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Whenever a new multifocal lens promises to deliver better visual performance, I am honestly skeptical.  The current daily disposable multifocal market had been rather uninspiring in lens technology with Proclear 1-Day Multifocal delivering relatively limited performance in higher adds (plus a fitting process that left a lot to be desired on initial lens selection) and the Dailies Aqua Comfort Plus Multifocal utilizing the same Air Optix design we all know.  But since I started fitting Clariti 1-Day Multifocal (also called Freshday Multifocal), I have to admit that I have been impressed with the results.  Like all multifocals, this lens is not perfect.  But for the design options on the market, this lens routinely is delivering the best reading vision without distance interference for a larger number of my patient base and has become my go-to daily multifocal lens.

It's the same lens, just different packaging depending on if you are a Vision Source member via

The Lens:

Clariti 1-Day is a silicone hydrogel daily lens with a Dk/t of 86 and a base curve of 8.6
Power Range = +5.00 to -6.00 in .25D steps
Add Range = LOW can accommodate up to +2.25 add, HIGH can accommodate up to +3.00
Center Near design

Fitting Guide:

Use up to date glasses Rx with vertexed distance.  Determine ocular dominance with +2.00 blur test.  The lens can tolerate up to 0.75D of astigmatism, but if the patient has greater than this don't expect clear vision.  Like all multifocal designs, performance depends on good, bright lighting for best visual performance.

There are 2 different fitting guides depending on if the patient is a hyperope or an emmetrope/ myope.  I have found that following the guide is extremely effective so definitely keep it handy!

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It is highly recommended that the initial lens from the fitting guide is dispensed on day one -- the patient will need time to adapt to the lens technology and a follow-up in about 1 week will allow that appropriate "learning" time.

At the return check up, follow these tips for trouble shooting problems:

Take Home:  There's a good reason that so many optometrists are discovering this lens is a new favorite -- it works!  It's not a miracle worker, but I have had much better patient acceptance of distance and near vision without compromise with this multifocal design than any other daily disposable multifocal to date.  It won't work for every patient, and it still requires the normal patient expectation discussions about lighting and dominance (Don't compare your eyes individually! It will look different between the eyes on purpose because that's how this lens is designed!).  For another vote of confidence, check out The Top 5 Ophthalmic Products of 2015 My Practice Can't Live Without  by Dr. Courtney Dryer.  She lists the Clariti 1-Day line of products as #1 on her list.

My advice is to keep the fitting guide with your set (or just have this post handy on your phone) and follow it exactly in initial lens selection.  I have only had to make an adjustment from this initial lens in 1 patient thus far, so it holds very true in my experience which is great for your chair time and your patient's time!

Studies suggest that up to 90% of Americans who work on a computer on a daily basis suffer from dry eye (whose symptoms include burning, redness, watering, and fluctuating vision). The culprit? One of the biggest contributing factors is that we don't blink as frequently as we normally would while at the computer.  In fact, we blink about 50% less often, when engaged in a high demand visual task (such as reading or working on your computer screen).  Since blinking mechanically releases tear film from glands in the eyelids, going longer and longer in between blinks leads to a drier and more disrupted ocular surface -- which means discomfort and blur to you!  We know that blinking is a chief issue in dry eye, but trying to get those missing blinks back has posed an even larger problem. Try telling yourself to blink every 13 seconds.  Within a few turns you'll realize you spend more time thinking about blinking than actually getting work done.  The goal of an effective solution would be to blink more without having to actively think about blinking, and the makers of Japan-based Wink Glasses are attempting to achieve just this.

Every 10 seconds the battery charged fogging of a liquid crystal sheet across the left lens of the glasses occurs for a split-second, theoretically signaling the brain to blink. via

Wink Glasses visibly signal your eye to blink by fogging for 0.1 to 0.2 seconds every 10 seconds. The momentary visual blur is intended to subconsciously trigger a blink reflex as your brain tries to "clear away" the fogged image.  Using a small battery in the left temple, fogging is achieved by inducing an electrical current through a liquid crystal sheet in the lens of the glasses.  Earlier versions of the product could be individually regulated with a sensor to track your personal blinks that would fog with a greater or less frequency if desired, but the 2013 Wink Glasses edition has simplified things to aim for that 10 second mark between fogging where most people would naturally blink if they weren't on the computer.  This streamlined version of the technology sells for around $150 in Japan, and can be upgraded with your prescription for an additional charge.  A quick search found versions available on ebay for $370 with the individualized blink setting capacity.

