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Clinical Guide for Scleral Lens Success
From books? From publications? From your daily work in your quiet chamber? Well, that too. But at least as important as the disciplined work in the office, in the lab or in the care of patients, is the exchange with colleagues and professionals in the field. These valuable experiences are inspiring and expand your knowledge – and you can use and recycle them for your profession.
At the end of April, the industry met again for the annual EFCLIN conference and exhibition. This time, the experts gathered in The Hague, Netherlands. Attendance was as high as before the pandemic. This is despite the fact that the Corona pandemic has had a significant impact on conference attendance in general. Yes, the events industry worldwide has suffered.
Some of the major trade shows and conferences went into a tailspin as a result and are still struggling. Many events were canceled or postponed, resulting in significant financial losses for event organizers, service providers and suppliers. The event industry had to adapt quickly and find alternative solutions, such as virtual events or hybrid events. But these meetings always lacked the crucial factor: genuine exchange among colleagues on an eye-to-eye level. Although many organizers 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
are key elements for new ideas and good networking for a successful future.
There was such a key moment a year ago when Euromcontact presented the issue around the use of PFAS. This brought it into central focus in the contact lens industry. A whole morning was dedicated to the topic and there was also a very detailed update on it at the last conference. Is a ban on PFASs really looming and how will it affect our industry? In this issue you can read a review of the EFCLIN conference with an interview with EFCLIN President Armin Duddek.
In addition, the question of whether orthokeratology is sustainable in everyday life is currently being discussed once again. Due to the change of the daily visual acuity, especially the suitability for road traffic has been questioned. We already presented a current study on this in the last issue. You can read another article on this subject starting on page 38, which leads to a clear conclusion. ■
SILKE SAGE Editor-In-Chief silke@global-cl.com
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
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
D
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.
Haag-Streit UK (HS-UK) has announced that they have moved the UK headquarters from Harlow to Bishop’s Stortford in Hertfordshire. The new site is just ten miles away from the previous Harlow location, where the company has been for
After a long break since 2019, the 6th EurOK took place in Barcelona at the Gran Hotel Rey Don Jaime from April 28-29. For two days, an intensive educational program was offered, focusing on seminars as well as general scientific lectures related to ortho-K and myopia management. During the two days, examinations for myopia management certification were also held and an
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 and have a more modern look and feel. We look forward to welcoming both customers and colleagues for meetings, as well as inviting delegates to attend training in our new dedicated Academy space.”
Review of Myopia Management (RMM) has been named the official media sponsor of the upcoming 19th International Myopia Conference (IMC)in September 2024 in Hainan Island, China. The event will be hosted by the Aier Institute of Optometry and Vision Science, Aier Eye Hospital Group. Review of Myopia Management
award was bestowed to those who demonstrated their knowledge in this field.
The meeting is held each edition in a different European country. The last edition of EurOK was held in Cluj Napoca, Romania at the end of 2019. The European Academy of Orthokeratology (EurOK) is a non-profit, independent organization and represents the European section of the International Academy of Orthokeratology (IAO).
is a leading online publication designed to help eyecare professionals maximize the emerging field of myopia management. It will work with the IMC to promote the event to eyecare professionals and vision scientists across the U.S. and globally. The groups plan to collaborate on soliciting abstracts for the conference, encouraging attendance, and publishing coverage of the event before, during and after it takes place.
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 1984. The planned investments represent a significant expansion of our global manufacturing footprint and continued positive impact on the island’s economy,” said CooperVision Executive Vice President of Global Operations Rolando Torres, during a press conference where he was joined by Secretary of the Department of Economic Development and Commerce Manuel Cidre Miranda.
In Juana Diaz, the company will convert a 22,000-square-foot warehouse for production use, installing new, high-volume, automated contact lens manufacturing cells. A second initiative will add 120,000 square feet to the current manufacturing floor, accommodating additional new manufacturing cells for substantially increased local production volumes. The third project in Juana Diaz expands CooperVision's main building by 100,000 square feet for warehousing and new packaging lines.
In Ponce, the company is acquiring the former facilities of Roche Diagnostics, converting the location into a 115,000-square-foot hub that expands capacity to manufacture soft contact lenses shipped globally, including MiSight 1 day. Representing approximately $100 million of the total $500 million investment, the 14-acre site—with sustainable design and advanced technologies—is expected to employ 400 people in its initial operating phase.
“We continue to take strategic actions to maintain our global success and improve our competitiveness. The growth in local production volumes, capital investment, and job creation have been constant and forceful drivers for economic development in Puerto Rico. Today’s announcement accelerates this trajectory and deepens our longstanding commitment to the island,” said Torres. “Puerto Rico’s selection for the CooperVision expansion followed considerable study and analysis of multiple options, highlighting the extraordinary talent who lives here.”
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.
Already for the twelfth time, Hecht Contactlinsen GmbH invited to a Forum in the Konzerthaus Freiburg, Germany, from May 6 to 7, 2023. Hecht, with its founding father Dieter Muckenhirn, looks back on many years of experience in the field of contact lenses as well as the organization of further education opportunities for interested parties. The two-day
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 discussed. The participants visibly enjoyed the intensive professional exchange during the numerous breaks in a cordial and relaxed atmosphere. At the evening event, the participants danced and celebrated together. The forum will probably take place every three years in the future. We are already looking forward to the next Forum and have many ideas for it."
Bausch + Lomb has announced the U.S. launch of Bausch + Lomb INFUSE Multifocal silicone hydrogel (SiHy) daily disposable contact lenses. Featuring a material infused with ProBalance Technology and the company’s 3-Zone Progressive design, the new lens is aimed at patients with presbyopia and promises clear vision with seamless transitions across near, intermediate and distance vision while helping to minimize contact lens dryness.
"Presbyopic patients have unique vision needs due to their age and lifestyle. Our Bausch + Lomb INFUSE Multifocal SiHy contact lenses were designed to directly address the common problems that they experience with multifocal contact lenses, such as contact lens dryness, which nearly 70% of multifocal contact lens wearers report experiencing during lens wear," said Yang Yang, senior vice president, Vision Care, Bausch + Lomb. “With the prevalence of presbyopia estimated to be nearly 80% by age 45-55 in North America, and an increasing aging society in the United Statesthat spends more than nine hours a day on digital devices, we are proud to use our latest science and contact lens technologies to provide eye care professionals and their patients with this new innovative multifocal lens option.”
Bausch + Lomb INFUSE Multifocal contact lenses are made with a SiHy daily disposable lens material (kalifilcon A) that combines breathability with a low modulus and high moisture, allowing the lens to maintain 96% of its moisture for 16 hours. The lens material is infused with ProBalance Technology, which includes a combination of ingredients inspired by the Tear Film and Ocular Surface Society’s DEWS II report and is released during lens wear to help maintain ocular surface homeostasis and minimize contact lens dryness.
According to a recent study, 90% of presbyopic patients surveyed agreed Bausch + Lomb INFUSE Multifocal contact lenses allow them to effortlessly move from various tasks throughout the day. In addition, eye care professionals surveyed agreed that Bausch + Lomb INFUSE Multifocal lenses were easy to fit for 99% of patients. "Ocular surface changes that occur with age, as well as lifestyle changes such as increasing digital device usage, can have an impact on presbyopic patients, leading them to experience eye strain and other eye symptoms. As a result, multifocal lens fitting can sometimes prove to be a challenge, particularly with patients who express comfort and vision concerns,” said Mile Brujic, O.D., Premier Vision Group, Bowling Green, OH. "Bausch + Lomb INFUSE Multifocal contact lenses demonstrate consistent focusing power in each zone of vision, help ensure a smooth, wettable surface for patient comfort and are easy to fit."
Johnson & Johnson Vision has presented a range of new clinical data and learning opportunities for developments in contact lenses at the 2023 British Contact Lens Association (BCLA) Clinical Conference and Exhibition from 9 – 11 June in Manchester, UK. A platinum sponsor of the event, Johnson & Johnson Vision had prepared two feature presentations, along with a series of free papers and poster sessions available to Eye Care Professionals in attendance. New data examined the technological features of Acuvue Oasys Max 1-Day and Acuvue Oasys Max 1-Day Multifocal contact lenses, including filtering high-energy visible (HEV) light designed to reduce visual discomfort.
Acuvue Oasys Max 1-Day contact lenses are designed with a combination of two new technologies: TearStable Technology and OptiBlue Light Filter. TearStable Technology is designed to maximise tear-film stability and retain moisture. The OptiBlue Light Filter is the highest-level blue-violet filter, with 60% blue-violet light filtering designed to reduce light scatter.
