Mile Brujic, OD, FAAO

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As optometry continues to evolve, it is critical for proactive practitioners to stay abreast of new developments that will help them provide improved clinical outcomes. This article highlights 10 new treatments in eye care that every optometrist should know.

Tangible HydraPEG (THP; Tangible Science) is a relatively new surface treatment for gas permeable (GP) contact lenses. It has been available on SynergEyes Duette lenses, and it is present on the surface of Simplifeyes soft contact lenses. Plus, THP is available on most Optimum (Contamac) and Boston (Bausch + Lomb) materials.

THP is a polymer that encapsulates the lens, improving wettability of the surface through water retention. This increases the lubricity of the surface, providing a more comfortable wearing experience for the patient. Additionally, because the surface is hydrophilic, it repels lipid deposits on the surface of the lens.

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With the benefits of this new coating, it is important to understand how these lenses need to be cared for because some of the rules for caring for GP lenses without THP do not apply. As an example, lenses coated with THP shouldn’t be cleaned with abrasive cleaners because such cleaners will strip the coating off of the lens. Five solutions are approved to be utilized for GP lenses with THP:

Some GP wearers have a habit of rinsing their lenses with water. Although this is not recommended with any GP lens, it is contraindicated for lenses with THP on their surface.

Soon, Tangible Science will launch Tangible Boost, a monthly soaking solution formulated to re-build the coating that may have naturally worn away over time with normal cleaning and conditioning of the lens.

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Prostaglandin analogues have been a first-line therapy for glaucoma patients for two decades. Prostaglandin analogues increase outflow of aqueous from the anterior chamber through the uveoscleral pathway. They provide a significant reduction in intraocular pressure (IOP) while featuring a convenient once-daily dosing regimen. Recently, there have been several additions to the armamentarium to care for glaucoma patients.

Xelpros (latanoprost 0.005%, Sun Pharma) is a recent addition to the family of prostaglandin analogues. What makes this formula different is the presence of a benzalkonium chloride (BAK)-alternative preservative. This medication is preserved with potassium sorbate and is intended to be dosed once in the evening.

Vyzulta (latanoprostene bunod, Bausch + Lomb) is a new class of medication. The active pharmaceutical is a nitric oxide-donating prostaglandin analogue. In addition to increasing uveoscleral outflow, the nitric oxide that is donated from the latanoprost molecule increases trabecular meshwork outflow, facilitating additional IOP-lowering by working on two outflow pathways. It is dosed in the evening.

Rhopressa (netarsudil 0.02%, Aerie) is a rho kinase inhibitor. Rho kinase is an enzyme that promotes actin-myosin contraction in the trabecular meshwork. When rho kinase enzymatic levels are high, it can act to decrease the aqueous outflow through the trabecular meshwork. By inhibiting this enzyme, it facilitates additional outflow through the trabecular meshwork and thus reducing intraocular pressure.It is dosed once a day.

Another new medication, Rocklatan (netarsudil 0.02%, 0.005% latanoprost, Aerie), is a combination drop containing a rho kinase inhibitor along with a prostaglandin analogue. This drop is intended to be dosed once daily.

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ODs are fortunate to have several specialty soft lens designs that allow presbyopic astigmatic patient to successfully wear contact lenses. Benefits to these lenses are that they are custom made and can be modified for patients’ unique needs. Part of the challenge that exists with these designs is that they require the practitioner to order the lenses. If the first lens that comes in isn’t ideal for the patient, another order is then required. 

Recently a soft multifocal toric lens has been introduced that is available as a standard design in offices. Fitting a standard design gives the practitioner the ability to fit patients immediately with a proven design.

Ultra Multifocal for Astigmatism (Bausch + Lomb) features the company’s 3-Zone Progressive and OpticAlign designs. The lens is made of silicone hydrogel samfilcon A material and is 46 percent water. Ultra Multifocal for Astigmatism is available in sphere powers from +4.00 D to -6.00 D with cylinder powers of -0.75 D, -1.25 D, and -1.75 D. Axes availability is 10° to 180° in standard 10° increments. The lens is designed with a low and a high add powers. The low add is intended for presbyopes who have add powers up to +1.50 D. The high add is intended for presbyopes who have greater than +1.50 D add.

