

that can be extended even further? That will be difficult.

statistics. I have also spoken with several labs that have completed the data sheet. The time required is 30-45 minutes.

GlobalCONTACT: How is the cooperation with other organizations?

This time investment, I think, is acceptable for any lab if it

Duddek: As EFCLIN, we are a member of EUROMCONTACT,

helps to explain whether we have in Europe, 2 or 10 million

we attend all meetings, we also work in the commissions. From

wearers of RGPs and how many jobs depend on it. Because

that point of view, the exchange is good, but here only numbers

until now, these numbers didn't exist, and I'm very glad that

about sold soft lenses and care products are collected. And our

in the U.S., the big companies have already joined in.

members are less affected by that. Therefore, we need good figures on GP contact lenses in Europe.

GlobalCONTACT: Thank you very much for the interview.

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22.05.23 12:21 11:49 27.07.23

INTERNATIONAL NEWS

Looking through the Lens of LEAN

CONTINUOUS IMPROVEMENT

EFCLIN Forum

FLOW

It was a real privilege to be asked to speak at the EFCLIN Forum in April 2023. I was contacted by Johannes Pfund, Gareth Browne and Pat Murphy to support and develop a keynote talk for the

VALUE RESPECT FOR PEOPLE BUILT IN QUALITY

EFCLIN Forum around lean and continuous improvement cultures that would help spur on ideas and new approaches for the industry. We selected the title “Looking through the Lens of Lean” as it was important for the delegates to learn more about lean, bringing insight into concepts and ideas from other industries that could help in scaling our businesses and bring increased operational efficiencies. By Mike Denison Over the last 30 years,

Lean is often misunderstood in its form as applied at Toyota

I have sha red my

and misrepresented depending on what someone has been

experiences and business

immersed in or exposed to whilst learning about lean. Many

process i mprovement

people see lean as a set of tools and techniques that can be

approaches many times with

applied to improve their operations and many organisations

many industries and this is the

have adopted and adapted lean techniques to make significant

first time I have been involved

improvements in productivity, quality, and cost savings. But

with the Contact Lens Industry,

lean is more than a set of tools and techniques, it is a way of

which of course meant some research

operating a business focused on supporting, developing, and

and alignment with the processes and

continually growing the capabilities of all its people to succeed

challenges of the industry.

One thing became immediately apparent was the similarity

in their work, based on the philosophy of the complete elimination of all waste in pursuit of the most efficient methods

with many other high and low volume manufacturing industries.

for the benefit of its customers and society as a whole.

There were product forming processes such as turning, shaping,

Ideally lean thinking in an organisation should be focused on

polishing, and coating, preparation processes and finishing

people more than its processes and whilst it’s the tools and

processes. There are raw material inventories, work in process,

techniques that might actually make the improvements, it is leaders

finished goods storage and between process transference. All of

developing peoples capabilities, creativity, and scientific approaches

which lend themselves to applying lean methodologies to help

to managing challenges and problems that enable a continuous

improve product flows, reduce lead times, eliminate wasteful

improvement culture that can consistently adapt and innovate to

activities, and increase the opportunity to build in quality into

the challenges of their business and the world today.

each stage of the lens manufacturing operation.

In a Lean World, we look at everything through a lens of value,

Lean means very different things to different people, it’s such a

value for the customer and value of how leaders, lead learning

broad concept that has encompassed many methodologies over

to enable the potential of the people and the business and real

the last 50 years. It has its roots in Toyota’s Production System

value can only be defined through the eyes of the customer. It

and was coined lean in the 1980’s in the book The Machine that

would be an insightful exercise to understand what value in

Changed the World by James P Womack, Daniel T Jones and

the flow of the contact lens manufacturing business is.

Daniel Roos, who wrote about their research into Toyota’s

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manufacturing approach where, when studying Toyota they

EXERCISES IN LEAN THINKING

used the term Lean Production, because Toyota: “……uses less

We used a couple of simple and fun exercises to highlight lean

of everything compared with mass production – half the human

thinking, one, by looking for numbers on a page for the delegates

effort in the factory, half the manufacturing space, half the

to see how, by removing waste and systematically organising

investment in tools, half the engineering hours to develop a new

how the numbers are presented can speed up the process and

product in half the time. also, it requires keeping far less than

increase productivity. This workplace organisation exercise

half the needed inventory on site, results in fewer defects, and

illustrates the power and impact of visual management and waste

produces a greater and ever growing variety of products.”

elimination. The second explored the myth of multitasking and

In truth, until recently Toyota didn’t even use the term “Lean”,

looked at the kinds of non-value adding leadership and

I certainly never came across the term lean whilst working there.

management activities that can also be classed as wasteful. This GlobalCONTACT 2-23

30.06.23 14:11

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INTERNATIONAL NEWS

gave the delegates something to think about from their own

that sets the direction and expectations, this ensures that the

perspective and how important it was to lead by example in

organisation is continually developing its capability and capacity

increasing their own productivity in areas such as meetings,

for expansion.

engaging with staff, and planning their Big Rock activities for

There is a huge focus on teaching and coaching on the job, this

reducing their own low value, non-value adding activities to

also ensures the DNA of the organisation the culture is

spend more time engaging, coaching, and supporting their staff.

continually embedded within the people. This kind of approach

Waste can manifest in many ways; most waste is designed into

fosters an environment of Respect for People, of establishing

the process or has been absorbed through years of doing

mutual trust through meaningful support and creating an

something a certain way and it becomes comfortable to follow

environment in which people and teams can succeed. Harvey

this pattern of production. All these "waste" elements intertwine

S. Firestone, a 20th century industrialist is quoted “The growth

with each other to create more waste, eventually impacting the

and development of people is the highest calling of leadership”

management of the corporation itself.

Toyota’s 21st century principle is “We build our people before

Finally, we shared the concept of the Inverted Organisation, it

we build our cars.” n

has its roots in TQM, it’s a model of growth, of leaders supporting the people where the value is mostly added. Sometimes referred to as Servant Leadership, growing people to grow the business.

This organisational model, I call it an enabling organisation is founded on the premise of leaders routinely engaging, teaching, coaching and supporting the people who report to them to develop their knowledge and skills that they can apply to continuously improving their work and increasing he value to

Mike Denison, FIC, People Centred Excellence. He is an executive coach, lean leadership facilitator and a business transformation advisor, he suppor ts organisations and senior leaders to successfully lead their lean and OpEx pro gr am s t hrough c hange tow ard s establishing a CI culture.

the customer. It is this role model coaching and supporting

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INTERNATIONAL NEWS

‘Agenda-setting’ BCLA Clinical Conference to shape the future of contact lens practice around the world The global eye care professional network’s “unquenchable thirst for learning” ensured the success of the first in-person BCLA Clinical Conference & Exhibition in four years, with delegates from around the world gathering to hear the latest research and guidance from industry-leading experts.

Having been moved online due to COVID restrictions during the

on the subject of how dendritic cells’ response to immediate

pandemic, the conference bounced back in style with delegates

soft contact lens wear is impacted by their physical contact

from around the globe enjoying a packed programme featuring

with nerves in the human corneal epithelium.

some of optometry’s leading names. Held at Manchester Central,

The wider program, which included an application track, ‘cutting

the three-day event featured keynote presentations, lectures, peer

edge’ track, peer review track and skills development workshop

reviews and hands-on workshops detailing the latest clinical insights

track, featured more 100 speakers from around the world.

and demonstrating the latest technology available to practitioners. the leading lights in contact lenses and anterior eye for the first

TWO POWERFUL KEYNOTE PRESENTATIONS BY PROFESSOR GREGORY SAWYER

BCLA Clinical Conference in four years has been a huge honour.

Among other highlights was Professor Gregory Sawyer, who

The world has been through so much since everyone was last

used his extensive bioengineering background to deliver two

together here in Manchester but our members have shown incredible

powerful keynote presentations.

strength and resilience to not just withstand everything thrown

The first, on the art of contact lens comfort, explored the biological

at them but to thrive under that pressure. Their seemingly

history of the tear film and the similarities shared by “soft, wet

unquenchable thirst for learning continues and the standard of

and squidgy” contact lenses and jellyfish. He explored the

lectures and presentations has been incredible – showcasing cutting

opportunities for AI and machine learning in treating cell damage

edge science and research and translating that into impactful

before demonstrating the concept of friction co-efficient. The

techniques for use in everyday practice. Myopia management, dry

second session gave a more advanced understanding of the tear

eye disease and the tear film remain key areas of interest and the

film and how it interfaces with a contact lens.

BCLA is as determined as ever to give our members access to the

Data revealed during a session looking at contact lens wear in children

insights that can make a difference to the everyday lives of their

showed that eye care professionals around the world are growing

patients. This has been a real agenda-setting conference. These

increasingly confident in fitting contact lenses in children but there

three days will drive evidence-based best practice.”

remains a need for greater proactivity around discussing the potential

BCLA chief executive, Luke Stevens-Burt, said: “Bringing together

myopia management options available to young patients.

This year’s BCLA Medal address was given by Professor Eric Papas, entitled ‘How football, luck and good people saved me

MYOPIA MANAGEMENT

from the golf course’. Eric discussed his career path from his

Sessions focusing on patient-reported outcomes included seeing

early days in practice to his key role in developing silicone

the myopia management contact lens journey through the eyes

hydrogel lenses, citing major influences including Ross Maskell,

of 12-year-old patient Maddy Stickley, who shared her experience

Richard Abadi, Graeme Young and Brien Holden.

of wearing contact lenses over the past four years.

Kah Ooi Tan and Jong-Mei Khew gave practitioner perspectives

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Dr Sonia Trave-Huarte delivered the Irving Fatt Memorial

of myopia control in a session that exemplified the global reach

Lecture, which looked at dry eye management and treatment

of the conference, showcasing the latest research based on 90

studies and how they can support evidence-based dry eye practice.

practitioner interviews carried out around Asia, with this

Rabia Mobeen delivered this year’s Da Vinci Award presentation

qualitative study exploring the potential barriers and GlobalCONTACT 2-23

23.06.23 12:32

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INTERNATIONAL NEWS

determinants in offering myopia management in practice, including cost, and stressing the need for a strategic advocacy and professional education plan to advance patient care.

Dr Etty Bitton asked delegates how well they know their ocular lubricants, discussing the pros and cons of the various options available to eye care practitioners and highlighting the impact of Vitamin A on meibomian gland dysfunction.

