GP ANNUAL REPORT
GP Annual Report 2011
A review of this year's GP market trends, developments, and resources as well as where the market is heading.
By Edward S. Bennett, OD, MSEd, FAAO
A recent GP Lens Institute-sponsored symposium/workshop with the cornea and contact lens residents at The Ohio State University reminded me that young people can embrace GP lenses if the experience and education are provided. As an educator, I am far from unique in recognizing the benefits and applications of GP lenses. It's exciting to see that the dynamics of the GP industry appear to be changing in a positive direction as a result of recent advancements in lens design. This article will highlight those advancements as well as current market trends, GP lens resources, and where the market is headed in the future.
GP Market Trends
Recent publications have concluded that GP lenses result in the lowest incidence of microbial keratitis among contact lens modalities (Bourcier and Sauer, 2011; Stapleton et al, 2008). However, the percentage of contact lens fits and refits with GP lenses in the United States in 2010 as reported by Editor Jason Nichols, OD, MPH, PhD, FAAO (“Contact Lenses 2010,” January 2011 issue), was 8 percent for GP lenses and 1 percent for hybrids.
In spite of these numbers, there is much reason for optimism regarding GP contact lenses. Independent market data obtained from Jeff Johnson, OD, MBA (vice president, senior research analyst, Robert W. Baird & Co., Inc.) showed that the worldwide GP market increased between 15 percent and 20 percent in the first half of 2011 versus 2010. When reviewing the data for strictly the Asia-Pacific and the Americas regions, this growth was more than 20 percent. Dr. Johnson indicated that an important reason for this growth is a gradual reduction in soft contact lens use, especially daily disposables, in Japan over the past few years. This appears to be the result of Japan's economy and reimbursement changes that went into effect in either 2008 or 2009.
Another trend worth noting is one that has been ongoing for the last five years and pertains to the growth of large-diameter (i.e., scleral) lenses. According to David Bland, director of Global Boston GP Business (Bausch + Lomb), the sales of large-diameter buttons had increased six-fold from 2006 to 2010 and has increased 14 percent in 2011 versus 2010.
GP Lens Applications Today
It is evident that GP lenses are growing in certain specialty areas, and this should continue in the years ahead. When the GP Lens Institute (GPLI) Advisory Committee—consisting of 80 clinicians who have much expertise in fitting GP spherical and specialty lens designs—were recently surveyed for their opinion on the benefits and applications of GP lenses, three areas were predominant among those who responded: 26 indicated that sclerals are the leading area of GP growth in their practice, 17 indicated GP multifocals, and 15 reported corneal reshaping. Some representative quotes appear in “Comments from the Experts Part 1,” below.
Scleral Lenses Many laboratories have introduced scleral lens designs in the past year. The predominant diameter range in common use today is in the semi-scleral to mini-scleral range (i.e., 14.6mm to 18.0mm) (van der Worp, 2010). Their good initial comfort—rivaling that of soft lenses—complemented by their ability to bridge over an irregular cornea while providing good visual acuity, makes these designs a viable alternative to both smaller-diameter GP lenses and hybrid designs. It is important, however, to carefully evaluate the lens-to-cornea fitting relationship to ensure that adequate central clearance is present as well as an absence of peripheral conjunctival impingement.
Patient education is also critical as it pertains to application, removal, and utilization of the appropriate care solutions. To minimize any toxicity effects of solution preservatives being in contact with the cornea for long periods of time, it is recommended that a non-preserved solution be used for application. This can include Optive Refresh Sensitive (Allergan) preservative-free unit dose, Unisol 4 (Alcon), or sodium chloride inhalation solution (by prescription, 3mL, 0.9%) (DeNaeyer, 2011). However, in a recent I-Site survey, practitioners reported that 22 percent of their patients were applying their scleral lenses with GP solutions (van der Worp, 2010).
Multifocal Lenses Many of the recently introduced GP multifocal designs provide add power on the front surface, some with aberration-control properties. This minimizes corneal topography changes not uncommon with high-eccentricity back-surface designs while also allowing for high add capabilities. In addition, several designs have recently been introduced for the growing number of individuals who have had refractive surgery and are now presbyopic (these will be discussed in detail later). In addition, Art Optical offers the SO2Clear Progressive, a multifocal corneo-scleral design. Currently there are more than 100 aspheric designs and more than 50 segmented, translating designs, many of which have intermediate corrections (www.gpli.info).
