GlobalCONTACT - 03/2023

ISSN:1386 0194

3

2023 (95)

Fitting Background • State of the Art(ificial) • Scleral Lens HOA Correction

Report • Alcon: Investing in the Future • Presbyopia Treatment with Eye Drops?

Sustainability • Interview: Circular Economy Contaflex

Clinical Guide for Scleral Lens Success

Eyepress Fachmedien GmbH Saarner Str. 151 45479 Muelheim a. d. Ruhr Germany

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LETTER FROM THE EDITOR

Navigating the green wave The term sustainability is omnipresent. Almost inflationary. At

Investing in energy efficiency is not only worthwhile in terms

a time when environmental awareness is no longer just a buzzword

of environmental protection: it also pays off in the long run.

but can also be a fundamental aspect of business success, small

Small and medium-sized companies can significantly reduce

and medium-sized companies find themselves at a crossroad:

their carbon footprint through energy-efficient technologies.

What is a matter of course for some, causes others to break out

Even if the initial costs may seem daunting, the long-term

in a sweat – or perhaps even anger – over regulations that seek

savings are definitely worth it.

to influence their own company from the outside.

Working sustainably also involves looking at supply chains.

Yes, whether it is possible to work sustainably certainly varies

Review suppliers' practices and re-evaluate them if necessary.

according to location, company management and, of course, the

The green path is certainly not easy for every company, and it

financial resources available. However, sustainability is not a

is easy to fall into the trap of greenwashing. To avoid this,

luxury, but a necessity, both for all of us and for the long-term

communication must be right. It should be transparent and the

viability of companies. It's not enough to have an environmentally

goals, progress – but also the setbacks – should be clearly

friendly label to start on the road to sustainability; it requires

communicated to the stakeholders. Authenticity creates trust,

real commitment and well thought-out measures.

and customers are increasingly demanding when it comes to green claims. Use platforms such as social media, your website

Before embarking on the road to sustainability, entrepreneurs

or product labeling to keep your audience informed.

should carry out a thorough analysis of their current environmental impact. This includes an assessment of energy

The road to sustainability for small and medium-sized businesses

consumption, waste generation and supply chain practices. On

is both a challenge and an opportunity. Don't just catch the green

this basis, realistic and measurable sustainability targets can

wave – learn to navigate it! And make your business fit and

be set. These targets should be tailored to the size of the company,

attractive for the future. ■

its industry and the resources available.

Once you have arrived here: Integrate it into the corporate

SILKE SAGE

culture. But you will always have old hands saying, "we didn't

Editor-In-Chief

need that in the past", sure, but "the past" is over. Welcome to

silke@global-cl.com

the 21st century. Employees at all levels should understand the importance of sustainability and be encouraged to contribute their own ideas. This cultural change promotes innovation and a collective sense of responsibility.

ONLINE VISIT OUR BRAND NEW WEBSITE WWW.GLOBAL-CL.COM GlobalCONTACT 3-23

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50th

EFCLIN

EUROPEAN FEDERATION OF THE

CONTACT LENS AND IOL INDUSTRIES

CONGRESS EXHIBITION

25TH – 27TH APRIL 2024 VILAMOURA, PORTUGAL

The Algarve in Portugal is one of the most beautiful holiday destinations anywhere. The great infrastructure in Vilamoura makes this combination the perfect congress location.

The 50th EFCLIN Congress & Exhibition takes place there from 25th – 27th April 2024.

For an engaging lecture program, EFCLIN forum and the best trade exhibition in the business, it can’t be beaten. It’s where the Contact Lens & IOL Industry from Europe, the Far East, North America and beyond come together… will you be there?

SAVE THE DATE

www.efclin.com/congress or e-mail us on info@efclin.com

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ENGAGING

MINDS EMPOWERING

SUCCESS

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

20.07.23 14:47 31.10.23 10:47

CONTENT

ISSN:1386 0194

LETTER FROM THE EDITOR 3

Navigating the green wave Silke Sage

3

INTERNATIONAL NEWS

2023 (95)

6

Fitting Background • State of the Art(ificial) • Scleral Lens HOA Correction

All about you

10 All about markets

Report

11 All about products

• Alcon: Investing in the Future • Presbyopia Treatment with Eye Drops?

12 All about research

Sustainability • Interview: Circular Economy Contaflex

FITTING BACKGROUND Clinical Guide for Scleral Lens Success

16 State of the art(ificial) – part 1 Eef van der Worp and Bart van der Linden Eyepress Fachmedien GmbH Saarner Str. 151 45479 Muelheim a. d. Ruhr Germany

20 Vision beyond 20/20: Unraveling the world of scleral lens HOA correction 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: V-Optics, www.v-optics.fr Page 9: K & Y Diamond Ltd, www.kydiamond.ca Page 13: AMETEK Precitech, Inc., www.precitech.com

Page 15: SCHNEIDER GmbH & Co. KG, www.schneider-om.com

By Ariel Cerenzie

HISTORY 24 Early set of scleral lenses Hans-Walter Roth

REPORT 26 Sicht.Kontakte 2023 Hanna Diewald

28 Alcon: Investing in the future Silke Sage

32 Presbyopia treatment with eye drops Lena Petzold

Page 23, 31: OPTOCRAFT GmbH, www.optocraft.com Page 25: REM Vision Technologies SL, www.remvt.com Page 35: Larsen Equipment Design Inc., www.larsenequipment.com Page 43: LAMBDA-X S.A., www.lambda-x.com Inside back cover: Acuity Polymers, Inc, www.acuitypolymers.com Outside back cover: DAC International, Inc., www.dac-intl.com

NAMES TO NOTE Cerenzie, Ariel Larsen, Erik Larsen, Andrew Maak, Alexander Nygren, Daren Petzold, Lena Roth, Hans-Walter van der Linden, Bart van der Worp, Eef Veil, Jennifer GlobalCONTACT 3-23

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20 36 38 44 39 32 24 16 16 40

MANUFACTURING 36 Reader submission Erik Larsen

38 Wait a minute: What are you doing there?

Silke Sage

39 Misupco has new owners Silke Sage

SPECIAL TOPC: SUSTAINABILITY 40 Interview with Jennifer Veil: Contact lens fitters and sustainability Hanna Diewald

40 Interview with Alexander Maak: Circular economy Hanna Diewald

NEWS 48 Yellow Pages 5

24.11.23 14:48

INTERNATIONAL NEWS

All about you Topcon introduces non-mydriatic retinal camera to the European market

the known causes of poorly graded images in its ability to

Topcon Healthcare has announced the

effectively image smaller pupils, from 2.00 mm or larger. A

launch of the NW500 to the European market

12-megapixel sensor delivers excellent quality color fundus

during the 23rd Euretina Congress in

images for clear review and analysis. The instrument contributes

Amsterdam in October. The NW500 is a new

to a streamlined workflow and enhanced patient experience

user-friendly, robotic color fundus camera

by offering the ability to acquire retinal images in a lighted

that provides enhanced image quality in

setting without the need to dilate patients. A variety of

ambient light, even through small pupils. It

connectivity options are available to suit the needs of clinical

offers innovative slit scan illumination and

practices and screening businesses.

a rolling shutter mechanism, which helps to overcome one of

BostonSight licensing partnership with Moorfields Eye Hospital

manufacturing, the partnership between our organizations

BostonSight, a nonprofit healthcare organization that advances

Under the agreement, Moorfields will manufacture and

the treatment of diseased and damaged corneas and dry eye,

distribute BostonSight Scleral lenses in the UK through the

has announced a licensing partnership with Moorfields Eye

NHS (National Health Service). BostonSight and Moorfields

Hospital NHS Foundation Trust in the United Kingdom.

will also collaborate on educational initiatives, for both patients

“This partnership continues our commitment to ensure no one

and doctors, to increase awareness of the benefits of scleral

suffers loss of sight from corneal disease or irregularities and

lenses and the conditions they treat.

brings us one step closer to a world where everyone who needs

“Being able to produce these scleral lenses in-house will give our

a scleral lens can access one,” said Sara Yost, BostonSight’s

optometrists flexibility to effectively manage ocular surface

President and CEO. “Patient care is the cornerstone of

disease and corneal ectasia, to provide comfort and relief to

BostonSight’s mission. With Moorfields’ aligned focus on clinical

patients, and help improve their vision,” said Sarah Canning,

care, scientific research, education, and medical device

head of optometry at Moorfields Eye Hospital.

makes a fantastic match.”

Haag-Streit announces winners of Slit Lamp Imaging Competition 2023 Haag-Streit has announced the winners of its Slit Lamp Imaging

Qu Qu Q

Competition 2023. Pia Emilia Lohri, from Lucerne Cantonal Hospital, Switzerland, was the competition’s overall winner. Her

En Enh En au aut au

image, taken on the BX 900 slit lamp, displays a patient with dislocated intraocular lens. The image was selected for its overall execution. Pia wins a top-of-the-range Nikon Z 6 II plus NIKKOR lenses and will have her work published in a leading ophthalmic

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journal.

With over 350 submissions from 18 countries, including USA,

Yang Zhang, of Beijing Tongren Hospital, China, takes the

UEA, China, India, Mexico, and Australia, as well as representation

runner-up position. His image – of the exudative membrane

all over Europe, the competition once again united ophthalmic

connecting the anterior capsule to the cornea – was praised for

photographers from around the world. Now in its fourth year,

its technical mastery. Yang wins an Apple Watch Ultra for his

the competition also attracted the most image submissions so

great work.

far, making it the most popular round of the contest to date.

Katie Lachut-Yevich from VCU Health System, USA achieved

The competition was judged by a panel of jurors that included

third place. Her image, displaying a Morgagnian cataract,

Marc Curchod, professional photographer, Jesús Conejero,

impressed the jury with its artistry. Katie takes the prize of a

ophthalmologist, and Frank Wenger and Jacqui Kenyon, both

stylish Ona Brixton leather camera bag for her efforts.

of Haag-Streit.

GlobalCONTACT 3-23

24.11.23 11:37

• • • •

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Your You Yo You

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INTERNATIONAL NEWS

CLMA announces retirement of Pam Witham

customer service, financial prowess, and good humor

After 35 years of dedicated service, Pam Witham has retired

over her 35 years of service.

from her position as Administrative Director of the Contact

Dr. Ed Bennett, Executive Director of the GPLI, made

Lens Manufacturers Association (CLMA) on September 1st.

the following remarks which have been echoed by

Pam worked part time for the CLMA/GPLI in the late 1980’s,

many colleagues, “My 35-year tenure with the GPLI

became a full-time staff assistant in 1996, and became

has been shared by one person, Pam Witham. I watched

Administrative Director in 2001. She has provided varied

her transition from the CLMA financial officer to

professional support functions ranging from financial planning

Administrative Director. She handled the annual

and controls, marketing collateral,

meetings, the many onsite board meetings, monthly

press releases, and event coordination

journals, and all communications. Her positive attitude

for the CLMA and the Gas Permeable

and willingness to help and learn new tasks made her Ed Bennett and Pam Witham

Lens Institute (GPLI).

the perfect person for this position. There is not

Pam won the 2023 Thomas E.

enough to be said about what she has meant to the CLMA, the

Anastor GPLI Distinguished Service

GPLI, and to me personally. She is beloved by all she worked with

Award at the Rising Stars Reception

and impacted.”

of the GPLI summit at the Global

Pam has transfered her duties to Beth Anderzhon. Beth has

Specia lt y Lens Sy mposium in

been promoted to Administrative Director supporting both the

January. She was recognized by Dr.

GPLI and CLMA.

Pam Witham

Ed Bennett for her positive attitude,

Source: CLMA

Johnson & Johnson Vision teams up with photographer and author Kate T. Parker

Vision Made Possible will explore personal stories of patients

Johnson & Johnson Vision has announced the launch of Vision

various eye diseases – myopia, presbyopia, cataracts, and

Made Possible, a global effort to raise awareness and ignite

others – to highlight how their life improved with better

conversation about the importance of eye health across all ages

vision and educate others on the importance of comprehensive

and stages of vision. To capture the real-life stories of patients,

eye care.

