Optometric Office March 2019

OPTOMETRIC OFFICE PRODUCTS AND TECHNOLOGY FOR YOUR PRACTICE

MARCH 2019

INSTRUMENTS:

AT-A-GLANCE:

CONTACT LENSES:

MANAGING GLAUCOMA WITH OCTA p 8

NUTRACEUTICALS THAT SUPPORT VISION HEALTH p 15

DOCS SPEAK OUT ABOUT DIGITAL EYE STRAIN p 12

OCULAR ALLERGIES |

IDENTIFY AND TREAT SYMPTOMS

p 10

SUPPLEMENT TO VCPN MARCH 2019

OPTOMETRIC OFFICE EDITORIAL STAFF

Table of Contents

VP, Editorial John Sailer | JSailer@ FVMG.com Editor Joanne Marchitelli | JMarchitelli@FVMG.com Creative Director Megan LaSalla | MLaSalla@FVMG.com Production and Web Manager Anthony Floreno | AFloreno@FVMG.com Contributing Writers Mile Brujic, OD, FAAO | Lindsay Berry, OD

BUSINESS STAFF President/Publisher Terry Tanker | TTanker@FVMG.com Executive Vice President Shawn Mery | SMery@FVMG.com Vice President, Marketing Debby Corriveau | DCorriveau@FVMG.com Regional Sales Manager Eric Hagerman | EHagerman@FVMG.com

EDITORIAL ADVISORY BOARD Jeffrey Anshel, OD • Sherry Bass, OD • Murray Fingeret, OD • Ed De Gennaro, MEd, ABOM • Deepak Gupta, OD • Alan Homestead, OD • Nikki Iravani, OD • Bill Jones, OD Alan G. Kabat, OD • Kenneth A. Lebow, OD, FAAO • Jerome A. Legerton, OD, MBA Scot Morris, OD • John Schachet, OD • Eric Schmidt, OD • Leo Semes, OD Peter Shaw-McMinn, OD • Joseph Sowka, OD, FAAO Jennifer Stewart, OD • J. James Thimons, OD

INDUSTRY ADVISORY BOARD Dwight Akerman, OD, Alcon Laboratories, Inc., a Novartis Company Steve Baker, EyeFinity • Joseph Boorady,OD, TearScience, Inc. Sally M. Dillehay, OD, Visioneering Technologies, Inc. Dave Hansen, OD, Ophthalmic Consultant • Carla Mack, OD, Alcon Laboratories, Inc. Dave Sattler, Dave Sattler Consulting Michele Andrews, OD, CooperVision, Inc. • Ellen Troyer, Biosyntrx, Inc. Millicent Knight, OD, Johnson & Johnson Vision Care, Inc.

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DEPARTMENTS 2 | Views

4 | One-to-One: Thomas E. Burke, III, ABB Optical Group 5 | Think About Your Eyes: Demystifying Allergies 6 | Product Buzz 13 | New Product Gallery 15 | At-A-Glance: Nutraceuticals

FEATURES

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8 | INSTRUMENTS: OCT-A: The Latest Advance in OCT Technology Helps Manage Patients with Glaucoma 10 | PHARMACEUTICALS: Solutions for Ocular Allergy Symptoms 12 | CONTACT LENSES: Docs Speak Out About Digital Eye Strain

Throughout this magazine, trademark names are used. Instead of placing a trademark or registration symbol at every occurrence, we are using the names editorially only with no intention of infringement of the trademark. www.Facebook.com/OptometricOffice www.Twitter.com/OO_Magazine www.Linkedin.com/showcase/Optometric-Office-Magazine

VIEWS Joanne Marchitelli It’s been an exciting past year for space discovery. It seemed you couldn’t escape an aeronautical news story— from the February 2018 launch of the Tesla Roadster hitching a ride on SpaceX’s Falcon Heavy rocket to China’s robotic Chang’e 4 mission landing on the far side of the moon in January 2019, and sadly, to NASA declaring Opportunity rover dead after a remarkable 15 years exploring Mars.

Besides exploring unknown worlds beyond Earth, space exploration also helps us understand our own. Take for example, the current mission involving optical coherence tomography (OCT) technology.

In May 2018, NASA launched Heidelberg Engineering’s SPECTRALIS with the OCT2 Module to the International Space Station (ISS). Its flight aboard the Antares 230 Cygnus CRS OA-9 departed from Wallops Island, VA, and the imaging platform was placed into service in December. The instrument replaced the SPECTRALIS OCT that has been in operation at the ISS since 2013.

The purpose of the OCT’s mission is to better understand Space Flight Associated Neuro-Ocular Syndrome (SANS). By imaging the choroid and optic nerve of astronauts during flight and upon return to Earth’s gravity, it will help researchers counter the effects of SANS in future, farther, space travel.

According to NASA, the use of the OCT device will monitor the changes to crew members’ eyes during the mission and

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FAR OUT

provide real-time medical evaluations to physicians on the ground. The use of OCT technology will also improve data gathering for investigations studying visual impairment and intracranial pressure in space.

Ongoing research through NASA’s Vision Impairment and Intracranial Pressure (VIIP) project has been studying the effects of long-term exposure to microgravity on the structure of the eye. Dilated fundus examinations with binocular ophthalmoscopy, cycloplegic refraction, OCT, magnetic resonance imaging (MRI) of orbits, and fundus photography for before and after space missions are just several ophthalmic procedures performed on astronauts.

In one VIIP study, 27 astronauts underwent thin-section, 3D, eye orbital, and conventional MRI brain scans. Eight astronauts underwent repeat imaging after an additional mission in space. All astronauts had previous exposure to microgravity.

Image analysis of the optic nerve sheath, optic disc, posterior globe, and pituitary gland was performed and compared for association with intracranial evidence of excessive fluid buildup inside the skull, cells, tissues, or body cavities, venous blood clotting in the brain and/or mass lesion.

MRI findings suggest that intracranial hypertension is an important component to visual acuity degradation, but since not all astronauts show visual acuity degradation, existing risk factors could be to blame. By using OCT imaging they hope to better understand the cause-and-effect relationship of intracranial pressure after exposure to microgravity and who may be at risk.