Frank Schaeffel – head of The IOB Myopia Research Group in Basel – delivered the final day’s keynote presentation on the topic of ‘visual cues for emmetropization and mechanisms of myopia control’. The session considered factors such as choroidal thickness changes and the impact this has on allowing the

BCLA Medal address Professor Eric Papas

retina to inhibit eye growth in positive defocus. in the contact lens industry. Former BCLA president Andy

BITE-SIZED CHUNKS OF LEARNING

Yorke was also named an honorary life member while

As a new initiative for 2023, the BCLA offered attendees

Fakhruddin Barodawala and Mhamed Ouzzani were named

micro-credential certificates in four topics; Advanced Contact

the winners of the BCLA poster competition and the Diane

Lenses, Dry Eye, Myopia Control and Ocular Health.

Gould photography competition respectively.

These bite-sized chunks of learning are designed to help eye care practitioners to develop knowledge and skills in a specific

33 NEW FELLOWS OF THE BCLA

area and identify that an individual has focused their learning

A total of 33 new Fellows were formally welcomed at the event,

on a particular specialism.

bringing the total number of FBCLAs, globally, to more than

The conference, held from 9-11 June, also saw the inaugural

250. The BCLA Fellowship program continues to go from

‘BCLA Celebrates’ – a new social event held at the Imperial

strength-to-strength and 25 long-standing Fellows were honoured

War Museum North. Sharon Flora was named the winner of

for 15 years continuous commitment during the conference.

the Dry Eye Practitioner of the Year Award, sponsored by

The BCLA AGM, held on the second day of the conference,

Scope, while Kathryn Webber received the Myopia Management

saw outgoing president Neil Retallic hand over the reigns to

Practitioner of the Year Award, sponsored by CooperVision.

Rakesh Kapoor, who will lead the association for the next 12

Martin Rubenstein was Hospital Optometry Practitioner of

months – a period that will see the return of BCLA Asia, to be

the Year while the BCLA Industry Award was given to

held in Chengdu province in China next Spring. n

CooperVision’s Project Sunf lower team in recognition of their work to combat the reliance upon single use plastics

Source: BCLA, for more information, visit www.bcla.org.uk

Advertisement

!AZ.indd 4 22_BCLA.indd 23

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MANUFACTURING

Photos: Silke Sage

Blocking Tooling and Process

In the last issue of GlobalCONTACT Magazine 2023_01, I

Part 2

I had the privilege of receiving contributions to these articles

As many of you know, I have been involved in the development

Eyecare. As I mentioned in the previous article, they are tasked

of lens manufacturing processes for quite some time. There is

with coordinating the manufacturing processes within the

always room for improvement and process is no exception. One

family of companies across CooperVision.

tenant of any process is to reduce variation whether that is in

I first met Nir when he hired in at Soflex in Israel. He has a

the product(s) or the steps in the process. By Erik Larsen

degree in engineering (which I can identify with) and I have

discussed the tooling (blocking arbors) and processes involved in manufacturing Rx (specialty) contact lenses. The challenge is how to make a highly variable product as if it was a large batch of identical parts. Of course, by definition, Rx lenses are the epitome of variation in both physical parameters and chemistry.

by Mr. Pat Murphy and Mr. Nir Karpik of CooperVision Specialty

been happy to work with him in the evolution of the manufacturing process at Soflex. After the acquisition of Soflex

by CooperVision, Nir was tapped to his present position.

So Nir, tell me a little about your engineering and manufacturing background.

Since I remember myself, I was always curious to understand how technology works. It was natural for me to attend mechanical engineering school, as a student I started to work for an aerospace and defense company in Israel. When I graduated, I took a full-time position as an engineer and spent a few years in opto24

24_Erik Larsen.indd 24

GlobalCONTACT 2-23

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MANUFACTURING

mechanical design and thermal\dynamics analysis. Later in my career I moved to a medical device company that specialized in aesthetic surgical equipment. That was the first time I was exposed to the medical device industry – and I loved it. That led me to do a master’s degree in biomedical engineering. My first interaction with the Ophthalmic Industry was in 2009 when I joined Soflex as R&D manager, I was responsible for the process engineering and lens design. To learn the process, I spent weeks manufacturing and inspecting lenses learning the fine details of the process and understanding the challenges and limitations.

Soflex was an R&D hub for the local startup companies in the ophthalmic arena, we worked on IOL prototypes, smart lenses, cornea implants and other precision optics products.

At 2016 Soflex was acquired by CooperVision and I was promoted to manage the manufacturing operations for the Israeli site.

Since 2016 CooperVision acquired 6 additional specialty labs and today I’m managing the global manufacturing of the seven Specialty Eye Care facilities.

Your education provided a good foundation, but I know you have

Nir, what to you foresee in the industry as far as process and

learned a lot with your immersion in the industry. Have you formulated

machinery?

a plan of action relative to the various sister companies’ processes?

As I mentioned before, the technology behind the machinery

Getting into the labs has been an eye-opener, I’m still in the

is similar, but the processes are different. I believe that as we

stage of analyzing the processes of the latest acquisitions. It is

keep seeing challenges in recruitment in different parts of the

interesting that they all use similar machinery to solve similar

world and the constant need to become more efficient, more

problems in different ways. I expect that the analyses will show

automation will be applied to the process which will require

that some processes are more efficient than others. Based on

equipment that can support the interface with the different

this data, we can move forward to standardization.

controllers. There are discussions of 3D printing lenses, but I haven’t seen a contact lens that was 3D printed yet.

As was covered in the first article, it is a good idea to reduce parameter variation and/or make the process “immune” to variation. One aspect

A closing remark: Thank you to Pat and Nir for their comments

is to standardize blocking tooling; what are your thoughts on this?

and insights. From their technical education and experience

Transfer blocking is a good place to start. Eliminating the stress

in large manufacturing industries, it is evident they take an

done by the collet is important for process stability. You should

analy tical approach to manufacturing processes and

also consider keeping the arbors short (25 mm). Hollow lens

development. Lenses per person per shift is part of the analysis.

blank arbors allow the center thickness (CT) to be measured

Worker skill and decision-making requirements are a subset.

directly. The blank stays on the arbor until deblocking for the

If a new machine and/or process needs the worker to make

front lathing. We understand the limitation of “one size fits all”

lens specific decisions, that can reduce productivity and lead

as relates to tooling, we are looking at different arbor’s geometries

to errors. If a new machine and/or process improves productivity,

to better match the base curve (BC).

it is a good choice moving forward.

Looking ahead, while it has not been openly promoted, we at Larsen

There are two camps relating to monitoring of base curve center

have been privileged to work with leading labs providing the

thickness: Direct CT measurement on the BC or measuring the lens

machinery that is robot-ready for automated manufacturing. n

blank and having the lathe keep track of the cut depths. Would you say there is an inherent advantage to one over the other or is it just by lathe brand.

I have seen both processes, the product mix will guide us to a different solution. Labs that produce high, mix and low volume will find value (reducing variations) in measuring the CT after the BC lathing, labs that produce low, mix and high

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.

volume can see efficiencies in using constant blank thickness in the process.

GlobalCONTACT 2-23

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HISTORY

The Hard Facts The 75th anniversary of the rigid corneal lens The rigid corneal lens as we know it today celebrates its 75th anniversary this year - a fact that cannot go unmarked within our specialty lens arena. Hence, in this GlobalCONTACT is a special report on the birth of the hard lens, with many interesting facts but also the unmasking of a few ‘myths’ surrounding the history of contact lenses. These are the ‘hard facts’ regarding hard lenses. By Eef van der Worp, Craig Norman, Patrick Caroline

TUOHY – FACTS AND MYTHS The reason for celebrating the 75th anniversary, is the first article ever describing a corneal lens – the 'Tuohy lens' – which was published in 1948. This article starts there with that fact.

Following experiments conducted in 1947, on 28 February 1948, an application for a patent was filed on behalf of Kevin M. Tuohy for a plastic contact lens without a scleral zone, and this patent was granted on 6 June 1950. A fantastic recent peer-reviewed article in Contact Lens & Anterior Eye by London (UK)-based optometrist and historian Richard Pearson describes this story in detail.

Tuohy was born on 11 July 1921 in New Jersey (US). He was the youngest of the six children of Joseph Michael Tuohy and Deborah Abigail Tuohy, both of whom were born in Ireland.

In 1944, Tuohy married Mildred Marta Schilling, with whom he had two sons. Marta unfortunately died in 1959 at the age of 39, and in 1961 Tuohy married Anita Behrens, with whom he had one son. Tragically, on 28 October 1968, Tuohy took his own life. His grave is situated in the Holy Cross Cemetery in Culver City, Los Angeles (US).

Pearson, in his publication, was able to neutralize three known ‘facts’ about the invention of the rigid corneal lens by Tuohy.

26

26_Eef_Pat+Craig.indd 26

Original drawing by Da Vinci on the perceived concept of ‘contact lenses’, which seems to not illustrate the neutralization of refractive power but rather describes a theory as to how images are formed from the cornea to the optic nerve.