Year in review of optometric advancements

It has been well established that a patient’s line of sight has a significant influence on the optical alignment of multifocal lenses. Line of sight is often not directly through the center of the pupil but rather is nasally located within the pupil. This creates an interesting challenge for some patients. If the difference between the line of sight and the pupil’s geometric center is low, standard multifocal contact lenses may be an appropriate option of vision correction for these patients.But if large discrepancies exist, there may be better options.

Multifocal lenses that have the optics of the lens decentered nasally in order to better align with the patient’s line of sight are called nasally offset optics. SpecialEyes 54 Multifocal is produced with OptiSync Technology, which offsets the optics nasally and stabilizes the lens on the eye by leveraging a prism ballast.

Multifocal scleral lenses are now also being created with offset optics. Zenlens  (Bausch + Lomb) is available as a multifocal scleral lens with offset optics to optimize the optical alignment with the patient’s line of sight. Other manufacturers are currently working on multifocal lens designs with offset optics to help optimize vision for these patients.

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Other contact lens advancements are noteworthy to discuss.

Recently, Johnson & Johnson Vision incorporated Transitions technology into its Acuvue Oasys contact lenses and refer to the incorporated design as light intelligent technology. Just as ophthalmic lenses are activated with this technology when exposed to ultraviolet radiation darkening the lenses, so are Oasys lenses. It provides patients the opportunity to recognize the benefits that changing ophthalmic lens provides but in the convenience of a contact lens.

Another recent advancement is Eyeris, an advanced doctor locator that provides patients the ability to look online for same-day appointments for doctors who are signed up for the service. Recently Eyeris launched a daily disposable contact lens that is exclusively available through doctors’ offices in an attempt to help control the quality of medical devices prescribed to patients.

Related: Spectacle lenses do more: Embrace new technology

In November 2019, CooperVision’s MiSight was the first contact lens approved by the U.S. Food and Drug Administration (FDA) for slowing the progression of myopia. MiSight is a daily disposable lens and will be available in the near future.

Another noteworthy contact lens technology is in the area of scleral lenses. As ODs know, the solution that is utilized to fill the bowl of a scleral lens must be preservative free because the solution will be in close proximity to the cornea for an extended period of time. Nutrifill (Contamac) is a new filling solution that was recently FDA approved.

Nutrifill is a balanced solution containing calcium, potassium, magnesium, sodium, and phosphorous. This fill solution has been engineered to be osmotically balanced to the natural tear film, providing a physiologically balanced environment for cornea.

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Procedures to re-normalize the function of the meibomian glands and ultimately re-establish a normal lipid layer are critical to offer patients for meibomian gland dysfunction. There are several technologies that provide the practitioner an opportunity to provide the benefits of this treatment to their patients.

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LipiFlow (Johnson & Johnson Vision) is a 12-minute procedure that warms the meibomian glands from the posterior surface of the lids. While heat is applied to the posterior surface of the lids, intermittent pressure is applied to the front surface of the lids. The simultaneous heat and pressure allows evacuation of obstructed meibomian glands.

iLux (Alcon) is another advanced meibomian gland warming and evacuation procedure. It involves warming the lid through the outer surfaces of the upper and lower lids. Pressure is applied to the lids to evacuate the meibum from the glands. The glands that are being evacuated can be viewed through a magnifying lens that is focused on the lid margin as the procedure is being performed.

TearCare (Tear Science) is a meibomian gland warming and evacuation procedure in which smart lids are placed on the upper and lower lids.  There is a simultaneous warming of the lids at 45° C for 15 minutes. After the warming occurs, the meibomian glands are evacuated with forceps designed to optimally work with the lid margins.

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7. Controlling ocular surface inflammation

It has been well established that ocular surface inflammation is at the root of dry eye disease. Clinicians have leveraged this understanding of the ocular surface physiology to help their patients with dry eye disease.

Cyclosporine has been the traditional pharmacological therapy for patients with dry eye. It has been available for over 15 years (Restasis, cyclosporine 0.05%; Allergan) in unit dose vials that is dosed twice a day. Recently, cyclosporine has become available in a multidose bottle that is preservative free, providing patients the benefits of 0.05% cyclosporine in a bottle (Restasis Multidose, Allergan).

