A non-wetting scleral contact lens via

If you've ever tried driving through a foggy windshield, you know the vision quality is far from ideal (or safe!).  For many contact lens wearers, lens fogging is a daily struggle.  Typically this fog is created by debris from the surface of your own eyes - tear film lipids, proteins, and mucins sticking and smearing on the surface of the contact lens and creating an oily coating.  Blinking just spreads the film around, and typically only removing the lenses and cleaning the surface will improve your vision.  In soft contact lens wearers, the solution to fogging issues is most often changing to daily disposable contact lens materials which maintain clarity due to a fresh, clean surface every day and being made from thinner and more debris repellent materials.  For hard or rigid gas permeable lens wearers, hybrid contact lens wearers, or scleral contact lens wearers, no such solution exists.  Luckily there are several options for improving clarity and busting fog with these lens options too!

Enhancing Rigid Gas Permeable Lenses
When I first started fitting scleral contact lenses, the image above was all too frequent in my exam chair.  Patients would be putting on their first lenses directly from the lab, only to immediately find their vision foggy and distorted.  Non-wetting lenses cause immediate fog issues from the moment of dispense; they look completely normal off the eye, but once on the eye the patient's tear film beads up into non-spreading droplets of tear film on the lens' surface.  There is no way to clean or polish off this nonwetting issue.  The best bet is to reorder the lens with a few pro tips:

1. Call the lens manufacturer to report the issue. 
During the manufacturing process, rigid gas permeable contact lenses are cut on a lathe. For scleral contact lenses especially, this lathing process can expose the lens to excessive heat. Higher temperatures during manufacturing can prevent the lens from being able to properly wet on the eye. The lens manufacturer will make a note when remaking the lens to reduce lathing time in this case.

2. Ask for Plasma Treatment and Wet Shipment.
Plasma treatment is not a coating, but rather a hyper-cleaning technique that removes microscopic debris on the surface of the contact lens after the manufacturing process. Rigid gas permeable (RGP) contact lens plasma treatment involves the blasting of ionized oxygen particles against the surface of the lens in a vacuum chamber.  The oxygen interacts with organic debris on the surface of the contact lens, especially effective against organic lipids and oils.  Right after plasma treatment the lens is as clean as it will ever be!  It is immediately placed in a liquid storage solution (most labs use Boston Simplus) because if the lens is stored dry at this stage, the surface will immediately start collecting debris again. Studies show plasma treatment improves lens wettability and initial patient comfort, and reduces the risk of lens fogging.

How to Care for Plasma-Treated Contact Lenses

If you have plasma treated contact lenses, the best way to maintain this level of surface clarity at home is to use the right RGP lens cleaner. Boston Simplus, Optimum pH, and peroxide based cleaners like CLEAR CARE are all compatible. Do not use abrasive lens surface cleaners like Boston Advance.

3. Talk Materials
Silicone-based materials are very popular in today's contact lens marketplace due to their better breathability, but silicone can make contact lenses more hydrophobic - meaning they collect more debris. Changing to a lens material without silicone or with lower amounts of silicone can help reduce surface build-up issues.

Fluoroperm 60 or 30
For healthy eyes without any evidence of prior scar tissue or oxygen loss (hypoxia) traditional, Fluoroperm is an incredibly debris repellent material!  Fluoroperm 30 is considered an old-school work horse for heave depositing patients, but watch carefully for oxygen issues to the cornea like neovascularization or pannus.  For patients in such low oxygen permeable lenses, changing lenses regularly is important to maintaining corneal health. For most RGP wearers, recommended disposal is 1-2 years to prevent infection or corneal scarring or warpage.

The above patient has pannus (white areas seen temporal and nasal on the cornea) associated with Salzmann's nodular dystrophy. A low oxygen transmissible lens wouldn't be a good option in this patient because it could exacerbate corneal scarring.  via

Tyro 97
For scleral contact lenses that cover more of the eye, Fluoroperm does not offer enough oxygen transmission to be safe.  In this case, Tyro 97 is an excellent option for debris repellent lens material that still provides enough breathability to be safely used in a scleral contact lens fit.

For years this was a go-to lens material, but many patients still experienced surface fogging and debris despite doing all of the above.  Enter the newest lens material of choice for scleral lenses in my clinic: Optimum Extra with Hydra-Peg

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What You Need to Know About Tangible Hydra-PEG
Tangible Hydra-PEG (Tangible Science) is an exciting new coating available across multiple lens materials.  Synergeyes hybrid lens materials and RGP Optimum lens materials are compatible currently, and by the end of 2018 it's expected that Boston materials will be available too. The PEG in Hydra-PEG stands for polyethylene glycol, a lubricant that's been used in artificial tears for decades. The Hydra-PEG coating is permanently bonded to the surface of the contact lens material, encapsulating the core lens material to improve wettability and help prevent surface lens debris.  Multiple studies have shown that the addition of Tangible Hydra-PEG to the lens surface improves both wettability of the lens and lubricity (reduced friction across the surface of the contact lens as you blink).