Johnson & Johnson Vision’s booth hosted a variety of interactive education opportunities and hands-on demonstrations. Visitors were invited to try the Acuvue Virtual Reality vision experience with a demonstration on fitting multifocal contact lenses. The new Virtual Reality vision experience is being shared by Johnson & Johnson Vision with Eye Care Professionals across multiple EMEA countries to help improve contact lens learning and training experiences. The company also hosted multiple educational presentations as part of the 2023 BCLA program, with the opportunity for attendees to hear from leading experts about clinical data and guidance in contact lens innovations. As part of ongoing environmental sustainability efforts, the Johnson & Johnson Vision booth at BCLA was built re-using materials from previous events and was 100% paperless, with all education and marketing materials available electronically. Every time a visitor used the digital screen to download material, the amount of paper saved was added to a running total that was visualized on-site through a virtual “living tree” installation.
Micky became secretary general of the Association of Contact Lens Manufacturers (ACLM) in succession to a very successful and charming former colonial administrator. There was a view that a former major general might place his stamp too firmly on the organization. He didn’t. He skillfully corralled the disparate membership – 30 or so, mainly managing directors of UK-based contact lens manufacturers – and gave them brilliant support and very subtle guidance reflecting his expertise as a staff officer. This was at a time when the European economic community was flexing its muscles and bringing in a directive that would regulate medical devices. Micky recognized that this regulation needed to be drafted so that it did not bring a disproportionate burden on the industry that would be too much, especially for the smaller manufacturers.
That was the beginning of a great initiative largely led by him in which a Europe-wide federation of contact lens manufacturers, Euromcontact, was formed. Micky became its first secretary general and brought in the ACLM equivalents from across Europe. He spent many a long day in Brussels and was very influential in getting a special clause in the Directive for the Contact Lens Industry – that was probably a unique achievement for any device industry. Micky developed some firm friendships in the commission and was widely highly regarded. It was probably at this time that he started to use ‘Michael’ rather than ‘Micky’ largely to avoid the disappointment on the faces of senior French officials when they discovered that Micky was not a petite brunette but a robust British general.
Micky was always an adept political operator. Without appearing to do so, he ensured that Euromcontact had a president who was competent and chosen from a different European country on a rotational basis. Without exception, each president was delighted to have Micky at their right hand. Meetings were usually held in Paris where the lunch was a joy not allowed to eclipse the business. There was always an annual meeting in a smart city. During the Italian presidency, guests arrived at the excellent Venice hotel to find a welcome gift in their room. When unwrapped there was some disappointment to discover each had received a pair of rubber boots – care was taken with French sensibilities by not calling them Wellingtons. The boots proved invaluable as Venice was flooded. It was over a dinner in a pleasant Venice restaurant, most diners wearing said boots, that Micky showed characteristics long admired. His liver arrived and it was not what he wanted though it was precisely what he had ordered. Seeing that the dish of the lady opposite him was more to his taste he suggested that his was such a superior dish that he felt honor bound to offer to exchange it with hers. She read him accurately and declined the generous offer.
Micky and Sybil moved to Normandy during Micky’s tenure at Euromcontact which made for easier travel to meetings and played to his Europhile instincts. It was over a pleasant lunch that he and the then Euromcontact president conceived a panoptical, pan-Europe cooperation which brought together five organizations representing between them: optometrists, opticians, ophthalmologists, contact lens specialists and the contact lens manufacturers to form the European Contact Lens Forum. It, like much of Micky’s legacy in the contact lens industry, lives on. An aging group of folks from the UK contact lens industry and practice continue to lunch together each year and Micky’s name invariably crops up in reminiscences of a very formative time for the contact lens world. Michael Tillotson died at the age of 95 in May 17th. He will long be remembered. n
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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
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
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
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 NurkanovicHistorically, protein deposits on rigid gas permeable (RGP) contact lenses have been difficult to measure because of test sensitivity limitations. Scientists at the Centre for Ocular Research & Education (CORE) have used radiolabeled proteins to overcome that challenge. They had used the technique for soft contact lens deposition studies in the past and now applied it to RGPs for the first time.
The Biosciences Group incorporated radiolabeled lysozyme into an artificial tear solution and then determined on-lens protein sensitively through radioactive counts. Seven common
RGP lens materials were soaked in the radioactive artificial tear solution for 16 hours, followed by eight hours of exposure to a 3% one-step hydrogen peroxide (OSP) care solution to investigate cleaning ability. Investigators determined the deposits were minimal, ranging from 1.2 ± 0.2 μg to 3.2 ± 0.7 μg per lens without use of a cleaning solution. Moreover, the OSP solution significantly reduced the amount of radioactive lysozyme present on the majority of RGPs after 30 alternating incubating and cleaning cycles when compared to using phosphate buffered saline, with measurements of remaining lysozyme on cleaned lenses ranging from 1.3 ± 0.1 μg to 2.5 ± 0.1 μg per lens.
“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)
Researchers know today quite well that the brain has the critical ability to adapt to different sensory experiences and, in some ways, to “compensate” for the lack of one sense or the other. In a recent study, a group of researchers from the IMT School for Advanced Studies Lucca (Italy), in collaboration with a group from the University of Ulm (Germany), added new insights on how the brain manages to adapt to changes in the flux of information coming from eyes and ears.
Several studies have already shown that the lack of sight, even for a short period of time, for example through the occlusion of one eye for a few hours, is sufficient to induce a temporary change in how the brain processes visual information. Yet, it was unknown whether these plastic effects have an impact on other senses beyond vision and influence their activity. For this new study, the researchers from the MOMiLab (Molecular Mind Laboratory) of the IMT School blindfolded the eye of 20 participants of the experiment and asked them to look and count simple flashes of light while sound beeps were also presented. During the experiment, the activity in the brain was registered with millisecond precision with the electroencephalogram. The researchers observed that neural activity in response to visual and auditory input was altered following the eye patch removal. “In this research, we demonstrated for the first time that even
a short period of monocular deprivation – the occlusion of one eye with an eye patch for about two hours – also affects auditory processing. In particular, we observed a very selective increase of neural response to sounds,” says Alessandra Federici, a researcher in cognitive neuroscience at the IMT School, and first author of the paper. In other words, even a small perturbation of visual experience is enough to induce a change in the balance between vision and audition. Indeed, the effects of monocular deprivation were paradoxical: after patch removal, the brain became more sensitive to the visual information provided by the eye that was occluded, as if the lack of input led to an increase in neural excitability. The brain also became more susceptible to auditory input, but selectively when the environment was monitored with the other, non-patched, eye. "While many studies have demonstrated the 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 profound impact that sensory experience continuously exerts on our brain," says Davide Bottari, researcher at the IMT School and principal investigator of the study. The study was published in the journal NeuroImage.
DOI: 10.1016/j.neuroimage.2023.120141
Source: IMT School for Advanced Studies Lucca
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.
The scientists asked 22 human subjects to walk on a treadmill then choose between different settings displayed on a computer screen: a brief walk up a steep grade or a longer walk on flat ground. The Researchers observed that the subjects’ eyes tended to move their eyes faster when they looked toward the options that they ended up choosing. The more vigorously their eyes moved, the more they seemed to prefer their choice.
In the study, the team set up a treadmill on the CU Boulder campus. Study subjects exercised on various inclines for a period of time then sat down in front of a monitor and a
Research led by scientists at the University of São Paulo (USP) in Brazil has found that SARS-CoV-2, the coronavirus that causes COVID-19, can be detected in tears collected by swabbing. The researchers analyzed samples from patients diagnosed with the disease by conventional methods and admitted to the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC) run by the Bauru Dental School (FOBUSP) in the first half of 2021. SARS-CoV-2 was detected in
high-speed, camera-based device that tracked their eye movements. While at the screen, they pondered a series of options, getting four seconds to pick between two choices represented by icons: Did they want to walk for two minutes at a 10 % grade or for six minutes at a 4 % grade?
As the subjects considered their options, they flitted their eyes between the icons, first slowly and then faster. Once the subjects decided on their pick, their eyes slowed again. The researchers think that apart from giving valuable insight into the workings of the brain, tracking eye movements could also be useful as a diagnostic tool for certain diseases where slowed movements are a symptom, e.g. Parkinson’s. The research was published in the journal Current Biology.