Lifitegrast 5% (Xiidra, Novartis) has been FDA approved for both signs and symptoms of dry eye disease. It is dosed twice a day. It is available in preservative-free unit dose vials. Lifitegrast’s mechanism of action features a lymphocyte functioning antigen-1 (LFA-1) antagonist. LFA-1 are molecules found on T-cells that bind to intercellular adhesion molecule-1 on the surface of inflamed ocular surface tissues. This interaction propogates ocular surface inflammation promoting the signs and symptoms of dry eye. Lifitegrast is a LFA-1 antagonist preventing this interaction.

More recently, a newer formulation of cyclosporine has been approved-Cequa (cyclosporine 0.09%, Sun Pharmaceuticals). The vehicle that the molecule is packaged in is referred to as nanomicelle technology; it optimizes absorption of the medication into the ocular tissues. It is intended to be used twice a day.

Technological advancements in glaucoma management

Hypochlorous acid is released from neutrophils as an essential part of the immune system. Hypochlorous acid kills microorganisms by neutralizing inflammatory toxins released by pathogens. It is beneficial for the management of lid margin disease by helping prevent excessive biofilm formation on the lid margin.

Over the last several years, a number of hypochlorous acid formulations have been developed and available to eyecare providers and patients. Currently available hypochlorous acid formulations are:

TheraTears Sterilid Antimicrobial Eyelid Cleanser (0.01%, Akorn)

Bruder Hygienic Eyelid Solution (0.02%, Bruder)

Heyedrate Lid and Lash Cleanser (0.015%, Eye Love)

Prevention, artificial intelligence, and the future of optometry

Optical coherence tomography (OCT) has revolutionized the way that ODs view ocular tissues. It allows for viewing cross-sections of the retina and optic nerve, providing critical diagnostic information to manage a plethora of ocular conditions.

Recently, angiography capabilities have become available within the OCT software platform. OCTA allows the clinician the ability to see blood vessels within the retina. This offers clinicians new perspectives of the vasculature bed within the retina. This is useful for macular degeneration patients to help rule out neovascularization and in glaucoma to help understand early reduction in vascularization around the optic nerve with early glaucomatous damage.

Additionally, new insights into the diabetic patients are now giving us a better understanding of the foveal avascular zone (FAZ).  Early increases in the FAZ in diabetics may represent the earliest forms of diabetic retinopathy and capillary dropout.

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The vast array of pharmaceuticals available to treat ocular conditions provides the practitioner with a large armamentarium of choice. With that said, manufacturers are constantly exploring ways to better deliver these medications to their target tissue. Cyclosporine 0.09% was previously discussed as one of these options which has been formulated in a nanomicellular technology.

Loteprednol is now being formulated to be more targeted for tissue penetration. Two new formulations are noteworthy to discuss here.

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Inveltys (loteprednol etabonate 1%, Kala) is FDA approved as a bid dosing regimen for postoperative inflammation and pain following ocular surgery. Amplify is the drug delivery technology. Nanoparticles 200 nm to 400 nm enhance penetration through the mucous barrier on the ocular surface.

Lotemax SM (loteprednol etabonate 0.38%,  Bausch+Lomb) is FDA approved for postoperative inflammation and pain following ocular surgery. The delivery mechanism features sub-micron particles (0.4 µm to 0.6 µm) leading to greater tissue and aqueous humor penetration.

Often, newer medicines are accompanied with a higher concentration of active medication.  In this case of Lotemax SM, the concentration of loteprednol has been reduced from its predecessor, Lotemax Gel (Bausch + Lomb),  which contains 0.5% active medication.

With the advancements in optometry, it is critical for practitionersto stay abreast of changes in eye care. In doing so, optometrists will have a larger armamentarium of diagnostic and treatment options to help care for patients.

Articles

10 new treatments in eye care

The views expressed here belong to the author. They do not necessarily represent the views of 

was introduced to the optometric community, many ODs did not understand the capabilities of the technology-nor how they would be utilizing it in their clinical practices.

Over the last decade, ODs have learned how to maximize the use of OCT in clinical practice.

There are four commonly utilized reasons for anterior segment OCT.
	
	

Previously by Dr. Brujic and Dr. Kading: 

Blog: Understand the science and art of managing chronic conditions


	Anterior segment OCT was initially developed to measure the anterior segment-not 

. Many proactive contact lens practitioners realized that they could see the contact lens resting on the cornea when using this technology. This became an exceptional imaging system when ODs realized they could utilize it for fitting more advanced lenses like scleral lenses.