No reports yet of any studies being done showing an improvement in dry eye symptoms with use of Wink Glasses, but as the technology becomes more affordable and mainstream outside of Japan we should know more about its effectiveness!  Until then, if you are suffering from dry eye symptoms at your computer or workstation, remember to blink.  Try to take a break and blink every 20 minutes or so during the day to allow your eyes a chance to recover.

Love this promotional graphic from Hobson Eye Associates: "Ask use about multifocal contact lenses.. Yes, we even have dailies!"

The other day I met a woman in line at the store, pouring over magazines in the checkout.  "Look at her face -- that's not what 40 looks like! The crow's feet, the chin sag, the pores on your face getting bigger..."  It took all the reservation in my body to not say, "And don't forget about your vision!"  But maybe she hadn't admitted the awful truth quite to herself yet.  After 40, we just can't see like we used to.  The process is called presbyopia, and every day in my exam chair I try to help transition my patients in this age group in ways to enhance and ease the difficulties that come with their birthdays. We all know our population is aging --between 2000 and 2010 in the US, the population of people between the ages of 45 to 64 grew 31.5% to 81.5 million people.  But according to the 2015 Global Specialty Lens Symposium report, only 15% of all contact lens wearers are in this presbyopic age group (If you haven't read Contact Lens Spectrum's great review of the Global Specialty Lens Symposium, follow this link for more fascinating data about contact lenses in our industry). We all know people in this age group are struggling to see, but for some reason they just aren't wearing contact lenses. Why?

Obstacle 1: Comfort
The single biggest reason that contact lens wearers "dropout" of lens wear and return to glasses is due to comfort.  In fact, studies show an average of 16% of lens wearers dropout every year in the US.  In the population over 40, several other factors contribute to comfort issues beyond the contact lens material itself:

• increased computer and digital device use 
• 57% of Baby Boomers (age 51-69) have symptoms of digital eye strain and 63% of Gen Xers (age 35-50)
• increased incidence of underlying dry eye disease, especially in women
• increased incidence of demodex infestation in the eyelid (increasing ocular discomfort)
• Studies show 84% of people over age 60 have demodex mite infestation on their eyelids

British sunglass power-house Cutler and Gross has been delivering high-end fashion sunglasses for decades, but this season brings the designer's aesthetic to a duo of American based groups. For the 2015 spring/summer season they've teamed up with FRYE, an American brand known best for leather goods and cowboy boots. Their 12 piece capsule collection focuses on updates of classic American styles; familiar shapes from aviators to wayfarers get the Cutler and Gross reboot, featuring a minimalist focus on design lines and several pieces in the trending pastel color palate that was spotted all over runways this spring.

The 12 piece collection features familiar frame shapes with a gradient tinted lens. via

The Orchard Aviator via

The Mercer via

Actress Emma Roberts wearing the Mercer around the streets of New York via

I'll be the first to admit that I didn't truly understand orthoK before I attended the excellent Vision By Design conference this year.  And I don't think I was the only doctor that thought the principle of orthoK was that  you use a contact lens to forcibly press and flatten the central cornea. If this is your working model of orthoK, it's time to totally rethink everything you thought you knew!

The lens itself doesn't manually push the cornea, but the difference in dynamic forces caused by the lens design creates movement of fluid in the cornea underneath via

The biggest myth of orthoK is that the corneal mold or contact lens being used manually presses the cornea flat.  In actuality, the lens ideally won't be directly touching any part of the cornea -- there is a minimal amount of tear film underneath the lens at all times, even at the central treatment zone! Typically this area is dark when stained with NaFl dye, making doctors believe it must be an area of touch.  But levels of NaFl dye less than 20 microns thick are not visible when viewed via slit lamp, and OCT studies of on-eye relationship between lens and eye prove that there is a very slim tear film layer at all times between the eye and lens.