DOI 10.1016/j.cub.2022.10.053
Quelle: University of Colorado at Boulder
18.2% of the samples, suggesting this method could be an alternative to nasopharyngeal swabbing. Moreover, a combination of the factors more comorbidities and a higher mortality rate among patients whose tear samples tested positive suggests that this method of detection of the virus could be a prognosis predictor. The findings suggest that the probability of detecting the virus in tears is greater when the patient has a high viral load.
The study cohort comprised 61 hospitalized patients, with 28 testing negative and 33 positive for COVID-19 by
RT-qPCR via nasopharyngeal swab. Tears were analyzed from all 33 positives and from 14 of the 28 negatives. In addition to collection by conjunctival swab, the scientists also used the Schirmer strip test, in which a strip of filter paper is placed for five minutes inside the lower eyelid. The samples were analyzed between July and November 2021. SARS-CoV-2 was detected in 18.2% of the samples collected by conjunctival swab and 12.1% of those collected by Schirmer strip. As expected, none of the patients who tested negative for the virus via nasopharyngeal swab had tears that tested positive.
The Charlson Comorbidity Index (CCI) was used to predict risk of death within a year of hospitalization for patients with 20 specific conditions. Patients with SARS-CoV-2 particles in tear samples had an almost sevenfold chance of
dying compared to patients with a negative result. Those patients also had other factors that could contribute to death, such as a poor ten-year survival rate based on CCI. The study also included demographic, clinical and ocular symptom data. The main diagnostic test used was real-time quantitative PCR (polymerase chain reaction). Innovating in comparison with previous research, in this study viral RNA positivity was determined much more precisely by analyzing the nucleocapsid (N), envelope (E) and RNAdependent RNA polymerase (RdRp). The study was reported in an article published in the November 2022 issue of the Journal of Clinical Medicine
DOI 10.3390/jcm11236929
Source : Fundação de Amparo à Pesquisa do Estado de São Paulo
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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 SageWhen the upcoming location of the congress was announced last year, the war in Ukraine had started only a few weeks before. Budapest as a venue felt wrong to many participants. The organizers showed flexibility and therefore complied with the members' request and moved the conference quite a bit further west: In The Hague a successful EFCLIN conference could take place with 333 international participants from 32 countries. In addition to an excellent program of presentations, the event was, as always, flanked by an exhibition that
showcased all areas of the contact lens manufacturing industry and its suppliers. Thus, the leading material manufacturers for RGPs, custom soft contact lenses and intraocular lenses were present, as well the machine manufacturers currently active on the market and the most important suppliers of metrology instruments and systems. The diamond manufacturers for tools, manufacturers of blockers and polishing systems and suppliers of consumables and software were not to be missed.
The EFCLIN Forum kicked off at noon on Thursday with a well-attended panel. On Friday morning, shortly after the welcome by EFCLIN President Armin Duddek, Laure-Anne Copel from EUROMCONTACT addressed the topic that is currently keeping the association and its members on their toes: The impending ban on per- and polyfluoroalkyl substances – PFAS for short.
The background:
These chemical substances are viewed very critically; they are by now everywhere and can hardly be removed from the environment or organisms. However, they play an important - if not central - role in many products. Some provide comfort or improved product properties, for example, as anti-fogging agents in eyeglass lenses, as non-stick coatings in pots or serve as rain protection in breathable clothing. The use of the approximately 10,000 different chemical compounds known by the collective term PFAS in the products we use every day is almost as varied as their number.
Five countries from the EU have spoken out in favor of a ban on PFASs, setting a ball rolling that could become a major
problem for contact lens manufacturers mainly of RGPs. In early February 2023, the European Chemicals Agency (ECHA) published a proposed ban on all PFASs. This is the most comprehensive restriction proposal of its kind.
ECHA has now published a public consultation to gather additional information on the use of PFAS in order to consider whether exemptions from the PFAS ban can be granted for certain uses. This could then apply to contact lenses. There are currently no alternatives for three PFASs used in the manufacture of dimensionally stable contact lenses. These include: Fluoropolymers and Perfluoropolyethers. While a possible exemption could be justified here, the evidence needs to be supported with numbers. Additional information from manufacturers is urgently needed here - and as quickly as possible by September 2023, because that is when the consultation period ends, during which evidence of the use of certain PFASs can be submitted to the responsible EU body.
Currently, there are only two options for manufacturers: Obtain an exemption for contact lenses, or develop new materials and surfaces without the use of PFASs within a transition period of 12 years. We talked about this and other topics with EFCLIN President Armin Duddek in The Hague.
GlobalCONTACT: Another position has just been added to the EFCLIN Board with Marc Botticella. What are the reasons behind this?
Duddek : When planning the conference, we keep coming across topics where we realize we need more input. So, we agreed that we needed more minds on the board. This will bring new perspectives and suggestions to the organizing team. With Marc, we have an expert with a large network and a good professional background. Moreover, the board is not limited to a certain number of people. Thus we have extended it by a new position. This ensures the quality and will help to keep the level on a high level in the future.
GlobalCONTACT: What are the most pressing issues for the association at the moment?
Duddek : After the Covid epidemic and the cancellation of the conference twice, we focused on the financial status. Fortunately, the association did not lose any money due to Covid and the conference could take place as usual. Nevertheless, we are trying to get new members. Content-wise, still a big issue is the transition from MDD to MDR, with the first companies having successfully completed their audits and being MDR certified. Some others only need to rework small corrections in their files.
GlobalCONTACT: The PFAS issue is an important topic for many industries right now. For the contact lens industry, it can become a serious problem. What is the background?
Duddek : Yes, since this year, everything around PFAS is an extremely important topic at EFCLIN, which admittedly caught us cold. The topic was not present for us until the push came from the five countries in the EU Parliament to ban PFAS. At the moment, we cannot yet estimate what this means for us. We are working with EUROMCONTACT and other stakeholders to lobby and inform in the EU with
the aim to vote against this motion in this form. We can live with the full ban of PFAS if necessary if there is the transitional arrangement of up to 12 years. The material manufacturers, as far as I am informed, do not currently have an alternative, but this would buy them time to develop new materials. Then the industry could actually look well into the future. Now, it would be not good for us if the EU governments really decided on a total ban without PFAS exemptions.
GlobalCONTACT: For exemptions that can be requested, appropriate cases must be documented. Qualitatively and quantitatively, for how many this medical device has an important function and how many people have no alternative. Who would be questioned about this? Only the industry or also eye care practitioners?
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 tries to get some overview of the numbers probably in preparation for the EU Commission. Currently we get figures via EUROMCONTACT, but there are rather the big companies organized and there it is mainly about soft lenses, which are partly also affected by the PFAS issue. But we must prove how many patients are affected in Europe to show the EU Commission how many jobs in the industry depend on it – and how many patients' jobs depend on it, too. If they no longer have their sight, they can no longer do their jobs.
At the end of the day, this is also a matter of health policy, and I think we should also receive reasonable figures from EFCLIN and EUROMCONTACT, from the entire industry.
GlobalCONTACT: If you look at it more closely, with custom lens users, it mostly affects people who sometimes can't switch to glasses, for example, when using scleral lenses for the severe form of dry eye or keratoconus or other irregular corneas....
Duddek : Exactly, among our members it concerns many labs that manufacture specialty lenses. Their patients have no alternative to oxygen-permeable form-stable contact lenses.
They can't wear soft lenses, they can't wear glasses, these Patients are just too unwell. So, we need the arguments to delay the transition period as long as possible to develop alternatives that have the same purpose and have the same oxygen permeability.
GlobalCONTACT: Is the 12-year transition period already fixed or can it be extended?
Duddek : The EU Commission's proposal was 5-12 years for this transition. So, we are already at the back end there. Whether that can be extended even further? That will be difficult.
GlobalCONTACT: How is the cooperation with other organizations?
Duddek : As EFCLIN, we are a member of EUROMCONTACT, we attend all meetings, we also work in the commissions. From that point of view, the exchange is good, but here only numbers about sold soft lenses and care products are collected. And our members are less affected by that. Therefore, we need good figures on GP contact lenses in Europe.
GlobalCONTACT: The CLMA (Contact Lens Manufacturers Association, USA) has collected statistics which, with a participation rate of 95%, allow very good conclusions to be drawn about the fitted RGP contact lenses. Could a similar procedure be applied to the European market?
