"It’s a really exciting time to be in the contact lens industry”

A comprehensive programme of education, from clinic tours to presentations on key areas of practice and research, was on offer at the British Contact Lens Association (BCLA)’s Virtual Clinical Conference and Exhibition this June (13–14).

Held as a virtual event for the first time, the trade show was live-streamed across 30 hours, enabling 1000 delegates from 50 different countries across multiple time zones to login for the lectures and presentations.

BCLA president, Indie Grewal, said of the event: “This year’s programme was arguably our most comprehensive yet, covering practically every conceivable subject area within contact lenses and the anterior eye.”

The event was approved for COPE accreditation, CET points, OCI and Singapore CPE credits, which Grewal described as a first for the BCLA.

The programme was split into tracks, with ‘application’ hosting a number of discussions and insights into practice clinics, and the ‘skills development’ track covering key topics with a practical approach, while event hosts highlighted the “astonishing” number of papers available through the ‘Cutting edge’ track.

A key focus of the event was the BCLA Contact Lens Evidence-based Academic Reports (CLEAR) research project, sponsored by Alcon and CooperVision and published in April. Lead authors from the reports presented their key findings in a thread of dedicated sessions through the programme.

Luke Stevens-Burt, chief executive of the BCLA, suggested the CLEAR sessions, “had really brought this extensive piece of research to life.”

The reports are available to download for free online, but only until April 2022. 

Building on this work, the CLEAR summary for evidence-based practice was launched at the event, providing key takeaways form the reports, as well as links to the papers. 

The conference also saw the BCLA award lectures, with PhD student at IOBA, University of Valladolid, Marta Blanco-Vasquez, receiving the Da Vinci Award and delivering a presentation on corneal nerve plexus in patients suffering from chronic ocular pain and dry eye disease. Associate professor, Stephen Vincent, of Queensland University of Technology, was presented the Dallos Award following his session on Impact of short-term fenestrated scleral lens wear on intraocular pressure, while Dr Orla Murphy, assistant lecturer at the Technological University Dublin, presented the Irving Fatt Memorial Lecture on the detection and management of demodex blepharitis.

Sessions will remain available to revisit for those who registered for the conference, with the BCLA expected to share more details on accessing the recordings in due course.

The event closed with the granting of the BCLA awards. Dr Keyur Patel was named Dry Eye Practitioner of the Year, while Sabrina Sheik received the title of Young Contact Lens Practitioner of the Year. The Industry Award was granted to Alcon’s John Pruitt and Erich Bauman.

Andrew Jelly, Jonathan Jackson and Joanne Logan received the award for best poster, while Marco Tovaglia was named the winner of the Diane Gould Photography Competition.

 

Changes afoot

Looking at how the contact lens industry has changed since the BCLA’s last clinical conference, Grewal pointed to the Alcon spin-off from Novartis, the collaboration between Johnson & Johnson Vision and Menicon, and the acquisition of No7 Contact Lenses by CooperVision.

“It’s a really exciting time to be in the contact lens industry, an exciting time for products coming forward,” Grewal added.

Of course, much has changed for practices too, and Grewal reflected on his own experience of the past 18 months, sharing: “Like many of us, closing my practice in March [2020] was one of the toughest things we had to do. It was really quite sad but it gave me an opportunity to look forward to see what I was going to do when I came out of it.”

Back in practice and looking ahead, however, he said: “We’re faced with a load of new products that have come out during these past few months which were due to be released in 2020 but were paused. So now, with manufacturers bringing these new products to market it’s a really exciting time for me as an eye care practitioner who fits contact lenses to be seeing all of this new technology.”

The evolution of contact lens and anterior eye science and ocular health in general never stops, it's always moving

The CLEAR initiative

With the CLEAR initiative making up a key part of the event, the event hosts introduced the resource, with Stevens-Burt commenting: “When you think about the changes that we see through industry, it just goes to show that the evolution of contact lens and anterior eye science and ocular health in general never stops, it's always moving. There's always something new to find out about.”

Executive chair of CLEAR, Professor James Wolffsohn from Aston University, and Professor Philip Morgan, head of optometry and deputy head of the division of pharmacy and optometry at The University of Manchester, introduced the CLEAR initiative, discussing the background and methodology of the project.

Describing how previous projects within eye care research have brought together experts in key fields such as dry eye, with TFOS DEWS2, and myopia through the International Myopia Institute, Morgan suggested it seemed to be the time for something specifically dedicated to contact lenses.

We’re in a really fast-moving field. It means that there are new and fresh challenges every day

“It was our turn to pull together experts who understand the literature and summarise it for us,” Morgan added, providing an evidence base for practitioners to build their clinical practice and procedures around.