Johnson & Johnson Vision is collaborating with Kate T. Parker,

Vision Made Possible will share real stories of individuals around

a professional photographer/director and New York Times

the globe captured by Kate T. Parker across a variety of channels,

best-selling author who is known for her modern highly stylized

as well as social content creators who will share their stories

approach to visual art and photography.

through their personal social channels.

around the world and eye care professionals (ECPs) across

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INTERNATIONAL NEWS

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Fifth annual retreat for cornea and contact lens residents

lab training. Thanks to funding by BostonSight and support

BostonSight held their annual FitAcademy Retreat for residents

“We are incredibly grateful for our sponsors, the John W. Henry

at New England College of Optometry (NECO) in Boston on

Family Foundation, NECO, Glaukos Corporation, Contamac,

September 15-16, 2023.

and Tangible Science,” said Dr. Karen G. Carrasquillo, OD, PhD,

This year marks the fifth anniversary of this free event for

FAAO, FSLS, FBCLA, BostonSight’s Senior VP of Clinical and

emerging clinicians in cornea and contact lens residencies and

Professional Affairs and director of the FitAcademy program.

fellowships at schools and colleges of optometry and accredited

“Their support and collaboration allow us to provide scleral lens

fellowship sites throughout the United States and Canada.

education to emerging clinicians and future key opinion leaders,

FitAcademy was held at NECO’s Clinical Training Center,

as the need for specialty lenses continues to grow.”

where residents learned about scleral lens fitting and assessment,

“The educational program of FitAcademy offers our cornea and

how to manage and co-manage a range of corneal and ocular

contact lens residents skills to be life-changing providers for their

surface disorders, including dry eye disease and keratoconus,

future patients,” shares Dr. Jennifer Liao Assistant Professor of

and scleral lens application and removal techniques. In addition

Optometry at NECO and Attending Optometrist at NECO Center

to the educational component, FitAcademy’s intimate setting

for Eye Care. “Not only do residents learn creative techniques in

provides residents a unique opportunity to collaborate with

fitting scleral lenses, they also learn skills to manage patients

fellow residents, strengthening their professional connections

with complex ocular diseases from experts in this specialty. It is

as they begin their careers.

a scleral lens educational program unlike any other.”

This year, 29 cornea and contact lens residents attended in

Learn more about FitAcademy at www.bostonsight.org/

person for the full curriculum, which included a hands-on wet

practitioners/education/fitacademy

Karen Walsh appointed to lead CooperVision Global Professional Affairs

scientific publishing, product support and education outreach,”

Responding to its continued global growth and expanding

& Life Cycle Management, CooperVision. “Working hand-in-hand

partnerships with eye care professionals (ECPs) worldwide,

with their regional Professional Affairs colleagues, Karen’s group

CooperVision has announced the creation of a unified, full

will help CooperVision colleagues and our customers thrive as

scope Global Professional Affairs organization. The group will

the eye care and ocular health sectors evolve.”

be led by Karen Walsh, MCOptom, PGDip, FAAO, FIACLE,

Dr. Walsh is a widely recognized ophthalmic opinion leader.

FBCLA, who has been promoted to Senior Director in

Prior to joining CooperVision in 2021, she built international

conjunction with the development.

acclaim as an educator, researcher, and author at the Centre for

“ECPs are central to patient

Ocular Research and Education (CORE) at the University of

prescribing choices and influential

Waterloo. Following a decade working in clinical contact lens-

advocates whose v iews a nd

focused practice, she also served with Johnson & Johnson Vision

decisions shape the contact lens

as Professional Affairs Manager for the U.K. & Ireland. Dr. Walsh

category. Establishing a singular,

is a Fellow of the American Academy of Optometry, the

ECP-led Global Professional

International Association of Contact Lens Educators, and the

Affairs team will better inform

British Contact Lens Association. She also is a member of the

ou r pr o du c t d e ve l o pm e nt ,

U.K. College of Optometrists and holds a post-graduate diploma

commercialization strategies,

in clinical optometry from City University, London.

from sponsors, students attend FitAcademy for free.

said Simon Seshadri, Senior Vice President, Global Marketing

GlobalCONTACT 3-23

24.11.23 11:37

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INTERNATIONAL NEWS

Mo.Events to manage CLASS Symposium from 2024

future. “I had the pleasure of attending CLASS 2022 in

Contamac has announced that Maureen Trusky of ­Mo.Events LLC

excitement of the presenters, staff, and attendees,” Maureen

will assume management of CLASS (Contact Lenses of the

Trusky, founder of Mo.Events, said. “I am thrilled at the

Americas Specialist Symposium) from 2024.

opportunity to expand the reach and relationships of CLASS.”

CLASS was founded on the pillars of high-quality education

"Our agreement with Mo.Events will allow CLASS to continue

at accessible prices with simultaneous translation in English

to grow in a market with a mutual understanding on the

and Spanish. The first CLASS Symposium was held in Bogota,

importance of education and its role in supporting the

Colombia and attracted more than 1,000 delegates. Since its

development of the sector. Leaving it in the capable hands of

inception in 2018, it has become a widely recognized event,

Maureen and VME, we are excited to see the continued success

not just in the Latin American market, but globally.

of the event!” remarks Carlos Mayoral of Contamac.

Robert McGregor, Managing Director at Contamac Ltd thanks

CLASS workshops took place in Latin America throughout

Carlos Mayoral, Contamac’s Key Account Manager in Latin

2023. An inaugural CLASS USA event will follow in the fall of

America, for his founding vision with CLASS, remarking:

2024 before returning to Latin America in 2025. “This is an

“Carlos recognized the demand for CLASS and has been

excellent opportunity for a new event to be introduced in the

instrumental in its success over the past five years. My thanks

USA, offering COPE-accredited education to optometrists and

go to Carlos for his passion and drive in delivering top-quality

eye care professionals,” comments Rob McGregor. “CLASS

education to the eye care professionals of South America.”

Symposium has been hugely successful in South America, and

With a wealth of first-hand experience and extensive knowledge

I am confident that under the stewardship of Maureen and her

in vision care tradeshows, Maureen Trusky and Mo.Events will

educational partner, it will continue to grow into a leading

bring a multifaceted approach to CLASS Symposium in the

event in the industry calendar!”

Cartegena, and I was immediately struck by the passion and

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CONTACT LENS AND IOL DAC Optoform Moore Nanotech UPL Precitech Nanoform REM Vision

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24.11.23 11.06.19 11:37 10:55

INTERNATIONAL NEWS

All about markets Growth in contact lens market In 2022, the market value of soft contact lenses at industry to eye care professionals level grew by 11.9%, to

€ 1,710 million for the eleven European reported countries, where 6,6% of the population between the ages of

Work related vision impairment

15 and 64 wear soft contact lenses. Growth in total wearers is positive, up 4.76% in 2022 over 2021.

According to Eye Health and the World of Work, Source: Euromcontact

13 million people live with vision impairment linked to their work, with an estimated 3.5 million eye injuries occurring in the workplace every year. This amounts to 1% of all non-fatal occupational injuries.

Source: The International Agency for the Prevention of Blindness

Interest in smart eyewear purchases One-in-three (33%) US-adults say they are likely to consider purchasing smart eyewear products in the next 12 months.

Males, those ages 18-44, those in urban communities, and early adopters of technology are especially likely to consider purchasing smart eyewear products.

Source: The Vision Council

> 90%

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Treatability of vision impairment Over 90% of vision impairment cases are either preventable or treatable through existing, cost-effective interventions

GlobalCONTACT 3-23

21.11.23 15:44

INTERNATIONAL NEWS

All about products TRIOPTICS: Optimizations for IOL production testing OptiSpheric IOL PRO 2 is TRIOPTICS’ fully automated optical IOL test stand. Developed for use in production, it provides a throughput of up to 100 lenses per batch. The ISO-compliant measurement of hydrophobic and hydrophilic lenses in air or in-situ can be performed with an accuracy of 0.3 % (power) for all types of intraocular lenses (incl. EDOF, multifocal and trifocal). With the latest software module, the system can be connected to your database in accordance to FDA 21 CFR PART 11. This allows you to retrieve sample-specific data and measurement scripts from the server as well as to archive your measurement results in conformity with the standards. www.trioptics.com – sales@trioptics.com

CLE-MENTOR: SECONDARY APERTURES plug-in for segmented optics from Lambda-X The Secondary Apertures software plug-in makes it possible to define two independent apertures and to calculate power for respective apertures. The software allows separate definitions of diameter and position for each aperture to measure. It is all compatible with the ability of NIMOevo to measure the lens whatever its position or orientation in the field of view. When measuring a toric lens, positions of the secondary apertures follow the orientation indicated by the marks. This provides great flexibility for labs to analyse lenses with segmented or decentred optics and typically control the base power and the addition of the optic. It can also be fully integrated in a production measurement context. Good news: this plugin can be added to your NIMOevo with CLE-MENTOR – Welcome to contact Lambda-X Ophthalmics for a trial!

Ophthalmics.lambda-x.com – sales-ophthalmics@lambda-x.com – +32 67 79 40 80.

Fast and robust inspection of contact lenses and IOLs

by Optocraft The need to measure the properties of ophthalmic lenses arises not only from the international standard or out of simple curiosity, but also from the desire to improve the lens quality and to enable better vision for the patient. Optocraft offers dedicated turn-key solutions for measurement of refractive data and image quality, in less than a second. Advanced systems are available, adapted to the constraints and needs in daily lens production, offering a temperature controlled, clean open-top cuvette. Surface shape measurement of semi-finished lenses is possible within less than 20 sec. Additional information on tool offset and tool wear can be obtained and used for predictive maintenance. Furthermore, inline measurement modules with flexible hard- and software interfaces can be integrated directly into production lines for a fast identification of faulty lenses.

We’re looking forward to hearing from you! www.optocraft.de/en/shsophthalmic – sales@optocraft.de

V-OPTICS unveils VO-Scancore Viewer for lens cosmetic inspection For optical manufacturing, V-OPTICS introduces VO-Scancore Viewer, a new software functionality integrated into their QualiLENS instruments for enhanced lens assessment. Based on phase-shifting deflectometry, the advanced optical system produces accurate processed maps, highlighting most surface and material defects. The Viewer mode displays Amplitude and Raw maps side by side on the screen, enabling operators to visualize the most minute defects in the blink of an eye. Field results show a dramatic improvement in the consistency of inspection in comparison to traditional visual control. VO-Scancore Viewer acts as a bridge, facilitating the transition from manual to automated defect detection, the next level of cosmetic inspection. www.v-optics.fr

GlobalCONTACT 3-23

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INTERNATIONAL NEWS

All about research

Aging of the eye, closed-eye perception of brightness, VR game for ADHD detection Research from the University of California, Irvine, suggests aging is an important component of retinal ganglion cell death in glaucoma. Osaka Metropolitan University scientist finds closed-eye perception of brightness significantly stronger than previously reported. Tracking of eye movement while playing a virtual reality game

O

offers an objective assessment of attention deficit disorders and may lead to an improved therapeutic approach.

By Rebekka Nurkanovic

Repeated stress accelerates aging of the eye

transcriptional changes similar to natural aging. And, how in

Research from the University of California, Irvine, suggests

young retinal tissue, repetitive stress induces features of

aging is an important component of retinal ganglion cell death

accelerated aging including the accelerated epigenetic age.

in glaucoma, and that novel pathways can be targeted when

Aging in the eye is a major risk factor for a group of neuropathies

designing new treatments for glaucoma patients.

called glaucoma. Because of the increase in aging populations

The study, titled, “Stress induced aging in mouse eye,” was

worldwide, current estimates show that the number of people

published in 2022 in Aging Cell. Along with her colleagues,

with glaucoma (aged 40-80) will increase to over 110 million

Dorota Skowronska‐Krawczyk, PhD, assistant professor in the

in 2040.

Departments of Physiology & Biophysics and Ophthalmology

In humans, IOP has a circadian rhythm. In healthy individuals,

and the faculty of the Center for Translational Vision Research

it oscillates typically in the 12-21 mmHg range and tends to be

at the UCI School of Medicine, describes the transcriptional

highest in approximately two thirds of individuals during the

and epigenetic changes happening in aging retina. The team

nocturnal period. Due to IOP f luctuations, a single IOP

shows how stress, such as intraocular pressure (IOP) elevation

measurement is often insufficient to characterize the real

in the eye, causes retinal tissue to undergo epigenetic and

pathology and risk of disease progression in glaucoma patients.

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▪I m

▪E c

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21.11.23 15:47

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INTERNATIONAL NEWS

Long-term IOP fluctuation has been reported to be a strong predictor for glaucoma progression. This new study suggests that the cumulative impact of the fluctuations of IOP is directly responsible for the aging of the tissue.

“Our work shows that even moderate hydrostatic IOP elevation results in retinal ganglion cell loss and corresponding visual defects when performed on aged animals,” said SkowronskaKrawczyk. “We are continuing to work to understand the mechanism of accumulative changes in aging in order to find potential targets for therapeutics. We are also testing different approaches to prevent the accelerated aging process resulting from stress.”

Researchers now have a new tool to estimate the impact of stress and treatment on the aging status of retinal tissue, which has made these new discoveries possible. In collaboration with the Clock Foundation and Steve Horvath, PhD, from Altos Labs, who pioneered the development of epigenetic clocks that can measure age based on methylation changes in the DNA of tissues, it was possible for researchers to show that repetitive, mild IOP elevation can accelerate epigenetic age of the tissues.

When the UCI-led team investigated the optic nerve head of eyes treated with mild pressure elevation, they noted that in the young optic nerve head, there was no sign of loss of axons.