Back on earth, OCT is used to diagnosis and monitor the progression of diseases such as diabetic retinopathy, retinal vascular disease, vein occlusion, artery occlusion, macular degeneration and glaucoma. In this issue, we explore how glaucoma can be monitored with OCT angiography—a feature that is on the OCT2 Module—to get a better understanding of disease progression. The latest frontier of this technology is sure to push the boundaries of treatment. *** Joanne Marchitelli | Editor | JMarchitelli@FVMG.com

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continue that tradition. I want to build solutions that our customers view as valuable. I want to evolve in ways that will really benefit our customers either through revenue growth, expense efficiencies or through better service to their patients.

JM: How do you see ABB helping the independent eyecare professional grow?

TB: For us, being able to give doctors unique solutions to continue to care for their patients is where we fit in. One example is that we’re not just in the contact-lens distribution business. We also have optical labs nationwide and we are in the frames distribution business. We also provide data and analytics around best-in-class service to eyecare practices.

And we’re going to continue to evolve in even more solutions as we go forward.

JM: Where is ABB going from here?

ONE-TO-ONE Thomas E. Burke, III Chief Executive Officer, ABB Optical Group

Prior to joining ABB Optical Group in August 2018, Thomas Burke served as CEO of Medical Specialties Distributors; senior vice president/general manager of Innovative Delivery Solutions for Cardinal Health; and CEO and president of Novis Pharmaceuticals. He has nearly four decades of experience in the distribution and healthcare industry with extensive experience in sales management, operations and employee development.

Joanne Marchitelli: What is your general vision for ABB? Thomas Burke: We’ve got an amazing business that is essential to the distribution platform, specifically on the contact-lens side of the optical world. The reason we are who we are is because Angel Alvarez and others deeply cared about our customers and our vendor relationships, and made decisions based on what’s good for the doctor and the community.

Supporting the doctor differentiates us, and we will 4 M a r ch 2 01 9 | O p to m e tri c O f f i c e .c o m

TB: We are focused on six priorities, and all of them are equally important and critical to our success and the success of our customers.

One priority is to take a good, hard look at the role we play with information and how we can provide information to our partners as well as to doctors in the field that can help them be more productive.

Another priority is to continue to build out solutions that can help the doctor either grow, manage their expenses in their practice, or become better service providers.

Another absolute priority for us is to continue building meaningful relationships that are founded on trust. That’s with our customers, our vendors and our employees. I don’t want to be everything to everybody. I don’t believe in that. I believe in being everything to the people we partner with in a very transparent way.

Next is eyewear. We’re making a major investment in a new lab in the Midwest this year. We are continuing moving forward with the frames distribution piece of this business.

We’ve got an amazing lab to begin with. Eyewear is absolutely a priority for us.

Also a priority for us is network optimization. We recognize that we have to get it right. We want to get it right. Our customers depend on us to correctly pick, pack and ship the right products at the right price and at the right time.

We will continue to evolve, innovate and test our network strategies to make the process as efficient as possible so fill rates are up, errors are down, and our customers’ costs remain low.

Then the last one, which certainly is not last in terms of importance, is growth; but I don’t want to think about it in terms of ABB growth. I prefer to think about the growth of a practitioner because that’s what matters. Their earnings are what matters. To help them grow their top line and continue to serve their patients, we must have the right solutions for them to do that. ***

THINK ABOUT YOUR EYES

DEMYSTIFYING

ALLERGIES Blurry vision, red eyes, contact lens irritation… A patient could blame an old prescription or needing to try a new type of contact lens. However, all of these symptoms could be caused by allergies. While a runny nose and sneezing are the stereotypical allergy symptoms, allergies can also cause a host of vision and eye symptoms that we as optometrists need to be aware of when it comes to treating patients.

MEDICATION RECOMMENDATIONS When it comes to the treatment of allergies and accompanying vision issues, there are several routes one can take.

A medication anti-allergy eye drop may be recommended or prescribed, such as over-the-counter antihistamine eye drops that can provide relief. Most of these have twice per day dosage. A prescription anti-allergy drop can also be prescribed for those who do not respond well to the overthe-counter medications. Some prescription medications can also be used in prevention of symptoms for those who experience seasonal allergies every year. However, timing is crucial. If someone typically experiences allergy symptoms starting in March, they could be well served by starting treatment in February.

LIFESTYLE MODIFICATIONS Home remedies and lifestyle modifications may benefit patients with any severity of symptoms. These can include limiting exposure to allergens (i.e., staying indoors when pollen levels are high, or avoiding travel to locations with high levels of allergen). Practicing good hygiene and cleanliness can also vastly help alleviate systems. Frequent washing of hair, clothes, towels or bedding that may have

Lindsay Berry, OD Lindsay Berry, OD, is a member of the Texas Optometric Association and among the 22,000 doctors listed on the Think About Your Eyes online locator. Think About Your Eyes is a nationwide public awareness initiative promoting the importance of an annual eye exam and overall vision health. First Vision Media Group supports Think About Your Eyes as a media partner.

been exposed to an allergen can keep allergens and pollen from getting “trapped” and building up, leading to continuous exposure. I also counsel patients to manage systemic allergy symptoms. Those with more significant sinus issues due to allergies also tend to have more significant eye and vision symptoms. Managing the sinus congestion can also minimize eye symptoms.

It doesn’t always seem like a natural inquiry when visiting with a patient, but ensuring we have a complete picture of their health will only benefit us as advocates of their vision health. This makes the annual eye exam a crucial check-in with the patient. The Think About Your Eyes campaign continuously reminds patients to schedule an annual eye exam, which will allow us to continue to assist in other health issues that may be impacting their vision health. O|O

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PRODUCT | BUZZ LAUNCHES, PROMOTIONS, MERCHANDISING, EVENTS AND OTHER THINGS TO KEEP YOU IN THE KNOW. BAUSCH + LOMB CREATES NEW WEBSITE FOR PATIENTS WITH AMD SightMatters.com, a new educational online resource for people living with Age-related Macular Degeneration (AMD), was launched in February

by Bausch + Lomb.