Duddek : I was contacted by the previous president of the CLMA, Josh Adams. He showed me his figures and presented the study. There, within 1.5 years, with the help of a neutral institute, they managed to obtain data via a questionnaire. The data is so precise that it is possible to extract meaningful statistics. I have also spoken with several labs that have completed the data sheet. The time required is 30-45 minutes. This time investment, I think, is acceptable for any lab if it helps to explain whether we have in Europe, 2 or 10 million wearers of RGPs and how many jobs depend on it. Because until now, these numbers didn't exist, and I'm very glad that in the U.S., the big companies have already joined in.
GlobalCONTACT: Thank you very much for the interview.
monocrystalline and polycrystalline diamond tools
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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 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 DenisonOver the last 30 years, I have shared my experiences and business process improvement approaches many times with many industries and this is the first time I have been involved with the Contact Lens Industry, which of course meant some research and alignment with the processes and challenges of the industry.
One thing became immediately apparent was the similarity with many other high and low volume manufacturing industries. There were product forming processes such as turning, shaping, polishing, and coating, preparation processes and finishing processes. There are raw material inventories, work in process, finished goods storage and between process transference. All of which lend themselves to applying lean methodologies to help improve product flows, reduce lead times, eliminate wasteful activities, and increase the opportunity to build in quality into each stage of the lens manufacturing operation. Lean means very different things to different people, it’s such a broad concept that has encompassed many methodologies over the last 50 years. It has its roots in Toyota’s Production System and was coined lean in the 1980’s in the book The Machine that Changed the World by James P Womack, Daniel T Jones and Daniel Roos, who wrote about their research into Toyota’s manufacturing approach where, when studying Toyota they used the term Lean Production, because Toyota: “……uses less of everything compared with mass production – half the human effort in the factory, half the manufacturing space, half the investment in tools, half the engineering hours to develop a new product in half the time. also, it requires keeping far less than half the needed inventory on site, results in fewer defects, and produces a greater and ever growing variety of products.”
In truth, until recently Toyota didn’t even use the term “Lean”, I certainly never came across the term lean whilst working there.
Lean is often misunderstood in its form as applied at Toyota and misrepresented depending on what someone has been immersed in or exposed to whilst learning about lean. Many people see lean as a set of tools and techniques that can be applied to improve their operations and many organisations have adopted and adapted lean techniques to make significant improvements in productivity, quality, and cost savings. But lean is more than a set of tools and techniques, it is a way of operating a business focused on supporting, developing, and continually growing the capabilities of all its people to succeed in their work, based on the philosophy of the complete elimination of all waste in pursuit of the most efficient methods for the benefit of its customers and society as a whole. Ideally lean thinking in an organisation should be focused on people more than its processes and whilst it’s the tools and techniques that might actually make the improvements, it is leaders developing peoples capabilities, creativity, and scientific approaches to managing challenges and problems that enable a continuous improvement culture that can consistently adapt and innovate to the challenges of their business and the world today.
In a Lean World, we look at everything through a lens of value, value for the customer and value of how leaders, lead learning to enable the potential of the people and the business and real value can only be defined through the eyes of the customer. It would be an insightful exercise to understand what value in the flow of the contact lens manufacturing business is.
We used a couple of simple and fun exercises to highlight lean thinking, one, by looking for numbers on a page for the delegates to see how, by removing waste and systematically organising how the numbers are presented can speed up the process and increase productivity. This workplace organisation exercise illustrates the power and impact of visual management and waste elimination. The second explored the myth of multitasking and looked at the kinds of non-value adding leadership and management activities that can also be classed as wasteful. This
gave the delegates something to think about from their own perspective and how important it was to lead by example in increasing their own productivity in areas such as meetings, engaging with staff, and planning their Big Rock activities for reducing their own low value, non-value adding activities to spend more time engaging, coaching, and supporting their staff. Waste can manifest in many ways; most waste is designed into the process or has been absorbed through years of doing something a certain way and it becomes comfortable to follow this pattern of production. All these "waste" elements intertwine with each other to create more waste, eventually impacting the management of the corporation itself.
Finally, we shared the concept of the Inverted Organisation, it 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 the customer. It is this role model coaching and supporting
that sets the direction and expectations, this ensures that the organisation is continually developing its capability and capacity for expansion.
There is a huge focus on teaching and coaching on the job, this also ensures the DNA of the organisation the culture is continually embedded within the people. This kind of approach fosters an environment of Respect for People, of establishing mutual trust through meaningful support and creating an environment in which people and teams can succeed. Harvey S. Firestone, a 20th century industrialist is quoted “The growth and development of people is the highest calling of leadership” Toyota’s 21st century principle is “We build our people before we build our cars.” n
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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 pandemic, the conference bounced back in style with delegates from around the globe enjoying a packed programme featuring some of optometry’s leading names. Held at Manchester Central, the three-day event featured keynote presentations, lectures, peer reviews and hands-on workshops detailing the latest clinical insights and demonstrating the latest technology available to practitioners.
BCLA chief executive, Luke Stevens-Burt, said: “Bringing together the leading lights in contact lenses and anterior eye for the first BCLA Clinical Conference in four years has been a huge honour. The world has been through so much since everyone was last together here in Manchester but our members have shown incredible strength and resilience to not just withstand everything thrown at them but to thrive under that pressure. Their seemingly unquenchable thirst for learning continues and the standard of lectures and presentations has been incredible – showcasing cutting edge science and research and translating that into impactful techniques for use in everyday practice. Myopia management, dry eye disease and the tear film remain key areas of interest and the BCLA is as determined as ever to give our members access to the insights that can make a difference to the everyday lives of their patients. This has been a real agenda-setting conference. These three days will drive evidence-based best practice.”
This year’s BCLA Medal address was given by Professor Eric Papas, entitled ‘How football, luck and good people saved me from the golf course’. Eric discussed his career path from his early days in practice to his key role in developing silicone hydrogel lenses, citing major influences including Ross Maskell, Richard Abadi, Graeme Young and Brien Holden.
Dr Sonia Trave-Huarte delivered the Irving Fatt Memorial Lecture, which looked at dry eye management and treatment studies and how they can support evidence-based dry eye practice.
Rabia Mobeen delivered this year’s Da Vinci Award presentation
on the subject of how dendritic cells’ response to immediate soft contact lens wear is impacted by their physical contact with nerves in the human corneal epithelium.
The wider program, which included an application track, ‘cutting edge’ track, peer review track and skills development workshop track, featured more 100 speakers from around the world.
Among other highlights was Professor Gregory Sawyer, who used his extensive bioengineering background to deliver two powerful keynote presentations.
The first, on the art of contact lens comfort, explored the biological history of the tear film and the similarities shared by “soft, wet and squidgy” contact lenses and jellyfish. He explored the opportunities for AI and machine learning in treating cell damage before demonstrating the concept of friction co-efficient. The second session gave a more advanced understanding of the tear film and how it interfaces with a contact lens.
Data revealed during a session looking at contact lens wear in children showed that eye care professionals around the world are growing increasingly confident in fitting contact lenses in children but there remains a need for greater proactivity around discussing the potential myopia management options available to young patients.
Sessions focusing on patient-reported outcomes included seeing the myopia management contact lens journey through the eyes of 12-year-old patient Maddy Stickley, who shared her experience of wearing contact lenses over the past four years.
Kah Ooi Tan and Jong-Mei Khew gave practitioner perspectives of myopia control in a session that exemplified the global reach of the conference, showcasing the latest research based on 90 practitioner interviews carried out around Asia, with this qualitative study exploring the potential barriers and
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 retina to inhibit eye growth in positive defocus.
As a new initiative for 2023, the BCLA offered attendees micro-credential certificates in four topics; Advanced Contact Lenses, Dry Eye, Myopia Control and Ocular Health. These bite-sized chunks of learning are designed to help eye care practitioners to develop knowledge and skills in a specific area and identify that an individual has focused their learning on a particular specialism.
The conference, held from 9-11 June, also saw the inaugural ‘BCLA Celebrates’ – a new social event held at the Imperial War Museum North. Sharon Flora was named the winner of the Dry Eye Practitioner of the Year Award, sponsored by Scope, while Kathryn Webber received the Myopia Management Practitioner of the Year Award, sponsored by CooperVision. Martin Rubenstein was Hospital Optometry Practitioner of the Year while the BCLA Industry Award was given to CooperVision’s Project Sunflower team in recognition of their work to combat the reliance upon single use plastics
in the contact lens industry. Former BCLA president Andy Yorke was also named an honorary life member while Fakhruddin Barodawala and Mhamed Ouzzani were named the winners of the BCLA poster competition and the Diane Gould photography competition respectively.