However, in the optic nerves of old animals, significant sectorial loss of axons was observed similar to the phenotype commonly observed in glaucoma patients. Image: UCI School of Medicine

DOI. 10.1111/acel.13737 Source: University of California - Irvine

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21.11.23 20.03.23 15:47 12:46

INTERNATIONAL NEWS

An Osaka Metropolitan University scientist conducted experiments on 33 participants under relatively bright conditions (illuminance of 100 lux) in which each participant’s entire face was illuminated. A lighting device was used to increase or decrease facial illuminance, and closed-eye light transmittance was measured by having the participants make adjustments to match the levels of brightness they perceived with their eyes closed and with their eyes open. Picture: Hideki Sakai, Osaka Metropolitan University

Casting light on, and through, your eyelids

of brightness they perceived with their eyes closed and with

Sleep deprivation and sleep disorders are detrimental to health

their eyes open. Monochromatic red, yellow, green, and blue

and interfere with daily life. Studies have shown that changes

LEDs and a white LED were used as light sources.

in light exposure during the daytime and nighttime or during

The experiment results show that eyelid transmittance values

sleep influence circadian rhythms and sleep quality.

were up to ten times higher than those (i.e., 0.3%–14.5%) reported

Given that the eyes are closed while sleeping, understanding

in the past. The color of the light also made a difference, with

the light transmittance of the eyelids and perceived closed-eye

red light perceived as brighter and blue light perceived as darker.

brightness is essential to properly describe the lighting

Additionally, Professor Sakai noted significant differences

environment during sleep. Although several studies have been

between individual participants; for some, their perception of

carried out to measure eyelid transmittance, experimental

brightness remained almost unchanged between the open- and

conditions differed significantly from lighting environments

closed-eye conditions.

in daily life: evaluations were conducted under extremely low

“By properly understanding and utilizing the lighting

illuminance, for example, or with only one eye.

environment when the eyes are closed, I hope to advance research

Professor Hideki Sakai, from the Graduate School of Human Life

on appropriate lighting not only during normal sleep but also

and Ecology at Osaka Metropolitan University, applied a new

in various other situations, such as during naps or riding late-

method to measure the light transmittance of the eyelids when

night transportation,” stated Professor Sakai. “Since light colors

the eyes are shut. His results indicate that closed-eye perception

with low transmittance are perceived as dark only when people

of brightness is remarkably stronger than previously reported.

close their eyes, I think that this finding could be useful for

Professor Sakai conducted experiments on a total of 33

designing lighting in spaces with both awake and sleeping

participants under relatively bright conditions (illuminance of

people, such as evacuation centers.” The findings were published

100 lux) in which each participant’s entire face was illuminated.

in the journal Color Research and Application.

A lighting device was used to increase or decrease facial illuminance, and closed-eye light transmittance was measured

DOI 10.1002/col.22832

by having the participants make adjustments to match the levels

Source: Osaka Metropolitan University

Virtual reality game to objectively detect ADHD

children manage everyday situations. A team consisting of

Researchers have used virtual reality games, eye tracking and

researchers from Aalto University, the University of Helsinki,

machine learning to show that differences in eye movements

and Åbo Akademi University developed a virtual reality game

can be used to detect ADHD, potentially providing a tool for

called EPELI that can be used to assess ADHD symptoms in

more precise diagnosis of attention deficits. Their approach

children by simulating situations from everyday life.

W

could also be used as the basis for an ADHD therapy, and with

Now, the team tracked the eye movements of children in a

some modifications, to assess other conditions, such as autism.

virtual reality game and used machine learning to look for

T s

ADHD is a common attention disorder that affects around six

differences in children with ADHD. The study involved 37

percent of the world's children. Despite decades of searching for

children diagnosed with ADHD and 36 children in a control

objective markers, ADHD diagnosis is still based on questionnaires,

group. The children played EPELI and a second game, Shoot

interviews, and subjective observation. The results can be

the Target, in which the player is instructed to locate objects

ambiguous, and standard behavioral tests don’t reveal how

in the environment and “shoot” them by looking at them.

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“We tracked children's natural eye movements as they performed different tasks in a virtual reality game, and this proved to be an effective way of detecting ADHD symptoms. The ADHD children's gaze paused longer on different objects in the environment, and their gaze jumped faster and more often from one spot to another. This might indicate a delay in visual system development and poorer information processing than other children,” said Liya Merzon, a doctoral researcher at Aalto University.

Project lead Juha Salmitaival, an Academy Research Fellow at Aalto, conceived EPELI together with Professor Matti Laine

The player’s view. Picture: Peili Vision Oy.

from Åbo Akademi University and Erik Seesjärvi, a doctoral researcher at the University of Helsinki and clinical

Efficiency correlates with everyday functioning, whereas

neuropsychologist at Helsinki University Hospital (HUH). The

children with ADHD often have challenges,” says Siro.

game is available to neuropsychologists working in pediatric

The researchers envision broader therapeutic applications for

neurology and pediatric psychiatry at HUH.

virtual reality games. Beyond assessing symptoms, gaming

EPELI game development was led by Topi Siro, an Aalto alum

could also be used as an aid to ADHD rehabilitation. The team

who now works at Peili Vision Oy. ”The game provides a list

is exploring rehabilitation possibilities in a project with

of tasks that simulate everyday life, such as brushing your teeth

researchers at the University of Oulu.

and eating a banana. The player has to remember the tasks

The research was published in the journal Scientific Reports.

despite distractions in the environment, such as a TV being on. The game measures everything: how much the child clicks

DOI 10.1038/s41598-022-24552-4

on the controls and how efficiently they perform the tasks.

Source: Aalto University Advertisement

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FITTING BACKGROUND

State of the Art(ificial) Part 1: Understanding rigid contact lens design & fitting Artificial intelligence (AI) is getting a lot of attention lately, almost to the point of becoming a fashion statement: everybody is into artificial intelligence, it seems. A recent article by Hood et al in Optometry & Vision Science – one of our leading journals in the profession –shows that big data and AI will become important within the field of eyecare too. This article looked at using optical coherence tomography (OCT) images of the retina to create a reference database for glaucoma detection. In short, if you create databases with images of thousands of healthy eyes, it is not too difficult to see what is normal and what is not. The same has been successfully applied to detect diabetic retinopathy and ocular hypertension. It seems that (objective) technology can be better than (subjective) human beings at detecting anomalies. By Eef van der Worp & Bart van der Linden

How about our contact lens industry? Guess what: we are very

METRICS

much underway in the same direction, maybe without always

First off: the metric system is gaining territory in optics &

realising it. Look at myopia management (comparing a myopic

optometry. This is happening now too in myopia management,

kid’s eyes to a database of age-matched controls) or at

arguably the hottest topic of the moment. Eye measurements

keratoconus detection (the indices marked in ‘red’ or ‘green’

for myopia management are expressed in millimeters of axial

on the corneal topography map indicate whether a cornea is

length, which is supposedly a much more important parameter

abnormal or not). But it’s not just in detection; in fitting contact

than dioptric values and refractive error. For example, the

lenses, large databases can also be used to predict outcomes.

normal eye is defined as 23.5 mm, whereas the abnormal eye

Maybe not always to allow ‘self-learning’ yet – but that would

is ‘simply’ expressed as any eye over 26.0 mm of axial length,

be the logical next step. Let’s see where we are right now in our

with increased risk of myopic retinopathy. Progression of

industry: a state of the art(ificial) with regard to contact lens

myopia is measured in 0,1 mm steps (for some age groups,

fitting. In this first part (of two), we focus on rigid corneal

0,1 mm is considered ‘normal’ progression). However, it may

lenses and ortho-k.

be better to express these measurements in microns if they are

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FITTING BACKGROUND

less than 0,1 mm. Changes in axial length, for instance, of 50

be detected using t he fantastic cornea l topography

microns or 80 microns, etc, resonate better (especially with

technology that so many of us have within reach. If we plot

parents) compared to 0,05 mm or 0,08 mm. This is certainly

a healthy cornea over an area of a 9 mm chord (4.5 mm

the case with corneal, ortho-k and scleral lens parameters, as

from the centre, which would be roughly the area where a

the differences can be even smaller and more subtle. Contact

corneal rigid lens would land), then we see the following

lens trial sets increasingly use elevation data in microns (as

interesting results (Hickson-Curran et al, Optometry &

opposed to millimeters of curvature), certainly in the soft and

Vision Science 2014): The elevation of the ‘standard eye’ is

scleral lens arena.

determined by taking the average (and distribution) of the

So, what is a micron again? Most of us in Europe are familiar

base curve and eccentricity.

w it h k i lomet re s: t he h ig he st pe a k i n Au st r ia (t he

To define ‘a standard eye’ over a 9 mm, we can take the average

Großglockner), for instance, is 3,798 kilometres high, or

value of 1445 microns, and then take one standard deviation

3798 meters. If an adult would take one standard ‘step’ while

on each side; this would represent the 68% of corneas that are

wa l k i ng , t h is wou ld repre sent 0,74 meters (a s per

most prominent in the normal population – in other words,

standardization under Agrippa). So, four steps would be

the bulk of the eyes in a normal practice.

3,048 meters. In the metric system, the ‘step’ from meter to

These eyes would range in sagittal height (OC-SAG) from 1337

millimetre is the same as from kilometre to meter (a step of

and 1454 microns over the given chord (see figure 1). Hence,

1/1000). A typical scleral lens may have a height of 3,776

the difference is 115 microns: a narrow range, in fact.

millimetres – or 3776 micrometres (or microns), which is

Calculations with a Menicon Genius rigid corneal lens design

another 1/1000 step. For small increments, like many in our

(a lens with a spherical optical zone and an aspherical periphery)

contact lens industry, this is absolutely the unit to use. To

indicated that a base curve of 7,55 mm to 8,10 mm would suffice

put things in perspective, for instance, the human tear film

to fit all of these eyes (68% of all eyes). Interestingly, for the

(without contact lens) is thought to be anywhere between

next category, the following 27% of eyes (or two standard

2-5 microns thick (which would be inconveniently 0,002-0,005

deviations) range from 1286–1519 microns – a difference of

if put in millimetres). In comparison, the corneal epithelial

233 microns. This would be equal to using base curves from

layer is 50 microns thick, but subtle changes applied to the

7,25 to 8,40 mm. Let’s call these the ‘out-of-standard’ eyes. The

epithelium by ortho-k would be, for instance, between 0- to

next category would be ‘the outliers’: three standard deviations

20-micron. A soft lens on that ocular surface is typically

and the remaining 4% of eyes in a normal population. Corneas

invasive, by the way, and would be around 80-120 microns

in this category range from 1239–1593 microns, a 354-micron

(compared to a small tear film of only 2-5 microns). The

difference, in OC-SAG over the 9 mm chord, and for these eyes

post-lens tear film in soft lens wear would be extremely

your trial set would need to include base curves from 7,00 to

small (maybe 1-2 microns).

8,70 mm.

WORKBENCH

RIGID CORNEAL LENSES & ORTHO-K

To understand the use of large databases and corneal

Next, what elevation difference on the ocular surface would

detection in contact lens fitting, let’s shift our attention to

justify a toric back-surface design rather than a standard

measuring the ocular surface using microns. Because here

(spherical or aspherical) back-surface design? Studies at Pacific

too, subtle differences in elevation in the ‘y-direction’ can

University presented at the Global Specialty Lens Symposium

standard eyes ‘challenging eyes’

outliers

68% population Elevation range: 1337 – 1452 µm Δ 115 µm 27% population Elevation range: 1286 – 1519 µm Δ 233 µm 4% population Elevation range: 1239 – 1593 µm Δ 354 µm

Fig 1: ‘Bell-curve’ of normal eyes, broken up into different segments (68% of this population has standard eyes, 27% ‘challenging eyes’ and the remaining 4% are outliers. Elevation difference in each category (with range) plotted in microns.

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Fig 2: Height difference in microns (x-axis) between the flattest and steepest meridian of ordered ortho-k lenses (percentage on y-axis, in %) n=125.000.

have revealed that if there is more than 30 microns of elevation

However, only roughly one in three eyes with an elevation

difference on the ocular surface, then some sort of back-surface

differential between 201-400 microns could be fit in corneal

adjustments should be required (e.g., toric or more complex

lenses. They concluded that eyes with under 200 microns of

shapes) for both corneal rigid lenses and orthokeratology

elevation difference can confidently be fitted with corneal

(ortho-k) lenses. Work by Menicon in the Netherlands, based

lenses, while eyes with over 400 microns of elevation difference

on a database of 125.000 ortho-k lenses, seems to support this

may require scleral lenses due to the increased corneal

data: the popularity of toric lens designs starts to become

irregularity.