The site debuted to coincide with AMD Awareness Month. Specifically designed for the visually impaired with an increased font size and distinctive color contrast between different elements, patients can join a supportive online community and find clear, concise and actionable content on AMD. “It is estimated that as many as 16 million people in the United States have AMD. SightMatters.com will provide these patients with the information they need to manage their AMD. With its ‘AMD Action Plan’ questionnaire, patients can receive a personalized plan to understand the changes needed in their daily lives and how to check for signs and symptoms of AMD, so they can help reduce their risk of progression,” said Joe Gordon, U.S. president, Bausch + Lomb. “SightMatters.com is part of our ongoing commitment to help protect and enhance sight for the millions of patients who need to navigate life with AMD—no matter where they are on their journey.”

Go to SightMatters.com

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(L to R): Arch Holcomb, M.Sc., specialty consultant for ABB OPTICAL GROUP; Ilya Volk, Western University of Health Sciences; Nha Cao, Midwestern University Arizona College of Optometry; Julie Ervin, Southern College of Optometry; and Andy Jackson, director of specialty contact lenses for ABB OPTICAL GROUP.

ABB AND PARAGON ANNOUNCE WINNERS OF OPTOMETRY STUDENT CHALLENGE Three optometry students presented scientific posters at the 2019 Global Specialty Lens Symposium in Las Vegas as winners of the Optometry Student Challenge, a program designed by ABB OPTICAL GROUP, in partnership with Paragon Vision Sciences, to foster the study of contact lenses.

The lead authors of the scientific posters were Nha Cao of Midwestern University Arizona College of Optometry in Glendale, AZ, who focused on the effect of freezing temperatures on Senofilcon A soft contact lenses; Julie Ervin of Southern College of Optometry in Memphis, TN, who covered treatment of keratoconjuctivitis sicca secondary to sicca syndrome with scleral lenses; and Ilya Volk of Western University of Health Sciences in Pomona, CA, who

presented on the benefit of a scleral lens in the treatment of a post-corneal transplant epithelial defect.

More than 90 optometry students submitted contact lens related abstracts focused on study projects or studentbased case histories for the chance to win a travel stipend of $1,500 to attend the symposium and convert their abstracts into scientific posters.

The challenge was open to students in their third and fourth years of study.

Abstracts were judged on academic merit by a panel of industry experts.

“Every year we have an incredible response from students who amaze us with their outstanding submissions, and this year was no different,” said Andy Jackson, director of specialty contact lenses for ABB OPTICAL GROUP. “We believe the Optometry Student Challenge is a great experience, both academically and professionally, for students, helping them to put their best foot forward

as they work towards their optical careers.”

“Supporting students in their academic journey is essential to their success,” said Paragon Vision Sciences president Rich Jeffries. “Programs like the Optometry Student Challenge help foster well-versed students, and we are proud to join ABB in supporting the next generation of optometrists.”

company’s anti-VEGF drug, EYLEA (aflibercept) Injection, is indicated for diseases of the retina—wet age-related macular degeneration, diabetic macular edema (DME) or diabetic retinopathy in DME and macular edema following retinal vein occlusion.

Go to ABBOptical.com/ OptometryStudentChallenge

Drs. Susan and Mark Fromer of Fromer Eye Centers will receive the 2019 Eyes on Leadership Award during the celebration, and Dr. Max Gomez, senior medical correspondent for WCBS-TV, will serve as master of ceremonies.

REGENERON TO RECEIVE THE 2019 EYES ON INNOVATION AWARD

Go to SUNYopt.edu/Giving/ Gala-Information

Regeneron, a leading biotechnology company, will receive the 2019 Eyes on Innovation Award during the 16th annual Eyes on New York Awards Celebration at Cipriani 42 in New York City on Friday, March 22. The gala is the signature event of the Optometric Center of New York (OCNY), the affiliated foundation of the State University of New York (SUNY) College of Optometry.

Proceeds from the evening will directly support patient care, scholarships and research at the College.

Regeneron invents life-transforming medicines, improves the drug development process through its proprietary technologies and advances science through its research initiatives, including the Regeneron Genetics Center, one of the leading genomics efforts in the world. Founded in 1988 and led for three decades by physicianscientists Dr. Leonard S. Schleifer, president and chief executive officer, and Dr. George D. Yancopoulos, president and chief scientific officer, the Tarrytown, NY-headquartered company has a robust internally discovered and developed product pipeline, which has led to seven FDAapproved treatments and more than 20 investigational candidates. The

COALITION DRAFTS LETTER TO U.S. SURGEON GENERAL Vision 2020/USA, Prevent Blindness and other leading vision and eye health groups have joined together to issue a formal request to U.S. Surgeon General Jerome M. Adams, MD, to initiate a “Call to Action” to mark the year 2020. “Vision issues can affect anyone across the age spectrum, from infants to seniors, impacting everything from learning to the ability to work and be independent,” said Mitchell V. Brinks, MD, MPH, chair of Vision 2020/USA. “With the help of U.S. Surgeon General Dr. Jerome Adams and his colleagues, we can work together to successfully address and improve vision health in our country.”

The formal request was signed by 27 national leading organizations—each a member of Vision 2020/USA— and was delivered on Jan. 18, 2019.

“We are proud to join in the effort to engage entities across the country, including professional groups, federal, state and local governments, and more, to address the rising numbers of vision loss and impairment,” said Jeff Todd, president and CEO of Prevent Blindness.

Go to PreventBlindness.org

Eyefinity, a VSP Global company, has announced the completed integration of OfficeMate and CLX System.

Rainer Kirchhübel celebrated his 40-year anniversary at OCULUS. Lutronic Vision has initiated a preclinical trial to determine the optimal setting for its R:GEN laser for the treatment of the dry form of age-related macular degeneration (Dry AMD).