Highlighting the importance of evidence-based practice, Wolffsohn said: “We’re in a really fast-moving field. It means that there are new and fresh challenges every day.”

“Even our patients challenge us now, because of course they’ve got access to the internet; Google and Wikipedia, so they’re reading things which may or may not be true and coming back to you as the clinician,” he shared, adding: “Our job as eye care practitioners is to evaluate the science.”

This means looking at studies and considering the weight of evidence. He shared: “It’s really important that we do that and of course, we know that people have limited time. So one of the aspects of this was to give people that information at their fingertips.”

Showcasing the need for the CLEAR initiative, the researchers found approximately 19,000 peer reviewed papers had been published over time on the topic of contact lenses. Calculating the work that would be required to read all of those papers, Wolffsohn estimated that with the approximately 19,000 papers, at an average of 10 and a quarter pages, taking on average 4.09 minutes to read, the workload for reading them all would equate to 796,527.5 minutes – or 6.4 years.

“But you can’t stop there,” he added, highlighting that in the past year, another 971 papers with ‘contact lens’ in the title had been published.


Wolffsohn shared that while CLEAR is “not the end of the story,” it provides a benchmark “to give really good evidence of where we are up to now,” and in the future more material will need to be produced to keep up with the changing times.

On the agenda

New designs and innovations in materials formed a key topic through the conference with manufacturers sharing behind-the-scenes insights into their lens designs.

Delving into the topic of materials, Morgan delivered a CLEAR presentation on Effect of lens materials/design on the anatomy and physiology of the eye, talking attendees through a number of the key issues considered, from blinking to meibomian glands, to subclinical inflammation and sensitivity.

Dry eye was another key topic discussed through the conference, with a Johnson & Johnson-powered session on The vision behind the tears with insights from Professor Jennifer Craig, professor in ophthalmology at the University of Auckland, and Dr Charles Scales, senior principal scientist at Johnson & Johnson Vision.

Highlighting the importance of tear film, the effect of contact lens wear, and the different materials and ways of promoting wetting, Scales told attendees: “COVID-19 has ushered in a new era of digital experience for many across the globe, and drastically increased the demand, or burden, on patient’s eyes, creating a strong demand for the high-performance contact lens.”

During the event, the company also highlighted the opportunities still available to grasp in serving presbyopic patients, and revealed that its new lens; the Acuvue Oasys Multifocal with Pupil Optimised Design, would be available in the UK from July.

Dry eye in practice

Optometrist, Dr Keyur Patel, gave delegates an insight into his dry eye clinic and how the practice uses the TFOS DEWS I and II for a structure in assessing, diagnosing and managing patients.

The process has changed following COVID-19, Patel described, incorporating telemedicine into the assessment and diagnostics process and allowing clinicians to go through symptoms and history ahead of the in-practice consultation.

Discussing this remote appointment, Patel shared: “It allows us to build a rapport with the patient, it allows the patient to see who is going to be consulting them, who’s going to be doing their examination. And we found that patients like it, it's a little bit warmer than a telephone call.”

The practice has built on and adjusted the TFOS recommendations to find its own optimal flow of the patient through the practice and also make it easier for scheduling in the practice, “which is particularly important for the increased wipe-down protocols which are needed at the moment,” Patel shared.

Within the diagnostics suite, the clinical technician will complete osmolarity testing and measurement for proteins – MMP-9 testing, and inflammatory markers. Once key data has been gained, the clinician will carry out the physical assessments, such as using a topographer tool with a series of dry eye assessment diagnostic tests built in.

A huge part of dry eye assessment and dry eye management is having the patient understand what is happening, why it’s happening, and what they can do to help themselves to make it better

Patel emphasised that a lot of what can be done through the topographer could also be done with a slit lamp, “If you can take the time to do it and learn that skillset.”

Fluorescein and lissamine green are still key in the assessment, Patel said, adding that he uses both together after the osmolarity, MMP-9 measurement and non-invasive break up time.

Patel recommended taking pictures and records for the patient, commenting: “A huge part of dry eye assessment and dry eye management is having the patient understand what is happening, why it's happening, and what they can do to help themselves to make it better.

“Unfortunately, we still don’t have that magic pill that will help fix dry eye disease at the click of a finger. So the more you can get the patient onboard, have them understand what is happening, the more likely they are to heed your instruction and follow it through,” he shared.

A new world of contact lenses

A focus on the future was also apparent through the conference, and Professor Lyndon Jones, director at the Centre for Ocular Research & Education at the University of Waterloo, gave attendees a peek into upcoming and potential innovations through his session, Future applications of contact lenses.