GlobalCONTACT 2-23

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HISTORY

First, it had been suggested that the invention of the Tuohy corneal lens resulted from a manufacturing error; while making a scleral lens, the haptic zone would have ‘fallen off,’ and this would have encouraged Tuohy to create a corneal lens. While this is a good story, Pearson was able to reason that this was very unlikely. Furthermore, there is the erroneous assertion by some authors that the Tuohy lens had a monocurve backsurface design; the original publication on the Tuohy lens described it clearly as a bi-curve design and that ‘an area of

“ON THE ORIGIN OF LENSES” – MYTHS AND FACTS ABOUT THE HISTORY & DEVELOPMENT OF THE FIRST CORNEAL RIGID LENS-

Johann Volle – patent for a glass corneal lens, application filed November 12, 1900

approximately 1mm at the periphery of the lens on its posterior

THE DA VINCI CODE DECODED & DESCARTES

surface is of a flatter radius of curvature than the curvature

Pretty much every story on the origin of contact lenses

based on the curvature of the cornea – with the back peripheral

starts with a reference to Leonardo da Vinci. While it is

radius: 0.50mm flatter than the back optic zone radius’. Due

very tempting to have one of the greatest minds of all time

to the large size of the back-optic-zone diameter, the back-

on the timeline of an invention such as this, painstaking

optic-zone radius was fitted 0.30mm flatter than the flattest

review of the text and drawings of the original da Vinci

meridian of the cornea, in which the resultant power of the

manuscripts by French ophthalmologist Robert Heitz in

liquid lens was –1.50D. Finally, it has been suggested, without

2003 indicate that this is most likely not true. Patrick

any supporting evidence, that ‘guilt may have played a part in

Caroline and Craig Norman report on this in the February

Tuohy’s suicide as Xavier Villagran always maintained that he

2020 issue of Contact Lens Spectrum; in this article, they

was the one concerned with using the corneal section of a

quote Heitz stating that the famous images by da Vinci on

scleral lens’. Although Villagran, Tuohy’s business partner,

the concept of ‘contact lenses’ were not illustrating the

wrote in 1979 that ‘personal distrust and greed disturbed our

neutralization of refractive power but rather described a

relations, finally breaking them,’ he never claimed that he was

theory as to how images are formed from the cornea to the

the inventor of the corneal lens rather than Tuohy.

optic nerve. Therefore, there is no proof that da Vinci ever

It is known that the first wearers of the Tuohy lens were Kevin

conceived the concept of correcting eyesight with a lens

Tuohy himself, his first wife Marta, Xavier Villagran and a

placed directly onto the eye’s anterior segment. Based on

post-keratoplasty patient who ‘discarded his scleral lenses on

this, it seems like we may have been giving da Vinci too

the first occasion of receiving his corneal lenses’. His wife

much credit in the history chapters of contact lens textbooks

Marta was a 7D myope, Kevin Tuohy was a 4D myope and

and lectures to our students.

both had worn scleral lenses. By late 1947, about 12 people in

‘Next up’ in the timeline of publications may be the French

the US had been fitted with Tuohy lenses. This number rose

philosopher and scientist René Descartes. About 120 years

to 1300 in 1949 and to 75,000 by 1953. Following the

after da Vinci, Descartes described a f luid-filled glass tube

introduction of the Tuohy lens, sales of contact lenses in the

that could be placed directly on the eye. At the end of the

US increased dramatically from 50,000 pairs in 1946 to 200,000

tube would be a glass lens. With this publication in 1637,

pairs in 1949. While there were six major contact lens

Descartes described in essence the concept of a ‘contact lens’

laboratories in the US in 1950, by 1966 this number had

in ‘Discours de la methode, dioptrique’. He wrote this thesis

increased to approximately 300 of various sizes. It was

while in Amsterdam (he lived in the Netherlands from 1628

undoubtedly the success of the Tuohy lens that was responsible

to 1649). This piece is part of a larger publication that also

for this. Tuohy should absolutely be remembered as ‘The father

contains the famous quote: “Je pense, donc je suis" (I think,

of the corneal contact lens.’

therefore I am).

GlobalCONTACT 2-23

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HISTORY

Petrus Thier and Joseph Dallas ‘grinding’ glass scleral lenses in Budapest (HU) in 1935

Dutch Journal of Medicine - 83 III 33 – 19 augustus 1939 on ‘contactglazen’ made of plastic materials.

GLASS CORNEAL LENSES – KALT & VOLLE

pretty much as we know it today, although the materials have

While the concept of a contact lens was also described in the

evolved into lenses with ultra-high oxygen permeable properties,

early 1800s by Thomas Young and John Herschel, there is no

of course. But is Tuohy indeed the sole father of the corneal lens

proof whatsoever of practical applications of this. The first glass

as described above? There is another surprise to this story. While

scleral shells to correct keratoconus seem to have been

Tuohy’s patent was the first to be granted, prior to Touhy a

introduced in the 1886 to 1888 period by Adolf Eugen Fick and

gentleman by the name of Dennis England came into the picture.

Eugène Kalt, while brothers Friedrich and Albert Müller

Remember his (full) name, as it becomes relevant later in this

produced a non-powered glass shell to protect an eye around

story. But it starts with the fact that in 1945 – three years before

that same time. And additionally, August Müller worked to

Tuohy – England applied for a patent for a plastic rigid corneal

correct his own high myopia with a scleral device.

lens. England graduated from The Ohio State University School

Let’s fast-forward for the sake of the scope of this article from

of Applied Optics in 1940 and established an optometric practice

scleral devices to corneal lenses: who first came up with that

in Zanesville, Ohio (US). He there began to work on forming

idea? One of the first known stories regarding glass corneal

a corneal contact lens by cutting out the center of molded PMMA

lenses is believed to have come from Eugène Kalt, who in 1888

scleral lenses and rounding the edges. The tools that he used to

was a young ophthalmologist and Chief Clinical Assistant at

produce these lenses consisted of two extremely sharp metal

the Department of Ophthalmology at the Hôtel-Dieu Hospital

pins set a specific distance apart (7.8mm and 11.5mm) that were

in Paris. The historical record shows that from 1888 to 1893,

turned in the center of a scleral lens until a smaller “corneal”

Kalt experimented with 16.0mm to 22.0mm blown-glass shells;

lens was formed. These lenses (the center-less scleral and small

but, he also experimented with ground-glass lenses that had

corneal) and the patent application are on exhibit at the Contact

overall diameters of 11.0mm, 11.5mm, and 13.0mm—hence,

Lens Museum located in Forest Grove, Oregon (US).

corneal lenses.

However, the patent was denied several times. England fought

However, here also Caroline and Norman reported a new fact

these rejections at the patent office, without success: a frustrating

(Contact Lens Spectrum, August 2022): On Nov. 12, 1900,

and costly exercise. He went on to form the DMV Corporation

Johann Frederic Volle applied for the first US patent in the field

in 1968—the same company still in operation under the guidance

of contact lenses. Please note: these were glass corneal lenses.

of his son, Robert C. England—primarily providing accessories

It was just 12 years after the first contact lenses were introduced

for the application and removal of scleral lenses, the same

in Europe, and the question is how did a tinsmith from Scranton,

device that Dennis England hoped to replace with his invention

Mississippi (US), who had no optical or medical background,

more than 70 years ago. The ‘D’ in DMV stands for Dennis,

come to invent and patent the first contact lens in history? That

and the family did not come out completely unsuccessful.

remains a mystery, but there is a document with this exact patent granted to him on March 3, 1903.

PMMA, PILOTS & OOGLIJDERSGASTHUIS The final part of this story is the ‘invention’ of using PMMA

28

26_Eef_Pat+Craig.indd 28

THE DENNIS ENGLAND STORY

for contact lenses. This begins in Germany in 1928, when

The evolution of the contact lens follows the path from blown-

Otto Rohm patented PMMA as a paint binder. The plastic

glass scleral lenses to polymethylmethacrylate (PMMA) plastic

became extremely popular due to its clear optical properties

scleral lenses to corneal lenses made from plastic – the latter

To be continued on Page 30 >> GlobalCONTACT 2-23

23.06.23 12:44

PR-Advert

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!

Janine Bungo, Vice President

QUALITY MANAGER: RANDY MINGOY

PRESIDENT: KEITH PARKER

I have known Erik Larsen since 1992. Since then I have used

I have had the pleasure of working with Erik since the beginning

just about every piece of equipment his company has built. My

of Larsen Equipment. The first piece of equipment, a 6 spindle

experience with Erik and the Larsen team has been one of great

horizontal arm polisher revolutionized our production of GP

appreciation as they have always helped me in my needs of

contact lenses. Through the years, I watched his business grow

fully understanding equipment used to manufacture quality

as he and his team listened to our Industry needs and developed

contact lenses. Erik has also been able to engineer any part

now numerous products not only simplifying many tasks of

needed for me even it was a custom part.

manufacturing but improving the consistency of quality in

Erik (Larsen Equipment) has been and still is a pioneer in the

our finished products. Innovation has been an ongoing

contact lens and optical industry, and I am thankful to him

experience of our Company only made possible through the

for his support over the years.

innovation of necessary equipment developed and made Randy Mingoy

available by the Larsen team.

Quality Manager

Larsen Equipment is a family owned business hosting a team

Advanced Vision Technologies

of willing Staff all having the attitude of serving their

DIRECTOR OF OPERATIONS: JORDAN GOBEL

Customer’s needs. As a Customer, we are made to feel like we have a friend in the business helping us develop a more

There can be a lot of moving parts when it comes to managing

efficient process allowing our Company to deliver better

operations, so it is key to have reliable precision equipment

products for our Customers.

that assists in overall efficiency. Larsen Equipment delivers just

Our success of AVT simply could not have been possible without

that! I have been utilizing Larsen manufacturing equipment

the help, assistance and dedication of Larsen Equipment. I

for over 15+ years and have yet to run into an issue they could

will be forever grateful for my opportunity to work with Erik

not resolve. I am a satisfied owner of bladder polishers, edge

and his very capable Staff.

roller’s and auto-blockers etc. Each one of these units greatly

Keith Parker

assists in the reduction of rejects and manufacturing waste.

President

Their ability to customize and retrofit specific tools certainly sets them apart from the competition. Larsen stands behind their equipment with a knowledgeable staff that provides exceptional service. Simply put, we are a better laboratory because of our relationship with the folks at Larsen.

Jordan Gobel Director of Operations/Consultant Advanced Vision Technologies GlobalCONTACT 2-23

PR_Larsen.indd 29

969 S. Kipling Parkway, Lakewood, CO 80226 Phone: 303-384-1111 888-393-5374 Fax: 303-384-1124 www.AVTLENS.com 29

20.06.23 11:10

HISTORY

and its light weight. One of the first uses for the new plastic was to make aircraft canopies as World War II loomed on the horizon; however, it is a myth that the prime reason why plastics were used for contact lenses was because ‘splinters’ from these canopies after being scattered by bombs would not cause any inf lammation. The story may be true for intraocular lenses, though. But, there is evidence that by the late 1930s, people experimented with PMMA material as an

Sources - Caroline, Norman. Contact Lens Spectrum History of Contact Lenses Series: February 2020/April 2020/June 2020/August 2020/April 2022 - Efron. Contact Lens Practice, Third Edition Nathan Efron (editor) Elsevier - Phillips, Speedwell. Contact Lenses, 6th Edition. Anthony J. Phillips & Lynne Speedwell (editors) Elsevier - Bowden. Contact Lenses. The Story. Bower House Publications. 2009 - https://en.wikipedia.org/wiki/Dioptrique - Pearson. The 75th anniversary of the Tuohy corneal contact lens: A review. Contact Lens and Anterior Eye Febr 2023

alternative for glass scleral lenses.