EyePoint Pharmaceuticals, Inc. has announced the appointment of David Guyer, MD, to the company’s Board of Directors.

Ocutrx Vision Technologies has named Linda Lam, MD, MBA, chief scientific and strategy officer.

Virginia Eye Consultants has joined CEI Vision Partners.

The first patient was implanted with Implandata’s Eye Pressure Sensor for continual glaucoma monitoring.

Galimedix Therapeutics shared data showing safety, tolerability and potential for efficacy of its investigational eyedrops containing GAL-101 at Glaucoma 360 Conference.

New England College of Optometry (NECO) named Erik Weissberg, OD, FAAO, Vice President and Dean of Academic Affairs.

EyePoint Pharmaceuticals announced the U.S. commercial launch of YUTIQ (fluocinolone acetonide intravitreal implant) 0.18 mg., indicated for the treatment of chronic non-infectious posterior segment uveitis.

The CooperVision manufacturing facility in Alajuela, Costa Rica has been awarded LEED Silver certification for its environmentally conscious design and operation.

Clearside Biomedical, Inc. has announced that its pivotal Phase 3 trial of XIPERE (formerly “suprachoroidal CLS-TA”) in patients with macular edema associated with noninfectious uveitis shows the drug exhibits durability following second dose.

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INSTRUMENTS

OCT - A The latest advance in OCT technology helps manage patients with glaucoma.

A vessel density map of the patient’s right optic nerve head on the Optovue Avanti (left). The dark navy wedge on the bottom of the scan correlates with the wedge defect seen on the fundus image (right). The vessel density map allows for quantification of the non-perfusion in this area due to glaucomatous optic neuropathy.

B y J o anne Marc hitelli OCT in the optometric practice has been steadily gaining ground in recent years. The gold standard for glaucoma management has been, and still is, optic nerve head assessment and visual field perimetry, but here comes OCT-A technology to up the ante.

“For the first time we’re able to quantify blood vessel density which we haven’t been able to do. We’ve been able to look on a structural level, but we haven’t been able to look at what’s actually happening at a microvascular level,” said Julie Rodman, OD, MS, FAAO, associate professor, Nova Southeastern University, Fort Lauderdale, FL. “This has been really helpful to identify disease a lot earlier than we have been able to before. It’s a non-invasive way to view retinal vasculature and see where the damage has occurred, not just confirm that it occurred.”

THE DIFFERENCE BETWEEN OCT AND OCT-A OCT evaluates the structure of the retina—it provides an in-vivo analysis of both the retinal and choroidal anatomy, she explained. “OCT-A was created not to take the place of OCT but to provide a different dimension,” said Rodman. “OCT-A 8 M a r ch 2 01 9 | O p to m e tri c O f f i c e .c o m

“OCT-A was created not to take the place of OCT but to provide a different dimension.”

Julie Rodman, OD, MS, FAAO, Associate Professor, Nova Southeastern University

provides visualization of the peripapillary capillaries and correlates more strongly with a patient’s visual function by providing a functional analysis. Reduced peripapillary perfusion correlates with focal defects on visual field, RNFL and GCC thickness. Using them together, we get a structural and functional analysis side by side.”

WHAT IT MEANS FOR PATIENTS WITH GLAUCOMA “With regards to management of glaucoma, OCT-A opens the door for personalized glaucoma care,” said Carolyn Majcher, OD, FAAO, chief of the Retina Clinic and assistant clinical professor, University of the Incarnate Word Rosenberg School of Optometry in San Antonio, TX. While it’s been known for some time that vascular dysregulation contributes to the pathology of this multifactorial disease, for some eyes this may be more of a leading player than others. “When I see a glaucoma patient with substantial perfusion compromise as visualized with OCT-A, I am more inclined to

select a vasoactive agent such as dorzolamide,” said Majcher. “Similar to pattern ERG testing in glaucoma, perfusion compromise is at least initially a reversible thing. So it may prove to be useful in providing feedback to the clinician as to whether adequate treatment has been achieved.”

In the future, she believes that doctors may be titrating treatment to achieve “perfusion targets” rather than target IOP levels alone.

BENEFITS OF OCT-A “The literature that I’ve read and the experience that I’ve had is that OCT-A is very good at identifying early damage in primary open angle glaucoma (POAG); earlier than we would see with visual field or other modalities,” said Rodman. “The reason is that primary open glaucoma results from both mechanical factors and vascular dysregulation, and a vascular problem is going to be picked up on a vessel density analysis provided by OCT-A analytics.”

In angle closure glaucoma, the elevated intraocular pressure affects the

“With regards to management of glaucoma, OCT-A opens the door for personalized glaucoma care.” Carolyn Majcher, OD, FAAO, Chief of the Retina Clinic and Assistant Clinical Professor, University of the Incarnate Word Rosenberg School of Optometry

RNFL measurements before affecting the vascular density; thus OCT-A may be a more desirable objective screening tool for POAG.

OCT-A TECHNOLOGY Optovue’s Avanti AngioVue system is available in three configurations: AngioVue Comprehensive, AngioVue Essential and AngioVue Retina. The latter two can be upgraded to the Comprehensive system. “AngioVue Essential provides streamlined OCT-A image interpretation in a single page report allowing for an efficient way to evaluate and manage retinal disease that may necessitate a referral.” Its highresolution, non-invasive imaging of retinal vasculature helps visualize ocular disease. The single-page report displays individual layers of retinal vasculature alongside structural OCT B-scans.

With AngioAnalytics, doctors can measure foveal avascular zone parameters, areas of abnormal flow in the outer retina and choroid, and vessel density. Its multi-scan analysis allows for assessment of progression at each patient visit and trend reports help predict change over time. In addition, Optovue’s 3D projection artifact removal (3D PAR) software removes shadows from the vessels to improve image quality.

