March 2017

Nike & Zeiss: a new
innovation
SPECIALITY CL FORUM BY JACOB BENFIELD*
JURASSIC PARK, CLS AND A CATARACT
As the guest writer for this
issue’s speciality contact lens
forum, I thought I would
tackle a problem I have encountered
a few times and feel may become
more common as we test an aging
population.
First we have to go back, way back,
to my penultimate year at university.
Sitting in a lecture about the history
of contact lenses, I learned all about
dental technician Eugene Hirst
who brought rigid contact lenses
to New Zealand around the Second
World War. We heard how these
lenses, made of PMMA and other
old materials, took off and soon
became common place. We talked
about the challenges of fitting and looking after
patients with hard contact lenses and how more
modern materials had replaced them. Despite
this, we were warned, we would still occasionally
see patients who had been in hard contact lenses
for several decades. They might even be PMMA or
other old materials. These patients were known
affectionately as ‘dinosaurs’.
This leads me today’s patient, a 70-year-old
female – ‘LS’ – who has been in hard contact
lenses for at least 40 years. LS presented to my
practice as a new patient and is a true ‘dinosaur’
– not only is she a full-time wearer but she is
still in PMMA. LS had noticed a reduction in
vision over the past few months particularly in
her right eye, and felt her contact lenses needed
an update or a polish. On examination it was
revealed a cataract was the underlying cause.
It makes sense that these patients who have
been in contact lenses for thirty or forty years
may be coming in with blurry vision more often.
Even if they started lens wear in their twenties
they will at least be getting into their sixties
now, increasing the chance of cataract, macular
degeneration and other pathologies. I discussed
with LS that the cataract was blurring her vision
not the contact lenses and she wanted to have
this dealt with. Having been short-sighted her
whole life she was keen following cataract
surgery to still be slightly short-sighted for
the convenience of reading unaided. This got
me thinking about the effect PMMA has had
on her cornea and the potential effect on her
prescription and final cataract outcome.
PMMA and its effects on the eyes are well
known to optometrists with lack of oxygen
leading to oedema and corneal warpage among
other things. A topography following PMMA wear
shows this warpage (fig 1.) with irregular mires
and an irregular surface. This is immediately
noticeable to patients who switch from their
lenses into spectacles and notice blurry vision.
This patient has spent every waking moment
in PMMA lenses for the past 40 years with no
spectacle wear and hence no obvious blur. Of
course older, less oxygen permeable materials
have been dying off for more cornea-friendly
options such as Boston XO. But even these newer
materials can affect the cornea if the lens is
poorly fitting or if it flexes as it ages. This change
in corneal shape is of course not always bad and
with new designs and materials have started the
orthokeratology revolution.
Back to LS then. After removing the contact
lenses my initial refraction was R -7.50/ -1.50
x 45 (6/12-) and L -5.75/ -2.00 x 155 (6/7.5-). I
advised LS that for the best cataract outcome she
will need to cease contact lens wear and wear
spectacles until her corneas stabilise. I got her
back after one week without contact lenses and
the prescription was now quite different, at R
-7.50/ -4.50 x 80 (6/21) and L -4.50/ -3.00 x 160
(6/9.5+).
At this stage I wasn’t happy to prescribe
spectacles so I got LS back once more a week
later and things were quite similar to the week
before so I gave her a pair of single vision
distance spectacles. This got me thinking about
when was an appropriate time to review LS and
when do we expect her corneas to stabilise?
Fig 1: A topography showing corneal warpage
Further reading made me realise the answer
to this was really ‘how long is a piece of string’.
A study by Wang et al 1 found the average
resolution time of corneal warpage was eight
weeks but this had a standard deviation of
nearly seven weeks! Based on this I got LS back
two months later and her prescription was now
R -4.00/ -4.00 x 80 (6/12) and L -4.50/ -1.00 x 80
(6/7.5-).