At that time, a number of “all-plastic” PMMA scleral contact lenses were introduced, although the historical record is a bit cloudy, according to Caroline and Norman, as to whom can be credited with manufacturing the first PMMA contact lens.

At various times, István Györffy in Hungary, Theodore Obrig or Ernest Mullen in the United States and Harry Birchall at the United Kingdom’s Dixey Laboratories have been credited with being first. Györffy was a Hungarian ophthalmologist who took over the Contact Lens Department at the Ophthalmic Hospital and Clinic in Budapest following the departure of Joseph Dallos to London in 1937. He came across the Plexiglas

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.

plastic in the spring of 1938 and succeeded in manufacturing and fitting PMMA scleral contact lenses that same year.

Around that same time, Petrus Thier in the Netherlands, together with Professor Weve, described how they used plastic for scleral lenses, with the main benefit that it has ‘half het gewicht van glas’ – half the weight of glass. A publication found by Pearson in the Dutch Journal of Medicine (1939) explains how beneficial this is and that the PMMA may ‘form to the shape of the ocular surface by use of eye temperature’ (something of which glass obviously is not capable). They also stated that they had been working with this material for ‘about three years now’; hence, its origin would go back to 1936, basically. According to Pearson, this may be the first report on the use of plastic (‘harsproducten’, as they call it, but they do refer directly to ‘perspex’ as the name of the material) on human eyes in a scientific journal.

CLOSING REMARKS In summary, there is no ‘one’ birth of contact lenses or even corneal lenses. The history of contact lenses took a long and winding road from the general description of the concept to blown-glass devices for the correction of irregularities to actual prescription-based scleral lenses: first glass and then plastic, morphing to smaller-diameter (corneal) lenses. The ‘invention’ of plastic scleral lenses was pivotal in the development of contact lenses: it took only a couple of years after the first use of the lighter plastic material to develop plastic corneal lenses. Despite all this, and although it may be arbitrary to some degree, now seems a really good time to celebrate the ‘birth’ of corneal lenses as we know them, which have had such a significant impact on so many lives, both in our profession and in our industry. n 30

26_Eef_Pat+Craig.indd 30

Patrick Caroline serves as an associate professor at Pacific University College of Optometry and assistant professor of ophthalmology at the Oregon Health & Sciences University in Portland. He team-teaches the contact lens curriculum. He is a fellow member and Diplomat of the Cornea and Contact Lens Section of the American Academy of Optometry.

And a council member of the International Society for Contact Lens Research, as well as a member of the International Association of Contact Lens Educators and the American Association of Optometric Educators. For the past 15 years, he has served as a contributing editor for the Contact Lens Spectrum and is on the editorial board for Contact Lens and Anterior Eye Journal. He is a internationally recognized lecturer and researcher on contact lenses.

Craig W. Norman is a clinician for over 40 ye ar s , he has be en invol ve d in t he development and evaluation of numerous products and technologies in the soft, GP and scleral lens category. Recently, he was the founding Director of Research at the Michigan College of Optometry, Ferris State University where he remains as adjunct faculty. From its inception in 2002 through 2018 he was Education Committee Chairman of the Global Specialty Lens Symposium and a Consulting Editor to the Contact Lens Spectrum authoring a column on Prescribing for Presbyopia for 15 years. He is a Member of the Advisory Panel of the GP Lens Institute, Advisory Board Member of the International Keratoconus Academy and has been an Advisory Panel Member to numerous SCL and GP lens companies. He has published over 160 articles, posters, videos and book chapters on GP and Soft Lens Design, Presbyopic Contact Lenses, Specialty Contact Lens Uses and Eye Care Practice Management and lectured internationally on a variety of contact lens and eyecare related topics. Mr. Norman is presently the Co-curator of the Contact Lens Museum, President of Professional Optical Resources, Inc., a contact lens industry consultancy group, and CTO (Chief Thinking Officer) of Wink Productions, Inc., an eyecare training and professional development company.

GlobalCONTACT 2-23

23.06.23 12:44

PR-Advert

Blocking Without Compromise When planning a new manufacturing facility or optimizing an existing operation, it’s easy to focus on the lathe and neglect the role played by support processes such as material handling.

While the lathe is arguably the single most important piece of equipment in a contact lens or IOL manufacturing laboratory, its precision can be easily undermined by underperforming equipment elsewhere in the process, most notably blocking.

Today’s CNC lathes and lens design software combine to offer unprecedented options for meeting the needs of patients through precise control of lens geometry and sub-micron level surface accuracy, yet this can be easily undone by misaligned surfaces or unintended prism.

“If back and front [surfaces] are not perfectly aligned, you can get decentered optics, prism and poorly formed edges.”, says Manoel Carvalho, Director of Lab Operations and fitting consultant for BostonSight in Needham, Massachusetts. “All lenses need to have perfect optics. However, when dealing with multifocal or HOA correction, that becomes even more critical.”

DAC International has addressed these concerns by re-imaging the blocker from the ground up. The DAC Precision Blocker is a ‘no-compromise’ solution for RGP, Soft and IOL blocking

Pedro Araujo of BostonSight working with the DAC Precision Blocker

that was developed to maximize the full potential of the DAC lathe’s edge contouring capability and form accuracy. Back or

wax dosing, interchangeable waxpots and a fully programmable

front surfaces are blocked with a high degree of accuracy and

interface ensure that the DAC Precision Blocker has the flexibility

repeatability, and a minimum of time and operator attention.

to cover the full gamut of RGP, soft and IOL lenses currently in production.

The DAC Precision Blocker offers fast, reliable calibration, easy and intuitive initial setup, and stable, accurate and repeatable

Drop size is fully adjustable from zero to 2.5ml, and multiple

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that the DAC blocker holds calibration reliably over time,

different applications. Additionally, an on-board timer for wax

without the need to re-calibrate during the workday.

pot warm-up lets lab managers start their morning without any waiting time; different start times may be set for each workday.

A blocker that holds calibration yields better lenses, but it also saves time and money. Greg Wicker, Maintenance Manager

Finally, the DAC Precision Blocker is fully programable, with

for X-Cel Specialty Contacts in Duluth, Georgia, has worked

an LCD touch screen providing an intuitive interface that

out the numbers: “Based on the average maintenance tech

allows the user to optimize blocking variables to suit individual

spending about 15 minutes setting a traditional blocker twice

process needs. Key parameters such as drop count, temperature,

a day, [that’s] 30 minutes a day times 255 working days per year

and air-cooling controls can be accessed, configured and saved

- 7,650 minutes total, or 127.5 hours per year”. Greg continues

to any of six independently configurable blocking tables.

“Although more expensive than traditional blockers, I feel that it pays for itself with the reduction of prism related rejects and

Treating blocking like the mission critical process that it is

downtime for setting blockers.”

means looking seriously at the needs of a rapidly evolving industry and providing a robust and flexible solution that

While accuracy and reliability are important, an ideal blocker

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also needs the versatility to handle the wide range of specialty

DAC International, this is the meaning of blocking without

products manufactured by a modern laboratory. Safe, consistent

compromise. n

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20.06.23 11:07

FITTING BACKGROUND

Optometrist Jack Brown digging the foundations for the Scotlens Lab in 1979. Son Scott in the background.

20 years of Nocturnal at Scotlens Scotlens, a UK pioneer of the ortho-K night lens, has launched a campaign to celebrate 20 years of their Nocturnal night lens. However, the Scotlens night lens story stretches beyond 20 years, way back to the birth of Ortho-k. Retired optometrist Jack Brown, the founder of Scotlens, tells us how it all began. By Tom Griffiths

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As an optometrist in the early 1970’s Jack Brown couldn’t get

“I’m certainly proud to be one of the first Ortho-K pioneers

quality contact lenses anywhere in Britain, so he decided to

in the UK, and to have been the first company in Europe to

try and make his own. “I just gave it a go. We learned the hard

get a CE for GP lenses. It was great when my son Scott, also

way, using a granny flat at my house as our lab and buying

an optometrist, took an interest in lens design and joined the

various equipment which was rubbish! We finally launched

business in 2003 with fresh knowledge and a different approach.

Scotlens in 1976 after taking a couple of years to get up to the

The original concept back in the 1970’s was to take night

right standards”, he says.

lenses to the world. It’s great to see Scott now doing that with

Although George Jessen developed the Ortho-K concept in

nightlenses.com, and night lenses starting to become

the 1960’s, He first heard about Ortho-K at a BCLA lecture

mainstream. Sad that it has taken nearly 50 years! From day

in 1975/76. He was fitting contact lenses in Edinburgh, so he

one, we just did what we wanted to do – make quality lenses

thought he would try it with a couple of patients. The theory

– which Scott and the team at Scotlens still do to this day”,

seemed good, but the materials were wrong, mainly that they

he adds.

didn’t allow the cornea to get oxygen. So, he gave up.

Jack’s son, Scott Brown, bought the company out in 2014 and

When gas perm lenses arrived in the 1980’s he tried again

remains at the helm today. Reflecting on the company journey

and succeeded. In the late 1980’s he developed a computer

and the exciting future with night lenses, Scott says:

programme, to design lenses and it all started to take off. In

“When I left school, I became a scuba dive instructor. If you

2003 he decided to offer his Ortho-K lens to other people, so

told me I would follow in my dad’s footsteps as both an

he came up with the name Nocturnal.

optometrist and a lens designer, I wouldn’t have believed

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▪E c

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FITTING BACKGROUND

you! But it has been a great journey. It has been a tough journey at times, as soft lenses became the common choice for wearers and GPs the specialist option.

But throughout all we have stuck to dad’s original plan, to make the UK’s best quality lenses without compromise. We may be small, but we punch above our weight with the designs we offer, the quality of the lenses and our service. That reputation has kept us in business.

20 years of Nocturnal is special to me. It’s a product and brand that I’m particularly proud of and it’s fantastic to see it finally coming into its own in 2023. As many know, we’ve been at the centre of the disruption of changing the term ‘Ortho-K’ to ‘Night lenses’, a simple marketing idea that will single-handedly make night lenses a mainstream eyecare option next to glasses, day lenses and laser eye surgery. Something that would never have happened using the term ‘Ortho-k’. Within 2 years the public will know ‘Night lenses’ like they know ‘laser eye surgery’.

Father and son: Scott and Jack Brown.