Carl Zeiss Meditec, Inc. offers ZEISS AngioPlex on its CIRRUS HD-OCT. “AngioPlex OCTA imaging is able to noninvasively detect and highlight reduced perfusion and capillary vessel density loss in glaucomatous eyes within both the peripapillary and macular regions,” said Majcher. “It is therefore another tool in my ‘glaucoma tool belt’ along with other objective measures such

as retinal nerve fiber layer (RNFL)/ganglion cell complex thickness that aids in glaucoma diagnosis and detection of glaucomatous progression.”

New software versions are expected to include a 4.5 x 4.5mm optic nerve head OCT-A scan that automatically visualizes the radial peripapillary capillary network that is affected in glaucomatous eyes.

An OCTA montage of an eye with glaucoma using the CIRRUS AngioPlex from ZEISS (above). A composite of the NFL, ganglion cell complex (GCC) and visual field results of the same eye (below).

Heidelberg Engineering recently received clearance from the U.S. Food and Drug Administration for its OCT Angiography Module. The OCT Angiography Module can be added to new and existing upgradeable SPECTRALIS devices with the OCT2 Module. The upgrade delivers a lateral resolution of 5.7 μm/pixel. In addition, the module and the device’s TruTrack Active Eye Tracking allows the fine capillary networks to be visualized in great detail and its PAR tool utilizes information from the superficial vascular plexus to remove artifacts from OCT-A images and enables a more precise visualization of vascular structure and pathology.

While Topcon Medical’s OCT-A technology is not available on its instruments in the United States, the swept source technology in its DRI OCT Triton is still a valuable tool in a glaucoma diagnosis and management. “With the Triton SS-OCT, I can see the vitreous, I can image the retina, I can image the choroid,” said Victor Gonzalez, MD, founder of the Gulf Coast Eye Institute in the Rio Grande Valley in Texas. “This is so important in helping me decide how my treatment moves forward, or

how I need to alter that treatment.”

In addition, its en face technology allows visualization of various layers of the retina.

WHAT ARE YOU WAITING FOR? “Every optometric practice right now should hopefully have an OCT,” said Rodman. “I think in the next decade, every machine will have OCT-A on it, but for now, unfortunately, it’s still a novelty for a lot of folks.” But she assures that once novice users experience the technology and learn it, it will become not only easier to use but an essential part of the glaucoma practice. O|O

WHERE TO FIND IT Carl Zeiss Meditec, Inc. 800.342.9821 | Meditec.Zeiss.com/USA Heidelberg Engineering 508.530.7900 | HeidelbergEngineering.com Optovue Inc. 866.223.1130 | Optovue.com Topcon Medical Systems, Inc. 800. 223.1130 | TopconMedical.com

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PHARMACEUTICALS

SOLUTIONS FOR OCULAR ALLERGY SYMPTOMS How to successfully identify and treat in clinical practice.

B y MILE BR UJ IC , OD , FAAO Oftentimes we are presented with the acute symptomatic patient who comes in complaining about red, itchy, irritated eyes. It is incumbent to accurately identify ocular allergies and differentiate them from other conditions that may present similarly, such as dry eye, blepharitis, viral conjunctivitis, bacterial conjunctivitis and infiltrative keratitis.

There are several factors that can help identify allergic conjunctivitis from these other entities. Frequently, the presentation is an acute onset and symptoms are associated with seasonal changes and the presence of allergens in the environment. This is not an absolute rule as some individuals may have chronic ocular allergies that are present year-round and the symptoms simply spike with seasonal changes.

The most common accompanying symptom that these patients will have is itching. With acute allergic conjunctivitis, this symptom may be more prevalent in the inner canthal 10 M a r ch 2 01 9 | O p to m e tri c O f f i c e .c o m

region. This occurs because the natural blink mechanism moves the tears to the inner canthal region where they drain through the puncta on the superior and inferior eyelid. This can cause accumulation of allergens and histamine. Histamine causes much of the signs and symptoms associated with allergic conjunctivitis.

Other signs that accompany allergic conjunctivitis include conjunctival hyperemia, conjunctival swelling, eyelid swelling and epiphora.

Just as important as identifying the acute presentation of allergic conjunctivitis is identifying those individuals who may have allergic presentation outside of the time of their eye exam. As an example, if you see a patient during the winter months for their exam, it is important to question them about ocular symptoms that they may have or medications that they may take at other times of the year. Patients with seasonal allergic conjunctivitis may not think to make us aware of ocular symptoms that are

not present at the time of their visit.

Identifying patients that may take oral antihistamines at other times of the year is critical in order to determine the presence of ocular symptoms. If they do have ocular symptoms it’s incumbent upon us to offer appropriate treatment options for when their symptoms manifest.

PREVENTION For the contact lens wearer, oftentimes the best solution is to make sure that the patient is wearing daily disposable lenses. Since they are disposed of on a daily basis, any allergens that have accumulated on the lens during the day are disposed of. When a new lens is placed on the eye each day it minimizes the chances of the lens causing additional ocular comfort issues and can help reduce symptoms of allergic conjunctivitis.

If a patient’s prescription is not available as a daily disposable lens, hydrogen peroxide cleaning systems, such as CLEAR CARE and CLEAR

“If you see a patient during the winter months for their exam, it is important to question them about ocular symptoms that they may have or medications that they may take at other times of the year.�

CARE PLUS (Alcon Laboratories), work remarkably well to sufficiently clean the lenses. These two peroxide systems are also approved for gas permeable (GP) lenses, so be sure to keep them in mind for those allergy sufferers wearing GP lenses.

Patients can try removing themselves from the allergen or if that isn’t possible, removing the allergen from themselves. This is typically done with artificial tears but only usually provides temporary relief. Cold compresses help with inflammation of the lids but will not get to the root of the problem which is histamine being released from mast cells. Mast cells release histamine when allergens bind to immunoglobulin E (IgE) receptors on the mast cells.

This causes what is referred to as mast cell degranulation, releasing massive amounts of histamine, which causes itching, hyperemia and edema.

EYE DROPS Fortunately, several therapeutic options exist to help patients with seasonal allergies. There are several antihistamines that are available. Olopatadine, a mast cell stabilizer, is available in three concentrations from Novartis: 0.1% (Patanol), 0.2% (Pataday) and 0.7% (Pazeo). Patanol is approved as a twicea-day dosing regimen and Pataday and Pazeo as a once-a-day drop. Both 0.1% and 0.2% concentrations of olopatadine are available as generic drops.