A total of 33 new Fellows were formally welcomed at the event, bringing the total number of FBCLAs, globally, to more than 250. The BCLA Fellowship program continues to go from strength-to-strength and 25 long-standing Fellows were honoured for 15 years continuous commitment during the conference.
The BCLA AGM, held on the second day of the conference, saw outgoing president Neil Retallic hand over the reigns to Rakesh Kapoor, who will lead the association for the next 12 months – a period that will see the return of BCLA Asia, to be held in Chengdu province in China next Spring. n
As many of you know, I have been involved in the development of lens manufacturing processes for quite some time. There is always room for improvement and process is no exception. One tenant of any process is to reduce variation whether that is in the product(s) or the steps in the process. By Erik
Larsen
In the last issue of GlobalCONTACT Magazine 2023_01, I 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. I had the privilege of receiving contributions to these articles by Mr. Pat Murphy and Mr. Nir Karpik of CooperVision Specialty Eyecare. As I mentioned in the previous article, they are tasked with coordinating the manufacturing processes within the family of companies across CooperVision.
I first met Nir when he hired in at Soflex in Israel. He has a degree in engineering (which I can identify with) and I have 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 opto-
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 learned a lot with your immersion in the industry. Have you formulated a plan of action relative to the various sister companies’ processes? Getting into the labs has been an eye-opener, I’m still in the stage of analyzing the processes of the latest acquisitions. It is interesting that they all use similar machinery to solve similar problems in different ways. I expect that the analyses will show that some processes are more efficient than others. Based on this data, we can move forward to standardization.
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 is to standardize blocking tooling; what are your thoughts on this? Transfer blocking is a good place to start. Eliminating the stress done by the collet is important for process stability. You should also consider keeping the arbors short (25 mm). Hollow lens blank arbors allow the center thickness (CT) to be measured directly. The blank stays on the arbor until deblocking for the front lathing. We understand the limitation of “one size fits all” as relates to tooling, we are looking at different arbor’s geometries to better match the base curve (BC).
There are two camps relating to monitoring of base curve center thickness: Direct CT measurement on the BC or measuring the lens 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 volume can see efficiencies in using constant blank thickness in the process.
Nir, what to you foresee in the industry as far as process and machinery?
As I mentioned before, the technology behind the machinery is similar, but the processes are different. I believe that as we keep seeing challenges in recruitment in different parts of the world and the constant need to become more efficient, more automation will be applied to the process which will require equipment that can support the interface with the different controllers. There are discussions of 3D printing lenses, but I haven’t seen a contact lens that was 3D printed yet.
A closing remark: Thank you to Pat and Nir for their comments and insights. From their technical education and experience in large manufacturing industries, it is evident they take an analytical approach to manufacturing processes and development. Lenses per person per shift is part of the analysis. Worker skill and decision-making requirements are a subset. If a new machine and/or process needs the worker to make lens specific decisions, that can reduce productivity and lead to errors. If a new machine and/or process improves productivity, it is a good choice moving forward. Looking ahead, while it has not been openly promoted, we at Larsen have been privileged to work with leading labs providing the machinery that is robot-ready for automated manufacturing. n
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 CarolineThe 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.
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
approximately 1mm at the periphery of the lens on its posterior surface is of a flatter radius of curvature than the curvature based on the curvature of the cornea – with the back peripheral radius: 0.50mm flatter than the back optic zone radius’. Due to the large size of the back-optic-zone diameter, the backoptic-zone radius was fitted 0.30mm flatter than the flattest meridian of the cornea, in which the resultant power of the liquid lens was –1.50D. Finally, it has been suggested, without any supporting evidence, that ‘guilt may have played a part in Tuohy’s suicide as Xavier Villagran always maintained that he was the one concerned with using the corneal section of a scleral lens’. Although Villagran, Tuohy’s business partner, wrote in 1979 that ‘personal distrust and greed disturbed our relations, finally breaking them,’ he never claimed that he was the inventor of the corneal lens rather than Tuohy.
It is known that the first wearers of the Tuohy lens were Kevin Tuohy himself, his first wife Marta, Xavier Villagran and a post-keratoplasty patient who ‘discarded his scleral lenses on the first occasion of receiving his corneal lenses’. His wife Marta was a 7D myope, Kevin Tuohy was a 4D myope and both had worn scleral lenses. By late 1947, about 12 people in the US had been fitted with Tuohy lenses. This number rose to 1300 in 1949 and to 75,000 by 1953. Following the introduction of the Tuohy lens, sales of contact lenses in the US increased dramatically from 50,000 pairs in 1946 to 200,000 pairs in 1949. While there were six major contact lens laboratories in the US in 1950, by 1966 this number had increased to approximately 300 of various sizes. It was undoubtedly the success of the Tuohy lens that was responsible for this. Tuohy should absolutely be remembered as ‘The father of the corneal contact lens.’
Pretty much every story on the origin of contact lenses starts with a reference to Leonardo da Vinci. While it is very tempting to have one of the greatest minds of all time on the timeline of an invention such as this, painstaking review of the text and drawings of the original da Vinci manuscripts by French ophthalmologist Robert Heitz in 2003 indicate that this is most likely not true. Patrick Caroline and Craig Norman report on this in the February 2020 issue of Contact Lens Spectrum; in this article, they quote Heitz stating that the famous images by da Vinci on the concept of ‘contact lenses’ were not illustrating the neutralization of refractive power but rather described a theory as to how images are formed from the cornea to the optic nerve. Therefore, there is no proof that da Vinci ever conceived the concept of correcting eyesight with a lens placed directly onto the eye’s anterior segment. Based on this, it seems like we may have been giving da Vinci too much credit in the history chapters of contact lens textbooks and lectures to our students.
‘Next up’ in the timeline of publications may be the French philosopher and scientist René Descartes. About 120 years after da Vinci, Descartes described a fluid-filled glass tube that could be placed directly on the eye. At the end of the tube would be a glass lens. With this publication in 1637, Descartes described in essence the concept of a ‘contact lens’ in ‘Discours de la methode, dioptrique’. He wrote this thesis while in Amsterdam (he lived in the Netherlands from 1628 to 1649). This piece is part of a larger publication that also contains the famous quote: “Je pense, donc je suis" (I think, therefore I am).
“ON THE ORIGIN OF LENSES” –MYTHS AND FACTS ABOUT THE HISTORY & DEVELOPMENT OF THE FIRST CORNEAL RIGID LENS-
While the concept of a contact lens was also described in the early 1800s by Thomas Young and John Herschel, there is no proof whatsoever of practical applications of this. The first glass scleral shells to correct keratoconus seem to have been introduced in the 1886 to 1888 period by Adolf Eugen Fick and Eugène Kalt, while brothers Friedrich and Albert Müller produced a non-powered glass shell to protect an eye around that same time. And additionally, August Müller worked to correct his own high myopia with a scleral device. Let’s fast-forward for the sake of the scope of this article from scleral devices to corneal lenses: who first came up with that idea? One of the first known stories regarding glass corneal lenses is believed to have come from Eugène Kalt, who in 1888 was a young ophthalmologist and Chief Clinical Assistant at the Department of Ophthalmology at the Hôtel-Dieu Hospital in Paris. The historical record shows that from 1888 to 1893, Kalt experimented with 16.0mm to 22.0mm blown-glass shells; but, he also experimented with ground-glass lenses that had overall diameters of 11.0mm, 11.5mm, and 13.0mm—hence, corneal lenses.
However, here also Caroline and Norman reported a new fact (Contact Lens Spectrum, August 2022): On Nov. 12, 1900, Johann Frederic Volle applied for the first US patent in the field of contact lenses. Please note: these were glass corneal lenses. It was just 12 years after the first contact lenses were introduced in Europe, and the question is how did a tinsmith from Scranton, Mississippi (US), who had no optical or medical background, come to invent and patent the first contact lens in history? That remains a mystery, but there is a document with this exact patent granted to him on March 3, 1903.