Everything is set to explode, the starting point of the next chapter for us, the next 20 years!” n Scott Brown is Optometrist, Clinical Director & Lens Designer at Scotlens scott@scotlens.com, +44 7855 953 497

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FITTING BACKGROUND

The other side of myopia A wicked health problem Fortunately, behaviours that prevent progressive myopia are receiving increasing attention. Limiting individual risk behaviors and promoting behaviors that are protective, such as spending more time outdoors, help prevent or mitigate the development of high myopia. However, it's time to look at myopia from a different angle. Let's call it: The other side of myopia. By Jennifer Meerding

Over the years, we have come to know a lot more about myopia,

and promoting myopia protective behaviour such as

its etiology and what sight threatening conditions high myopia

spending more time outdoors will help prevent the

especially is associated with. Research has shown multiple

development of myopia.

effective treatment programs, visual environmental interventions,

Yet it is time to see myopia from a different perspective. Let’s

and optical and pharmacological treatments, to prevent myopia

call it: The other side of myopia. Myopia goes beyond the

from progressing, aiming at keeping levels of myopia as low as

definition of not being able to see distant images or objects

possible and reducing axial length grow. Besides genetic factors,

clearly, as it is more than “just a refractive error”, therefore

certain lifestyle habits such as screentime exposure and prolonged

stressing the urge to focus more at the health behavioural site

near vision tasks as well as spending less time outdoors have

and societal affect. However, how easy as it may sound to reduce

shown to influence the progression of myopia(1).

screentime and let children spend more time outdoors, it is

Fortunately, myopia preventive behaviours are receiving

quite a challenge and asks for involving as many stakeholders

increasing attention. Restricting individual risk behaviours

as possible to tackle the problem.

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FITTING BACKGROUND

focused and control behaviour, emotions and remember instructions. Children are born with the potential to develop these skills(5–7). Although this is not about myopia yet, it goes beyond. Screen exposure at this age is already harmful and affects later childhood development. It goes beyond myopia and the possible effects it has on axial length grow.

WHY DO CHILDREN ENGAGE IN SEDENTARY BEHAVIOUR SO MUCH? What is it that makes it so difficult to go outside for outdoor activities? Studies in Europe and the United States, show that children spend approximately eight hours per day sedentary(2).

It is important to have regular physical activity as well as low levels of sedentary behaviour, as this has been associated with a decreased risk of physical and mental health problems. Besides, spending eight hours per day sedentary is a lot for a child. This would call for a different strategy to reduce screen time. For example, school-based interventions to reform educational systems rigorously and increase outdoor time/activities, and/ or physical activity. Tracking sedentary behaviour during childhood might predict adverse health relationships during adulthood.

Preschool children have poor self-control, so they tend to always follow their parents’ rules and regulations. Especially parents play a significant role in facilitating and regulating their children’s behaviour. It is not only interesting to look at their view on potential determinants of their children's sedentary behaviour but also take children's determinants for sedentary behaviour into account. Children and parents indicated several

SEDENTARY BEHAVIOUR

matching potential perceived determinants of their sedentary

Today’s children are growing up in a digital world, saturated

behaviour of which sitting "because it is the norm" and sitting

with smart technology that is without a doubt indispensable

"because I can work/play better that way" are the most important

in our current society. Screentime is a form of what we call:

ones. This finding is also in line with the current societal norm

sedentary behaviour. Sedentary behaviour refers to activities

of a sedentary lifestyle(2). When behaviour becomes a habit, in

that do not increase energy expenditure more or less above resting level and includes activities such as sleeping, sitting, lying down, and watching television, and other forms of screen-based entertainment(2,3).

Besides, screen exposure already starts at a very young age. The World Health Organization (WHO) published guidelines regarding physical activity, sedentary behaviour and sleep for children under five years of age(4). It highly recommends to not expose young children to screens. Between age two and four screentime is restrained to a maximum of one hour, as sedentary behaviour is encouraged when it includes reading and storytelling with a caregiver. For children 2-5, limit non-educational screen time to about one hour per weekday and three hours on weekend days. For ages six and older, encourage healthy habits and limit activities that include screens(4). More research has shown that too much screen time during infancy may lead to changes in brain activity as well as problems with executive functioning in elementary school. Executive functioning enables us to stay GlobalCONTACT 2-23

34_Jennifer Meerding.indd 35

46% OF THE PARENTS CONSIDERED MYOPIA BEING A HEALTH RISK TO THEIR CHILDREN, WHILE ANOTHER IDENTICAL NUMBER (46%) REGARDED MYOPIA AS AN OPTICAL INCONVENIENCE. A SMALL NUMBER OF PARENTS EVEN CONSIDERED MYOPIA AS A SIGN OF INTELLIGENCE. 35

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FITTING BACKGROUND

CREATING PARENTAL AWARENESS CAN’T BE UNDERESTIMATED GIVEN THE IMPACT PARENTS HAVE ON CHILDREN’S LIFESTYLE CHOICES AND BEHAVIOUR.

even considered myopia as a sign of intelligence. Furthermore, many parents (76%) recognized the potential of digital technology to impact the eye, particularly as a cause of eyestrain and need for spectacles (8). An interesting difference was found between myopic and non-myopic parents. Myopic parents limited screentime use in their household more than nonmyopic parents. Creating parental awareness can’t be underestimated given the impact parents have on children’s lifestyle choices and behaviour.

The influence of sedentary behaviour is also what we notice during practice. It not only influences the onset and rate of myopia, it also negatively influences childhood development

this case sitting, it is automatically activated by environmental

in terms of socio-cognitive skills and healthy lifestyle habits.

stimulus or cues, instead of consciously deciding to engage in

Furthermore, due to reduced outdoor activity and prolonged

the behaviour. Parents might unknowingly stimulate their

near work it will overall influence body posture and possibly

children to sit(2).

overweight (9–11). These modifiable factors are ready for

Now, since we have insights in not only children but even so

behaviour change as this would call for a different strategy to

how parents perceive sedentary behaviour, it is also important

reduce screentime. For example, school-based interventions

to understand parents.

to change and implementing a very opposite educational system in which outdoor time/activities are increased as well

SO HOW DOES THIS RELATE TO MYOPIA?

as physical activity.

Since parents are role models of their children it is interesting attitudes? An interesting study by Hidding et al. (2017) assessed

HOW CAN EYE CARE PRACTITIONERS PROVIDE BETTER CARE WHILE PRACTICING MYOPIA MANAGEMENT?

the attitude of parents to myopia and its associated risks. 46%

Nearly all young myopes progress especially when taking

of the parents considered myopia being a health risk to their

baseline age, parental history, ethnicity, and sedentary behaviour

children, while another identical number (46%) regarded

into account. The younger you start treating myopes with

myopia as an optical inconvenience. A small number of parents

myopia management, the more effective the treatment will be.

to find out how parents perceive myopia, what are their

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FITTING BACKGROUND

Whether the optical intervention is executed with special spectacle lens design or myopia control contact lenses, both are ways to reduce axial length progression and slowing the rate of myopia.

When talking about compliance, it is important to keep the individual child in mind and together find the best optical intervention. Not every child is suitable for wearing spectacles, as this could also account for wearing contact lenses.

However, at a younger age, glasses are taken off more quickly, thus influencing the effectiveness of the treatment. Furthermore, high levels of autonomy are experienced by children with Ortho-K as well as higher levels of compliance because younger patients receive greater parental oversight regarding proper hygiene and lenses that are put in every night(12,13).

Fortunately, there are several ways to manage myopia. This also includes a shift in wearing schedules. Children may want to wear their spectacles but perceive them as a burden during sports or engaging in physical activities. Therefore, wearing spectacles combined with contact lenses during for example weekdays is a finding we surely come across more often in the future. This would opt for future research to investigate its outcomes on not only compliance levels but also the effectiveness of myopia management. Furthermore, contact lenses should be chosen for childrens’ motivation to wear contact lenses when aiming for success as well as assessing general health and cooperation.

ACCESS TO MYOPIA MANAGEMENT Lastly, myopia management in terms of optical interventions should be affordable for everyone. Although it is affordable by most, not everyone can afford specialty lens-based or contact

References 1. Dhiman R, Rakheja V, Gupta V, Saxena R. Current concepts in the management of childhood myopia. Indian J Ophthalmol. 2022 Aug;70(8):2800–15.

2. Hidding LM, Altenburg TM, van Ekris E, Chinapaw MJM. Why Do Children Engage in Sedentary Behavior? Child- and Parent-Perceived Determinants. Int J Environ Res Public Health [Internet]. 2017 Jun;14(7). Available from: https://pubmed.ncbi.nlm. nih.gov/28640232/ 3. van Stralen MM, de Meij J, Te Velde SJ, van der Wal MF, van Mechelen W, Knol DL, et al. Mediators of the effect of the JUMP-in intervention on physical activity and sedentary behavior in Dutch primary schoolchildren from disadvantaged neighborhoods. Int J Behav Nutr Phys Act. 2012 Nov;9:131.

4. Organization WH. Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age [Internet]. Geneva PP - Geneva: World Health Organization; Available from: https://apps.who.int/iris/handle/10665/311664 5. Duch H, Fisher EM, Ensari I, Harrington A. Screen time use in children under 3 years old: a systematic review of correlates. Int J Behav Nutr Phys Act [Internet].

2013;10(1):102. Available from: https://doi.org/10.1186/1479-5868-10-102 6. Law EC, Han MX, Lai Z, Lim S, Ong ZY, Ng V, et al. Associations Between Infant Screen Use, Electroencephalography Markers, and Cognitive Outcomes. JAMA Pediatr [Internet]. 2023 Mar 1;177(3):311–8. Available from: https://doi.org/10.1001/ jamapediatrics.2022.5674 7. Zhang Z, Adamo KB, Ogden N, Goldfield GS, Okely AD, Kuzik N, et al. Associations between screen time and cognitive development in preschoolers. Paediatr Child Health. 2022 May;27(2):105–10.

8. McCrann S, Flitcroft I, Lalor K, Butler J, Bush A, Loughman J. Parental attitudes to myopia: a key agent of change for myopia control? Ophthalmic Physiol Opt. 2018 May;38(3):298–308.

9. Wolffsohn JS, Calossi A, Cho P, Gifford K, Jones L, Jones D, et al. Global trends in myopia management attitudes and strategies in clinical practice – 2019 Update.

Contact Lens Anterior Eye [Internet]. 2020;43(1):9–17. Available from: https://www. sciencedirect.com/science/article/pii/S1367048419302589 10.Sherwin JC, Reacher MH, Keogh RH, Khawaja AP, Mackey DA, Foster PJ. The association between time spent outdoors and myopia in children and adolescents: a systematic review and meta-analysis. Ophthalmology. 2012 Oct;119(10):2141–51.