Scleral lens fitting abides by a few rules: They need to be fit with the appropriate central corneal clearance, limbal clearance, and landing zone fitting the relationship.
	ODs can measure the central corneal clearance along with limbal clearance. (Figures 1 and 2) This enables them to communicate more accurately with specialty lens laboratories and determine exact measurements and microns of clearance.
	
	

In our experience, this creates a more efficient fitting process and ultimately requires less lens adjustments to optimize the fit for the patient.


	Keratoconus is a condition traditionally monitored with topography to measure corneal curvature. With this condition, the cornea is steeper at the cone. 

Anterior segment OCT technology monitors the condition by assessing the corneal thickness and at the thinnest region of the cornea, typically located in the region of the cone. This has become critically important for ODs because some vision plans require this measurement to determine the severity of the keratoconus.

Anterior segment OCT provides an additional metric to topographies to monitor disease progression over time. 
	
	


	One study looking at the epithelial thickness maps (ETM) of patients showed that individuals with dry eye had thickened ETM compared to those without dry eye.

In a second study, researchers demonstrated a thinning of the ETM in the superior region of the cornea compared age-related normals.

Although these studies may seem contradictory, they can be viewed as representing different phases of 

. Thought leaders in DED realized early on that ETM thickening may be secondary to early inflammation. With more chronic long-term DED, there may be an increased risk of chronic inflammation, causing a thinning of the ETM.

We have noted this in our clinical experience as well. Those patients with earlier DED tend to have thickened ETM, while those who have had chronic dry eye for decades tend to have thinner ETM superiorly (Figure 3). We have also seen more variability in ETM in the dry eye patient than normal individuals.
	
	

This has become one of the new metrics to follow in dry eye patients. It is our goal to stabilize the ETM so there is less variability in the thickness of the ETM in those individuals with dry eye and to help avoid long-term thinning that can occur in some DED patients.
	
	

Blog: Don't leave dry eye disease patients high and dry 


	ETM has provided new insight and understanding into certain visual characteristics of post-

An interesting relationship was found between ETM and visual outcomes for patients. We determined that those individuals who experience more visual disturbance tend to have increased ETM. The total pachymetry readings of post-refractive surgery patients was predictably thinner centrally where the myopic ablation occurred.

But there is a variance in the ETM that exists in these patients, and we found a strong correlation between thicker ETM and more visual complaints. In normal individuals, the expected ETM is 50 to 59 µm. In some post-refractive surgery patients, we have seen ETM as high as 73 µm of epithelial thickness (Figure 4).
	
	

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	Other conditions for anterior segment OCT include epithelial basement membrane dystrophy (EBMD), Fuch’s endothelial dystrophy, and narrow-angle glaucoma.

Viewing the anterior segment with higher diagnostic technologies gives ODs a greater insight into understanding the physiology of the anterior segment and helps illuminate the unexplained visual outcomes that our patients may have.

With more time and research, ODs will continue to increase their understanding of anterior segment OCT as it becomes an increasingly important part of clinical practices.
	
	

1. Kanellopoulus AJ, Asimellis G. In vivo 3-dimensional corneal epithelial thickness mapping as an indicator of dry eye: preliminary clinical assessment. 

 2014 Jan;157(1):63-68.
	2. Cui X, Hong J, Wang F, Deng SX, Yang Y, Zhu X, Wu D, Zhao Y, Xu J. Assessment of corneal epithelial thickness in dry eye patients. 

Blog: 4 uses for OCT in OD practices

Contact lens wear is a tremendous portion of many optometry practices. Many patients come to ODs because of their ability to provide comfortable vision with

Unfortunately, without successfully providing 

 with a comfortable wearing experience, they may not be able to appreciate the full impact of the vision-correcting opportunities that contact lenses can offer. Many major manufacturers have invested significantly in attempts to improve comfort through new materials, lens designs, lens care solutions, and surface treatments.

Troubleshoot contact lens discomfort and prevent complications


	ODs have seen firsthand the positive outcomes these new modalities have had on patients’ lens-wearing experience. Even with the availability of new contact lens technologies, some patients will still discontinue contact lens wear. There are several reasons for this, including ocular redness, decreased visual acuity, and even cost of the contact lenses. Interestingly, the most commonly-cited reason that someone will discontinue contact lens wear is discomfort.