The evolution of the contact lens follows the path from blownglass scleral lenses to polymethylmethacrylate (PMMA) plastic scleral lenses to corneal lenses made from plastic – the latter
pretty much as we know it today, although the materials have evolved into lenses with ultra-high oxygen permeable properties, of course. But is Tuohy indeed the sole father of the corneal lens as described above? There is another surprise to this story. While Tuohy’s patent was the first to be granted, prior to Touhy a gentleman by the name of Dennis England came into the picture. Remember his (full) name, as it becomes relevant later in this story. But it starts with the fact that in 1945 – three years before Tuohy – England applied for a patent for a plastic rigid corneal lens. England graduated from The Ohio State University School of Applied Optics in 1940 and established an optometric practice in Zanesville, Ohio (US). He there began to work on forming a corneal contact lens by cutting out the center of molded PMMA scleral lenses and rounding the edges. The tools that he used to produce these lenses consisted of two extremely sharp metal pins set a specific distance apart (7.8mm and 11.5mm) that were turned in the center of a scleral lens until a smaller “corneal” lens was formed. These lenses (the center-less scleral and small corneal) and the patent application are on exhibit at the Contact Lens Museum located in Forest Grove, Oregon (US). However, the patent was denied several times. England fought these rejections at the patent office, without success: a frustrating and costly exercise. He went on to form the DMV Corporation in 1968—the same company still in operation under the guidance of his son, Robert C. England—primarily providing accessories for the application and removal of scleral lenses, the same device that Dennis England hoped to replace with his invention more than 70 years ago. The ‘D’ in DMV stands for Dennis, and the family did not come out completely unsuccessful.
The final part of this story is the ‘invention’ of using PMMA for contact lenses. This begins in Germany in 1928, when Otto Rohm patented PMMA as a paint binder. The plastic became extremely popular due to its clear optical properties
To be continued on Page 30 >>
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, VicePresidentI have known Erik Larsen since 1992. Since then I have used just about every piece of equipment his company has built. My experience with Erik and the Larsen team has been one of great appreciation as they have always helped me in my needs of fully understanding equipment used to manufacture quality contact lenses. Erik has also been able to engineer any part needed for me even it was a custom part.
Erik (Larsen Equipment) has been and still is a pioneer in the contact lens and optical industry, and I am thankful to him for his support over the years.
Randy Mingoy Quality Manager Advanced Vision Technologies
There can be a lot of moving parts when it comes to managing operations, so it is key to have reliable precision equipment that assists in overall efficiency. Larsen Equipment delivers just that! I have been utilizing Larsen manufacturing equipment for over 15+ years and have yet to run into an issue they could not resolve. I am a satisfied owner of bladder polishers, edge roller’s and auto-blockers etc. Each one of these units greatly assists in the reduction of rejects and manufacturing waste. 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/ConsultantAdvanced Vision Technologies
PRESIDENT: KEITH PARKER
I have had the pleasure of working with Erik since the beginning of Larsen Equipment. The first piece of equipment, a 6 spindle horizontal arm polisher revolutionized our production of GP contact lenses. Through the years, I watched his business grow as he and his team listened to our Industry needs and developed now numerous products not only simplifying many tasks of manufacturing but improving the consistency of quality in our finished products. Innovation has been an ongoing experience of our Company only made possible through the innovation of necessary equipment developed and made available by the Larsen team.
Larsen Equipment is a family owned business hosting a team of willing Staff all having the attitude of serving their Customer’s needs. As a Customer, we are made to feel like we have a friend in the business helping us develop a more efficient process allowing our Company to deliver better products for our Customers.
Our success of AVT simply could not have been possible without the help, assistance and dedication of Larsen Equipment. I will be forever grateful for my opportunity to work with Erik and his very capable Staff.
Keith Parker Presidentand 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 inflammation. 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 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 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.
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
Sources
- C aroline, Norman. Contact Lens Spectrum History of Contact Lenses Series: February 2020/April 2020/June 2020/August 2020/April 2022
- E fron. Contact Lens Practice, Third Edition Nathan Efron (editor) Elsevier
- Phillips, Speedwell. Contact Lenses, 6th Edition. Anthony J. Phillips & Lynne Speedwell (editors) Elsevier
- B owden. Contact Lenses. The Story. Bower House Publications. 2009
- https://en.wikipedia.org/wiki/Dioptrique
- P earson. The 75th anniversary of the Tuohy corneal contact lens: A review. Contact Lens and Anterior Eye Febr 2023
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.
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 years, he has been involved in the 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.
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 that was developed to maximize the full potential of the DAC lathe’s edge contouring capability and form accuracy. Back or front surfaces are blocked with a high degree of accuracy and repeatability, and a minimum of time and operator attention.
The DAC Precision Blocker offers fast, reliable calibration, easy and intuitive initial setup, and stable, accurate and repeatable blocking. Additionally, the rigid, ½” steel construction and a design that manages ambient heat in the machine frame means that the DAC blocker holds calibration reliably over time, without the need to re-calibrate during the workday.
A blocker that holds calibration yields better lenses, but it also saves time and money. Greg Wicker, Maintenance Manager for X-Cel Specialty Contacts in Duluth, Georgia, has worked out the numbers: “Based on the average maintenance tech spending about 15 minutes setting a traditional blocker twice a day, [that’s] 30 minutes a day times 255 working days per year - 7,650 minutes total, or 127.5 hours per year”. Greg continues “Although more expensive than traditional blockers, I feel that it pays for itself with the reduction of prism related rejects and downtime for setting blockers.”
While accuracy and reliability are important, an ideal blocker also needs the versatility to handle the wide range of specialty products manufactured by a modern laboratory. Safe, consistent
wax dosing, interchangeable waxpots and a fully programmable interface ensure that the DAC Precision Blocker has the flexibility to cover the full gamut of RGP, soft and IOL lenses currently in production.
Drop size is fully adjustable from zero to 2.5ml, and multiple drops can be programmed. Wax pots are hot-swappable with no down-time required to rapidly switch between waxes for different applications. Additionally, an on-board timer for wax pot warm-up lets lab managers start their morning without any waiting time; different start times may be set for each workday.
Finally, the DAC Precision Blocker is fully programable, with an LCD touch screen providing an intuitive interface that allows the user to optimize blocking variables to suit individual process needs. Key parameters such as drop count, temperature, and air-cooling controls can be accessed, configured and saved to any of six independently configurable blocking tables.
Treating blocking like the mission critical process that it is means looking seriously at the needs of a rapidly evolving industry and providing a robust and flexible solution that takes no shortcuts in design, materials or construction. To DAC International, this is the meaning of blocking without compromise. n
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
As an optometrist in the early 1970’s Jack Brown couldn’t get quality contact lenses anywhere in Britain, so he decided to try and make his own. “I just gave it a go. We learned the hard way, using a granny flat at my house as our lab and buying various equipment which was rubbish! We finally launched Scotlens in 1976 after taking a couple of years to get up to the right standards”, he says.
Although George Jessen developed the Ortho-K concept in the 1960’s, He first heard about Ortho-K at a BCLA lecture in 1975/76. He was fitting contact lenses in Edinburgh, so he thought he would try it with a couple of patients. The theory seemed good, but the materials were wrong, mainly that they didn’t allow the cornea to get oxygen. So, he gave up.
When gas perm lenses arrived in the 1980’s he tried again and succeeded. In the late 1980’s he developed a computer programme, to design lenses and it all started to take off. In 2003 he decided to offer his Ortho-K lens to other people, so he came up with the name Nocturnal.
“I’m certainly proud to be one of the first Ortho-K pioneers in the UK, and to have been the first company in Europe to get a CE for GP lenses. It was great when my son Scott, also an optometrist, took an interest in lens design and joined the business in 2003 with fresh knowledge and a different approach. The original concept back in the 1970’s was to take night lenses to the world. It’s great to see Scott now doing that with nightlenses.com, and night lenses starting to become mainstream. Sad that it has taken nearly 50 years! From day one, we just did what we wanted to do – make quality lenses – which Scott and the team at Scotlens still do to this day”, he adds.
Jack’s son, Scott Brown, bought the company out in 2014 and remains at the helm today. Reflecting on the company journey and the exciting future with night lenses, Scott says:
“When I left school, I became a scuba dive instructor. If you told me I would follow in my dad’s footsteps as both an optometrist and a lens designer, I wouldn’t have believed
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’. Everything is set to explode, the starting point of the next chapter for us, the next 20 years!” n
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 MeerdingOver the years, we have come to know a lot more about myopia, its etiology and what sight threatening conditions high myopia especially is associated with. Research has shown multiple effective treatment programs, visual environmental interventions, and optical and pharmacological treatments, to prevent myopia from progressing, aiming at keeping levels of myopia as low as possible and reducing axial length grow. Besides genetic factors, certain lifestyle habits such as screentime exposure and prolonged near vision tasks as well as spending less time outdoors have shown to influence the progression of myopia(1) Fortunately, myopia preventive behaviours are receiving increasing attention. Restricting individual risk behaviours
and promoting myopia protective behaviour such as spending more time outdoors will help prevent the development of myopia.