11. Wildsoet, C.F., Chia, A., Cho, P., Guggenheim, J.A., Polling, J.R., Read, S., Sankaridurg, P., Saw, S.M., Trier, K., Walline, J.J., Wu, P.C., Wolffsohn JS. IMI- Interventions for Controlling Myopia Onset and Progression Report. Invest Ophthalmol Vis Sci. 2019;60:M106–31.

12. Cho P, Tan Q. Myopia and orthokeratology for myopia control. Vol. 102, Clinical and Experimental Optometry. Blackwell Publishing Ltd; 2019. p. 364–77.

13.Bui TH, Cavanagh HD, Robertson DM. Patient compliance during contact lens wear: Perceptions, awareness, and behavior. Eye Contact Lens. 2010;36(6):334–9.

lens-based interventions to manage myopia control. In most European countries pharmacological interventions are mostly partly covered by health insurances. When looking at the scope of practice across Europe we find only a handful of countries in which the social system pays for eye exams in children when the optometrist is doing the examination. Any treatment option that is not covered by health insurances leaves parents with increasing expenses. There are many stakeholders involved in this growing global health problem.

Myopia goes beyond just being a refractive error and implies other strategies. It involves not only children, teachers, parents/guardians at the micro level, also municipal health services, local authorities, media, the industry itself at the macro level should expand cooperation with other professions to create awareness, therefore making a change. Therefore, if myopia management is regarded as a serious eye condition with irreversible visual impairment in the long term and reimbursements are given by the government, myopia management will become even more accessible to every child suffering from myopia. Myopia control is not a product, but

Jennifer Meerding graduated as an optometrist in 2015 and worked since then in different optometry settings. She has experience in refractive and cataract surgery, fitting many types of contact lenses including specialty contact lenses, and myopia control. She obtained her MSc in Health Education and Promotion from UM (Maastricht University, the Netherlands) in 2019. The program focuses on different topic s of health educ ation such as psychology, communication, epidemiology, sociology, and political science. Given the fact that this program is multidisciplinary it allowed her to develop and take a broader position not only within the field of optometry but in healthcare as whole. Since then, she started combining her work as an optometrist with her role as health promoter. She enjoys providing eyecare, fitting contact lenses and giving lectures on eye health related topics at schools. Furthermore she is passionate about health promotion and myopia prevention especially when it comes to understanding and changing health-related behaviour from the individual and environmental perspective.

the approach to control the myopia epidemic. n GlobalCONTACT 2-23

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FITTING BACKGROUND

Diurnal changes in visual acuity and spherical equivalent after corneal reshaping Since the market introduction of orthokeratology contact lenses, the question of whether orthokeratology holds up in everyday life continues to be debated. Orthokeratology lenses deform the cornea in the epithelial area. The "deformed" epithelial layer, which – overnight – has undergone a reshape, acts like a correction surface during the day. In this way, orthokeratology enables an everyday life in which no additional optical visual aid is necessary. By Alina Kinder

INTRODUCTION

An older study from 2003, in which the diurnal fluctuations

Can orthokeratology wearers whose corneas have undergone

of visual acuity and the cornea were measured, evaluated and

corneal reshaping overnight really go about their daily lives in

recorded, shows to what extent the fluctuations affect vision.

the same way as those with conservative correction methods

Furthermore, the results of this study were compared with the

such as glasses or conventional contact lenses? Many situations

criteria for the prescription of driving licences. The prescription

in everyday life involve complex visual tasks and are sometimes

of the driving licence is strictly regulated and serves in this

extremely demanding. Included is participation in road traffic,

scientific discussion as a proxy for the testing of orthokeratology

which does not allow any loss in refraction or visual acuity.

for suitability for everyday use.

To address this question, it is interesting to look at visual acuity

In Annex 6 (to §§ 12, 48 subsections 4 and 5) of the German

under physiological conditions.

Driving Licence Ordinance, the following criteria for passing

Minimal diurnal changes in the visual acuity of the eye are

the eye test (§ 12 subsection 2) are laid down for categories A,

subject to many factors. Among others, the composition of the

A1, B, BE, M, S, L and T:

tear film, the wettability of the cornea and thus also the renewal

• The eye test is passed if the central daytime visual acuity

of the epithelial layer are among the factors that can have an influence on visual acuity. Within 24 to 48 hours, the two outer layers of the corneal epithelium regenerate and the entire

with or without visual aids is 0.7 in both eyes.

• An eye test certificate shall be issued in accordance with § 12 Para. 3.

epithelial layer of the cornea renews itself within a period of 7 days. Accordingly, minor fluctuations in the cornea can already

If the eye test is not passed, an ophthalmological examination

be observed under physiological conditions. Now the cornea

(§ 12 par. 5) must be carried out. The following minimum

experiences a reshape, which is consciously caused by wearing

requirements must be met here:

orthokeratology contact lenses. This can be counted as an additional factor that can lead to changes or fluctuations in

• Incorrect vision must be corrected.

• In the case of binocularity, the central visual acuity of the

visual acuity during the course of the day. Whether this

better eye must be at least 0.5 and that of the worse eye at

additional change is still bearable or whether the visual system

least 0.2.

is burdened instead of supported seems to be a question that is often discussed in this context.

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• In the case of monocularity, i.e. the visual acuity of the worse eye is less than 0.2, the visual acuity must be at least 0.6.

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FITTING BACKGROUND

In addition to the presumption that visual acuity after

Driving Licence Ordinance, the data of the right and left eyes

orthokeratology does not meet the minimum requirements

were also evaluated separately.

for daytime visual acuity, it was further presumed that visual acuity deteriorates during the day, when no contact lenses are

CENTRAL DAYTIME VISUAL ACUITY

worn, to such an extent that this leads to a hazard in road traffic.

For all 174 eyes, the mean visual acuity in the morning was

The aim of the present study was to determine,

1.04 with a standard deviation of 0.15. The median visual acuity

• whether the central daytime visual acuity after overnight

was 1.0. In the evening, the mean visual acuity was 1.00 with

wearing of orthokeratology contact lenses complies with

a standard deviation of 0.20. The median visual acuity was

the criteria of the Driving Licence Ordinance according to

0.98. For the right eye, the median visual acuity was 0.98.

§ 12 paragraphs 2 and 5.

For the right eye, the mean values for central visual acuity in

• whether and, if so, how central daytime visual acuity changes

the morning and evening are shown in Table 1. In twelve

during the day when orthokeratology contact lenses are

cases, the morning visual acuity was less than 1.0, but in every

not worn.

case a visual acuity of at least 0.7 was achieved. In 75 cases

• whether and, if so, how the spherical equivalent changes during the contact lens-free interval.

MATERIAL AND METHODS There were 87 participants in this study, so that data from a total of 174 eyes were available. The measurements were taken by nine experienced orthokeratology specialists. The age of the test

Time

Mean

Standard deviation

Median

morning

1.04

0.14

1.0

evening

1.00

0.21

1.0

Tab. 1: Medium central daytime visual acuity (right eye).

participants at the time of the respective examinations was 80

standard deviation of nine years. The median age distribution

60

was 33 years. The wearing duration of the orthokeratology contact lenses was determined to within half a month at the

Number

between 16 and 55 years. The mean age was 34 years with a

time of the examination. The minimum wearing time of

40 20 0

<0.7

orthokeratology contact lenses was four months, and the maximum wearing time was 40 months at the time of the study.

The mean wearing time was 17 months with a standard deviation of nine months. The median wearing time was 16.5 months. The

acuity devices were used for this purpose, as they are used for the driving licence vision test. The first visual acuity measurement was taken in the morning one to two hours after removing the orthokeratology contact lenses. The second measurement was taken ten to eleven hours later in the early evening. Visual acuity

Visual acuity (evening)

of the German Driving Licence Ordinance. Standardised visual

1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0

was determined monocularly for both eyes as well as binocularly.

0

0.5

either refraction measuring glasses or a phoropter were used.

The data were statistically evaluated. The deviations of the values

significances between the values measured in the morning and in the evening were determined.

RESULTS The results of 174 eyes were available. In order to meet the requirements of Appendix 6 to §§ 12, 48 Para. 4 and 5 of the GlobalCONTACT 2-23

38_A. Kinder_Ortho K.indd 39

2

80 Number

of the Wilcoxon test. Furthermore, the correlations and their

1.5

Fig. 2: Point cloud distribution of daytime visual acuity from the morning and evening. The blue lines represent the upper limit of 0.7. In one case, the evening visual acuity is at the lower limit of 0.5.

of the central daytime visual acuity measured in the morning and in the evening were examined for their significance by means

1

Visual acuity (morning)

Furthermore, the spherical equivalent (best spherical lens) was determined in the morning and early evening. For this purpose,

1.0 and more

Fig. 1: Distribution of daytime visual acuity of the right eye.

central daytime visual acuity was measured for all participants, as is usual for the driving licence vision test according to § 12

0.9

Visual acuity (OD)

evening

morning

0.8

0.7

60 40 20 0

0 and better

0.7

0.8

0.9

Change in visual acuity (OD)

Fig. 3: Change in visual acuity from morning to evening during the contact lens-free interval.

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(86%), the morning visual acuity was 1.0 or more. In individual cases, visual acuities of 1.6 were also achieved. In the evening, a visual acuity of less than 1.0 was achieved in 23 cases. In one case, the visual acuity was below the critical value of 0.7 with a value of 0.5. In 64 cases (74%), the visual acuity in the evening was 1.0 or higher. Looking at the change in visual acuity of the right eye over a period of ten to eleven hours,

Visual acuity (evening)

FITTING BACKGROUND

1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0

during which no orthokeratology contact lenses were worn,

0

0.5

visual acuity did not change in 63 cases. In eight cases, there was even an improvement in visual acuity. In ten cases, the decrease in visual acuity was less than or equal to 0.2. Only

acuity in the morning and evening were as shown in Table

Number

For the left eye, the mean values of central daytime visual 2. In twelve cases, the visual acuity of the left eye in the

70 60 50 40 30 20 10 0

morning was less than 1.0, but in every case a visual acuity of at least 0.7 was achieved. In 75 cases (86%), the visual acuity in the morning was 1.0 or more. In individual cases, visual acuities of 1.6 were also achieved. In the evening, a visual acuity of less than 1.0 was achieved in 23 cases. In 64 cases (74%), the visual acuity of the left eye was 1.0 or higher in the evening. Looking at the change in visual acuity of the left eye over a period of ten to eleven hours during which no orthokeratology contact lenses were worn, visual acuity did not change in 62 cases. In three cases, there was even an improvement in visual acuity. In 16 cases, the

1.5

2

Fig. 5: Point cloud distribution of daytime acuity from the morning and evening. The blue lines represent the upper limit of 0.7.

in six cases did the visual acuity decrease by a value of more than 0.2. The maximum decrease here was 0.5.