Corneal Reshaping This area is evolving quickly. At the 2011 Global Specialty Lens Symposium (GSLS), Pauline Cho, PhD, FAAO, FBCLA, presented the initial results of both the Retardation of Myopia in Orthokeratology (ROMIO) and, for high astigmatic subjects, the Toric Orthokeratology-Slowing Eye Elongation (TO-SEE) studies. In addition to significant astigmatic reduction in the latter study, both studies resulted in a significant reduction in axial length growth (Cho, 2011). Kang and Swarbrick (2011) followed up research by Dr. Earl Smith at the University of Houston and found that orthokeratology lenses can be used to induce myopic defocus in the periphery in myopic children and may therefore serve as a potential mechanism for myopia control. Dr. Jaume Paune Fabre likewise presented his preliminary findings on a new GP design for myopia control to produce peripheral myopization at the 2011 GSLS meeting (Fabre, 2011).
Other Applications The number of lens designs exhibiting aberration control, notably for irregular cornea patients, continues to increase while resulting in enhanced visual quality (Gemoules and Morris, 2007; Villa-Collar et al, 2009; Gumus et al, 2011). Another important area is the continuing introduction of standard lens designs that are intended to simplify the GP fitting process in an effort to effectively compete with soft lenses. Ongoing improvements in manufacturing technology have resulted in consistent edges, uniform edge clearance peripheries, and ultrathin profiles, which have resulted in the ability to fit both spherical and multifocal lens designs empirically such that the first lens applied to a patient's eye is a design that should result in good vision. As demonstrated in “Comments from the Experts, Part 2,” below, these designs are increasingly successful in meeting this objective.
Recent GP Developments
Lens Designs
• Advanced Vision Technologies (AVT) has introduced PediaSite, a fitting system/GP lens designed to effectively prescribe healthy visual development for babies born with congenital cataracts. The AVT Scleral lens features a tangent carrier angle system offering different carrier angles to more effectively align on the scleral slope. A standardized diagnostic system allows for a more simplified approach to successfully utilizing scleral lenses for irregular corneas and dry eye ocular conditions.
• Art Optical continues to focus on presbyopia and will be introducing new design options over the next few quarters. The designs in development will address post-refractive surgical patients who have presbyopic needs as well as patients who have moderate and mature add requirements.
• Blanchard Contact Lens can now manufacture its Reclaim Aspheric Multifocal optics on the anterior surface of most of the company's specialty GP contact lenses. This offers the opportunity to provide progressive multifocal presbyopic vision correction for numerous specialty GP lens designs including: Essential, Essential Xtra, RSS (post refractive surgical), Rose K, Rose K2 IC, and Rose K2 Post Graft. The company has also recently launched Paul Rose's latest addition to the Rose K2 series of lenses: the Rose K2 NC, which is designed specifically for nipple cones.
• Conforma Contact Lenses recently introduced its VFL3 with HD Optics, or HD-AP for advanced presbyopes via the company's front-surface technology that results in aberration-control optics.
• Lens Dynamics has made available the Dyna Semi-Scleral design in various diameters. It is available in a front toric option, with the company's Quad Sym edge treatment option, and in a multifocal design.
• The SynergEyes Duette Hybrid Contact Lens for Astigmatism, introduced in late 2010, became available to a broader market in early 2011. The rigid center (MaxVu) has a Dk of 130 with a class II UV blocker. The low-modulus, 32-percent-water silicone hydrogel skirt (Flex2O) has a Dk of 84. SynergEyes also has launched its Duette Multifocal.
• Tru-Form Optics has introduced its DigiForm 18 scleral lens with unique diagnostic markings. The company also has introduced TruPMD, a new lens that is designed to simplify fitting pellucid marginal degeneration.
• Valley Contax has developed and released the LasikNear—a reverse-geometry-back-surface, aspheric front multifocal—for the needs of post-refractive surgery presbyopic patients.
• Walman Optical has introduced a new large GP lens design with diameters ranging from 14.0mm to 16.0mm that utilizes a four-curve peripheral system for irregular cornea patients.