‘mainstream’ pretty much at 30-40 microns of height difference

How about when to ‘go toric’ with scleral lenses? That is still

between the flattest and the steepest meridian of ordered ortho-k

a debate in our industry and within our profession. One

lenses (see figure 2).

would guess that for scleral lenses, the height differential values are much larger, as these differences can be greater

SCLERAL LENSES

on the scleral portion of the ocular surface. Based on

Next is to decide when to use a ‘scleral’ rather than a rigid

historical data, this indeed has been suggested (DeNaeyer

corneal lens when the irregularities on the ocular surface are

et al. 2017) to maybe be in the 300-micron range of elevation

larger in scale. Another study at Pacific University by Randy

difference (on a 16-mm concentric circle around the apex).

Kojima et al. (2023) showed that 96% of eyes with 0-100 microns

However, recent data presented at a Menicon inspiration

of elevation difference and 94% of eyes with 101-200 microns

event in Amersfoort in the Netherlands showed that 70% of

of elevation difference were successfully fit with corneal lenses.

ordered scleral lenses have relatively small height differences

Fig 3: Height difference in microns (x-axis) between the flattest and steepest meridian of ordered scleral lenses with a diameter of 16.0mm (percentage on y-axis, in %) n=90.000.

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FITTING BACKGROUND

between the steepest and f lattest meridian of only 80-100 microns (see figure 3). And some of the scleral lenses manufactured show height differences of only 40-60 microns.

Interestingly, and maybe not surprising given the previous

"blanching"

information, 97% of sclera l lenses produced by t his manufacturer are toric.

We are increasingly in control over the (scleral) lens fit. The scleral landing zone pressure can now be calculated quite precisely, including where the scleral lens lands in the periphery and how much pressure this would generate. For instance, a standard scleral lens with a standard peripheral shape (a landing zone angle in this example) would exert 100% pressure just outside the limbus. By changing the landing zone angle slightly, the pressure distribution is altered by small amounts, e.g., the peak in the pressure distribution of 105% would add eight microns of conjunctival compression (for a flat fit, see figure 4), and a peak of 115% would be an increase of 23 microns of conjunctival compression (for a steep fit). We can ‘play’ with this regarding scleral lens fit and therefore influence the amount of scleral blanching.

If you take into account that standard conjunctival capillaries are about 10-20 microns in diameter, and a human red blood cell is about eight microns in size – one can imagine that ‘increasing’ the pressure on the vessels by a little over ten microns may physically limit the circulation of red blood cells in the given capillaries, causing blanching of the area and showing a nice visualisation of the interaction between the lens and eye.

Fig 4: Conjunctival blanching in the scleral lens landing zone (photo: Henny Otten; Visser Contactlenzen, Nijmegen, the Netherlands).

References 1 Hood DC, Durbin M, Lee C, Gomide G, La Bruna S, Chaglasian M, Tsamis E. Toward a Real-world Optical Coherence Tomography Reference Database: Optometric Practices as a Source of Healthy Eyes. Optom Vis Sci. 2023 Aug 1;100(8):499-506. doi: 10.1097/ OPX.0000000000002049. Epub 2023 Jul 27. PMID: 37499165.

2 Hickson-Curran et al. Comparative evaluation of Asian and white ocular topography.

Optom Vis Sci. 2014 Dec;91(12):1396-405. doi: 10.1097/OPX.0000000000000413.

PMID: 25325762.

3 Turpin et al. When is a Toric Orthokeratology Lens Design Indicated? Poster Global Specialty Lens Symposium 2018, Las Vegas (USA).

4 Kojima et al. How Often Should We Prescribe Toric Orthokeratology Lenses? Poster Global Specialty Lens Symposium 2021, Las Vegas (USA).

5 Kojima et al. To Corneal GP or not to Corneal GP, that is the Question? Poster Global Specialty Lens Symposium 2023, Las Vegas (USA).

6 DeNaeyer et al. Qualitative Assessment of Scleral Shape Patterns Using a New Wide Field Ocular Surface Elevation Topographer - The SSSG Study.Journal of Contact Lens Research and Science. Nov 2017. https://doi.org/10.22374/jclrs.v1i1.11.

CLOSING REMARKS In some parts of the world, and the Netherlands is one of them, topography-based fitting has become the standard for rigid lenses. Most corneal lens fits are topography-based. This means that either eye care practitioners use corneal topography with applied software to design a lens themselves, or (more commonly) they upload the topography to the manufacturer and ‘the perfect’ lens is designed – again using thousands of corneas in their databases as references. This is certainly the case for ortho-k lens fits: almost all ortho-k lenses in the Netherlands are ‘topography-based’, and trial-sets are hardly used. Scleral lenses,

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.

assuming that correct anterior ocular surface shape data is available over a sufficient area, could go the same route.

In the next part of this two-part article, we shall focus on what all this means in terms of soft lens fitting. Can we use the basedatabase there too? Is there room for custom-made soft lenses?

Or is the soft lens modality moving more into a ‘one-size-fits-all’ direction? And what are the soft lens options for the irregular cornea?

ACKNOWLEDGEMENTS Special thanks to Randy Kojima for his contributions to elevation data usage in this article. n

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Bart van der Linden, MSc PhD, is Managing Director / CEO of Menicon, the Netherlands (NL). He received his PhD in Biomechanical Engineering at the University of Twente (NL).

Bart started his career at Menicon (formerly known as NKL) 25 years ago as product and process engineer for the development of made to order contact lenses and the process of manufacturing and the software supported fitting of lenses. He has developed several GP, made-to-order (MTO) soft, and scleral lens designs or under his management, creating a full portfolio of MTO lenses for the Menicon group globally. Since 2012 he is (technical) managing director.

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“20/Unhappy” Vision beyond 20/20: Unraveling the world of scleral lens HOA correction “Which is better, one or two?” asks the doctor, to which the patient responds with “Neither.” This encounter may sound familiar to many eye care practitioners, particularly when refracting patients with irregular corneas. Fortunately, scleral lenses have revolutionized vision correction for these patients. The fluid reservoir that rests beneath the scleral lens and above the cornea masks most optical distortions caused by irregularities of the anterior corneal profile, which is particularly helpful in patients with conditions like keratoconus, pellucid marginal degeneration, post-penetrating keratoplasty, and other irregular corneal conditions (1). After a scleral lens is fit appropriately, the lens offers a stable platform for the addition of sphero-cylindrical optics. Despite these characteristics, patients wearing scleral lenses may still be “20/Unhappy”, and aberrations are likely to blame. Fortunately, technology advancements allow for the accessibility of state-of-the-art optical correction with higher-order aberration (HOA) correction in scleral lenses. By Ariel Cerenzie

UNDERSTANDING ABERRATIONS

describes a specific aberration, like astigmatism or spherical

In a perfect optical system, light will refract to a precise point;

aberration (4). Root mean square (RMS) is a mathematical measure

however, even in eyes with seemingly “perfect”, emmetropic

used to quantify the overall magnitude of these aberrations,

vision, there is some variation from this precise point. These

calculated from the coefficients of the Zernike polynomials (4).

variations are defined as aberrations

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20_HOA.indd 20

(2,3)

.

The RMS value is typically expressed in micrometers (µm) and

In order to quantify these deviations, aberrations can be broken

helps the practitioner to better understand the optical quality

down by type and severity through Zernicke polynomials and

of the eye. A lower RMS value indicates fewer aberrations and

Root mean square calculations (RMS). Each Zernike polynomial

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FITTING BACKGROUND

distortions that result from variations in the shape of the cornea, lens, and other optical components of the eye. Symptoms of HOAs include reduced contrast sensitivity, glare and haloes, difficulty with night vision, visual distortion, and/or reduced visual acuity despite optimal sphero-cylindrical correction (5).

NECESSARY STEPS BEFORE ADDRESSING HOAS Start with Full LOA correction: Before addressing HOAs, it is essential to ensure that the patient’s vision is optimally corrected in the scleral contact lens. Achieving accurate and stable spherico-cylindrical corrections forms the foundation for managing HOAs. Avoid inducing HOAs: Due to the shape of the sclera, scleral lenses typically decenter inferior-temporal (7). Decentration of scleral lens optics can induce or exacerbate HOAs, particularly coma (6). Customizing the edge profiles (haptics) of scleral lenses and ensuring proper central and limbal tear clearance can help optimize the centration of scleral lenses (8).

QUANTIFYING HOAS Patient feedback: Subjective feedback from patients can provide insight on the visual impacts of HOAs (9). Do the letters seem to be smeared on the chart? Are you seeing shadows? At night, do you experience haloes or glare? In some instances, it may be helpful for patients to demonstrate their vision experience through illustrations or drawings.

Aberrometer: Aberrometers are instruments that analyze the wavefront of light as it passes through the eye. By measuring aberrations and potentially poorer vision quality (see figure 1).

the wavefront distortions, an aberrometer can provide a detailed

Aberrations of the eye can be broadly categorized into two

map of both LOAs and HOAs present in the patient's visual

groups – lower order aberrations and higher order aberrations.

system. This data is valuable for creating custom HOA correction

Lower order aberrations (LOA): LOAs such as defocus and

in scleral lenses (10).

astigmatism are correctable with traditional glasses and contact lenses through sphero-cylindrical correction. Typically, in

INCORPORATING HOAS INTO A SCLERAL LENS

patients without corneal disease, sphero-cylindrical correction

There are several approaches to correcting HOAs in patients

is sufficient in providing clear and precise vision (5).

wearing scleral lenses:

Higher order aberrations (HOAs): HOAs are optical

Front surface eccentricity (FSE): FSE refers to altering the

imperfections that extend beyond lower order aberrations.

anterior curvature of the scleral lens to compensate for HOAs.

Clinically applicable HOAs include coma, trefoil, and spherical

FSE helps reduce common aberrations, such as coma and

aberration. HOAs are characterized by complex wavefront

spherical aberrations, the HOA most commonly observed in

Fig. 1: (1a) An eye with uncorrected best-corrected visual acuity of 20/15 and plano refractive error. Despite the patient’s emmetropic status, both lower and higher order aberrations exist. (2a) An eye with uncorrected acuity of counting fingers at two feet with a refractive error of -4.75-11.75 x 108.

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FITTING BACKGROUND

aberrometry is performed to assess for residual HOAs with lens wear. These HOAs can then be added into the scleral lens to provide the patient with the most customized vision solution (13).

Scleral lenses have transformed the lives of individuals with irregular corneas. Now with the accessibility of HOA correction, patients’ troublesome symptoms related to HOAs can be improved with FSE technology or neutralized with custom HOA correction. By embracing this technology, the journey from "20/Unhappy" to “20/Happy” is now within reach. n Fig. 2a: Aberrometry readings of a cornea post-penetrating keratoplasty. The irregular cornea results in high levels of HOAs (0.869 um).

Fig. 2b: The patient from figure 2 with a well-fit scleral lens over the irregular cornea. The smooth optical surface of the scleral lens, as well as the fluid between the back surface of the lens and cornea, result in a significant reduction in HOAs (0.379 um).

Fig. 2c: The patient from figure 2 was refit from the lens in figure 2b to BostonSight Scleral contact lens with FSE 1. Most notably, the patient’s spherical aberrations were reduced from 0.119 um to 0.032 um

References Scleral contact lenses and vision correction for irregular corneas: 1. Brown, A., & Johnson, L. (2020). "Scleral Contact Lenses for Irregular Corneas." Eye Care Journal, 55(3), 211-225.

2. Johnson, M., & Davis, R. (2018). "Optical Aberrations in Emmetropic Eyes." Optics and Vision Journal, 32(4), 421-435.

3. Thibos LN, Hong X, Bradley A, Cheng X. Statistical variation of aberration structure and image quality in a normal population of healthy eyes. Journal of the Optical Society of America A. 2002;19(12):2329-2348.

4. Williams, P., & Wilson, S. (2017). "Quantifying Aberrations Using RMS and Zernike Polynomials." Optics Express, 25(8), 789-802.

5. Anderson, K., & White, L. (2019). "Higher Order Aberrations in Clinical Practice."

Ophthalmic Practice Journal, 41(6), 545-561.

6. Kowalski, Louise P., Michael J. Collins, and Stephen J. Vincent. "Scleral lens centration: The influence of centre thickness, scleral topography, and apical clearance." Contact Lens and Anterior Eye 43.6 (2020): 562-567.

7. Hall, L. A., Hunt, C., Young, G., & Wolffsohn, J. (2013). Factors affecting corneoscleral topography. Investigative ophthalmology & visual science, 54(5), 3691-3701.

8. Barnett, M., Carrasquillo, K. G., & Schornack, M. M. (2020). Clinical outcomes of scleral lens fitting with a data-driven, quadrant-specific design: Multicenter review. Optometry and Vision Science, 97(9), 761-765.

9. Miller, S., & Jackson, R. (2020). "Patient Feedback in Evaluating HOAs." Clinical Optometry Journal, 12(3), 213-225.

10. Roberts, M., & Smith, D. (2019). "Aberrometry and Its Applications in Vision Correction."

Journal of Optometric Technology, 48(2), 112-128.

11. Taylor, R., & Hall, A. (2018). "Front Surface Eccentricity for HOA Correction in Scleral Lenses." Contact Lens Research Journal, 37(4), 321-335.