1

Visual acuity (morning)

0 and better

0.1

0.2

>0.2

Change in visual acuity (OS)

Fig. 6: Change in visual acuity from morning to evening during the contact lens-free interval.

Time

Mean

Standard deviation

Median

morning

1.13

0.18

1.1

evening

1.11

0.17

1.1

Tab. 3: Average binocular visual acuity

decrease in visual acuity was less than or equal to 0.2. Only in six cases did the visual acuity decrease by a value of more

SPHERICAL EQUIVALENT

than 0.2. The maximum decrease was 0.4. The binocular

The spherical equivalent of all 174 eyes was +0.13 dpt in the

visual acuity was higher than the monocular visual acuity

morning, which corresponds to a slight hyperopia. A standard

of the left and right eye both in the morning and in the

deviation of 0.28 dpt was determined. The median spherical

evening (see table 3).

equivalent was 0.00 dpt. In the evening, the mean spherical equivalent of all 174 eyes was – 0.8 with a standard deviation of 0.25 dpt. The median was 0.00 dpt. Tables 4 and 5 show the Median

spherical equivalent values for the right and left eyes listed slight overcorrection of myopia of about one eighth of a diopter

Time

Mean

Standard deviation

morning

1.05

0.17

1.0

evening

1.01

0.19

1.0

separately. Both tables show that in the morning there was a in both eyes. The spherical equivalent changed on average by less than a quarter of a diopter from the morning to the evening examination. For the right eye a mean deviation of 0.20 ± 0.24

Tab. 2: Mean central daytime visual acuity (left eye).

Number

dpt and for the left eye a mean deviation of 0.23 ± 0.22 dpt 80 70 60 50 40 30 20 10 0

morning

was found between the morning and evening values. In 39 cases, no changes in spherical equivalent were found in the right eye. In 29 cases, the diurnal change in spherical equivalent was 0.25 dpt. In two cases, there was even a change of -0.25 dpt in the spherical equivalent, which corresponds to a slight 0.7 evening

0.8

0.9

Visual acuity (OS)

1.0 and better

hyperopia of the eye. This means that in 80% of all cases the diurnal change of the spherical equivalent was 0.25 dpt and below. In the left eye, no change was observed in 38 cases and a change of 0.25 dpt in 27 cases. In 75% of all cases, the change

Fig. 4: Distribution of daytime visual acuity of the left eye.

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in spherical equivalent in the left eye was 0.25 dpt and below.

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FITTING BACKGROUND

Mean (dpt)

Standard deviation (dpt)

Median

morning

+0.14

0.30

0.00

evening

-0.06

0.29

0.00

Time

confidence intervals for the values of visual acuity and spherical equivalent from the morning and evening were as shown in Table 6. ρ

Confidence interval 5%

Significance

Confidence interval 1%

Significance

Visual acuity

0.762

0.655 – 0.839

yes

0.612 – 0.859

yes

0.635

0.485 – 0.749

yes

0.428 – 0.776

yes

Tab. 4: Mean spherical equivalent (right eye).

Mean (dpt)

Standard deviation (dpt)

Median

Spherical equivalent

morning

+0.12

0.27

0.00

Tab. 6: Correlation coefficients ρ and confidence intervals for visual acuity and spherical equivalent (right eye).

evening

-0.09

0.23

0.00

Time

For the left eye, the correlation coefficients and confidence

Tab. 5: Mean spherical equivalent (left eye).

intervals for the morning and evening visual acuity and spherical equivalent values were as shown in Table 7. The correlation of

Number

50 40

the binocular visual acuities from the morning and evening

30

was very high with r = 0.818. The mean deviations of the visual

20

acuities and spherical equivalents were small, but the evaluation

10 0

morning

of these data with the Wilcoxon test showed that the deviations -1.00 -0.75 -0.50 -0.25 evening

0.00 0.25

0.50

were all statistically significant (p < 0.001). The z-values for all 174 eyes were as follows.

Spherical equivalent (dpt)

ρ

Confidence interval 5%

Significance

Confidence interval 1%

Significance

Visual acuity

0.806

0.6716 – 0.870

yes

0.680 – 0.886

yes

Spherical equivalent

0.591

0.432 – 0.714

yes

0.372 – 0.748

yes

Fig. 7: Distribution of the spherical equivalent of the right eye.

IN THE MORNING THERE WAS A SLIGHT OVERCORRECTION OF MYOPIA OF ABOUT ONE EIGHTH OF A DIOPTER.

Tab. 7: Correlation coefficients ρ and confidence intervals for visual acuity and spherical equivalent (left eye). ρ

Confidence interval 5%

Significance

Confidence interval 1%

Significance

0.818

0.732 – 0.878

yes

0.696 – 0.894

yes

Tab. 8: Correlation and confidence intervals for binocular visual acuity.

50

Number

40 20 10 0

-0.50

right eye

z

Significance

Visual acuity

11.03

yes

Spherical equivalent

11.42

yes

30

-0.25

left eye

0.00

0.25

0.50

0.75

1.00

Change (dpt)

Tab. 9: Results of the Wilcoxon test (n = 174).

Fig. 8: Change in spherical equivalent from morning to evening during the contact lens-free interval.

STATISTICAL ANALYSIS OF THE MEASUREMENT RESULTS The measurement results of the visual acuities and spherical equivalents were subjected to a statistical analysis. To do this, we calculated the correlations between the respective measured values in the morning and in the evening. In addition, the Wilcoxon test was used to test whether the deviations between the evening and morning measurements were statistically significant. For the right eye the correlation coefficients and GlobalCONTACT 2-23

38_A. Kinder_Ortho K.indd 41

IN 80% OF ALL CASES THE DIURNAL CHANGE OF THE SPHERICAL EQUIVALENT WAS 0.25 DPT AND BELOW. 41

27.06.23 09:58

FITTING BACKGROUND

VISUAL ACUITY RETURNS TO NORMAL WHEN THE CONTACT LENS IS RE-CENTRED ON THE EYE DURING SUBSEQUENT NIGHTS. THE VISUAL ACUITY CHANGES ONLY SLIGHTLY DURING THE DAY.

DIURNAL CHANGES IN VISUAL ACUITY AND SPHERICAL EQUIVALENT The mean spherical equivalent in the morning corresponds to a slight but optically negligible hyperopia (0.14 dpt and 0.12 dpt, respectively) in both the right and left eye. During the day, there is a slight myopia of the eye in the order of about a quarter of a dioptre. The effects of this myopia on vision can be neglected because of the size of the spherical equivalent (-0.06 dpt or -0.09 dpt). The imaging depth of the eye will compensate for both morning hyperopia and evening myopia. The determined changes in visual acuity and spherical equivalent are small but statistically significant. The magnitude of the change in spherical equivalent is within the range of physiologically normal diurnal variations in corneal refractive error. The accuracy of the measurement correlations of the

DISCUSSION: VISION REQUIREMENTS IN ROAD TRAFFIC

spherical equivalents can be rated as high. The fact that the

According to Annex 6 to § 12 of the Driving Licence Ordinance,

slight diurnal decreases in visual acuity and spherical

the vision test obligatory for obtaining a driving licence is

equivalent are statistically significant results inevitably from

deemed to have been passed if a visual acuity of at least 0.7 has

the relatively large number of eyes examined (n = 174) and

been achieved in both eyes. If this is not the case, the driving

the small number (n1 = 11) of negative deviations in visual

licence can be obtained after an ophthalmological examination

acuity, i.e. improvement in visual acuity.

if the visual acuity in the better eye is at least 0.5 and in the worse eye not less than 0.2. It should be noted that a visual

1.1

impairment (grade 1) according to the criteria of the World Health Organisation. A visual acuity of 0.5 can also be caused by a slight degree of amblyopia. Therefore, serious changes in the optical and visual system can or must be present before the driving licence can be refused. In the case of one-eyedness, a visual acuity of at least 0.6 must be achieved.

The International Council of Ophthalmology considers a visual acuity of 0.5 for binocularity to be sufficient with regard to the safety requirements for road traffic (www.icoph.org/standards/

Visual acuity

acuity of 0.2 already corresponds to the conditions of a visual

0.8 0.6 0.4 0.2 0.0

0

1w

1m

3m

6m

9m 12m 15m 18m 21m 24m

Time of measurement

Fig. 9: Development of the best uncorrected daytime visual acuity of 144 eyes over a period of 2 years. (after Berke and Starfinger, 2004; m = month; w = week).

driving5crit.html of 16.8.2005).

European Union directives require a minimum visual acuity

Negative deviations of the spherical equivalent were also

of 0.5 for binocularity and 0.6 for monocularity. These values

observed only in a few cases (n2 = 2). For this reason, the

have been widely adopted by the countries of the European

z-values for the significances of the changes in visual acuity

Union. The discussion as to whether orthokeratology

and spherical equivalent are close to the maximum possible

deteriorates vision to such an extent that safe participation

value of 11.44. Central daytime visual acuity is the visual

in road traffic is no longer possible should be based on a

function with the greatest (legal) significance for road traffic

threshold value of 0.5, the internationally widely accepted

fitness. In no case was a central daytime visual acuity of less

threshold value, and not 0.7. The latter is to be regarded merely

than 0.5 found. Only in one case was a visual acuity of 0.5

as a threshold value of a general screening, the aim of which

found, with the partner eye having a visual acuity of 1.0. In

is to make a rough selection based on a compromise between

this case, too, the test participant meets the requirements

sensitivity and specificity of visual acuity in order to refer an

set by the European Union for the visual acuity of a road

acceptable number of conspicuous findings to further

user. Low visual acuity with successful orthokeratology is

ophthalmological examination. However, due to the low

not a permanent condition. The most likely cause is likely

sensitivity of visual acuity, it cannot be assumed that the eye

to be an orthokeratology contact lens that has been decentered

and the visual system are intact even with a visual acuity of

during the night. Visual acuity returns to normal when the

0.7. Cataracts and diseases of the optic nerve are also

contact lens is re-centred on the eye during subsequent

compatible with a visual acuity of 0.7.

nights. The visual acuity changes only slightly during the

42

38_A. Kinder_Ortho K.indd 42

GlobalCONTACT 2-23

27.06.23 09:58

!AZ.ind

FITTING BACKGROUND

day. It can therefore be assumed that the changes in corneal

of the European Union. The changes are stable during the

geometry caused overnight are stable in the contact lens-free

contact lens-free interval during the day, so that a deterioration

interval during the day. This is also underlined by the

of daytime vision cannot be assumed. n

observation that after six months of orthokeratology, almost every second wearer of orthokeratology contact lenses only has to wear their contact lenses every other night. The results presented here record visual acuity and spherical equivalent at only one point in time. However, studies over a period of

Literature reference:

two years showed that after the stabilisation of corneal

Schulze, A., Berke, A.: Diurnal changes in visual acuity and spherical equivalent

reshaping, which usually takes only a few weeks, the visual

under consideration of the Driving Licence Regulation 03/2005; 2-6.

acuities remained permanently far above the required threshold values of 0.5 and 0.7 over the two-year period (Berke and Starfinger, 2004).

