Held June 9 to 11, 2022, the Global Specialty Lens Symposium: Virtual (GSLS:V) was a massive success, reaching all corners of the globe. There were more than 1,200 registrants from nearly all continents with major contingencies representing Asia, Latin America, and Europe.

Not only were there practitioners, academics, and students from around the world in attendance, but they were also taking advantage of the interactive capabilities of the streaming platform. In fact, more than 2,600 messages were exchanged between attendees. GSLS:V was sponsored by Bausch + Lomb, Johnson & Johnson Vision, Acuity Polymers, Contamac, Essilor Custom Contact Lens Specialists, and X-Cel Specialty Contacts.

In addition to the main educational sessions highlighted in this article, the event also featured industry-sponsored talks, a virtual exhibit hall, social media and engagement contests, and more. At the conclusion of each session, one attendee was awarded a free registration to the in-person GSLS, which is being held in January 2023 (see sidebar on page 43 for more details).

The following provides highlights from the four education sessions. To view the GSLS:V sessions in their entirety, visit clspectrum.com/gsls-virtual .

• GSLS-AOC SESSION: THE ASIAN PERSPECTIVE ON SPECIALTY CONTACT LENSES: CORNEAL TOPOGRAPHY, FITTING SCLERAL LENSES, AND MYOPIA CONTROL

GSLS:V kicked off with a session co-hosted by the Asia Optometric Congress (AOC) that was co-moderated by Patrick Caroline in the U.S. and Charlie L. Ho, MD, in the Philippines.

The first speaker was Richard Wu, OD, MS (in Taiwan), who looked at corneal topography. Dr. Wu presented research that looked at Sim K versus Zone K measurements and how those two differed substantially.

He shared that the research explains why some patients complain of visual issues even with matching prescriptions concluding that this information may give rise to a new generation of asymmetrical optical design.

Next, Joserine Samson-Brogan, RN, OD (in Dubai), tackled the art of fitting scleral lenses. She says that a simple acronym (ADPIE) can help with fitting: Assessment – the data gathering stage; Decision Making – Is a scleral lens appropriate for this patient?; Planning – Which type of scleral lens is good for this patient? Did the patient come from a referral?; Implementation – the actual fitting, ordering, and dispensing, as well as application and removal education and training; and Evaluation – the follow-up and troubleshooting tasks.

The final speaker was Mr. Caroline, who looked at what eyecare professionals have learned about myopia over the last three years. He stated that not all myopia is created equal because the research shows that those who have early onset of myopia are much more likely to develop high myopia (greater than 6D) later in life.¹ He also reviewed the various treatment options (e.g., contact lenses, spectacle lenses, atropine, and time outdoors).

• THE REAL STORY PANEL DISCUSSION (PARTS 1 AND 2): SPECIALTY SOFT LENSES, HYBRID LENSES, CORNEAL GP LENSES, AND SCLERAL LENSES

Moderator Karen DeLoss, OD, invited panelists Lynette Johns, OD, and Mr. Caroline (all in the U.S.) plus Eef van der Worp, BOptom, PhD (in the Netherlands), to get to the bottom of “The REAL Story” on specialty contact lenses.

Dr. Johns opened the discussion by defining special uses of contact lenses beyond vision repair: bandage contact lenses and rehabilitative contact lenses. She emphasized that prescribing bandage contact lenses can make a huge difference in patients’ lives without needing to refer them for more invasive procedures—in some cases, patients only need to wear these lenses for three to five days.

Mr. Caroline asked viewers to reconsider the application of GP lenses. In the category of astigmatic fits and refits, he also said it is necessary to consider corneal elevation when fitting spherical and toric GP lenses. Research shows that when the height differential exceeds 30 microns between the flat and steep meridian, one should consider a toric GP lens.²

When fitting for irregular astigmatisms, data also found a consistent boundary: If it’s less than a 200-micron differential in elevation, consider a corneal GP for the patient. If the differential is between 201 and 400, it could be either a corneal or scleral lens. If it’s over a 400-micron differential, consider a scleral lens design. Mr. Caroline believes that using height differential as a guide may be a new paradigm shift for our industry.

Closing the first part of “The REAL Story” panel discussion, Dr. van der Worp asked, “Are scleral lenses too big to fail now?” Since what he dubbed as “the decade of scleral lenses,” the industry knows much more about the shape of the ocular surface: non-rotational symmetrical, more irregular toward the periphery, and the tangential shape corneoscleral profile.

In part 2 of this session, the panelists from the earlier panel discussed cases and clinical management of patients. It covered commonly encountered patient issues and how to troubleshoot.

