Transcript The Future of Contact Lenses

Developments in Contact Lenses
No financial interest
Market Developments
• The European drop out rate is 30.4%
• The owner/manager of the Danish
Kontaktlinse Instituttet reported that in 2011
they had 850 new fittings but 700 dropouts.
• Multiples have gained 3% of the CL market
share at the expense of independents.
The Internet
• Prescription eyewear (PEL) which owns
glassesdirect.com, lensOn, myoptique.com
and Sunglass Shop.com say that 3-4% of the
European eyewear market is online.
• Other high growth e-commerce categories
such as fashion and apparel are closer to 10%.
It is anticipated that optics will follow this.
• Total loss ≈ 13%
But they still have to come to me
for aftercare?
• Out of 8 internet CL sites checked only 4 asked me
for a copy of my Rx or my optician’s details.
• When was the last time you took a call from an
internet site asking to confirm a patient’s Rx?
• Prosecution – get the sites closed down?
– MK is 4 in 10,000 wearers per year
– Risk of loss of two or more lines of vision is 6 in 100,000.
Internet associated with a 4.5x greater risk.
• The sale of CLs is effectively already deregulated.
What can we do?
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Charge realistic fitting fees.
Offer them something new at aftercares
Fit more RGPs.
Ortho-K
Sclerals
• Predicted to be the future of CLs
• RGP lens material.
• Can be divided into different types based on
diameter:
– Corneoscleral – 12.9 to 13.5mm
– Semi-scleral – 13.6 to 14.9mm
– Mini-scleral – 15 to 18mm
– Scleral – 18.1 to 24+mm
Image from CL Spectrum
Corneosclerals
• These do not completely vault the cornea.
• They are good for any patient who requires
the visual correction of an RGP lens but
cannot tolerate them.
• The larger diameter than RGPs means less lid
interaction and so less adaptation making
them more suitable for part time wearers.
• They can be made with or without
fenestration.
Image from No. 7
SOClear Lens
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A corneoscleral lens from No. 7
Does not require a topographer for fitting
No. 7 run free training courses for fitting.
Rinsed, wetted and stored with a
preservative free soft CL MPS e.g. Sauflon
Synergi
• Cleaned with an alcohol based cleaner
available from No. 7
• Protein removal can be done monthly with
Menicare Progent.
Images from No. 7
Myopia Control
• Child needs regular aftercare. Less opportunity to
buy lenses from the internet.
• The decision to instigate anti-myopia treatment
should be based on hyperopia of +0.50D or less at
age eight, parental myopia and binocular vision
status (esophores are more successful).
• Can be as simple as fitting the child with a centre
distance MF lens.
What’s New in Myopia Control
• In Hong Kong Coopervision are trialling the
MiSight daily disposable lens designed for
myopia control.
• Alcon is conducting a multi-year clinical study
in China to evaluate the efficacy of specially
designed myopia-control silicone hydrogel
contact lenses
Image from Coopervision
What’s new now and what is
coming?
• In CL solutions polaroid has introduced the
contactspod.
Menicon Magic
The Meibographer
• Topcon make a non-contact IR device which
can be attached to their slit lamps which
allows visualisation of the meibomian glands.
Slit Lamp Fundus Viewing System
CL Materials: Comfort
• As discomfort is No. 1 reason for CL dropout
and dryness is the leading cause of discomfort
manufacturers are always looking for ways to
make lenses more moist.
• HPMC in packaging saline.
• PEG releases early from the lens
• PVA slowly releases from the lens throughout the
day by blink action.
• Outer surface of the lens designed to mimic
lipid layer of tear film.
• Water content of lens (78%) is the same as
that of the cornea but still has a DK/t of 42
even though it does not have silicone.
Antimicrobial surfaces
• Ciba, Menicon & Sauflon (synergi) have a
microblock contact lens case.
• What about a microblock CL surface?
• Contact lenses with a built in microblock have
already been made in labs and tested but
additional research is needed.
• Their compatibility with lens care systems
needs to be established along with any
likelihood of allergic reaction.
• Build up of endotoxins.
If successful
• There would likely be an increase in extended
and• continuous
wearthis
lenses and a decrease in
We can avoid
the CL solutions market.
Amphibious Lens
• Mini-scleral
• RGP material
• High powered segment centrally (for water
viewing)
• Peripheral distance correction for viewing in
air
Images from CL Spectrum
CLs for Drug Delivery
Problems with Glaucoma Drops
• A 2008 Canadian study reported that over
50% of glaucoma patients surveyed were
either non-compliant with drops or
demonstrated improper administration.
• It is thought that BAK preserved drops may be
causing damage to the cornea, conjunctiva
and even the trabecular meshwork.
• The conjunctival damage can affect the
success rate of trabeculectomies.
Drug-eluting CLs
• First used in 1965.
• The advantages of drug delivery via CLs are:
– Lower concentrations of drugs can be used
– The patient can have their vision corrected as well
– The drug is in direct contact with the cornea and
there is less secondary penetration through the
conjunctiva
Recent trials
• Silicone hydrogel lenses with timolol and
vitamin E (the vitamin E prolongs the drug
delivery) have been successfully shown to
decrease IOP in Beagle dogs.
Challenges
• There are major hurdles to commercialization
including processing and storage issues,
regulatory issues, high costs of clinical studies,
and cost-benefit analysis.
• It is also not clear whether drug-releasing
contact lenses are suited to be sold in
pharmacies or directly by healthcare
professionals such as ophthalmologists and
optometrists.
Monitoring Biomarkers
• In the University of Akron they have
developed a CL that detects glucose in the
tears and then changes colour if there is a
build up of glucose.
Augmented Reality Eyewear
• Innovega are designing propriety display
technology to go into contact lenses.
Applications
• Soldiers can be given real time images from
unmanned reconnaissance planes.
• Fully immersive video games.
• Augmented reality
• Cheating in exams
Thank you for your attention