CONCLUSIONS The changes in the eye caused by wearing orthokeratology contact lenses have no negative effects on roadworthiness. The visual acuity of all 174 eyes examined met the requirements of

Alina Kinder (EurOptom, Master of Science (Klin. Optometr y)) is a lecturer at the Professional School for Optometr y in Cologne (HFAK). She also works as an examiner on the examiner board of ECOO diploma and optometrist (ZVA/ HWK).

the German Driving Licence Ordinance, the recommendations

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38_A. Kinder_Ortho K.indd 43 !AZ.indd 5

27.06.23 11.06.19 09:58 10:55

BUSINESS+MARKETING

Ensuring that jobs and skills go hand in hand How role-based descriptions instead of position and tasks can achieve this WANTED! Employees urgently needed! In addition to an increasing shortage of suitably qualified people, there is another, and equally fundamental reason why positions remain unfilled: many jobs are defined too rigidly in terms of the tasks to be performed. And, as ever of course, one is always looking for the “jack of all trades” – with years of experience. The consequence is, that those with the right talents – as this is not only those at the beginning of their career who are often more willing to change – do not apply. So, it is time for the advantages of horizontal, agile ways of working to replace the more hierarchical structures traditionally favored by the personnel department. By Timm Urschinger

44

44_B+M_Recruiting.indd 44

GlobalCONTACT 2-23

23.06.23 13:53

BUSINESS+MARKETING

If we are talking about Human Resources (HR) 2023, we are

key step which HR departments can take in this direction is

also talking about how to develop horizontal structures and

to replace rigid job descriptions by a set of roles which a company

autonomous teams. How to open up lines of communication

is looking to fill.

between team members in different departments and how to break down barriers. How to help employees develop their

POSITION-RELATED WORK AND RECRUITMENT

skills and work out how they can best contribute their talents

When a position is to be filled in an organization around the

and strengths. And how to use all these techniques to drive

world, advertisements contain familiar details such as the

innovation and productivity in an organization forward.

formal title of the job, details of the position, a list of

We should not overlook the fact that in doing so, HR professionals

responsibilities and duties (usually already outdated by the

can – indeed probably have to – improve and revitalize some

time of hiring), and the name of the department to which the

of their key processes, such as performance management,

position reports.

succession planning or recruitment and talent acquisition by

Although this has long been the practice, finding people for

taking a more agile approach.

rigidly defined positions in a hierarchical or vertical structure

This article, however, will focus particularly on the challenge

leads to unnecessary bureaucracy and challenges in many if

of formulating job descriptions in horizontal systems, combined

not most companies – particularly if they are truly committed

with agility and taking responsibility for one’s own work. A

to agility and autonomously operating teams.

GlobalCONTACT 2-23

44_B+M_Recruiting.indd 45

45

23.06.23 13:53

BUSINESS+MARKETING

Often the job description does not accurately reflect what the

which includes the title of the role, e.g. Community Coordinator,

person is expected to contribute to the company. A Social Media

the purpose of the role, and a list of tasks that fall entirely

Community Manager, for example, can do more than

within the scope of that role and team or group.

communicate with people on LinkedIn, Facebook or Twitter.

Based on the example of the Community Manager, the last

He can also help organize events or design promotional

task on the list – helping with company-wide events – could

materials. Perhaps the sales department can turn to him or

be split off into a new role: Event Coordinator.

her for ideas on how to acquire new customers; or the

In this way, the person a company hires to connect with people

communications department may need his or her skills to

on social media can also take on tasks such as organizing a

develop an internal social media platform.

major event – or not, as the case may be – depending on their

If HR were now to expand the scope of the job description to

skill set.

include what the community manager can actually do, the

One key indicator that roles offer more flexibility and innovative

description may become too wide-ranging or vague, so that it

opportunities is that – unlike positions – they do not match

is of little use for performance evaluation or the hiring process.

1:1 with team members; which is also the biggest challenge

It will probably require a review of the function or salary level

when hiring in such a system.

and certainly raise additional questions on the administrative

So what does this look like in practice, if we don't have a clear

side. Worst of all, even if the job description reflects the reality,

1:1 relationship? The employee with the Community Coordinator

it will soon become out of date, as projects come to an end or

role does not have to worry about events; they can focus on

the expertise is needed elsewhere.

social media engagement or something else – training, for

The challenge: A job today and in the future may require tasks

example. What is critical is that more than one team member

and responsibilities that a single person cannot fulfill. Thus,

is capable of taking on the community coordinator role.

the job description will become too idealistic.

Rather than having overlapping roles and responsibilities,

HR managers therefore have to look for people with skills that

leading to boundaries that have to be crossed and weaken

match as many of these areas as possible – without assessing

decision-making and hierarchy, roles can help team members

what a candidate could contribute on an overall basis, or bring

to complement each other and act more decisively.

to the company through one particular strength.

IN A NUTSHELL: WHAT IS “ROLE-BASED WORKING”?

THREE BEST PRACTICES FOR TRANSITIONING TO ROLE-BASED HIRING AND WORKING

Instead of defining job vacancies in terms of rigid positions,

The process of breaking down rigid hierarchical positions into

recruiters and/or HR managers should post a role description

roles takes time and effort. Drastically changing the structure

46

44_B+M_Recruiting.indd 46

GlobalCONTACT 2-23

23.06.23 13:53

BUSINESS+MARKETING

of an organization this way makes it more complex, especially

3. HIRE ON A TRULY ROLE-BASED APPROACH!

when you consider that one person can hold multiple roles; but

Organizations should advertise all vacancies that need to be

multiple people can also hold the same role.

filled. This should not just be on a "once-a-year-for-three-days"

This gets even more complicated when employees take on

basis. If vacancies are posted in Peerdom or Holaspirit (software

new roles or leave them, or when new employees are hired.

platforms that provide clarity and transparency at all levels,

On the other hand, it is worth the effort of focusing on the

to help companies on the path to self-organization), additional

transparency and flexibility that these roles provide within

information should be included such as: how much work on

the company.

average it is expected this position will involve – or even better,

The following three tips will facilitate the transition to role-

how much work it requires today.

based hiring and working:

Candidates can then choose to apply for a specific role, perhaps a part-time position with all the benefits this implies both for

1. IDENTIFY KEY ROLES

the employer and the employee. Or candidates can choose to

One way to incorporate roles into the hiring process, without

apply for a range of roles, a sort of "role package". This package

creating too much confusion and complexity for candidates

could then take up 80-100 % of their time and will likely reflect

unfamiliar with this type of organization and role-based

their interests and hopefully their strengths.

working, is to identify a number of key roles.

The additional complexity is that organizations will have a

These key roles take up the majority of new employees' time

multitude of role packages and combinations to offer, potentially

when they start their new job, and help to familiarize them

making it more difficult to decide on a candidate because it

with the idea of flexible and agile role-based working. The

could mean tradeoffs regarding other positions and their hiring

key roles are similar enough to the positions they might have

processes. The major benefit, however, is that candidates who

expected, that they shouldn't cause applicants too many

truly embrace a role-based approach to work will come forward,

problems, while at the same time affording HR the opportunity

and organizations will genuinely find candidates that others

to explain how role-based working really works.

failed to hire because the job descriptions were too inflexible.

If the key roles take up about 60-80 % of the new employee´s

Thus, companies open themselves up in the labor market to

time, they still have time to take on other roles, as they get

highflyers and people who want to make a career change – with

to k now t he structure of t he company. During t his

all the benefits that entails.

acclimatization phase, HR – or even better the hiring team

Role-based working holds an enormous potential to boost a

– should explain how the roles work, how they may change

company’s agility. While it is important to focus on defining

over time, and how team members can best manage their

these internal roles clearly and getting the organizational

time to fulfill them. It is also a good idea to share the role-

structure right, one should not forget how HR can apply these

based organizational chart with new employees. It is likely

practices to hiring and other functions like remuneration – and

that looking over the non-key tasks may actually stimulate

the challenges associated with these.

interest and motivation. After all, we all want to learn and

Trailblazers already exist that are doing a great job demonstrating

develop further!

how this can work, helping companies solve the challenges of finding the right talent to fill vacant positions. n

2. SEPARATE THE DEFINITION OF ROLES AND REMUNERATION Another way to make an organization's role-based structure work smoothly in the labor market is to simplify remuneration and avoid tying salary to the number or complexity of roles a candidate is assigned.

This would make administration more cumbersome, as organizations not only have many different roles, but also specific roles that particular people hold. One also wants to avoid people taking on roles simply to get into a higher pay grade. To get around this, organizations should define grades and functions for hiring, and set the remuneration accordingly. In practice, a job posting would include this or that pay grade, and applicants' salaries would be determined based on this. Of course, the interview would focus on how well the applicant fits the role they are applying for, not how

Timm Urschinger is co-founder and CEO of LIVEsciences. After his studies and several years working for a well-known pharmaceutical group in Switzerland, and in consulting, he decided to set up his own company. His expertise in managing global programs and transformation inspired in him a passion for developing pragmatic and innovative solutions – both for his own company and for customers.

New organizational models like Teal play an equally important role as self-leadership, so that people once again feel a sense of purpose and enjoyment in their professional lives. www.livesciences.com

close they are to a particular pay grade or range.

GlobalCONTACT 2-23

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