The addition of Hydra-PEG coating improved wettability and comfort across all lens types, gas permeable, soft silicone hydrogel based lenses, and hybrid contact lenses. via

On-eye studies performed at the University of Iowa also had compelling results.  Existing RGP contact lens wearing patients were refit into lenses with Hydra-PEG coating.  There was no change in visual acuity, but the patients classified before the study as moderate or heavy depositors in their habitual lenses reported clearer vision, better overall comfort, and less haze in their new Hyrda-PEG coated lenses.

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Removing Lenses with Tangible Hydra-PEG
The addition of Tangible Hydra-PEG can cause changes to the handling of the contact lens as well.  Because of the increased lubricity (decreased friction) on the lens' surface, the contact lens becomes more "slippery" after the addition of Tangible Hydra-PEG.  For gas permeable lens wearers, this is not typically an issue because the lenses are removed most often with plungers. But for soft or hybrid contact lens wearers, it might be more difficult to grip the lens between your fingers to remove.

If you are having difficulty removing your Synergeyes hybrid contact lenses with Tangible Hydra-PEG coating, the company recommends using a tissue over your fingers to help get a better grip.


Cleaning Lenses with Tangible Hydra-PEG
Approved lens cleaners for use with Hydra-PEG include Boston Simplus, Unique pH, and CLEAR CARE cleaning and disinfection solution. Do not use alcohol based cleaners as they could damage and strip the coating with time. Alcohol based cleaners like MiraFlow are commonly recommended for patients with heavy depositing issues, but if you switch to a Tangible Hydra-PEG coated contact lens, this solution should be discontinued.

Treating the Root of the Problem
The most common reasons for fogging, debris, and lens wetting issues are because your own tear film's lipids and proteins are smearing up and collecting on the surface of the lens. Many doctors approach fogging as a two-prong attack: changing the lens surface to make it more resistant, and changing your tear film to make it more balanced.  Patients with dry eye and meibomian gland dysfunction (MGD) are at increased risk of lens fogging because their tear film components of mucin and lipids are out of balance.  Restoring the tear film to homeostasis can help decrease the amount of protein, lipid, and debris floating around in your tear film and thus decrease the risk of it causing fogging and debris on the lens surface.

Meibomian gland dysfunction is extremely prevalent! Over 80% of the estimated 20-30 million Americans with dry eye syndrome have meibomian gland disease.  The meibomian glands express the lipid or oily layer of the tear film.

To minimize lens surface issues in patients with MGD, doctors will often advise using a nightly warm massage or Bruder mask to improve gland expression, and cleaning the eyelid margins thoroughly each morning before inserting lenses.  Avenova eyelid cleansing spray or OCuSOFT lid wipes are commonly prescribed options for daily lid hygiene. 

Lotions and Makeup
The products you use around the eyes and face could also contribute to lens fogging!  Before inserting your lenses, make sure you thoroughly wash off any lotions or creams from your hands and finger tips and dry your hands completely on a clean cloth. Makeup and lotions are heavy on oils, which can immediately fog your contact lens if they come in contact.  Insert your lenses before applying any makeup or skin cream to avoid exposure of these oils to the lens surface. And when you do apply eye makeup, make sure you avoid the waterline area!  This is where the delicate meibomian gland openings are located, and any makeup products applied here will be smeared across the surface of your eye and contact lens all day long.

Makeup applied on the waterline (as above) is a major contributor to contact lens discomfort and fogging! via

What's Next
If you've been frustrated by foggy, cloudy contact lenses, there is plenty of hope in sight! Tangible Hydra-PEG coating is continuing to expand to multiple lens materials, and we may even see it commercially applied to standard soft contact lenses in the near future.  Fighting off fog is a constant battle for patients with underlying risk factors like chronic dry eye, so working closely with your doctor to explore all causes and solutions for your particular underlying issues is essential to maintaining clear vision.  The addition of coatings like Tangible Hydra-PEG is truly just the beginning! A recent Review of Optometry article previewed a future where contact lenses are coated with anti-microbial films to reduce the risk of contact lens related infections, of where contact lenses were treated with surface coatings that allow for electro-conduction, turning your contact lens into wearable lens technology that could monitor your health status directly from the surface of your eye.

For many Americans, grabbing a bottle of eye drops at the store is just something you do without much thought.  Whether your eyes are red, itchy, watery, or just feel like something is irritating them, grabbing a drop is the go-to solution.  But what are you really picking up when you grab an eye drop off the shelf?  And does what you select really matter?  We're breaking down the biggest myths and misconceptions about the $540 million a year over the counter eye drop industry!

As a dry eye sufferer myself (especially when flying or travelling), I like to keep artificial tears in my purse or carry-on bag at all times.  You never know when your eyes are going to feel uncomfortable!  If you are flying, I highly recommend putting in a drop before the flight takes off, and then if it's a long flight, reinserting each time you are fed a meal.  This can help prevent major red eye and sandy/gritty discomfort when you land!