Lens Care
• Menicon America recently introduced a novel GP lens care system in the United States consisting of Menicon Unique pH, Menicon Progent, and Menicon Rewetting Drops. Menicon acquired the Unique pH brand name and worldwide manufacturing license from Alcon, while Progent is now FDA-approved for bi-weekly cleaning by patients at home. Menicon has also introduced the Menicon Web-Store, hosted by eyecare practitioners for ease of access to this care system.
• AVT has introduced its Naturalens RDS (No Tap Water Rinse) Multipurpose Solution in a TSA-compliant travel size.
Miscellaneous
• DMV Corporation has recently introduced a device for application of the large-diameter, deep-welled GP lenses that require filling the lens with solution. The device is intended to keep lenses from falling off the finger and is called the DMV Vented Scleral Cup.
• Larsen Equipment, manufacturer of modification tools and accessories, has expanded its tools to assist in the verification and modification of scleral lens designs.
Resources
A large and increasing number of resources are available to assist with GP spherical and specialty lens designs. The Scleral Lens Education Society has educational programs and videos on scleral lens fitting and patient education. It also provides workshop programs all throughout the United States. The organization's officers are essentially a “Who's Who in GP Specialty Lenses,” including Drs. Greg DeNaeyer, Christine Sindt, Jason Jedlicka, Eef van der Worp, Muriel Schornack, and Mindy Toabe.
The National Keratoconus Foundation is a very good resource for both patients and practitioners, providing educational booklets, forums and support groups, and an insurance reimbursement request letter among the many resources available.
The Orthokeratology Academy of America offers many resources for both consumers and practitioners, including podcasts and a very comprehensive annual educational symposium. The next meeting will take place from April 19 to 22, 2012 in Scottsdale, Ariz., and is recommended for anyone desiring to incorporate this important and potentially life-changing modality into their practice. Both Bausch + Lomb (B+L) and Paragon Vision Sciences offer certification training for this modality online as well as information webinars.
B+L also has informational booklets on scleral lenses, correction of presbyopia, and orthokeratology. In addition, all CLMA member laboratories have resources including webinars, fitting guides, and calculators on their websites—not to mention trained consultants—to assist in GP lens design and fitting skills.
The GP Lens Institute introduced several new resources in 2011. Click N' Fit is a simulated fitting program that allows you to virtually attempt different lens designs on the same patient and observe changes in the fitting relationships. It also provides troubleshooting pearls. Webinars provided by experts in irregular cornea, orthokeratology, presbyopia, sclerals, and high astigmatism are provided monthly through the website. New narrated Power-Point presentations on keratoconus diagnosis, associated corneal topography, lens designs/fitting, and troubleshooting have recently been introduced. Likewise, a narrated PowerPoint on optimizing initial comfort has recently been introduced with upcoming programs on orthokeratology as well as scleral contact lens fitting and patient education soon to be released.
Table 1 provides the websites for these resources.
The Future
The further development and application of scleral lens designs will be an important factor in the future growth of GP lenses. As the comfort of these designs rivals that of soft lenses, we can predict that some forms of this design, likely corneo-scleral and semi-scleral designs, will increase in popularity for managing healthy astigmatic eyes, as outlined in the article “Semi-Scleral Applications for Healthy Eyes,” in this issue by Drs. Jason Jedlicka, Marsha Malooley, and Renee Reeder.
Likewise, the future looks very bright for myopia control. Dr. Pauline Cho (2011) recently reported some promising results of a lens design that can be successful with subjects having ≥ 6.00D of myopia. In addition, the promising work being performed to use corneal reshaping lenses to alter optics resulting in peripheral retinal emmetropization or mild defocus bodes well for slowing down children's eye growth at a critical time in their development. It will be very interesting to see what the near future will hold in these areas as we approach 2012. CLS
| COMMENTS FROM THE EXPERTS PART 1: How Have GPs Benefitted Your Practice? |
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“GP lenses benefit our patients by providing optimal vision performance in the safest modality of contact lens wear. They provide good vision for individuals who have irregular corneas and potentially allow us to control myopia progression via corneal reshaping technologies. For the practice, GP lenses have helped us in our differentiation—by fitting more than 30 percent of our patients in some form of GP lenses, we are considered a true contact lens specialty practice.”