12. Hussoin, T., Le, H. G., Carrasquillo, K. G., Johns, L., Rosenthal, P., & Jacobs, D. S. (2012). The effect of optic asphericity on visual rehabilitation of corneal ectasia with a prosthetic device. Eye & Contact Lens, 38(5), 300-305.

13. Garcia, M., & Martinez, E. (2021). "Custom HOA Correction in Advanced Scleral Lenses." Optometric Science Journal, 58(7), 621-635.

patients with keratoconus (11,12). A great advantage of utilizing FSE technology is accessibility, such as BostonSight Scleral’s SmartSight FSE. Practitioners utilize the scleral lens fit set which has varying levels of eccentricity, over-refract over the selected lens, and then assess the patient’s subjective vision experience with the over-refraction (see figure 2c).

Custom HOA correction: In advanced scleral lens designs, aberrometry data can be utilized and translated into custom HOA optics. This method requires a precise fitting process of the scleral lens to ensure stabilization and centration. Following a proper fit, a lens with markings may be dispensed, and 22

20_HOA.indd 22

Dr. Ariel Cerenzie started the Charlotte Contact Lens Institute to focus on specialty lens care after witnessing the profound impact specialty contact lenses have on improving the current and future lives of patients. She is a fellow of the American Academy of Optometry and the Scleral Lens Education Society and is a member of the American Academy of Orthokeratology and Myopia Control.

GlobalCONTACT 3-23

22.11.23 10:29

PR-Advert

If you can’t spot it, you can’t fix it A metrologist’s view on contact lens manufacturing “Know your quality” shows where you stand when it comes to producing lenses at consistent standard. This is not only true when the level of manufacturing quality is already high but significantly more important when not.

Optocraft has been developing and manufacturing metrology solutions for optics spanning a wide variety of markets and applications: From high-precision immersion objective lenses for microscopy, over laser systems for eye surgery to optical instruments that are sent into space on a satellite to improve our global understanding of weather and climate. And of course, for the measurement of the quality of contact and intra ocular lenses

its own, where a dedicated but still easily adaptable software is

to enable a better vision for the patient in all circumstances.

needed, that also guides the operator and facilitates measurement procedures for the different lens types. Additionally, process

From a metrology perspective, the contact lens market is quite

automation plays an increasingly important role, and the need

diverse. Measurement equipment has to deal with a wide variety

for inline metrology solutions that can be flexibly interfaced and

of lenses: classic RGPs, sclerals, soft spheric, toric or multifocal

integrated into the production line.

lenses as well as smart lenses. With the multitude of different designs, a considerable number of parameters have to be taken

Traditional metrology like classical lensmetres and shadow-

into consideration: material, refractive power, geometry, etc. And

graphs can no longer cope with this ever-expanding list of

especially when it comes to soft contact lenses, a well-controlled

requirements. Hence, the need for advanced metrology

measurement environment is needed. As a result, special demands

systems. With more than 20 years of experience in wavefront

are placed on the capabilities of the metrology solution chosen.

metrology, Optocraft’s team continues to passionately develop new multifunctional and simple to operate instruments for

Depending on the size and the structure of the lens manufacturing

the ophthalmic lens market.

company, quality control processes are set up and implemented quite differently, again imposing different requirements on the

We’re looking forward to hearing from you! Let’s put our

metrology hard- and software. Documentation is a big topic on

heads together. n

“For several years, we use SHSOphthalmic instruments in production and development of contact lenses. Functional range and quality of the instruments, but also the excellent and obliged support are of very high value for us in the daily business.”

Hecht Contactlinsen GmbH GlobalCONTACT 3-23

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15.11.23 08:17

HISTORY

WITHOUT THESE SCLERAL LENSES, THEIR WEARER WAS CONSIDERED AS BLIND.

Early set of scleral lenses Roth Collection series Contact lenses have been known as a valuable visual aid and eye bandage since the end of the century before last. Especially in the case of high refractive errors and pathological corneal topography, they are superior to spectacles, and in many cases they even have advantages over refractive corneal surgery or implants. Today, they are also used as a transparent bandage and medication carrier in the treatment of severe corneal diseases such as keratoconus, after corneal injuries, burns or chemical burns. By Hans-Walter Roth

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24_Roth.indd 24

The beginning of contactology was quite adventurous. The

stored, cleaned and disinfected. Recently, a contact lens

molding of deformed anterior eye segments, the production

container with two undamaged scleral lenses turned up at an

of the lens from glass or later a hard plastic was complicated,

auction in the USA. We succeeded in acquiring the set for the

and its durability was limited. There was a lack of experience

institute's collection.

in storing and caring for them.

Upon inspection of the lens case, it is clear that it is the same

We do not have the originals for a historical review of the early

hinged case made of sheet iron that was commonly used for the

history of the contact lens. We do not know how they were

so-called “Zwicker”-spectale before the First World War. With GlobalCONTACT 3-23

21.11.23 15:58

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HISTORY

a total length of 12 cm, it is not suitable for spectacles. It is

The auctioneer was unable to provide more precise information

covered with brown imitation leather on the outside and lined

on provenance when asked. His focus is on used military items,

with blue felt on the inside. Inside the case, there is a small metal

which he usually obtains from veterans. These scleral lenses

bowl on the right and left, open at the top, to hold the two lenses,

are said to have come from a naval officer. This is questionable,

as well as a compartment for the applicator with suction cup,

as their owner would certainly have been unfit as a soldier.

which is probably from a later period, and a sealed glass tube

The exact age of this set of contact lenses is difficult to determine.

containing the dried residue of a lubricant. In the laboratory,

If one compares the two scleral lenses with the few specimens

this can be identified as common salt. It can be concluded that

preserved in museums, it is clear that these lenses were pressed

the lens wearer suffered from dry eyes, but certainly had to

over an eye cast and not cut on a lathe. This means that only

lubricate his lenses carefully when inserting them.

the period between 1931 and 1939 can be considered. J. Dallos

Brown rust breaks through the felt in many places and shows

described their manufacture in 1930.

that the container has been in damp conditions for a long time

When examining a contact lens for all its technical data, one

or even buried in the ground. The lens manufacturer remains

should not forget that each lens reflects a human destiny. Without

unknown, and the owner's name or details are also missing.

these scleral lenses, their wearer was considered as blind. n

The label on the lid of the case is detached. Even an examination with a UV lamp resulted in no further conclusions.

The two lenses are thermoplastically molded and could still identify the former owner with the same precision as fingerprints, provided that the owner's eye mold was found at some point.

The lens diameter on both sides is between 20.1 and 23.2 cm, the central inner curvature of less than 6.9 mm indicates a steep corneal radius. This indicates either myopia magna – or more likely keratoconus. The center thickness is 1.2 mm. The refraction is plane. The material, undoubtedly a polymethyl methacrylate (PMMA) of its time, is impermeable to gas, which indicates a maximum possible wearing time of around three

Dr. Hans-Walter Roth, Ophthalmologist and Director of the Contact Lens Research Institute in Ulm, Germany, is the author of numerous publications and books on the physiology of the contact lens and the history of eyesight. He is a city councilor of the city of Ulm, specializing in education, social affairs, art and culture. He is also the founder of the Ulm Hospital for the Poor.

to four hours; prolonged wear leads to corneal edema.

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www.remvt.com 24_Roth.indd 25 !AZ.indd 6

21.11.23 30.05.23 15:58 14:16

REPORT

Sicht.Kontakte 2023 Top-class educational program with over 50 lectures and workshops Thanks to a full three-day program – including specialist lectures, workshops and the industry exhibition – inquisitive opticians and optometrists once again got their money's worth at this year's "Sicht.Kontakte" conference. Whether contact lens fitting, pediatric optometry or optometric examinations, the range of topics covered the latest scientific and practical issues moving the industry. By Hanna Diewald

Sicht.Kontakte takes place at a different location every year.

interesting special topics from practice, such as piggyback

This autumn, the organizers had invited participants to Berlin

fitting for keratoconus, there was certainly something exciting

from October 6 to 8. This year, the official program of the

for every contact lens fitter. An important contribution to this

organizers included around 50 program items, consisting of

day was also made by VDCO Young – an interest group for

lectures and workshops, and the conference of the German

young optometrists, where students and master trainees

Central Association of Opticians and Optometrists was not

network. Three presentations on the first day came from this

even included. Interested parties therefore often had to ask

group. Bachelor's and master’s theses were presented on the

themselves less whether they were interested in a lecture, but

topics of "Treatment zone size after orthokeratology fitting",

rather which of the highly topical lectures or workshops they

"Sustainability and plastic consumption in contact lenses" (an

should choose. Sicht.Kontakte" is jointly organized by the

interview on this topic can be found on page 40) and "A

International Association for Binocular Vision (IVBS), the

prospective survey on the use of fitting guides for soft contact

Association of German Contact Lens Specialists and

lenses". Meanwhile, the adjoining seminar rooms were also

Optometrists (VDCO) and the Central Association of Opticians

packed, as this is where the workshops took place, in which

and Optometrists (ZVA).

participants were able to immerse themselves in optometric practice. It soon became clear that the organizers had struck

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26_KL_VDCO.indd 26

DAY 1 – CONTACT LENS, KERATOCONUS AND IMPORTANT CONTRIBUTIONS FROM VDCO YOUNG

a chord with many visitors with their choice of topics: some

In the Berlin lecture room, interested visitors had the

down on the floor in the overcrowded rooms. Fortunately for

opportunity to listen to a wide range of specialist presentations

the unregistered interested parties, the workshop leaders

on the topic of contact lens fitting. From stage-appropriate

spontaneously allowed unregistered participants in and showed

therapy for keratoconus to free-form scleral lenses and

a talent for improvisation.

workshops were so well attended that participants even sat

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REPORT

One example was the workshop "Myopia – The 10 most common misconceptions in myopia management" by Philipp Hessler. Other contributions dealt with pediatric optometry, retinal examinations, computer-assisted visual training and much more.

And even during the breaks, there was no opportunity for the participants to get bored. Not only was there a buffet with great food right in the middle, between the different rooms, but there was also an industry exhibition. Important contact lens and glass manufacturers were represented here and were on hand to answer questions from all interested parties.

DAY 2 – ALL ABOUT MYOPIA MANAGEMENT For those interested in contact lenses and optometry, the second day continued with top-class presentations. One focus was on the important topic of myopia management, which was examined from a wide variety of perspectives. From myopia

working life. For example, on "Eye examinations for people

management with contact lenses to a comparison of clinical

with intellectual disabilities" and on "Oculomotor disorders

studies and various options for myopia control through to

in the senium".

accommodation, everything was covered.

In addition to such "trend topics", however, there were also many solutions for completely different challenges in everyday

DAY 3 – BETWEEN DRIVING LICENSE SUITABILITY AND EVERYDAY OPTOMETRY On the last day of the event, the "Day of Optometry" took place at which, among many other topics, the first interim results of a current study were presented, based on which findings on the fitness to drive of Ortho-K lens wearers are expected.

The influences and possible applications of different light colors on the visual system were also examined in a lecture. One of the focal points was the effect of blue light. The lecturer from the Ernst Abbe University of Applied Sciences in Jena used the state of scientific knowledge as well as individual case studies from practice as a basis for discussion.

Dr. Daniela Oehring, Professor at the University of Plymouth, addressed alternative treatment options for glaucoma in her presentation. Among other things, she discussed neuroprotection

Josefine Dolata on the influences and possible applications of different light colors on the visual system. Photo: ZVA-Peter Magner

as a complementary strategy, including other factors such as

Maarten Hobé and Dr. Stefan Bandlitz open the Day of Optometry.

Photo: ZVA-Peter Magner

Susanne Krostitz, Tanja Malkus and Armin Duddek

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oxidative stress and neuroinflammatory processes. n

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Pictures: Silke Sage

Investing in the future Alcon is committed to Germany as a business location Alcon marked the completion of its innovation initiative in Germany with a major event held at Grosswallstadt on September 19, 2023. A total of 600 million euros have been invested in technology at the site in northern Bavaria, and over 600 new jobs created. International guests from the global management team were delighted by what they saw and joined the employees from Grosswallstadt, the mayor and district council as well as the Minister President of Bavaria at the celebration. By Silke Sage At Alcon in Grosswallstadt over one billion contact lenses

“The investment also focused on expanding the capacity and

are produced by some 1,950 employees every year. Contact

portfolio of existing products. We are particularly pleased that

lenses have been manufactured at this site for almost 60 years

through these investments we have been able to create more

and the focus is clearly on the future. Under a major innovation

than 600 new jobs.”

offensive, the facility has been further consolidated and

28

28_Alcon.indd 28

expanded in recent years, with 600 million euros being invested

MISSION POSSIBLE

in 14 new production lines covering an additional area of

He told the audience that three key factors had been especially

30,000 m².

important in achieving this success. First and foremost was

The venue for the event in the new building complex at the

the trust placed in the German plant by the Headquarters. He

Grosswallstadt facility was well attended, as Norbert Dörr,

personally thanked the representatives of the global management

manager at the Alcon site, stood up to welcome the guests.

from the Alcon headquarters in Forth Worth, Texas/USA, who

The focus here has been on the development and production

were present. Their support and commitment to the team and

of new generations of contact lenses, he explained, adding:

the Grosswallstadt site made him proud.