Jones began by highlighting: “In terms of where contact lens technology is going to take us, we typically tend to think of contact lenses as really just correcting refractive error,” but added that the CLEAR report instead looks at “the opportunities for contact lenses in the near and far future as well.”

Looking at these opportunities, he first pointed out innovation that “almost seems futuristic but are with us at the moment,” pointing to myopia management or contact lens innovation such as photochromic products.

Examining the use of contact lenses beyond this, however, Jones outlined some of the key future applications and opportunities for contact lenses, including in areas of diagnosis and screening for systemic diseases – such as glaucoma. Likening this to existing wearable sensor markets, such as smart watches, Jones described the technology that would be needed to support this application and which would all need to be miniaturised in a lens.

Similarly, Jones indicated the potential for screening for ocular diseases, as well as for monitoring in situations like dry eye or ocular surface temperature, unpicking some of the challenges to creating viable commercial concepts, as well as some of the projects that have already been carried out.

He also explored the potential for treatment of ocular conditions, primarily through drug delivery contact lenses. Noting that with eye drops, only 5% of the drug put onto the ocular surface becomes bioavailable, he highlighted that soaked contact lenses are anticipated to release drugs more slowly, and highlighted the relevant longer-term diseases this could benefit – such as ocular allergy and glaucoma, as well as the short-term issues it could aid such as microbial keratitis and severe corneal abrasions.

Contact lenses have been around for over 100 years and you’ll be glad to know the future remains bright

He highlighted the example of a commercial product licensed in Japan and Canada from Johnson & Johnson Vision, the Acuvue Theravision with Ketotifen – a drug-releasing contact lens providing vision correction for patients with itchy allergy eyes – as an example of “the future of contact lenses here today.”

He also touched on the possibilities of antimicrobial lenses, and innovations within storage cases to prevent high levels of bacteria and contamination.

Finally, Jones outlined the more futuristic opportunities of contact lenses for optical enhancements – particularly in augmented reality and virtual reality. Listing some of the key companies operating or interested in this field, he named big players such as Apple, who he shared, “Have recently said that within the next 10 years they imagine having a virtual reality contact lens,” as well as a number of start-ups which are making steps in this area, such as Mojo Vision. He also indicated a number of applications such as within low vision, military, education and training.

Directing attendees back to the CLEAR publication, Jones shared: “The review certainly demonstrates the incredible diversity of new technologies under development that will shape the future for contact lenses.”

“Contact lenses have been around for over 100 years and you’ll be glad to know the future remains bright,” he concluded.

Remote consultations in practice

With telemedicine technologies supporting new ways of meeting patient needs, the topic of remote consultations threaded through a number of discussions and presentations at the event.

Therapeutic optometrist and clinical lead for a group of independent practices in the Bristol area, Rebecca Donnelly, shared her experiences of using remote consultation software in practice: “Teleoptometry to me, is not a short-term solution to the pandemic or to social distancing. It's a long-term solution to retaining our patient base, building a new patient base, and another tool in the belt of the community optometrist to compete against large online retailers of spectacles and contact lenses.”

One of the main ways Donnelly’s practices have used remote consultations has been in soft contact lens aftercare, using Advanced Ophthalmic Systems (AOS). The eligibility criteria that the practice uses for remote consultations restricts the offering to soft contact lens wearers who are asymptomatic and wear their lenses on a daily basis, and only if the practice has a patient record for them.

I believe that remote care is here to stay, but we need to adopt it safely and appropriately to improve patient experience, workplace efficiency and access to expert care

Presenting event attendees with an inside-look at a simulated patient journey through the process, Donnelly explained that following the consultations, patients are provided a PDF record along with leaflets on the dos and don’ts of contact lens wear and their prescription.

This open communication has changed how patients view contact lens aftercare, Donnelly shared: “Before they didn't understand why they would need two appointments for their sight tests and their contact lens check. Whereas now that open communication and all of the information that we send them has really highlighted that contact lens care is a specialty in itself.”

The use of remote consultations could help to prevent drop-outs, Donnelly suggested, sharing how she also uses CooperVision’s My Lens Coach to guide trialists through the first few weeks.

Beyond contact lens aftercare, the service has been useful for contact lens follow-up teaches, and to check in with the patient six to eight-weeks after they have been signed off on their contact lenses. It has also been useful for following up with patients on a dry eye management plan.

“I believe that remote care is here to stay, but we need to adopt it safely and appropriately to improve patient experience, workplace efficiency and access to expert care,” Donnelly shared, noting that she would value seeing more professional guidance regarding remote care.