Lastacaft (Allergan) is 0.25% alcaftadine and is approved as a once-daily dosing regimen. Two other prescription options that are available are epinastine 0.05% (Elestat from Allergan) and azelastine 0.05% (available as a generic). These are both approved as a twice-a-day dosing regimen. There is also an over-the-counter option that is available for the treatment of allergic conjunctivitis. Ketotifen 0.025% is approved as a twice-a-day dosing

regimen and is available under several brands including SYSTANE Zaditor (Alcon), Alaway (Bausch + Lomb) and Equate Eye Allergy Relief Drops from Walmart.

A new antihistamine drop will be available in the U.S. in 2019. It is Zerviate (Eyevance Pharmaceuticals), which is the first topical ocular formulation of cetirizine. It is formulated at a concentration of 0.24%. Cetirizine is an antihistamine that competitively binds to histamine receptors to reduce the signs and symptoms of allergic conjunctivitis. Cetirizine is currently commercially available as an oral medication, Zyrtec (Johnson & Johnson Consumer, Inc.).

CORTICOSTEROIDS There are times when a patient with active allergic conjunctivitis requires a topical corticosteroid to control the signs and symptoms initially and before managing with a topical antihistamine.

Although you need to make sure that you are assessing the intraocular pressure when a topical corticosteroid is used, they are usually used for only a short period of time to sequester the inflammatory response caused by the allergen. There are several topical corticosteroids available.

Loteprednol is available in two concentrations: 0.2% and 0.5%. The 0.2% is available as Alrex (Bausch + Lomb).

Alrex is approved as a four-times-a-day dosing regimen for allergic conjunctivitis. The higher concentration of 0.5% is commercially available as loteprednol gel. Although not specifically approved for allergic conjunctivitis, many use it to sequester the initial symptoms of the disease.

Fluoromethalone acetate 0.1% is a topical corticosteroid available as Flarex (Novartis). Although not specifically approved for allergic conjunctivitis, it is

approved for the treatment of steroid responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea and anterior segment of the eye. The acetate formulation has shown significant improvement in efficacy over the alcohol formulation of fluoromethalone.

Managing allergic conjunctivitis is becoming an increasingly important component to our practices.

Understanding appropriate identification and treatment strategies is critical to effectively managing these patients.

A proactive approach is the best way to help these patients manage their symptoms. O|O

Mile Brujic, OD, FAAO, is a partner of Premier Vision Group, a three-location practice in northwest Ohio. He has authored more than 250 articles for publication and given more than 1,300 lectures.

WHERE TO FIND IT Alcon Laboratories 800.451.3937 | Alcon.com Allergan 800.347.4500 | Allergan.com Bausch + Lomb 800.828.9030 | Bausch.com Eyevance Pharmaceuticals 817.677.6120 | Eyevance.com Johnson & Johnson Consumer, Inc. 800.343.7805 | Zyrtec.com Novartis 862.778.2100 | Novartis.com

O p tometr ic O ffic e. c om | M a r ch 2019

11

CONTACT LENSES

DOCS | SPEAK OUT Di g i t a l E y e S t r a i n

According to a report from The Vision Council, people may suffer from discomfort after only two hours of screen use. Since 80% of American adults report using digital devices for more than two hours per day, it’s no surprise the percentage of patients complaining of digital eye strain is high. But what about patients who wear contact lenses? Optometric Office asked how you advise your patients who wear contact lenses and suffer from digital eye strain.

What symptoms of digital eye strain do your contact lens-wearing patients report? (answer all that apply) Dry, irritated eyes: Headaches:

97%

20

%

100%

85%

Neck and shoulder pain:

0

NO 0

70%

Blurred vision:

Other:

Do you discuss digital device use with your contact lens patients?

45%

YES

9% 40

60

80

100

What products or therapeutics have you suggested patients try to minimize their symptoms?

“Artificial tears.”

“I recommend Systane Complete.

Sometimes patients tell me what they are using to confirm it is ok and I authorize those also.”

“A blue light protection screen for their computer monitor.”

“Blink Contacts lubricating eye drops; clean, warm compresses; lid scrubs; digital massage; vision therapy; prism glasses; Eyezen lenses; workspace lenses; Lipiflow.”

“Use rewetting drops; wear daily disposable lenses.”

“Prescribe Neurolens prism lenses.”

“Oasis lubricating drops.”

12 M a r ch 2 01 9 | O p to m e tri c O f f i c e .c o m

“Refresh tears with improved frequent blinks and mild readers if presbyopia (measure/ calculate accordingly) is present.”

Energys contact lenses, low add soft multifocal.”

“FreshKote lubricant eye drops.”

“I recommend Acuvue Oasys 1-Day contact lenses, artificial tears or re-wetting drops, Crizal Prevencia anti-reflective (AR) lens and/or a blue blocker tint.”

“Fish oil supplements, hot compresses, gel tears at bed time, and artificial tears.”

“Clerz Plus eye drops.”

“Humidifier.”

“Daily disposable contact lenses; Biofinity Energys contact lenses; re-wetting drops; adding Omega-3 supplements to diet; and using blue blocking materials.”

“Humidifier, re-wetting drops, general hydration, taking breaks (20-20-20 rule), blink education, punctal plugs.”

“Dietary supplements for dry eyes and/or re-wetting drops.”

“Digital boost lenses.”

“Refresh Tears or other similar artificial tears, Gunnar computer glasses, office lenses with blue AR coating.”

“Humidifier, rewetting drops, Biofinity

“Treat dry eye first.”

“Lid scrubs and drops.”

What lifestyle recommendations do you suggest to patients who experience digital eye strain symptoms?

“I tell patients to write the word ‘blink’ on a Post-it note and put it on the computer monitor and every time they see it, blink really hard.”