From a clinical perspective, ODs know who is wearing lenses but determining those who have discontinued lens wear is a more difficult exercise.

Some patients will tell their ODs about their comfort challenges and seek help, but most are silent sufferers because they attribute discomfort as a necessary evil of wearing contact lenses. These patients may seek other professional opinions, or they could simply come in to their next eye exam wearing their glasses, uninterested in continuing contact lens wear.
	
	

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I went through a self-realization several years ago when I asked patients in my practice to grade their

 comfort on a scale from 0 to 10 (10 being the most comfortable wearing experience and 0 being the least) at the beginning and the end of the day.

I found that even my seemingly comfortable contact lens wearing patients were experiencing a significant drop in comfort toward the end of the day. This is when ODs typically consider intervening with new contact lens technologies to positively influence patients’ end-of-day comfort.

I think all practitioners should embrace the newest contact lens technologies, including material science and optical designs. Contact lens innovation provides our patients with a remarkable improvement in wearing experience. I believe ODs have the opportunity to reduce the number of contact lens dropouts, but we need to be proactive in the way we ask questions in the exam room and, ultimately, offer patients the highest-quality contact lens designs and optical properties that manufacturers have to offer.
	
	

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	Unfortunately, only a certain level of comfort can be obtained by optimizing lens designs. ODs need to understand and appreciate the effects of the ocular surface and how it can influence contact lens wear. A healthy ocular surface will not guarantee a successful wearing experience but will maximize the chances of it occurring.

With the ocular surface, critical clinical consideration should be made to the health of the lid margins, conjunctiva, cornea, tear film, and all glands involved in producing the tear film.

Lid margins that become serrated over time can be a sign of chronic lid margin disease, resulting in poor lid dynamics. Excessive bacterial overpopulation can lead to signs of collarettes at the base of the lashes. Other signs include folliculitis, meibomian gland capping, and lid margin hyperemia. This can ultimately alter the quality of the meibum, affecting the tear film dynamics.

 Blepharitis has been shown to be a risk factor for comfortable lens wear, too.

The lid wiper area is the small region just posterior to the line of Marx on the superior lid margin that provides much of the wiping capacity of the upper lid over the ocular surface. The lid wiper area can become inflamed and will absorb vital dyes, including fluorescein and lissamine green. This is called lid wiper epitheliopathy (LWE) and has been associated with contact lens discomfort.

Look for small signs to prevent contact lens complications

Inflammation has also been associated with contact lens discomfort. With advancing technologies, the ability to measure ocular surface inflammatory markers has improved. It has been recently demonstrated that elevated levels of leukotriene B4 are associated with symptomatic contact lens wear.

Nutrition can influence ocular surface health and contact lens discomfort. Patients randomized to receive oral omega-3 supplementation showed improvements in contact lens comfort and a reduction in ocular surface inflammatory markers.

A number of strategies may improve contact lens comfort through improving ocular surface health. Fortunately, there is significant information on ocular surface treatment strategies that have been found to help contact lens wearers have a more comfortable wearing experience.

Here, we will review several strategies that have been shown positive responses in studies to treat the ocular surface in order to improve patients’ contact lens comfort.
	
	

Increase contact lens comfort by paying attention to the lids


	Appropriate meibomian gland health is critical for a healthy ocular surface. The meibomian glands produce meibum that form the outer layer of the tear film, preventing premature evaporation of the tear film’s aqueous layer. Research has shown that meibomian gland dysfunction (MGD) can cause a reduction in contact lens comfort.

A single 12-minute thermal pulsation treatment has demonstrated significant improvements in meibomian secretion, tear film parameters (including MMP-9 levels), and patient symptoms measured by the Standardized Patient Evaluation of Eye Dryness (SPEED) questionnaire. 

Recently, researchers looked into the influence of MGD and contact lens discomfort in contact lens wearers with MGD and dry eye symptoms. Participants were randomized to a single thermal pulsation treatment and compared to a control group that received no treatment.

The treated group significantly improved both signs and symptoms associated with contact lens discomfort and increased comfortable contact lens wear time by four hours. The study followed these patients for three months, and the treatment effect was sustained for that time frame.