OCT imaging of an orthoK lens on the eye shows a thin tear film layer between cornea and lens throughout, but a larger tear fluid volume at the mid periphery. This gradient difference creates the negative pressure centrally that moves corneal fluid into the mid periphery and thus results in the desired corneal reshaping for vision treatment.  via

Corneal epithelium (top) and stroma (bottom) in an eye before orthokeratology

So how does orthoK reshape the cornea if the lens is not actually pressing on the cornea?   

After one night in orthokeratology: central corneal epithelium shows no cell loss, but there is an obvious increase is mid peripheral corneal epithelial fluid volume via

The process works because of the reverse geometry shape of the lens.  Because the central zone of the lens is much flatter than the mid periphery (return zone) of the contact lens, a negative pressure gradient is created that drives movement under the lens towards the mid peripheral areas.  What is actually moving?  Another popular misconception is that you are
pushing corneal epithelium out of the central cornea and into the mid periphery with ortho K.  In actuality, the cells aren't really changing their location, but the fluid within the cells are being redirected.  Corneal epithelial cells are connected to each other with a number of different cellular level junctions.  Gap junctions are the ones that let orthoK work -- these junctions allow fluid to pass between cells depending on osmolarity and pressure gradient. In orthoK the pressure gradient created by the orthokeratology lens shape shifts fluid between these open gap junctions towards the mid peripheral area.  As a result, the corneal epithelial cells centrally in the treatment zone are still present -- there is NO migration or loss of epithelial cells in this area!-- and the flattening effect witnessed is just the fluid movement underneath. Studies show that even after 5 years of orthoK wear, there is no loss or damage to the corneal epithelial cells.

What happens when you stop wearing orthoK lenses?  Eventually the cornea returns to its natural shape, since the corneal cells themselves have not been manipulated.  The amount of time needed to return to normal baseline varies between individuals and prescriptions.  Many doctors suggest waiting a period of 6 months without orthoK lens wear if you are wanting to have LASIK or other permanent corneal reshaping surgeries performed to ensure that the cornea is completely returned to its natural state.  What we do know is that orthoK is in no way permanent.  Any treatment effect you achieve using orthoK lenses will not last when you discontinue lens wear, and your eye is expected to return to the prescription it was before orthokeratology lenses were begun (or potentially with some slight myopic increase if they were begun on a growing child).  The largest orthoK study to date, the ongoing SMART study with an enrollment group of 200 children aged 8 to 14 has reported after 3 years of treatment an average progression of -0.17D of myopia in the treated group after 3 years of wear versus -1.01 D of progression in the control group (glasses wear) in 3 years. So while some progression of your prescription will likely still happen with orthoK lens wear, the rate of progression is greatly minimized. Stay tuned for the next post about myopia control theory -- why does orthokeratology work so well at slowing myopia progression?  We talk peripheral defocus theory in the next post of this series!

80-90% of school aged children in Asia are myopia -- creating an international epidemic of nearsightedness and a quest for a way to intervene via

If you've been paying attention to the news, you've likely heard the words "myopia epidemic." Rates of near-sightedness have been skyrocketing, with over 1/3 of the US population suffering from this visual condition (a 66% increase in the last 30 years!).  In Asian countries an estimated 80-90% of school aged children are near sighted, causing a flurry of research and attention to this growing problem.  Visual corrective aids like glasses and contact lenses can relieve blurry vision associated with this issue, but they do not prevent the eyes from getting worse year after year as a child grows.  This is the true issue with myopia -- as long as a child is growing, the eyeball can continue to lengthen every year causing higher and higher prescriptions to develop.  This pathologic progression results in high adult prescriptions, but also an increased risk of damage to the eye due to a stretched and
thinned retinal tissue, which increases the risk for potentially blinding conditions like retinal detachments, glaucoma, and macular disease processes.  For years scientists and doctors have known that myopia and its progression were the result of a combination of both genetics and environmental factors, but there was no evidence of potential treatments that could intervene in the pathologic progression of near-sightedness.  Several options now exist for parents that are eager to control the speed with which their child's prescription advances, so sooner intervention at the first signs of nearsightedness is key!