—S. Barry Eiden, OD, Deerfield, Ill. “While still perceived as a niche market, GP patients seek out practitioners who work with and use these lenses. By incorporating GPs into your comprehensive contact lens care, you can attract more patients and offer additional options.” —Robert M. Grohe, OD, Homewood, Ill. |
“GP patients consistently see better and are very loyal to the practice. GPs are the mainstay of building a specialty reputation.”
—Walter Choate, OD, Goodlettsville, Tenn. “GP lenses are the mainstay of my specialty contact lens practice, which services a significant number of patients who require visual rehabilitation secondary to corneal ectasias, post-operative corneal irregularities, and patients who wish to experience the best visual acuity in presbyopic lens wear.” —Susan A. Resnick, OD, Roslyn, N.Y. “Large-diameter and scleral lenses seem to benefit many patients and help those we previously could not accommodate. So much easier for the patient to tolerate for better VA.” —Patricia M. Keech, OD, Shoreline, Wash. |
| Comments From the Experts, Part 2 | |
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| GP lenses are often perceived as more time-consuming and more complex to fit compared to soft lenses and—notably—compared to soft torics. In what ways have recent advancements in GPs reduced this gap between modalities? Will this be reduced more so in the future and, if so, why? | |
| “More GPs have been designed with set parameters or reduced parameters to offer non-GP fitters an opportunity to fit GPs easily. That way they don't have to design their own peripheral curves or calculate edge lift. Toric programs have been developed to aid in bitoric designs. More labs are helping with empirical fittings through their consultants and computer programs.”
—LaMar G. Zigler, OD, MS, Columbus, Ohio “Fitting GP lenses is no more time consuming than fitting soft lenses. Utilizing basic lens fitting methods, we can actually fit both out of our office inventory and via empirical methods in a high percentage of cases. Additionally, new topography lens fitting software allows us to also fit ‘virtually' with greater success.” —S. Barry Eiden, OD, Deerfield, Ill. “With the advent of virtual fitting and online software such as Click N' Fit, practitioners can dramatically reduce chair time and better manage more complex cases.” —Robert M. Grohe, OD, Homewood, Ill. |
“Technology in manufacturing GP lenses has advanced, and the increased use of topography and other in-office instrumentation will help with fitting GP lenses empirically. In addition, larger-diameter GPs have narrowed the comfort gap with soft lenses.”
—Bruce W. Morgan, OD, Big Rapids, Mich. “One of the properties of soft torics that makes this perception so widespread is that they often come in only one or two base curves and no other controllable parameters (i.e., one size fits all). Scleral lenses have the potential to emulate this property in that you fit most patients with the same one or two base curves and adjust other parameters accordingly only as needed. Also, practitioners need to become more familiar with CLMA lab consultants. Many practitioners think that they should be designing their own torics from scratch, but in a fast-paced clinical practice this takes time that I believe is better spent with patients when the lab consultants can successfully design the lenses empirically.” —Roxanna I. Potter, OD, Sylvania, Ohio |
Acknowledgements: Bruce Anderson, OD; Mark André, FCLSA; Doug Benoit, OD; Richard Brannen, OD; Ray Brill, OD; Karen Carrasquillo, OD, PhD; Walter Choate, OD; Robert Davis, OD; Greg DeNaeyer, OD; Barry Eiden, OD; Art Epstein, OD; Robert Grohe, OD; Lynette Johns, OD; Pat Keech, OD; Jon Kendall, OD; Ann Laurenzi-Jones, OD; Mike Lipson, OD; Bob Maynard, OD; Bruce Morgan, OD; Clarke Newman, OD; Neil Pence, OD; Roxanna Potter, OD; Miles Press, OD; Tom Quinn, OD, MS; Phyllis Rakow, FCLSA; Susan Resnick, OD; Jack Schaeffer, OD; Joe Shovlin, OD; Jeff Sonsino, OD; Shawna Vanderhoof, OD; Jeff Walline, OD, PhD; Michael Ward, MMSc; Frank Weinstock, MD; LaMar Zigler OD, MS.
For references, please visit www.clspectrum.com/references.asp and click on document #191.
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Dr. Bennett is assistant dean for Student Services and Alumni Relations at the University of Missouri-St. Louis College of Optometry and is executive director of the GP Lens Institute. You can reach him at ebennett@umsl.edu. |
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