• LATEST TRENDS IN CONTACTOLOGY: A QUICK REVIEW FROM THE LATAM PERSPECTIVE: SCLERAL LENSES, IRREGULAR CORNEA, AND MYOPIA MANAGEMENT

To build on the true nature of global participation, this session was simultaneously broadcast in Spanish and translated into English. The session was co-moderated by Edgar Dávila-García, OD (in Puerto Rico), and Elise Kramer, OD (in the U.S.).

Ricardo Pintor, OD (in Mexico), kicked off the session by noting that many of his patients do not have normal, healthy corneas. Irregular corneas could be due to adverse events, scars, surgery, keratoglobus, keratoconus, etc. He noted that there are different treatment preferences throughout Latin America. For example, Brazil has more ophthalmologists so they may lean toward surgical procedures, while other countries have laws that allow optometrists to do some procedures.

Dr. Pintor also noted that Colombia has been slower to adopt contact lenses, especially specialty contact lenses. Dr. Dávila-García added that because some Latin American countries have access to non-U.S. Food & Drug Administration (FDA)-approved products and procedures, this allows for earlier adoption of new technologies.

Next, Leonardo Orjuela Mariño, OD (in Colombia), started his talk about myopia management in Latin America by asking, “What kind of practitioners do we want to be for the community, and how can we be considered good if we do not diagnose the preventable?”

He noted that there have not been a lot of studies on myopia prevalence in Latin America; some have only included six countries or even the U.S., as well. Because of that, there are some limitations on what ethnic differences may influence myopia. Going forward, he thinks practitioners need to get a better, more comprehensive picture of what myopia looks like in Latin America.

In the final presentation, Ariolfo Vazquez, OD (in Ecuador), spoke on scleral lens use in Latin America. He noted that Latin America has about 650 million people in 20 countries that includes many ethnic, social, and legislative differences. Dr. Vazquez explained that some obstacles include insurance coverage limitations, long supply and delivery time frames, and changing laws when government administrations change.

• SCLERAL LENS SUPERSESSION: HANDLING, FITTING AND SHAPING

The GSLS:V ended with a session co-hosted jointly with the British Contact Lens Association (BCLA) during its BCLA Focus conference. This session was co-moderated by Nick Howard, FBDO (Hons) in the U.K., and Dr. Johns in the U.S.

Shreeti Lakhani, BSc (Hons), MCOptom (in the U.K.), began her talk with an overview of scleral lens terminology. She noted that corneal ectasia is still the most frequent indication for sclerals that she sees in her patients at Moorfields Eye Hospital. She then showed images and asked for the audience to weigh in on which lens (soft, corneal GP, mini scleral, or full-diameter scleral) they would use for the patient.

Mr. Caroline then asked whether scleral lenses should be designed empirically, and his answer was a definite “yes.” Specifically, he looked at assessing the lens-to-surface fitting relationship, measuring scleral angles, and corneal versus scleral toricity.

Next, Sophie Taylor-West (in the U.K.) looked at both old and new technology that can be used when fitting scleral lenses. She noted that obvious uses of a slit lamp include assessing clearance, centration, and blanching.

Less obvious uses may be for dynamic assessment of tear exchange, assessing rotation, or designing lenses with microvault and/or notches. In her experience, the use of optical coherence tomography is more for problem-solving than everyday use. She also covered other technologies, such as profilometry, impression-based scleral lenses, blue light, topography, radiuscope, and focimetry.

Dr. DeLoss wrapped up the session with a discussion of long-term scleral lens management because everything looks perfect when practitioners dispense the lenses, but what happens a year or even a few weeks later?

At the end, Nick Howard and Dr. Johns fielded questions for the panelists from those in attendance at BCLA Focus and via the virtual platform for GSLS:V. CLS

 

For more exceptional education, you won’t want to miss out on the in-person GSLS, which is being held Jan. 18-21, 2023 at the Horseshoe (formerly Bally’s) in Las Vegas. Up-to-date information about this premier event can be found at gslsymposium.com .

REFERENCES

1. Hu Y, Ding X, Guo X, Chen Y, Zhang J, He M. Association of Age at Myopia Onset With Risk of High Myopia in Adulthood in a 12-Year Follow-up of a Chinese Cohort. JAMA Ophthalmol. 2020 Nov 1;138:1129-1134.
2. Kojima R, Achong R, Turpin S, et al. Does Age Influence the Relationship Between Corneal and Refractive Astigmatism. Poster presented at the 2018 Global Specialty Lens Symposium, Las Vegas. January 2018.