“The 20-20-20 Rule (every 20 minutes, look at something 20 feet away for 20 seconds), adjust the screen’s brightness and wear multifocal lenses.”

“I provide a handout with ergonomic modifications and recommended working distances.”

Have you ever prescribed contact lenses for digital use or recommended plano eyeglasses with lens coatings or tints to help reduce digital eye strain? (answer all that apply)

Yes, I’ve prescribed contact lenses for digital use:

33%

Yes, I’ve prescribed plano eyeglasses with special lens coatings or tints for contact lens patients to wear while using digital devices:

39%

Yes, I’ve prescribed both contact lenses and

eyeglasses with digital lens coatings:

27%

5

10

15

20

25

BRUDER LAUNCHES EYELEVE COMPRESS FOR CONTACT LENS WEARERS Designed to help contact lens patients wear their lenses longer, the Eyeleve Contact Lens Compress delivers consistent, therapeutic moist heat to soothe dry, irritated eyes. The microwaveable mask alleviates symptoms of meibomian gland dysfunction and contact lens-related dry eye. By stimulating glands and increasing oil production, Eyeleve helps stabilize the ocular surface to reduce dryness and extend comfortable wear time of contacts. According to the company, it’s the first and only compress clinically proven to increase comfortable contact lens wear time by up to three hours daily. Also beneficial: Eyeleve features silver ion MediBeads and an anti-microbial EyeOnic material to reduce the risk of infections in contact lens wearing patients.

Go to Eyeleve.com

No, I’ve never recommended digital lenses: 27%

0

NEW PRODUCT | GALLERY

30

35

40

“Wear blue-light protective eyeglasses with contacts.”

“Use the F.lux app on devices. The free download warms the computer’s display at night to match indoor lighting.”

“Nutritional supplements for dry eyes; the “3-B” approach (Blink, Breathe and Break) and the 20/20/20 rule. I always try to get environmental information to suggest best practices.”

“Take a break from the screen every hour.”

“Walk around every 30 minutes.”

“Use blue light filters on digital devices.”

“Seated position (screen 15° to 20° below eye level and 20 to 28 inches from the eyes) and lighting.”

“The 20-20-20 rule; computer apps to remind patients of time; eye exercises to perform; specific apps that automatically adjust screen brightness; anti-glare screens for computers; stretching movements to perform during the day at computer; recommendations for regular chiropractic care and massage.”

“Spend no more than 20 minutes on the phone, 40 minutes on an iPad or 60 minutes on a computer.”

VITEYES RELEASES DIGITAL DEFENSE GUMMIES Harmful blue light has been attributed to many eye issues (light sensitivity, itchiness, redness, blurry vision, dry eyes) and contributes to headaches and sleep problems.

The latest dietary supplement from Viteyes, Blue Light Defender, enables your patients to safeguard their eyes from harmful blue light, which is emitted everywhere from digital devices, computer monitors, television screens, and even sunlight, by helping to block the detrimental effects of these blue wavelengths.

The all-natural gummies contain the antioxidant lutein to protect and maintain healthy cells within the eyes and absorb blue light to protect the eyes from damaging rays; the carotenoid zeaxanthin, which helps to maintain macular and retinal health, protecting the eyes from detrimental blue light as well; and bilberry fruit extract to improve blood flow and oxygen delivery in the eyes.

Go to Viteyes.com O p tometr ic O ffic e. c om | Ma r ch 2019

13

NEW PRODUCT | GALLERY ALCON DEBUTS ILUX MGD TREATMENT SYSTEM FOR DRY EYE DISEASE Alcon has introduced an in-office treatment that treats meibomian gland dysfunction, a leading cause of dry eye disease. The handheld, portable iLux Device with Smart Tip Patient Interface enables ECPs to directly target a patient’s blocked meibomian glands through the application of light-based, localized heat and compression to soften the blockages.

Go to Alcon.com

SYNERGEYES INTRODUCES SIMPLIFEYES 1DAY DAILY DISPOSABLE CONTACT LENSES SynergEyes, Inc. has launched the SimplifEyes 1Day daily disposable lens. The lenses are enhanced by Dual Tangible Polymers from Tangible Science—the company that developed Tangible Hydra-PEG for scleral, GP and hybrid lenses. With one tangible polymer coating on the lens surface and another tangible polymer in the solution, the Dual Tangible Polymers are designed to provide enhanced wettable surfaces, less debris build-up and excellent comfort.

SimplifEyes 1Day is available in powers of +0.50D to +4.00D, and -0/50D to -6.00D in 0.25D steps. The Etafilcon A with Dual Tangible Polymers lens has an ultra-thin edge design and UV blockers. The introduction of this lens means the company now offers a complete line of hybrid, scleral, gas permeable and soft contact lenses. The lenses are supported by the MyContactLens Online Ordering System, currently in beta, a portal available on eyecare professionals’ websites that makes it easy for patients to order lenses.

Go to SynergEyes.com

FORTIFEYE ADVANCED DRY EYE THERAPY OFFERS A BOXED SET FOR HEALTHY VISION After carefully evaluating all of the evidence-based science, Michael Lange, OD, CNS, of Fortifeye has combined three supplements in a cost-effective box called Fortifeye Advanced Dry Eye Therapy, which contains Fortifeye Super Omega, Fortifeye Focus and Fortifeye Black Currant Oil/GLA. These nutrients are supported by clinical studies showing benefits to dry eye, eye strain and fatigue, macular pigment density, skin health, joint health, muscle endurance, muscle recovery, mitochondrial support and much more. Formulated to help patients with dry, tired eyes, it is also recommended for anyone suffering with Computer Vision Syndrome.

Go to Fortifeye.com

NEW ZEN MULTIFOCAL SCLERAL LENS FOR PRESBYOPIA FROM BAUSCH + LOMB Bausch + Lomb introduced the Zen Multifocal scleral lens for Presbyopia, which will be exclusively available with Zenlens and Zen RC scleral lenses through the company’s Specialty Vision Products unit. The lens is a fit for presbyopic patients who have irregular and regular corneas, as well as those who suffer from ocular surface disease, such as dry eye, with add power ranges from +1.00D to +3.50D in 0.25D steps. The lens incorporates decentered optics, enabling the near power to be positioned over the visual axis. The multifocal design also offers variable near zones from 1.5 mm to 3.0 mm in 0.5 mm steps.