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22.11.23 11:27

REPORT

And courage was also an important factor in turning what

managed to do all this during the corona pandemic and its

seemed to be a “mission impossible” into a successful start for

aftermath. And, above all, without delays and without

the new production units. During this period, suppliers and

objections,” he stated. His colleague, Heather Attra, Senior

workers were often told, “this has to go faster”, he reported.

Vice President, Global Head Quality and Regulatory Affairs,

Indeed, the first machine arrived before the building had been

could not agree more. She said it made her proud to walk

completed. And yet all turned out well in the end. “This could

through the recently completed entrance, knowing what an

only have been done by working closely together: In Grosswallstadt

effort the transformation phase had entailed for all employees.

it was above all down to the excellent cross-divisional cooperation

The expansion was not only about the refurbishment of the

between employees from Research & Development, Quality

premises. Alcon's Research & Development department has

Assurance, Engineering as well as many others.” Without this

also been very active in the vision care sector, developing brand

joint determination, none of this would have been possible, and

new contact lens families (Precision1, Total30) in the daily and

once again he thanked everyone involved.

monthly disposable lens segments. The question for Franck Leveiller, Senior Vice President, Head Global R&D and Chief

PANEL DISCUSSION WITH THE TOP MANAGEMENT FROM THE USA

Scientific Officer, was: “What are your personal highlights in

Representatives of the top management from the USA then

is fueled by innovation. It is in the DNA of this company, and

took to the stage for a short panel discussion with Alcon

it is in evidence every day at the Grosswallstadt site. “We have

employees, with the Head of the Research & Development

developed two new contact lens materials through the innovation

department, Dr. Justyna Justynska, moderating the discussion.

platform and are working on a third. This has created

The Grosswallstadt site has grown dramatically in the past few

opportunities that are unparalleled in this industry,” he

years as a result of major investment. First she asked: “What

explained. “We are already the market leader in the USA and

is your impression when you come here and see all that has

I have no doubt that we will become the number one in this

changed?” Ed McGough, Senior Vice President, Head Global

segment worldwide in the coming years,” he concluded.

Manufacturing & Technical Operations, replied that he had

Justyna Justynska asked Max Wolf, Vice President & General

been visiting the plant since 2012 and had never doubted the

Manager for Global Vision Care and Contact Lenses, which of

implementation for a second. “I met the people here and got

the new contact lenses that Alcon has launched on the market

to know their strengths and technical expertise, and it was

in recent years was his favorite, and why? “That's not a very

clear to me from the start that the plans would be implemented

fair question,” he joked, “it's a bit like asking which is your

smoothly. But what impressed me most was that they had

favorite child. But seriously, we've launched five new products

Franck Leveiller, Senior Vice President, Head Global R&D

GlobalCONTACT 3-23

28_Alcon.indd 29

this development phase?” He replied that everything at Alcon

Bavaria's Minister President Markus Söder speaks at the celebrations

Norbert Dörr, Site manager of Alcon in Großwallstadt

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22.11.23 11:27

REPORT

Max Wolf, Vice President & General Manager for Global Vision Care and Contact Lenses, Heather Attra, Senior Vice President, Global Head Quality and Regulatory Affairs, Franck Leveiller, Senior Vice President, Head Global R&D and Chief Scientific Officer, Ed McGough, Senior Vice President, Head Global Manufacturing & Technical Operations and Dr. Justyna Justynska. Picture: Alcon

in two-and-a-half years, which is unprecedented. Four of them

the boundaries of what is possible. The second issue is myopia

are manufactured on production lines developed here in

progression, which is becoming an increasing concern, even

Grosswallstadt. All of them play an important role in the

outside Asia, and for which appropriate products are required.

product portfolio and have developed very well. One of them,

I am talking here about contact lenses designed specifically to

indeed, is unrivaled with no comparable product offered by

stop the progression of myopia and not simply to slow it down,

any competitor in this form. I am very grateful to those here

as is the case with some of our competitors’ products. These

who have worked to make this possible,” he enthused.

are the major challenges for the future and I think that we have the best conditions here in Grosswallstadt to tackle them.

The global economic and supply chain situation is currently a matter of concern for many companies. “How does this affect

VISIT BY MINISTER PRESIDENT MARKUS SÖDER

the franchise company?” Ed McGough offered a reply: “We've

Another speaker was Bavaria’s Minister President Markus

often asked how we got through the COVID pandemic and its

Söder (CSU), who was also delighted with the expansion of the

aftermath. To be honest, we just got on with our job, while

site, and the investment which had been achieved without any

having the feeling that we weren’t doing particularly well. I

state subsidies. This was not something to be taken for granted,

guess all of us had our own challenges during that time. There

and he expressed his praise and respect for this investment

were raw material supply bottlenecks, shortages of labor and

and the jobs it had created in the very north of Bavaria. “The

transport logistics problems – and yet we got through it. This

company is a role model for the entire region through its

was mainly due to the fact that the employees at Alcon are all

innovation, ensuring the development of contact lenses to a

focused on customers as people. They are always in focus. We

successful high-tech product and thus setting an example to

also sell around 90% of our products directly to our customers,

companies throughout the Federal State.” He then joined

and thus we are in direct contact with them.”

members of the district council and other guests for a tour of

Another question put to the panel was: “From a market

parts of the production facility.

perspective, what are the greatest unmet needs for vision aids

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28_Alcon.indd 30

at the moment? What do customers want?” Max Wolf answered

CRADLE OF NEW TECHNOLOGY IN GERMANY

this question: “At the moment, comfort is still high on the wish

The Grosswallstadt site clearly demonstrates that the Alcon

list. But the topic of presbyopia is also ever present. There are

Group is a leader in contact lens production technology. The

around 1.5 billion people worldwide in this category, and only

fully integrated site also has its own Research & Development

a very, very small percentage of them wear contact lenses.

department, highly efficient production facilities and distribution

Astigmatism, too, is certainly another constant topic. Around

logistics for the whole of Europe.

40% of us need this kind of care, but only around 20% have

Together with the global Alcon Research & Development team,

access to suitable contact lenses, either because they were not

the latest generations of contact lenses are being developed and

available or they were not good enough. There are many different

brought to production maturity in northern Bavaria. In the

ways of satisfying these needs, so I see a lot of potential here.”

past four years, six new contact lens designs have gone into

This was followed by the question of what the future of contact

production: the new Precision1 (spherical) and Precision1 Toric

lenses might look like. Franck Leveiller offered his thoughts

daily disposable contact lenses, Dailies Total Toric and the

on the subject: “I think it is the next generation of contact lenses

Total30, Total30 Toric and Total30 Multifocal monthly

for presbyopia customers which will be the future. We are

disposable lenses. Further products are still in the pipeline.

already working on new concepts. You will see, we are developing

The new technologies developed here will also be transferred

new optical designs that have never been seen before, pushing

to other Alcon companies in Asia and the USA. GlobalCONTACT 3-23

22.11.23 11:27

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Picture: Alcon

REPORT

A LOOK BACK When the two entrepreneurs Herbert Schwind and Hudson Titmus started researching soft contact lenses in a three-room apartment in Aschaffenburg (near Grosswallstadt) almost 60 years ago, they certainly could never have imagined what one day would become of their work: a giant global contact lens corporation that has now been trading under the name Alcon for over a decade.

HISTORY

UP TO 45,000 INTERNATIONAL DELIVERIES EVERY DAY The European central warehouse and distribution center “Eurologistics” is also located at Grosswallstadt. From here, up to 45,000 orders are dispatched daily all over the world, with orders for European customers delivered to within 24 hours. The majority of the customers are eye care specialists such as opticians and optometrists, ophthalmologists and eye hospitals. ■

In 1964 the company “Titmus Eurocon” was founded in Aschaffenburg.

The first soft contact lenses were launched in 1970.

The company was taken over by CIBA VISION in 1983.

In 1989 the company relocated to Grosswallstadt. After the merger of CIBA-Geigy and Sandoz in 1996, CIBA VISION GmbH became part of the then newly founded Novartis AG. In 2011 Novartis took over Alcon and integrated CIBA VISION into the Alcon Group.

In 2014 the Grosswallstadt site celebrated its 50th anniversary, and in 2017 Alcon celebrated the 70th anniversary of its founding.

On June 29, 2018, Novartis announced that Alcon would be spun off and listed on the SIX Swiss Exchange and the New York Stock Exchange. The Alcon IPO took place on April 9, 2019.

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30.10.23 11:27 16:56 22.11.23

REPORT

Presbyopia treatment with eye drops One drop and you regain the vision of a 20-year-old?

It sounds too good to be true. One drop on each eye and you can see as well as you did a few years ago. This is the dream of several U.S. pharmaceutical manufacturers. In recent years, they have made some groundbreaking advances in the pharmacological treatment of presbyopia. This article provides an overview of the latest developments and their practical applications. By Lena Petzold

BRIMOCHOL

The best-known study was published in 2019 in the International

The first drug expected to improve near vision over a longer

Journal of Ophthalmic Research, showing sustained

period of time is “Brimochol”. It was developed and produced

improvement in near vision for at least eight hours and an

by the pharmaceutical manufacturer Visus Therapeutics in

average improvement in line visual acuity of at least five levels,

Irvine, California (USA). “Brimochol” is a combination of

as measured by the Jäger visual chart. Side effects, such as

Carbachol and Brimonidin.

eyebrow pain or loss of distance vision, which were shown in

The former reduces the pupil diameter, whereas the latter

ot her studies, were not documented. Current ly, t he

increases the duration of the effect and reduces side effects in

pharmaceutical company Visus is in the second phase of clinical

comparison to other active ingredients. Because of this, the

trials with the drug.

drug has already been approved for further development by the Food and Drug Administration (FDA), the U.S. health

VUITY

authority.

The Allergan company, part of the pharmaceutical manufacturer

When administered once a day, Brimochol is said to optimize

Abbvie, has developed and produced the drug Vuity – also

near vision for at least eight hours. This has already been tested

known as AGN-190584 – which was approved by the FDA in

in six different studies involving over 200 test persons.

2021. The drug consists of a 1.25% solution of pilocarpine.

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32_Presbyopietropfen_Petzold.indd 32

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REPORT

light from near objects is not overlaid and can be more sharply focused on the retina. However, there may be side effects such as headaches and eyebrow pain.

Furthermore, vision may be darkened, leading to a negative impact on the ability to drive at night. In this connection, the effect of “Vuity” pilocarpine drops was investigated both for its effectiveness and for its safety.

The best-known study is called “Gemini 1”, in which the primary and secondary endpoints of the third phase have already been met. In this study, 323 participants were given either the pilocarpine drops or a placebo solution. One drop was administered to each eye once a day for a period of 30 days.

Documented side effects that occurred during the study were headaches (>5%). At the same time, a drop-out rate of 1.2% of the participants also occurred.

Another finding of the study was an improvement in near and intermediate vision of at least three lines. This was found to be the case in a significantly larger proportion of the presbyopia subjects. In addition, it was also shown that distance vision was not affected by treatment with “Vuity”.

A further study carried out with these pilocarpine drops showed that 30% of the test persons were able to see at least three visual lines better than prior to the study. The eye chart was positioned at the normal reading distance of one arm's length.

CSF-1 CSF-1 is the drug produced by the Israeli pharmaceutical company Orasis Pharmaceutics. Like “Vuity”, the active ingredient consists of pilocarpine and a diverse carrier solution.

However, at 0.4% the dosage of pilocarpine is lower than that of the other drug. To test the eye drops, the company carried out two studies with a total of more than 600 subjects.

The studies called “NEAR-1” and “NEAR-2” both represent phase three clinical trials. They are multi-center, randomized, double-blind, parallel-group studies conducted with the objective of evaluating the efficacy and safety of CSF-1.

In this context, pilocarpine is a parasympathomimetic and is

One group of subjects received one drop of CSF-1 bilaterally

thus used as a miotic (to induce contraction of the pupil). The

in both eyes twice a day. This drop administration procedure

drops are supposed to take effect within 15 minutes and last

was repeated for two weeks in this case. The comparison group

up to six hours.

received a placebo which was also administered twice a day

Initially developed as a treatment for glaucoma, the effect is

for two weeks.

now also used for the treatment of presbyopia. The effect behind

“Both studies met their primary and secondary endpoints on

it comes from stimulating the smooth muscle of the iris, causing

day 8, achieving a statistically significant gain of three lines or

the iris to smooth out and the pupil to narrow. At the same

more in distance-corrected near visual acuity (DCNVA) and

time, aqueous humor outflow is increased by contraction of

no loss of one line or more in distance visual acuity,” said the

the sphincter pupillae muscle.

company on its official website.