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	A clinical study at the University of Alabama at Birmingham School of Opometry found that subjects using Bruder moist heat compress had significantly improved meibomian gland scores and experienced steeper declines in their overall eye discomfort assessment scores. 

This was a four-week, single-center, three-arm, randomized, open-label clinical trial in subjects diagnosed with contact lens-induced dry eye (CLIDE) using the Contact Lens Dry Eye Questionnaire long form (CLDEQ). Fifty-one subjects were randomized to one of three treatment groups:
	• Application of the compress once a day
	• Application of the compress twice a day
	• Warm washcloth application twice a day

A statistically significant increase in mean hours of comfortable wear time was found in subjects who used the compress compared to those using a washcloth. No statistically significant improvement in comfortable wear time was found between subjects using the compress twice daily versus once daily.

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	Drs. James Rynerson and Henry Perry published a theory on the underlying cause of dry eye termed “dry eye blepharitis syndrome” (DEBS).

In their paper, they discuss bacteria-producing biofilms over the lid margin surface as the major contributor to inflammation and dry eye. As these bacterial populations within a biofilm increase above certain threshold populations, they undergo quorum-sensing gene activation and begin to produce toxins known as virulence factor. These virulence factors, such as lipases, cytolytic toxins, and super-antigens, directly cause the inflammation that leads to blepharitis and the long-term sequelae of dry eye disease.

This inflammation affects the ocular surface in phases based on the anatomical relationship of the structures within the lid. Initially, the signs are so mild that they may be overlooked. Folliculitis at the lash follicles show a mild volcano sign at the base of the lashes. Then, meibomian glands and the glands of Krause and Wolfring are affected, followed by eyelid architectural changes. These changes are chronic, long-term changes that occur over decades and manifest into the signs and symptoms of dry eye disease.
	
	

Blog: Don't leave dry eye patients high and dry 

Microblepharoexfoliation (MBE) can be utilized to counter act these changes. MBE is an in-office procedure in which a medical-grade micro sponge is spun along the edge of the eyelid and lashes. MBE has been shown to decrease the signs and symptoms of dry eye.

Additionally, MBE treatment has been shown to decrease MMP-9 levels on the surface of the eye. In one study, patients who had a positive inflammadry sign had MBE performed, and four weeks later, inflammadry testing was negative in all participants.

The question becomes whether there is an opportunity to provide relief to contact lens wearers through MBE. In an Australian study, symptomatic contact lens wearers had MBE performed. After a single procedure, 10 of the 17 were converted to asymptomatic lens wearers.

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	Punctal plugs have been a mainstay in dry eye treatment for decades. There are a few studies that have looked at the effects of punctal occlusion on contact lens comfort.

In one study, silicone plugs were placed in the lower puncta of one eye of symptomatic lens wearers and no plug in the other eye.

 Most study subjects experienced significant improvements in comfort in the eye that was occluded.

However, another study randomly selected patients to receive punctal plugs or a sham procedure, and the results showed no statistically significant differences in comfort.

  Although these seem to be contradictory findings, it may be that patients need to be appropriately selected for punctal occlusion. Some patients with certain ocular characteristics may respond better to plugs. 

As an example, patients who have no signs of blepharitis and test negative with InflammaDry (Quidel) may experience better results with punctal occlusion. More research needs to occur to help guide treatment patterns and utilization of punctal occlusion for contact lens wearers with comfort challenges.
	
	

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	Cyclosporine 0.05% has been used for over a decade in 

 treatment. A study looked at contact lens wearers experiencing discomfort and randomized them to a placebo or treatment with cyclosporine 0.05%, which was used twice a day. There was a significant improvement in contact lens comfort with the treatment group.

Another study with a similar design looked at the same endpoints.

 The big difference in this study is that patients were followed for three months, whereas patients were followed for five weeks in the first study. In this second study, there was no difference noted between groups.

Interestingly, it may be appropriate selection of patients that dictates appropriate cyclosporine use. As an example, my practice usually utilizes positive InflammaDry tests to determine appropriate candidates for inflammation reduction. It is worth considering this treatment option for your patients with contact lens discomfort.
	
	

New cyclosporine therapy joins fight against dry eye disease


	It is incumbent upon ODs to identify individuals with contact lens discomfort. When identified, it is critical to appropriately manage the ocular surface to provide an environment conducive to comfortable long-term contact lens wear.

