Dry eye and ocular surface disease are a core part of optometrists’ practices. This condition influences the outcome of everything they do-it can devastate vision, change refractions, cause patients to drop out of lens wear, and lead to infections and corneal scarring.
This month’s podcast guest Chandra Mickles, OD, MSc, FAAO, FSLS, is an associate professor at Nova Southeastern University College of Optometry and the dry eye service coordinator on campus.
She is passionate about educating the next generation of optometrists about the importance of treating even the earliest stages of dry eye and exploring new technology that can improve a patient’s day to day vision and comfort experience.
Dr. Mickles teaches a specialty contact lens course and provides patient care at the school in both the Dry Eye Center and specialty contact lens departments. She also serves as a consultant for Alcon and Johnson and Johnson Vision, and lectures and publishes research on cornea, contact lens, and ocular surface disease.
Previously by Dr. Lyerly: What ODs need to know about YAG laser vitreolysis for floaters
Interest in research
"My ultimate goal in research for patient care is to improve outcomes for contact lens and ocular surface disease patients,” says Dr. Mickles.
Most of her research is investigator initiated-she will apply for a grant or propose a research project to a financial backer aimed at providing data she hopes will help doctors make decisions to improve patient outcomes.
With so many challenges facing patients, Dr. Mickles is working on several upcoming and ongoing research studies aimed at practically impacting day-to-day patient care.
Up next, she is participating in a multicenter trial looking at digitally induced dry eye in children. It focuses on video game playing and how it affects blink rate and dry eye.
Related: Scleral lenses help manage ocular surface disease
She is also part of a contact lens assessment and use group study looking at risk factors associated with red eyes and exploring a new educational tool to determine which patients are most at risk for red eye and how doctors can best educate these at-risk patients.
One such project that she participated in has made a big impact on her prescribing philosophies when it comes to specialty contact lenses. Knowing that contact lens discomfort is one of the primary reasons that patients drop out of contact lens wear,1 Dr. Mickles is motivated to discover new technology solutions that keep her patients wearing contact lenses, especially for patients who need specialty contact lenses when glasses correction would reduce their visual function.
Dr. Mickles worked with Melissa Barnett, OD, FAAO, FSLS, FBCLA, and Jennifer Harthan, OD, FAAO, FSLS, on a double-masked, randomized, multicenter research study looking at the impact of Tangible Hydra-PEG coating on patient comfort in scleral lens wear. The study was presented at the 2019 Global Specialty Lens Symposium.2Also by Dr. Lyerly: First impressions of Acuvue Oasys with Transitionsn contact lenses
The study examined 19 scleral lens-wearing patients with moderate to severe dry eye disease. Patients wore their habitual scleral lenses for one month and were assessed for dry eye symptoms (with the Ocular Surface Disease Index [OSDI] survey), dry eye signs (tear film break-up time, ocular surface staining, lid wiper epitheliopathy), conjunctival papillae, and self-reported contact lens comfort (Contact Lens Dry Eye Questionnaire-8 [CLDEQ-8] survey).
Patients were given scleral lenses with the same parameters as their own lenses but with Tangible Hydra-Peg coating; patients wore the new lenses for one month.
Related: Blog: Why dry eye?
Tangible Hydra-Peg is a polyethylene glycol lubricant that is permanently bonded to the contact lens surface during manufacturing. It is designed to improve wettability and repel surface lens debris, according to the company. The Food & Drug Administration (FDA) has approved this coating on the majority of gas permeable contact lens materials, including Boston (Bausch + Lomb), Optimum (Contamac), and even SimplifEyes 1-Day Disposable soft contact lens from SynergEyes.
Statistically significant improvements were seen in all categories when patients wore the Tangible Hydra-Peg coated lenses, according to the study. Patients not only reported improvement in contact lens comfort, but also in vision consistency. They experienced foggy vision at almost half the rate of occurrence than in their uncoated lenses.
Dr. Mickles says she was surprised there was such a dramatic improvement in contact lens and dry eye comfort and clinical signs with just the addition of a coating, but it has led her to incorporate this technology in her practice.
Also by Dr. Lyerly: An OD's experience with online contact lens disruptors
What patients need to know
Dr. Mickles shares that while Tangible Hydra-Peg can be a great solution for patient comfort and experience in contact lenses, it is essential that doctors educate their patients about its different handling and cleaning needs.
The Tanigble Hydra-Peg coating makes the lenses more slippery
Because Tangible Hydra-Peg purposefully improves the lubricity and reduces the friction of the contact lens on-eye to improve comfort, it can also make the lens more difficult to remove. Fingers may slip right off when attempting to grasp the lens.
If patients use a plunger to remove scleral lenses, they may not experience this challenge. However, patients wearing soft or hybrid lenses may have difficulty.
Synergeyes recommends patients use a tissue draped over their fingers to remove the lens. Consider sharing this video with patients for further instructions: https://www.youtube.com/watch?v=d5Vd-ms56_0
Read more dry eye awareness content It’s important to use the appropriate solutions
Abrasive or alcohol-based cleaners can damage the Tangible Hydra-Peg coating.
Dr. Mickles says she is careful to prescribe specific solutions for her patients and educate why this is the solution they need to use going forward.
Tangible Science has launched new solution Tangible Clean that is FDA approved to clean both soft and gas permeable (GP) lenses safely with this coating.
Related: Peroxide lens care effective for GP lens wearers
Sclerals for dry eye
Dr. Mickles says that she has had great success with fitting scleral lenses for patients with moderate to severe dry eye.
In her experience, scleral lenses for dry eye work best for patients for whom aqueous deficiency is the primary cause of Dry eye. Patients with significant meibomian gland dysfunction are more likely to have challenges with scleral lens comfort and clarity because the dysfunctional meibum can coat and fog the lens surface.
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1. Aldridge C. Breaking the cycle of contact lens dropout. CL Spectrum. Available at: https://www.clspectrum.com/issues/2015/november-2015/breaking-the-cycle-of-contact-lens-dropout. Accessed 7/25/19.
2. Mickles C, Harthan J, Barnett M. A surface treatment solution for scleral lens wearers with dry eye. Tangible Science. Available at: https://tangiblescience.com/wp-content/uploads/2019/01/Final-GSLS-2019-Mickles-Tangible-Paper-Presentation.pdf. Accessed 7/25/19.