Besides the contraction of the pupil, the positive effects of

Side effects that occurred as a result of treatment with the drug

pilocarpine are the resulting pinhole disc effect together with

included headaches and pain in the eyes after administration

the accompanying improvement in depth of field and pseudo

of the drops. The former occurred with an incidence of 6.8%,

accommodation.

the latter with an incidence of 5.8%. Moderate adverse effects

On the other hand, the retina receives less light from distant

were reported by 2.6% of the participants but were not discussed

objects, for example due to the pupillary contraction. Thus,

further in the statement.

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of the ciliary muscle as well as the iris. In this context, the ciliary muscle has an effect both on the shape and on the position of the lens inside the eye.

The parasympathetic system can be affected by drugs. Examples of such drugs are physostigmine as well as carbachol and pilocarpine already mentioned. Pilocarpine is a muscarinic agonist and, in addition to the positive effects mentioned above, stimulates tear production by promoting secretion from the lacrimal glands as well as contraction of the ciliary muscle.

However, disadvantages of this drug, for example, may be chronic inflammation of the front part of the eye, a fixed pupil, or spasmodic contractions of the iris leading to a change in myopia. A combination of nonsteroidal anti-inflammatory drugs (NSAIDs) with miotics offers a solution. The NSAIDs produce an anti-inflammatory effect in the anterior uveal tract.

As a result, side effects, such as the previously mentioned or spasmodic ciliary contractions, pigment dispersion as well as posterior synechiae, can be reduced.

In 2012, Benozzi et al. investigated the effect of pilocarpine (1%) as well as the nonsteroidal anti-inflammatory drug (NSAID) diclofenac (0.1%, analgesic). The study showed that the subjects had no blurred visual perception either at a distance or in the intermediate range. Furthermore, no inflammatory reactions relating to the drugs concerned were observed in the 100 persons involved.

CONCLUSION The idea of treating presbyopia using eye drops represents an interesting alternative to existing vision correction methods, due to the non-invasive and potentially reversible approach.

In the coming years, the various pharmaceutical manufacturers, currently testing their products in parallel clinical trials, will In mid-October, the FDA approved Orasis Pharmaceuticals'

publish their results regarding efficacy and safety. In particular,

pilocarpine hydrochloride ophthalmic solution 0.4% (trademark

long-term tolerance is a major issue in this context, in order

QLOSI) for the treatment of presbyopia in adults. QLOSI is

to be able to detect at an early stage any side effects which might

expected to be commercially available in the U.S. in the first

subsequently arise as well as any potential reactions with other

half of 2024.

(ocular) drugs. n

MODE OF OPERATION OF THE DRUG In his 2020 publication on drug treatment of presbyopia, Andrzej Gryzbowski, PhD, described the two main mechanisms underlying the therapy. Drugs that reduce pupil diameter, leading to miosis, thereby enhance the depth of field. This can be technically described by spherical aberration, in which rays far from the axis are refracted more strongly than rays close to the axis. In simple terms, this creates a depth of field range in which objects are seen more sharply.

Another effect, associated with the extended depth of field, is that of the pinhole effect. Due to the narrowed pupil, fewer rays from the edges reach the retina, so that less light interference reduces the contrast. The extent of pupil miosis is regulated by the parasympathetic system, which controls the contraction 34

32_Presbyopietropfen_Petzold.indd 34

Lena Petzold. After graduating from high school in 2018, Lena Petzold began her bachelor's degree in optometry at the Ernst Abbe University of Applied Sciences in Jena, graduating in October 2021 and immediately continuing with her master's degree in the s ame mon t h. In 2022, s he had t he opportunity to present her bachelor thesis at the American Academy of Optometry. On the side, she has also been working at JenVis Research since 2021.

GlobalCONTACT 3-23

17.11.23 09:11

PR-ADVERT

Assistance, guidance, improvement, control A review of a visit to Soflex of Erik Larsen OLGA – PROCESS ENGINEER

share his knowledge with us. We designed new tooling (with

We invited Erik to visit our company a few months ago in

feedback from Larsen) for blocking and lathing the lenses.

order to assist in improving our work process regarding the

Larsen Equipment built the blocker to fit our process and our

Larsen Blocker machine. Erik taught us how the Auto-blocker

tooling.

is one part of the system including the lathes and blocking

Erik came to visit us for a 2-day training session, he tutored

tools. He reviewed the validation of the system and the blocker

our new engineers about the blocking process – and did “hands

calibration. He showed us how this can improve the process

on” training with the new blocker and new tooling.

Erik's visit was highly productive and we got our staff trained and our process optimized.

EITAN – PRODUCTION MANAGER The new back blocker helped us to prevent crimping the blanks and still be able to mount the blanks in a rigid way using our auto loading system. This process allows us to use the same lathe collet for both fronts and backs which gives us more production flexibility.

We needed a custom nozzle for the back blocker which Larsen Equipment was happy to design and ship. Imagine a custom device from request to delivery in less than two weeks.

The new blank blocker is amazing; easily blocking of manufacturing our contact lenses. We feel we have control

6 lens blanks per minute.

of the process. He provided us with guidance and useful

Our existing automation consists of work cells where one robot

information to deepen the understanding of the production

feeds two lathes. It is easy to see how we can integrate the

process. Erik worked with us in order to provide the best

Larsen machines in a similar cell. n

solution for our specific needs.

NIR – HEAD OF R&D AND TECHNOLOGY We were in the process of improving our blocking system in order to achieve better centration. During the design of the process, we consulted with Erik who was happy to help and

ERIK'S VISIT WAS HIGHLY PRODUCTIVE AND WE GOT OUR STAFF TRAINED AND OUR PROCESS OPTIMIZED. Left to right: Eitan Sarid, Production Manager; Olga Svechin, Process Engineer; Nir Karpik, Head of R&D and Technologies; GlobalCONTACT 3-23

37_PR_Larsen.indd 37

35

23.03.17 15:54

MANUFACTURING

A look back Reader submission by Erik Larsen I am writing this article on the flight home from Washington, DC in late September. The trip was to attend a memorial for colleague and friend George Glady.

George and Joann Glady have become friends and travel

in the axial direction. This process works for lenses that have

companions over a few decades; I want to let you know how

relatively small variations. Interestingly, the EPT Opteq

we met. In the spring of ’83 I started working with the engineers

blockers are still in use today. The dead-length process is easy

at Bausch & Lomb. A few months later one of their colleagues

to configure on some blocking machines and simplifies the

(George) called me from Wesley Jesson about polishing

process if it is monitored closely. Their current lathes are

machines. The business generated by these two companies

ultra-precision and require no polishing.

established Larsen Equipment Design (LED) as a player in the

Euclid bought some auto-blockers from us fitted with the

industry. It is safe to say that the support of George Glady

three-ball chucks. We later converted them to 12.7 mm collets.

changed my company from surviving to f lourishing. His

They tried another blocker, but eventually went back to EPT

continued support after he established Euclid Systems to

Opteq blocking machines.

specialize in reverse geometry lenses for myopia control was

Visionary Optics: Lab Manager Eric Marshal showed me around

a bonus for us.

their noticeably quiet processing area. The lab techs were

On the recent trip to the Washington, DC area, I visited Euclid

multitasking according to the cycle times of each machine.

Vision Corp. and Visionary Optics.. They recently came under

They loaded a machine and moved onto the next load/unload.

the same corporate umbrella. The contrast between the products

I commented to Eric, that at no station did I see the lab tech

of the two companies could not be more distinct. I mentioned

make any adjustment to a machine, especially the late model

that Euclid makes reverse geometry lenses which are sold

LED auto-blockers. Since the CT of a scleral BC can have a

worldwide. Visionary Optics makes scleral lenses. The

wide range, a method is needed to keep the wax thickness

fundamental difference between the two modalities is in the

consistent. This can be set manually or automatically depending

range in parameters. In reverse geometry lenses, the diameters

on the type of blocking machine you have. Eric chose the Larsen

are between 9 and 11 mm and the base curve center thickness

automatic blocker for its ability to determine the BCCT and

(BCCT) is between 2 and 3 mm. In scleral lenses, the diameter

transfer block to a consistent wax thickness. Optics uses

can be from 15 to 22 mm or more and the BCCT from 3 to 8

polish-free lathes but touches up the optics and edges as needed.

mm. So, it came as no surprise that the two companies utilize

Eric’s main goal is to keep the process simple for both technicians

significantly different manufacturing processes. I received

and set-up/maintenance. Machine stability, intuitive calibration,

permission to outline the processes from the company

reliability, and vendor support combine to realize this goal.

representatives.

Both facilities are high productivity, high quality lens producers.

Euclid Systems: Sr. Manufacturing Engineer Daniel Dabu

While actual production numbers are confidential, their teams

showed me the current process and discussed the dead-length

produce about 50 lenses per person per 8-hour shift. I have

lens holding process they use. With the narrow range BCCT,

seen higher productivity numbers in corneal lenses, but Ortho-K

a dead-length process (no BC or button thickness measurement)

and scleral lenses take a little more effort.

works for reverse geometry lenses.

Productivity (lenses per person per day) translates directly to

The machines initially employed by George Glady were the

profitability. If a manager is looking to maximize profit and

EPT Opteq lathe and blocking system developed in The

quality, examining the details of the manufacturing process

Netherlands in the late ‘80s, currently under other ownership1.

is a good place to start.

The system employed a unique chuck system that held the

Thank you both Dan and Eric for taking the time with me. Lab

arbor on a precision diameter and was secured by three balls

visits are always an eye opener. n

forced into a recess in the arbor. This was a dead-length system, meaning that the center of the BC needs to be a constant

In memory of George Glady.

length from the mounting datum of the blocking arbor. The front arbor needs to be blocked to the BC, so that the over-all length of the BC and two arbors is consistent. The final requirement is that the lathe needs arbor chucks that are fixed 38

36_Larsen_GeorgeGlady.indd 38

References 1 See Vision Monday 1, March 2010.

GlobalCONTACT 3-23

24.11.23 11:22

VISIT THE NEW WEBSITE YOUR GLOBAL INSIGHT INTO CONTACT LENSES Welcome to GlobalCONTACT Your prime international trade magazine for C ­ ontact Lenses and IOLs. The pulse of industry trends and global perspectives.

GlobalCONTACT offers you: Global Insights: Stay ahead with our worldwide perspective on industry dynamics and emerging trends.

Expert Analysis: Benefit from in-depth analyses, exclusive interviews, and thought-provoking articles.

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Community Hub: Join a global network of professionals passionate about advancing the Contact Lens and IOL industry.

Visit us online: www.global-cl.com Webseite_2023.indd 1

24.11.23 16:25

MANUFACTURING

Photos: Silke Sage

Wait a minute – what are you doing there?

Andrew Larsen, Technician, Shipping and Receiving Manager, Purchasing Manager “I am standing here (in the right) at a workbench in our

During assembly we are constantly working to improve the

workshop in Seattle and I am talking with my father Erik

machines both for our needs and the customers’ needs.

(left) about some of the components on our automatic blocking

Sometimes making a part slightly different would help with

machine. This is important because we make many of the metal parts for all of our machines in-house.

building the machine easier. But we also need to make sure the needs of the customer are met so we need

So, discussing potential improvements helps

to bring in the engineer to see if the idea will

with assembly. And ultimately this helps

work for everyone. I have been in the company

our customer.

since 2010 – well unofficially since birth

There are new challenges in my job every

(smiles). I work with a small team who all

day. My tasks also include having the

help with the assembly processes of our

materials available at the right time. I check

various machines." n

what goes into our workflow, whether all the parts for assembling a machine are available and order new materials in good time.

38

38_Larsen-MomentMal.indd 38

GlobalCONTACT 3-23

24.11.23 16:30

MANUFACTURING

Misupco has new owners Mike Fischer handed over to Lynn and Daren Nygren A while back In 2017, Mike Fischer said in our Closing Words column in reference to his company: “My greatest wish is that when I retire someone will continue making and improving Hydroblock.” This wish has come true, as Daren Nygren and his wife Lynn Nygren took over Misupco in July 2023. We asked Daren Nygren about this acquisition. By Silke Sage

GlobalCONTACT: You started your company in this industry over 40 years ago. Why did you choose this branch?

Daren: I was born into the contact lens industy. I started working summers at my father’s lab when I was in junior high school.

GlobalCONTACT: Do you have a particular trademark or focus?