Additionally, appropriate follow-up protocols should be set in place to monitor these individuals for improvement of symptoms. Only when ODs start thinking more globally about contact lens wearers and providing them solutions to optimize their tear film and ocular surface will they help to support the new technology lenses we are fitting.
	
	

Read more contact lens and lens care content here 

 is a 2002 graduate of the New England College of Optometry. He practices full-scope optometry with an emphasis on ocular disease management of the anterior segment and specialty contact lenses.
	He has received honoraria in the past two years for speaking, writing, participating in an advisory capacity, research, or meeting support from: ABB Optical, Akorn, Alcon Laboratories, Allergan, Art Optical, Bausch + Lomb Health, Blephex, Contamac, CooperVision, Euclid, Eyevance, Johnson & Johnson Vision, Luneau, Oculus, Optovue, Shire, Sight Sciences, Sun Pharma, Tangible Science, TelScreen, TruForm Optics, Valley Contax, Visionary Optics, VMax Vision, Walman Optical, Weave, Zeiss and Zea Vision. In his free time, Dr. Brujic enjoys spending time with his family.
	

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 Offer more comfort to contact lens wearers


	
	Optometry is a remarkably empowering profession. ODs care for patients’ visual welfare through appropriate refractive correction and optimizing ocular health.  Within the last 15 years, the technologies available to both diagnose and treat ocular conditions has drastically changed.

Looking back at our brief history as optometrists has been enlightening. Refractive care of patients is usually managed as a long-term chronic condition, but its symptoms are treated effectively by power changes that can be noticed immediately by the patient.

This makes refractive conditions somewhat straight forward as changes in treatment (the prescription in lenses), provides patients immediate improvement in symptoms.

Previously by Dr. Brujic and Dr. Kading: Blog: Keep an eye on meaningful metrics in the new year

An example is a myope whose myopia has progressed, and we are now increasing the power in his glasses. This provides immediate benefits to the patient.

If the patient is solely an eyeglass wearer, we can demonstrate the patient’s new prescription immediately with the help of loose lenses held over his glasses. 

wearer, ODs have an opportunity to demonstrate the immediate benefits of the new prescription by placing the patient’s updated prescription on his eyes.

This clinical interaction produces a positive patient response for the patient by providing a change in treatment (prescription change) after managing a chronic condition.

With the chronic condition of myopia, the acute symptom is a change in vision. A positive patient response is delivered by an appropriate refractive correction-through glasses and/or contact lens prescription.


	Chronic ocular disease brings a different set of opportunities and challenges with it. 

, for example, allows ODs to help patients avoid the potentially blinding effects of a condition that-for most patients-is relatively asymptomatic until the condition is advanced. 

Glaucoma can be diagnosed and treated by ODs in most states in the United States. Many ODs are directly involved in caring for these patients by making decisions on whether intraocular pressures (IOPs) are appropriately controlled in light of exam and diagnostic test findings. But, there are differences in managing a patient with this condition versus a patient experiencing a change in refractive error.

Related: Chronic ocular diseases and patient psyche


	Despite both being chronic conditions and requiring long-term patient care, these individuals are managed with different expectations. 

When managing a glaucoma patient, ODs may think they are successful with treatment because they have attained their set IOP goal.

Yet, the patient doesn’t see any better because of the treatment. The patient doesn’t feel any better because of the treatment. 

Interestingly, a significant portion of patients may experience symptoms created by the medications ODs utilize to treat the condition. 

This is what can often make compliance with glaucoma treatment a challenge. Unlike correcting refractive error, glaucoma treatment does not necessarily improve symptoms with successful treatment. 

Related: Why documenting target IOP helps ODs


	An OD’s role in treating the glaucoma patient is similar to the primary care physicians’ or endocrinologists’ role in treating a diabetic patient. 

Those healthcare providers utilize objective metrics-such as hemoglobin A1c levels-in order to determine success or failure with treatment. 

Although elevated glucose levels can have other effects on a person’s physiology, it will be the success or failure of maintaining appropriate glucose levels that will determine the long-term ramifications to other end organs-including the eye.

This is a similar strategy that ODs employ with glaucoma patients. Although ODs know the pathophysiology of glaucoma can be complex, the one modifiable risk factor is modifying the IOP.

Author | Mile Brujic, OD, FAAO

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