Go to BauschSVP.com 14 M a r ch 2 01 9 | O p to m e tri c O f f i c e .c o m

AT-A- GLANCE

NUTRACEUTICALS SUPPLEMENT

SUGGESTED DAILY INTAKE

FEATURED INGREDIENTS

BENEFITS

Alcon | 800.757.9780 | Systane.com SYSTANE ICAPS Eye Two softgels or Lutein, Zeaxanthin, Vitamins C • contains ingredients clinically shown to support eye health in Vitamin and Mineral coated tablets daily, and E, Copper and Zinc people with age-related macular degeneration (AMD)* Supplement AREDS2 1 in the morning and • levels of vitamins C and E, and zinc in supplement generally can 1 in the evening with Formula be attained only by supplementation and through diet alone meals, or as directed by your physician; or 2 • no added beta carotene, may contain trace amounts from natural Chewable Tablets per sources day with a meal SYSTANE ICAPS Eye Vitamin and Mineral Supplement Vision Health Formula

1 softgel per day, with meal or as directed by your physician

Lutein, Zeaxanthin, Omega-3 Fatty Acids and others

• provides a wide spectrum of important ingredients shown to support eye health and vision* • no added beta carotene, may contain trace amounts from natural sources

Bausch + Lomb | 800.553.5340 | Bausch.com PreserVision AREDS 2 Formula Eye Vitamins

2 softgels twice per day, with a meal

Lutein, Zeaxanthin; Vitamins E and C, Zinc, Copper; Betacarotene free

• patented formula containing the exact levels of 6 key nutrients from the AREDS2 clinical study conducted by the National Eye Institute • nutrient levels examined and proven clinically effective in the AREDS and AREDS2 clinical studies • family of products including: Soft Gels, with Multi-Vitamin, and great-tasting Chewables

Ocuvite Blue Light Formula

1 softgel daily, with a full glass of water during a meal

25 mg Lutein, 5 mg Zeaxanthin

• helps protect eyes from blue light • helps replenish the macular pigment layer that helps filter blue light

Fortifeye Vitamins | 866.503.9746 | Fortifeye.com Fortifeye Advanced Dry Eye Therapy

3 pills, once daily

Omega-3, Astaxanthin, Lutein • combination of Fortifeye Super Omega, Fortifeye Focus and and Zeaxanthin, Black Currant Fortifeye Black Currant oil/GLA work synergistically together to Oil/GLA (Omega-6 derivative) help decrease dry, fatigued, tired eyes

• helps to control oxidation and inflammation in the eye and entire body • used for years in dry eye centers throughout the country and is now available for the first time to the public as of January 2019

Lipotriad | 888.393.5476 | LipotriadVitamins.com

Lipotriad Visionary

1 softgel daily

Lutein, Zeaxanthin, and reduced Zinc

• formula based on AREDS2 Study • dye-free • small, easy-to-swallow soft gels

O p tometr ic O ffic e. c om | Ma r ch 2019

15

AT A GLANCE NUTRACEUTICALS continued

SUPPLEMENT

SUGGESTED DAILY INTAKE

FEATURED INGREDIENTS

BENEFITS

Lunovus | 800.980.6551 | Lunovus.com

Visual Advantage Premier Formula

1 capsule per day

Lutein, Zeaxanthin, Vitamins C • 100% daily Copper intake and E, Zinc and Copper • contains the same level of Lutein and Zeaxanthin as AREDS 2,

with a lower dose of vitamin C

MacuHealth | 866.530.3222 | MacuHealth.com

MacuHealth with LMZ3

1 softgel daily

Lutein, Zeaxanthin and Meso-Zeaxanthin

• can restore and maintain macular pigment to each individual’s optimal level • can improve symptoms of glare, and improve visual performance for those seeking sharper vision • powerful antioxidant properties protect RPE and photoreceptors throughout a lifetime from free-radicals that can lead to blindness from AMD • 10mg Lutein, 2mg Zeaxanthin and 10mg Meso-Zeaxanthin

Nordic Naturals | 800.662.2544 | NordicNaturals.com

Omega Vision

2 softgels daily, with food

Omega-3s, Lutein and Zeaxanthin

• contains 1,460 mg total Omega-3s, 20 mg Lutein and 4 mg Zeaxanthin • contains FloraGlo Lutein • promotes healthy eye moisture and tear production • supports brain and eye health, while protecting against damaging blue light

Viteyes | 800.890.3937 | Viteyes.com Viteyes Classic AREDS2 Formula

2 capsules or softgels daily

Viteyes Blue Light Defender Gummies

1 gummy daily

Vitamins C and E, Zinc, Copper, • based on AREDS2 study Lutein and Zeaxanthin • contains lower Zinc and Copper allowing for a single daily dosage

• available in capsules, softgels and allergen-free formulation Lutein, Zeaxanthin and Bilberry

• formulated to protect eyes from blue light, which may be emitted from electronic devices and sun exposure • formulated with Lutein (20mg) and Zeaxanthin (4mg), the only natural defenses our eyes have against the harmful effects of blue light.

ZeaVision | 866.833.2800 | EyePromise.com

EyePromise Restore

1 softgel daily

Zeaxanthin, Lutein, Vitamins C, • rebuilds low macular pigment, a leading risk factor for D3 and E, Omega-3s, Alpha age-related eye health Lipoic Acid, Mixed Tocopherols • replicates the natural 2:1 ratio of Zeaxanthin to Lutein found in a

healthy fovea • the only nutraceutical guaranteed to increase macular pigment optical density (MPOD) * These statements have not been evaluated by the U.S. Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

For a longer listing of Nutraceuticals, go to OptometricOffice.com. O|O 16 M a r ch 2 01 9 | O p to m e tri c O f f i c e .c o m

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