Yet it is time to see myopia from a different perspective. Let’s call it: The other side of myopia. Myopia goes beyond the definition of not being able to see distant images or objects clearly, as it is more than “just a refractive error”, therefore stressing the urge to focus more at the health behavioural site and societal affect. However, how easy as it may sound to reduce screentime and let children spend more time outdoors, it is quite a challenge and asks for involving as many stakeholders as possible to tackle the problem.
Today’s children are growing up in a digital world, saturated with smart technology that is without a doubt indispensable in our current society. Screentime is a form of what we call: sedentary behaviour. Sedentary behaviour refers to activities 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
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.
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 matching potential perceived determinants of their sedentary behaviour of which sitting "because it is the norm" and sitting "because I can work/play better that way" are the most important ones. This finding is also in line with the current societal norm of a sedentary lifestyle(2). When behaviour becomes a habit, in
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.
this case sitting, it is automatically activated by environmental stimulus or cues, instead of consciously deciding to engage in the behaviour. Parents might unknowingly stimulate their children to sit(2)
Now, since we have insights in not only children but even so how parents perceive sedentary behaviour, it is also important to understand parents.
Since parents are role models of their children it is interesting to find out how parents perceive myopia, what are their attitudes? An interesting study by Hidding et al. (2017) assessed the attitude of parents to myopia and its associated risks. 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. 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 in terms of socio-cognitive skills and healthy lifestyle habits. Furthermore, due to reduced outdoor activity and prolonged near work it will overall influence body posture and possibly overweight (9–11). These modifiable factors are ready for behaviour change as this would call for a different strategy to reduce screentime. For example, school-based interventions to change and implementing a very opposite educational system in which outdoor time/activities are increased as well as physical activity.
Nearly all young myopes progress especially when taking baseline age, parental history, ethnicity, and sedentary behaviour into account. The younger you start treating myopes with myopia management, the more effective the treatment will be.
CREATING PARENTAL AWARENESS CAN’T BE UNDERESTIMATED GIVEN THE IMPACT PARENTS HAVE ON CHILDREN’S LIFESTYLE CHOICES AND BEHAVIOUR.
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.
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 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 the approach to control the myopia epidemic. n
References
1. D himan 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. H idding 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. v an 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. O rganization 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. D uch 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. L aw 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. Z hang 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. M cCrann 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. W ildsoet, 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. C ho P, Tan Q. Myopia and orthokeratology for myopia control. Vol. 102, Clinical and Experimental Optometry. Blackwell Publishing Ltd; 2019. p. 364–77.
13. B ui TH, Cavanagh HD, Robertson DM. Patient compliance during contact lens wear: Perceptions, awareness, and behavior. Eye Contact Lens. 2010;36(6):334–9.
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 topics of health education 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.
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
Can orthokeratology wearers whose corneas have undergone corneal reshaping overnight really go about their daily lives in the same way as those with conservative correction methods such as glasses or conventional contact lenses? Many situations in everyday life involve complex visual tasks and are sometimes extremely demanding. Included is participation in road traffic, which does not allow any loss in refraction or visual acuity. To address this question, it is interesting to look at visual acuity under physiological conditions.
Minimal diurnal changes in the visual acuity of the eye are subject to many factors. Among others, the composition of the tear film, the wettability of the cornea and thus also the renewal 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 epithelial layer of the cornea renews itself within a period of 7 days. Accordingly, minor fluctuations in the cornea can already be observed under physiological conditions. Now the cornea experiences a reshape, which is consciously caused by wearing orthokeratology contact lenses. This can be counted as an additional factor that can lead to changes or fluctuations in visual acuity during the course of the day. Whether this additional change is still bearable or whether the visual system is burdened instead of supported seems to be a question that is often discussed in this context.
An older study from 2003, in which the diurnal fluctuations of visual acuity and the cornea were measured, evaluated and recorded, shows to what extent the fluctuations affect vision. Furthermore, the results of this study were compared with the criteria for the prescription of driving licences. The prescription of the driving licence is strictly regulated and serves in this scientific discussion as a proxy for the testing of orthokeratology for suitability for everyday use.
In Annex 6 (to §§ 12, 48 subsections 4 and 5) of the German Driving Licence Ordinance, the following criteria for passing the eye test (§ 12 subsection 2) are laid down for categories A, A1, B, BE, M, S, L and T:
• The eye test is passed if the central daytime visual acuity with or without visual aids is 0.7 in both eyes.
• An eye test certificate shall be issued in accordance with § 12 Para. 3.
If the eye test is not passed, an ophthalmological examination (§ 12 par. 5) must be carried out. The following minimum requirements must be met here:
• Incorrect vision must be corrected.
• In the case of binocularity, the central visual acuity of the better eye must be at least 0.5 and that of the worse eye at least 0.2.
• 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.
In addition to the presumption that visual acuity after orthokeratology does not meet the minimum requirements for daytime visual acuity, it was further presumed that visual acuity deteriorates during the day, when no contact lenses are worn, to such an extent that this leads to a hazard in road traffic. The aim of the present study was to determine,
• whether the central daytime visual acuity after overnight wearing of orthokeratology contact lenses complies with the criteria of the Driving Licence Ordinance according to § 12 paragraphs 2 and 5.
• whether and, if so, how central daytime visual acuity changes during the day when orthokeratology contact lenses are not worn.
• whether and, if so, how the spherical equivalent changes during the contact lens-free interval.
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 participants at the time of the respective examinations was between 16 and 55 years. The mean age was 34 years with a standard deviation of nine years. The median age distribution was 33 years. The wearing duration of the orthokeratology contact lenses was determined to within half a month at the time of the examination. The minimum wearing time of 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 central daytime visual acuity was measured for all participants, as is usual for the driving licence vision test according to § 12 of the German Driving Licence Ordinance. Standardised visual 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 was determined monocularly for both eyes as well as binocularly. Furthermore, the spherical equivalent (best spherical lens) was determined in the morning and early evening. For this purpose, either refraction measuring glasses or a phoropter were used. The data were statistically evaluated. The deviations of the values of the central daytime visual acuity measured in the morning and in the evening were examined for their significance by means of the Wilcoxon test. Furthermore, the correlations and their significances between the values measured in the morning and in the evening were determined.
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
Driving Licence Ordinance, the data of the right and left eyes were also evaluated separately.
For all 174 eyes, the mean visual acuity in the morning was 1.04 with a standard deviation of 0.15. The median visual acuity was 1.0. In the evening, the mean visual acuity was 1.00 with a standard deviation of 0.20. The median visual acuity was 0.98. For the right eye, the median visual acuity was 0.98. For the right eye, the mean values for central visual acuity in the morning and evening are shown in Table 1. In twelve cases, the morning visual acuity was less than 1.0, but in every case a visual acuity of at least 0.7 was achieved. In 75 cases
(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, during which no orthokeratology contact lenses were worn, 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 in six cases did the visual acuity decrease by a value of more than 0.2. The maximum decrease here was 0.5. For the left eye, the mean values of central daytime visual acuity in the morning and evening were as shown in Table 2. In twelve cases, the visual acuity of the left eye in the 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 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 than 0.2. The maximum decrease was 0.4. The binocular visual acuity was higher than the monocular visual acuity of the left and right eye both in the morning and in the evening (see table 3).
The spherical equivalent of all 174 eyes was +0.13 dpt in the morning, which corresponds to a slight hyperopia. A standard deviation of 0.28 dpt was determined. The median spherical 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 spherical equivalent values for the right and left eyes listed separately. Both tables show that in the morning there was a slight overcorrection of myopia of about one eighth of a diopter 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 dpt and for the left eye a mean deviation of 0.23 ± 0.22 dpt 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 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 in spherical equivalent in the left eye was 0.25 dpt and below.
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
confidence intervals for the values of visual acuity and spherical equivalent from the morning and evening were as shown in Table 6.
For the left eye, the correlation coefficients and confidence intervals for the morning and evening visual acuity and spherical equivalent values were as shown in Table 7. The correlation of the binocular visual acuities from the morning and evening was very high with r = 0.818. The mean deviations of the visual acuities and spherical equivalents were small, but the evaluation of these data with the Wilcoxon test showed that the deviations were all statistically significant (p < 0.001). The z-values for all 174 eyes were as follows.
IN 80% OF ALL CASES THE DIURNAL CHANGE OF THE SPHERICAL EQUIVALENT WAS 0.25 DPT AND BELOW.
IN THE MORNING THERE WAS A SLIGHT OVERCORRECTION OF MYOPIA OF ABOUT ONE EIGHTH OF A DIOPTER.