Daren: Quality! Quality has been the main focus of both our lab and now Misupco. Our Staff has a combined total of over

D aren N ygre n

100 years’ experience in the contact lens industry. We are

Mike Fischer

experts in lens fitting, and we can provide consultation even for exceptional patients’ eyes. All our lenses are custom

GlobalCONTACT: What advantages do you see from the acquisition?

manufactured on site, using major brands with high

Daren: Having been in the contact lens manufacturing business

quality materials. Plus: Every RGP lens is hand-finished and

for over forty years we have experience with the end user and

carefully inspected.

will be able to continue to innovate and develop new products that enhance the industry. Mike is a visionary, and we plan on

GlobalCONTACT: You took over Misupco from Mike Fischer in July.

continuing this vision!

What was the reason behind this?

Daren: We started using Hydroblock 17 years ago and it was

GlobalCONTACT: Will you integrate the company or even develop it

a game changer! It eliminated the use of solvents which in turn

further?

reduced our return of nonwetting lenses by 95%. Eliminating

Daren: Absolutely, we plan on continuing to develop products

solvents was great for the environment as well as my employee's

that enhance the industry.

exposure to the chemicals. We were so invested in the products that it was a natural fit for us to purchase Misupco.

GlobalCONTACT: What obstacles are there at the moment for contact lens manufacturers in general for RGPs? And for individual soft contact lenses?

Daren: Consolidation and private equity continue to change the landscape of the industry but as labs, we are used to navigating change and adapting.

GlobalCONTACT: In this issue, we report on the pharmaceutical industry's efforts to treat presbyopia with eye drops. How do you see this development? Do you think it’s a fundamental threat to our industry?

Daren: The vision industry has always been one of innovation. At

Pictures: Silke Sage

one point everyone thought Google glasses were the ultimate

GlobalCONTACT 3-23

39_Inte Daren about Misupco.indd 39

a nswer a nd we saw how t hat played out. Present ly pharmaceuticals seem to make inroads with drops to address presbyopia and myopia management. These developments have side effects some of which may be unknown so time will tell how this will play out but I do not see it having a dramatic effect on the contact lens industry. n

39

24.11.23 16:31

SPECIAL TOPIC

A small part of the big picture Contact lens fitters and sustainability Ophthalmic optics is becoming more sustainable. Even when it comes to contact lenses. Jennifer Veil's bachelor's thesis examined how contact lens fitters feel about this in everyday life and in stores in Germany and how familiar they are with the ecologically sound disposal of contact lenses and outer packaging. In this interview, she explains that there is still some catching up to do and what manufacturers are already doing and could do to change this. By Hanna Diewald

40

40_SP_KL und Nachhaltigkeit.indd 40

GlobalCONTACT 3-23

24.11.23 16:32

SPECIAL TOPIC

interested in it and was also very curious to see what results would emerge from the survey planned for the thesis.

According to your survey, how important is the topic of sustainability in general to contact lens fitters?

e:

te

ur

iva

practitioners were asked how important

Pr

In the survey, a total of 82 contact lens

t Pi c

the topic of sustainability and plastic reduction was to them in everyday life in general and how important it was in relation to contact lenses.

With regard to everyday life, 49% stated that the topic was very important to them, for 45% it was important, for 6% rather unimportant and no participant stated that it was

J e n n i f e r Ve il

completely unimportant.

When asked about the importance of sustainability and saving plastic in relation to contact lenses, the distribution was slightly different. 38% considered the topic to be very important, 43% rather important, 18% rather unimportant and 1% completely unimportant.

In general, the topic is therefore considered very important or somewhat important by the majority in both areas, although there is also a tendency for it to be considered somewhat less important in relation to contact lenses than in everyday life.

Disposal is also an issue with contact lenses. How well informed are contact lens fitters about how to dispose of contact lenses correctly?

With regard to contact lenses, there were four possible answers to choose from in the survey. 73% of participants answered correctly by stating that they dispose of contact lenses in the residual waste.

For contact lens blisters, there were five possible answers to choose from in the survey. 63% of respondents selected the correct answer "Dispose of blisters and contact lenses separately in plastic waste/the "yellow bin" (colloquial term for the yellow recycling garbage can in Germany)".

There were also four possible answers to the question about the disposal of outer packaging. 76% of respondents correctly stated that they dispose of outer packaging in the wastepaper bin.

Ms. Veil, in your bachelor's thesis you looked at the attitudes of

This means that the majority of respondents answered the

contact lens fitters towards sustainability and plastic consumption

individual questions correctly. At best, however, all three

in contact lenses. Why did you choose this topic in particular?

questions should be answered correctly by one person. In the

I have generally been interested in the topic of sustainability

cumulative presentation, it was observed that 37% answered

for some time now. There are many ways to act more sustainably

all three questions correctly, 39% answered two questions

without feeling restricted. Of course, any kind of change is a

correctly and 24% answered one question correctly.

little unfamiliar at first, but only until you get used to it. And

Based on the results of this survey, it can therefore be concluded

in my opinion, even the small changes are worth it, because

that the majority of fitters do not know how to properly dispose

they are certainly better than doing nothing.

of these three components that arise when handling contact

When this topic was presented as a possible subject for a

lenses. The greatest lack of clarity was found in the area of

bachelor's thesis at a university event, I was immediately

contact lens blisters.

GlobalCONTACT 3-23

40_SP_KL und Nachhaltigkeit.indd 41

41

24.11.23 16:32

SPECIAL TOPIC

Does your survey also provide information on the extent to which

How important is the issue of sustainability and saving plastic in contact lenses to you?

manufacturers are taking measures to improve sustainability? If so, what measures are already being taken?

Yes, the contact lens industry has already addressed sustainability in various areas. Of course, not all manufacturers are taking all measures and not all measures to the same extent. In general, however, the intention of manufacturers to make contact lenses and the associated processes (e.g. production and transportation of goods) more sustainable can already be clearly seen.

Very important

Rather important

Rather unimportant

Quite unimportant

Many companies already purchase electricity, at least in part, from renewable energy sources such as solar energy or wind power in order to reduce emissions.

Sustainability and plastic consumption in contact lenses

With regard to the transportation of goods, some manufacturers have already switched from air freight to sea freight, as sea

In your opinion, how are contact lenses disposed of properly?

freight also emits significantly less CO2.

To ensure that the large quantities of water produced during the manufacture of contact lenses can be reused, some manufacturers use the water from the manufacturing process for other purposes afterwards. For example, in air conditioning systems in office buildings.

Manufacturers have also found ways to optimize the packaging of contact lenses so that less material in the form of plastic or

Dispose of in residual waste

Dispose of in plastic waste / in the recycling garbage can

Dispose of down the drain or toilet

Other

paper is generally used. After all, this will be disposed of by the end consumer anyway.

The disposal of plastic in particular still often poses a challenge.

Evaluation "Disposal of the contact lens itself"

This is why some companies now offer plastic-neutral contact lenses. This means that the same amount of plastic that is used

In your opinion, how are contact lens blisters disposed of properly?

in the production of the contact lens is removed from the environment elsewhere. The manufacturers work together with a social enterprise that ensures that plastic is removed from beaches in coastal regions.

Unfortunately, there is currently no good alternative to the production of new plastic for contact lenses. Due to the Medical

Dispose of blister packs and aluminum unseparated in residual waste

Dispose of blisters and aluminum unseparated in plastic waste / in the recycling garbage can

Dispose of blister packs and aluminum separately in residual waste

Dispose of blisters and aluminum ­separately in plastic waste / in the recycling garbage can

Other

Devices Act, the use of many other materials is not possible as they do not meet the applicable material quality requirements for medical device packaging.

Of course, there are other measures that are no less important, but are only implemented by a few manufacturers. For example,

Evaluation "Disposal of contact lens blisters"

avoiding plastic bags, which are usually attached to European

In your opinion, how is the cardbord packaging of contact lenses disposed of properly?

deliveries, or using heat pumps in production plants to store warm air that can be used for heating in winter.

What surprised you most about the survey results?

In the survey, the participating fitters were asked to what extent they were familiar with "plastic neutrality" as a term and also with "plastic-neutral contact lenses". I was somewhat surprised that more than half of them stated that they were not familiar with the term "plastic neutrality". Although there are not (yet)

In the residual waste

In waste paper

In the plastic waste / in the recycling garbage can

Other

Evaluation "Disposal of cardbord packaging for contact lenses"

many manufacturers that offer plastic-neutral contact lenses, I did not expect the term as such to be quite unknown.

I was also surprised that even in cases where the fitters were aware of the topic of "plastic-neutral contact lenses",

42

40_SP_KL und Nachhaltigkeit.indd 42

GlobalCONTACT 3-23

24.11.23 16:32

!AZ.ind

SPECIAL TOPIC

the majority stated that they did not mention this aspect

Cumulative consideration of the questions relating to disposal

to customers. Of course, when fitting contact lenses, the focus should be on fitting the contact lens. Nevertheless, I would have assumed that this aspect would at least be mentioned to customers if it was a plastic-neutral contact lens that was selected.

In your opinion, what is the most important step towards making contact lens production or sales and handling even more sustainable?

It's very important to communicate about this aspect. The industry should communicate with fitters, the fitters with customers and they should exchange feedback and ideas.

three questions correct

two questions correct

one question correct

Cumulative presentation of the answers to the questions relating to disposal.

Of course, contact lenses are only a very small part of the big picture, but the proper disposal of blister packs, for example, can be applied to all packaging material made from different

requested and the material would actually be preferred in digital

types of plastic. We have the opportunity to draw customers'

form. One option might be to initially provide advertising material

attention to this and raise their awareness. This option is less

digitally and only printed on request in order to save resources

available elsewhere.

in the form of paper. Of course, only if this would be feasible for

It is also important that the feedback that is given is taken

the industry, also from an economic point of view. I am aware

seriously. In the survey for my thesis, some fitters stated that they

that this is unfortunately easier to imagine in theory than to

were often sent glosy advertising material, even if this was not

implement. n

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GLOBAL CONTACT The Website and the Magazine: The complete communication system for the contact lens industry. The magazine, 2,500 copies, is distributed to contact lens laboratories, wholesalers and other organizations active in the contact lens and IOL industry.

The website www.global-cl.com is free for all industry related professionals PUBLISHERS ADDRESS Eyepress Fachmedien GmbH Saarner Str. 151, D-45479 Mülheim a. d. Ruhr Tel.: +49-208-306683-00 Fax: +49-208-306683-99 Website: www.global-cl.com E-mail: info@global-cl.com CEO Petros Sioutis E-mail: p.sioutis@eyepress.de PUBLISHER Silke Sage, Efstathios Efthimiadis, Petros Sioutis EDITOR-IN-CHIEF Dipl.-Ing (FH) Silke Sage E-mail: silke@global-cl.com EDITOR Britta Laupichler E-mail: britta@mafo-optics.com TRANSLATIONS John Saniter, Bopfingen, Germany EDITORIAL BOARD Wim Aalbers, Erik Larsen, Eef van der Worp PRODUCTION & LAYOUT Efstathios Efthimiadis, Pascal Bruns DISTRIBUTION PressUp GmbH, Postbox 70 13 11, D-22013 Hamburg Tel.: +49-40-386666-308, Fax: +49-40-386666-299

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MEDIA CONSULTANT Constanze Classen Tel.: +49-208-306683-20 Fax: +49-208-306683-99 E-mail: constanze@global-cl.com ADVERTISING AGENT GREAT CHINA Beijing FOCUS Optics Culture Commnication Co. Ltd. Room 319, Building 2, Nr. 1, Northbank 1292, Nr. 15 Jianguo Eastroad, Beijing 100024 (Chaoyang), P.R. China Mrs. Jian Wang Tel.: +86-10-8537-6529 Email: jennywang_focus@126.com Skype: jennywang611 ADVERTISEMENT RATES Price list No. 12, valid from January 01, 2023 Publication Schedule 3 issues 2023: April, July, November SUBSCRIPTION COSTS PER YEAR European Union 80,00 € (plus VAT for German companies), Overseas Seamail 90,00 €, Overseas Airmail 110,00 €, United States Seamail 95,00 €, United States Airmail 125,00 €, Single issue 20,00 € (plus mailing costs) The Publisher requires three months written notice on cancellation. Subscribers please note that proof of notice may be required.

BANK DETAILS Bank account: Sparkasse Aachen IBAN: DE21 3905 0000 1073 3925 06 SWIFT: AACS DE 33XXX PRODUCTION & PRINT Kollin Mediengesellschaft mbh, Neudrossenfeld The publisher takes no responsibility for unsolicited manuscripts. Please note also that photographs submitted for use in GlobalCONTACT cannot be returned. The publisher's written permission is required for any reproduction, translation or recording of material published in GlobalCONTACT, including extracts of such material. Permission will normally be given, subject to the usual acknowledgement. Copies made of published items must be limited in number and for personal use only.

PHOTO CREDITS P.12: apinan, P.16: SHOTPRIME STUDIO, P.20: kichigin19, P.32: megaflopp, P.40: Olga, P.44: kyrychukvitaliy /stock.adobe.com /unsplash.com /istockphoto.com

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GlobalCONTACT 3-23

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2023-3 V3 updated .indd 1

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