Picture this: a sunny summer evening at a rooftop party in New York City atop the design studio of CFDA award winning designer, Christian Siriano.  Everything is decked out in white marble, gold, and a variety of pinks. Models hustle up and down the stairs for quick changes, showcasing Siriano's resort wear looks to a posh young crowd of fashion insiders and social media influencers.

If you've been diagnosed with dry eye in the last decade, you've likely been recommended fish oil/omega-3 supplements by your doctor.  Multiple studies since the early 2000's had indicated that dietary omega-3 intake was both anti-inflammatory and could improve signs and symptoms of dry eye over the course of a few months. The newly published DREAM study (Dry Eye Assessment and Management Study) funded by the National Institute of Health however is making waves by calling into question prior studies showing omega supplementation's effectiveness. In fact, the DREAM study showed patients with dry eye taking omega-3 supplements achieved no better outcomes than placebo.  The results are raising more questions than answers as doctors try to make sense of the study that was designed to be the largest investigation of omega supplements and dry eye to date.

Recommending omega-3 supplements has been standard of care for dry eye treatment for over a decade, but new research is calling the practice into question. via

For those of us in the eyewear industry, it's often hard to see past the "way things are done" and find true innovation. Many of us grew up wearing glasses, grew up shopping for glasses, and in our careers have talked and touched and troubleshooted glasses thousands upon thousands of times.  What familiarity and experience can't give us though, is a new way of looking at things.

Enter Wesley Knight, the unlikely young artist who's making a name in eyecare by doing everything differently. Knight didn't up wearing glasses or with any family association or experience within the industry. Growing up in a creative household, he found a passion for sewing and garment construction, constantly challenging himself with new materials and ideas. He was experimenting with design using an old cow horn when the idea of horn rimmed glasses first came to mind.  Only problem was, he had no idea how to make glasses. 

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There are no books or classes or local tradesmen that you can learn from to find a pattern for making glasses from horn.  His design process centered around the material first, and he worked backwards from there to construct his own patterns to make the glasses themselves.  What started as a project fueled by curiosity led to a passion that would become his career.  In 2013 he launched his own bespoke eyewear business in Nashville, TN and success came quickly. That year he was a runner-up for Garden & Gun Magazine's prestigious Made in the South Awards, and the success from that feature eventually led to his moving from Nashville to a studio in New York City in 2017.  Just this April he was featured in the New York Post, merely a month after attending his first ever Loft Eyewear Show during Vision Expo East.

A frame takes shape, via Instagram

Why Bespoke?
In 2018 the idea of bespoke is trending big, but in eyewear its concept is often over applied.  For Knight, bespoke has a meaning that is a true calling: "The word bespoke represents a relationship between man and maker. When I build bespoke I always tell my clients we build it together. Bespoke is an intimate process of creating functional art that you wear 12-14 hours a day. It has to be perfect."

Because of this passion for his craft, Knight's process is a lot different from the traditional optical experience.  From the humble beginnings of old cow horn, he's now using sustainably sourced water buffalo horn from India, lighter than plastic and with the added benefit of being absorbent of the oils on our skin and face. Instead of an optical where clients come to shop his designs, Knight typically travels to his client's home or office and gets to know their personal style and aesthetic. Each frame is custom designed for his clients, usually over the course of several meetings. The process is interactive between maker and client; Knight will create multiple designs and prototypes until the final design is approved and crafting the horn begins.  The result is a pair of glasses uniquely created for the wearer; designed to perfectly fit the width of a bridge and the bend of an ear, as well as to highlight the person's face shape and proportion.

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At the Loft Eyewear Show, Knight admits eyewear buyers didn't know what to make of his business model or his product.  That hasn't stopped some of the biggest names in optical from partnering with him on his product. He's producing a limited collection of ready to wear designs this year for luxury eyewear A-listers Selima Optique, Black Optical, 10/10 Optics, and Rapp Optical. While these ready to wear pieces won't be custom made, he has used his most classic design patterns curated from his many clients since 2013 to create an everyday luxury product for the larger population of eyewear aficionados.

Keep checking Knight's Instagram  for more details!

Check out his entire collection of bespoke eyewear on Knight's online portfolio

If you suffer from chronic bloodshot or red eyes, you're used to hearing a lot of unsolicited comments and questions.  "You look tired."  "Are you sick?" "Do you have pink eye?"  You may have even been incorrectly judged at work or by friends and family as being drunk or smoking marijuana.  But for most people with chronic redness, it's a symptom of their personal ocular chemistry and daily environment.  Hours of computer use, inflammatory skin conditions like rosacea or eczema, dry environments like sitting under a vent or fan, working around dyes or chemicals, frequent flying, or driving for long hours with the vents in your car blasting air right at your eyes -- all of these common conditions can lead to recurrent red eyes! For many jobs these work environments are ubiquitous and unavoidable, so to combat the appearance of bloodshot eyes, sufferers turn to the pharmacy eye drop aisle.  Visine and ClearEyes are household names, but how they work to accomplish red eye relief has left plenty to be desired.  Luckily, a new option is no available over the counter that is poised to revolutionize red eye relief for the millions of Americans suffering from the stigma and stereotyping associated with having chronically red eyes!