According to Annex 6 to § 12 of the Driving Licence Ordinance, the vision test obligatory for obtaining a driving licence is deemed to have been passed if a visual acuity of at least 0.7 has been achieved in both eyes. If this is not the case, the driving licence can be obtained after an ophthalmological examination 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 acuity of 0.2 already corresponds to the conditions of a visual 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/ driving5crit.html of 16.8.2005).
European Union directives require a minimum visual acuity of 0.5 for binocularity and 0.6 for monocularity. These values have been widely adopted by the countries of the European Union. The discussion as to whether orthokeratology deteriorates vision to such an extent that safe participation in road traffic is no longer possible should be based on a threshold value of 0.5, the internationally widely accepted threshold value, and not 0.7. The latter is to be regarded merely as a threshold value of a general screening, the aim of which is to make a rough selection based on a compromise between sensitivity and specificity of visual acuity in order to refer an acceptable number of conspicuous findings to further ophthalmological examination. However, due to the low sensitivity of visual acuity, it cannot be assumed that the eye and the visual system are intact even with a visual acuity of 0.7. Cataracts and diseases of the optic nerve are also compatible with a visual acuity of 0.7.
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 spherical equivalents can be rated as high. The fact that the slight diurnal decreases in visual acuity and spherical equivalent are statistically significant results inevitably from the relatively large number of eyes examined (n = 174) and the small number (n1 = 11) of negative deviations in visual acuity, i.e. improvement in visual acuity.
Negative deviations of the spherical equivalent were also observed only in a few cases (n2 = 2). For this reason, the z-values for the significances of the changes in visual acuity and spherical equivalent are close to the maximum possible value of 11.44. Central daytime visual acuity is the visual function with the greatest (legal) significance for road traffic fitness. In no case was a central daytime visual acuity of less than 0.5 found. Only in one case was a visual acuity of 0.5 found, with the partner eye having a visual acuity of 1.0. In this case, too, the test participant meets the requirements set by the European Union for the visual acuity of a road user. Low visual acuity with successful orthokeratology is not a permanent condition. The most likely cause is likely to be an orthokeratology contact lens that has been decentered during the night. 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
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.
day. It can therefore be assumed that the changes in corneal geometry caused overnight are stable in the contact lens-free interval during the day. This is also underlined by the 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 two years showed that after the stabilisation of corneal reshaping, which usually takes only a few weeks, the visual acuities remained permanently far above the required threshold values of 0.5 and 0.7 over the two-year period (Berke and Starfinger, 2004).
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 the German Driving Licence Ordinance, the recommendations
of the European Union. The changes are stable during the contact lens-free interval during the day, so that a deterioration of daytime vision cannot be assumed. n
Literature reference:
Schulze, A., Berke, A.: Diurnal changes in visual acuity and spherical equivalent under consideration of the Driving Licence Regulation 03/2005; 2-6.
Alina Kinder (EurOptom, Master of Science (Klin. Optometry)) is a lecturer at the Professional School for Optometry in Cologne (HFAK). She also works as an examiner on the examiner board of ECOO diploma and optometrist (ZVA/ HWK).
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By Timm UrschingerIf we are talking about Human Resources (HR) 2023, we are also talking about how to develop horizontal structures and autonomous teams. How to open up lines of communication between team members in different departments and how to break down barriers. How to help employees develop their skills and work out how they can best contribute their talents and strengths. And how to use all these techniques to drive innovation and productivity in an organization forward. We should not overlook the fact that in doing so, HR professionals can – indeed probably have to – improve and revitalize some of their key processes, such as performance management, succession planning or recruitment and talent acquisition by taking a more agile approach. This article, however, will focus particularly on the challenge of formulating job descriptions in horizontal systems, combined with agility and taking responsibility for one’s own work. A
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When a position is to be filled in an organization around the world, advertisements contain familiar details such as the formal title of the job, details of the position, a list of responsibilities and duties (usually already outdated by the time of hiring), and the name of the department to which the position reports.
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Often the job description does not accurately reflect what the person is expected to contribute to the company. A Social Media Community Manager, for example, can do more than communicate with people on LinkedIn, Facebook or Twitter. He can also help organize events or design promotional materials. Perhaps the sales department can turn to him or her for ideas on how to acquire new customers; or the communications department may need his or her skills to develop an internal social media platform.
If HR were now to expand the scope of the job description to include what the community manager can actually do, the description may become too wide-ranging or vague, so that it is of little use for performance evaluation or the hiring process. It will probably require a review of the function or salary level and certainly raise additional questions on the administrative side. Worst of all, even if the job description reflects the reality, it will soon become out of date, as projects come to an end or the expertise is needed elsewhere.
The challenge: A job today and in the future may require tasks and responsibilities that a single person cannot fulfill. Thus, the job description will become too idealistic. HR managers therefore have to look for people with skills that match as many of these areas as possible – without assessing what a candidate could contribute on an overall basis, or bring to the company through one particular strength.
Instead of defining job vacancies in terms of rigid positions, recruiters and/or HR managers should post a role description
which includes the title of the role, e.g. Community Coordinator, the purpose of the role, and a list of tasks that fall entirely within the scope of that role and team or group.
Based on the example of the Community Manager, the last task on the list – helping with company-wide events – could be split off into a new role: Event Coordinator.
In this way, the person a company hires to connect with people on social media can also take on tasks such as organizing a major event – or not, as the case may be – depending on their skill set.
One key indicator that roles offer more flexibility and innovative opportunities is that – unlike positions – they do not match 1:1 with team members; which is also the biggest challenge when hiring in such a system.
So what does this look like in practice, if we don't have a clear 1:1 relationship? The employee with the Community Coordinator role does not have to worry about events; they can focus on social media engagement or something else – training, for example. What is critical is that more than one team member is capable of taking on the community coordinator role.
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The process of breaking down rigid hierarchical positions into roles takes time and effort. Drastically changing the structure
of an organization this way makes it more complex, especially when you consider that one person can hold multiple roles; but multiple people can also hold the same role. This gets even more complicated when employees take on new roles or leave them, or when new employees are hired. On the other hand, it is worth the effort of focusing on the transparency and flexibility that these roles provide within the company.
The following three tips will facilitate the transition to rolebased hiring and working:
One way to incorporate roles into the hiring process, without creating too much confusion and complexity for candidates unfamiliar with this type of organization and role-based working, is to identify a number of key roles. These key roles take up the majority of new employees' time when they start their new job, and help to familiarize them with the idea of flexible and agile role-based working. The key roles are similar enough to the positions they might have expected, that they shouldn't cause applicants too many problems, while at the same time affording HR the opportunity to explain how role-based working really works. If the key roles take up about 60-80 % of the new employee´s time, they still have time to take on other roles, as they get to know the structure of the company. During this acclimatization phase, HR – or even better the hiring team – should explain how the roles work, how they may change over time, and how team members can best manage their time to fulfill them. It is also a good idea to share the rolebased organizational chart with new employees. It is likely that looking over the non-key tasks may actually stimulate interest and motivation. After all, we all want to learn and develop further!
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 close they are to a particular pay grade or range.
Organizations should advertise all vacancies that need to be filled. This should not just be on a "once-a-year-for-three-days" basis. If vacancies are posted in Peerdom or Holaspirit (software platforms that provide clarity and transparency at all levels, to help companies on the path to self-organization), additional information should be included such as: how much work on average it is expected this position will involve – or even better, how much work it requires today.
Candidates can then choose to apply for a specific role, perhaps a part-time position with all the benefits this implies both for the employer and the employee. Or candidates can choose to apply for a range of roles, a sort of "role package". This package could then take up 80-100 % of their time and will likely reflect their interests and hopefully their strengths.
The additional complexity is that organizations will have a multitude of role packages and combinations to offer, potentially making it more difficult to decide on a candidate because it could mean tradeoffs regarding other positions and their hiring processes. The major benefit, however, is that candidates who truly embrace a role-based approach to work will come forward, and organizations will genuinely find candidates that others failed to hire because the job descriptions were too inflexible. Thus, companies open themselves up in the labor market to highflyers and people who want to make a career change – with all the benefits that entails.
Role-based working holds an enormous potential to boost a company’s agility. While it is important to focus on defining these internal roles clearly and getting the organizational structure right, one should not forget how HR can apply these practices to hiring and other functions like remuneration – and the challenges associated with these.
Trailblazers already exist that are doing a great job demonstrating how this can work, helping companies solve the challenges of finding the right talent to fill vacant positions. n
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
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