GP Insights

Four Favorites from GSLS 2016

BY EDWARD S. BENNETT, OD, MSED, FAAO

The 2016 Global Specialty Lens Symposium (GSLS) once again represented a comprehensive program on how to implement specialty contact lenses and optimize their success. Of course, GP lenses—notably scleral and overnight orthokeratology (OK) designs—were greatly emphasized.

A Quick Look

To supplement the GSLS overview article on page 22, here are some additional highlights.

Determine the Appropriate Contact Lens to Optimize Success in Medical Cases Esther-Simone Visser, MSc, discussed her team’s recent work in developing an algorithm to help eyecare practitioners select the appropriate contact lens type to yield the best clinical results in medical cases. This was based upon a sample of 281 eyes of which 63% needed contact lenses for visual correction and 34% for bandage/protection. The sample included 25% with keratoconus, 23% with dry eye disease, 20% post-keratoplasty, 9% corneal scars, 7% refraction, 6% corneal decompensation, 4% corneal erosions, and 6% other. Using the algorithm, they ultimately fit 53% into scleral lenses, 35% into silicone hydrogel/hydrogel lenses, 6% into corneal GP lenses, and 6% into other lenses.

With the exception of lenses used for protection/lubrication in dry eye disease (for which there was no difference), there was a significant improvement in contact lens-corrected visual acuity versus best-spectacle visual acuity, including in keratoconus (20/50 spectacle; 20/25 contact lens) and post-keratoplasty (20/53 spectacle; 20/22 contact lens).

Overall Success and Complications with Mini-Scleral Lenses Mini-scleral innovator Langis Michaud, OD, MSc, FAAO (Dipl), FSLS, FBCLA, discussed the results from fitting 113 eyes from 60 subjects into either a 14.6mm diameter mini-scleral design for healthy and mild keratoconus patients or a 14.3mm diameter design for moderate keratoconus and other forms of irregular cornea patients.

His overall success was 78.7%. There was an absence of microbial keratitis, with mild bulbar redness and punctate keratitis representing the most common complications. The majority of the problems resulted from a misuse of the solution instilled into the reservoir (i.e., preserved solution) as solution toxicity can increase bulbar hyperemia and result in superficial punctate keratitis. Therefore, it is imperative to both prescribe a nonpreserved solution to scleral lens-wearing patients and to ensure compliance with this recommendation.

Present the Contact Lens Myopia Control Options to Parents Helen Swarbrick, PhD, FAAO, emphasized the importance of being proactive when recommending contact lenses for myopia control to all parents of young children who are perceived to be prone to myopia.

For children who have low degrees of myopia, she said that overnight OK is an especially viable option as active children would not have to wear a correction during the day and can enjoy outdoor activities and sports without the obstruction and compromise in peripheral vision resulting from spectacle wear.

Optimize Results with Specialty GP Fits In the GP Update presentation, I encouraged frequent communication with your laboratory consultants. If you can provide topography maps, photographs, or videos of the contact lens-to-cornea fitting relationship, it is even more likely that they can help in the design/troubleshooting and ultimately the success of these patients.

To gather these images and videos, eyecare practitioners can use an iPhone adaptor placed in front of the oculars of a biomicroscope that can take photos and videos of a contact lens on the eye to send to laboratory consultants.

These four represent only a small amount of the clinical pearls presented at the GSLS. I hope to see you next January in Las Vegas. CLS

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.