The end was in sight! Vision was stabilising,
retinoscopy reflex was good and corneas were
clear on slit lamp. To be safe I got LS back
once more one month later and found the
prescription was stable. Success! I have since
referred LS for private right cataract surgery to
be followed with left cataract surgery to balance
any anisometropia.
There may be nothing too startling about what
occurred with LS, but I think it may be a more
common scenario as long-time PMMA contact
lens patients (dinosaurs) develop age-related
pathologies. To give the best surgical outcome
we, as the optometrists, should be considering
the stability of prescriptions and the stability of
the cornea.
The options for these patients will vary with the
patients’ needs. The first step which will help in
the long-term will be to change these patients
to well-fitting newer materials before problems
occur. The patient may not be keen to change
from a winning formula but just as we change
soft contact lens wearers into silicon hydrogel
it seems sensible to change PMMA wearers
into more modern materials. If you do end up
with a patient like LS though, it is worthwhile
discussing with them that they will have a few
months of potentially average vision to give them
a long-term positive outcome. Once out of rigid
lenses patients, may decide to pursue spectacles
(although we must warn them the prescription
may change quickly) or soft contact lenses but
these of course can be difficult with rigid wearers.
I would be intrigued to find out how other
optometrists deal with this problem particularly
for a patient concerned with the cost of this
process. There doesn’t seem to be any universal
answer but it does seem certain that the
number of patients in rigid lenses whether it be
PMMA or modern materials are increasing in age
and therefore increasing in pathology. Cataracts
can affect these patients and it is our job to deal
with it to give them the best vision. ▀
References
1. Time to Resolution of Contact Lens-Induced Corneal
Warpage Prior to Refractive Surgery1 Wang, Xiaohong
M.D.; McCulley, James P. M.D.; Bowman, R. Wayne M.D.;
Cavanagh, H. Dwight M.D., Ph.D. CLAO Journal: October
2002 - Volume 28 - Issue 4 - pp 169-171
ABOUT THE AUTHOR:
* Guest columnist Jacob Benefield stepped in to help while our
regular speciality lens contributor
Alex Petty focused on establishing
his new practice in Tauranga.
Benefield, an optometrist based in
Palmerston North, splits his time
between Visique Naylor Palmer,
Bruce Little Optometrists and the
glaucoma clinic at Palmerston
North hospital. He too has a special
interest in ortho-k and fitting hard
contact lenses.
For those who missed it, General Optical’s stand
at last year’s Visionz conference was proudly
displaying the latest partnership innovation
between Nike and lens company Zeiss for Nike’s
most recent Vision Running Collection.
Though the companies have been working
together since 1998, last year saw the development
of a completely new construction method which
seamlessly fuses the lens material with the frame to
increase coverage and offer eyewear that is lighter
than the average performance product on the market
today, said the companies in a statement. The new
Nike Vapourwing, Tailwind and Bandit designs were
the result of two-years of collaborative development
between Nike Vision, Zeiss and The Shop, VSP Global’s
innovation lab, which develops technologies for the
physical and digital aspects of eyewear and eye care.
US-based VSP Global is the licensee owner for Nike
Vision, through its global design manufacturer and
distributor, Marchon Eyewear.
“The partnership started from scratch to
manufacture a new lens from a custom mould,”
said Stephen Tripi, Marchon’s marketing director.
“Once developed, the mould was refined using
ultra-precise machinery with diamond-polishing
technology to polish the complex lens shape down
to the nanometer. The end result is a lightweight,
state-of-the-art lens that maximizes coverage
and provides optimum clarity to allow athletes to
perform at the highest level.
“To better serve our athletes, we looked to the
future of sunglass design to incorporate new lens
geometry and materials, as well as fit technology
and design elements that haven’t been used in
the performance eyewear industry before. We
really wanted to elevate athletic performance by
developing a better system of eyewear.”
Leslie Muller, co-lead of The Shop and vice
president, design for Marchon said his team worked
side-by-side with Nike athletes to first understand
the unique eyewear demands of runners. The team
drew design inspiration from nature—known as
biomimicry—and looked at factors like the lattice
structure of bones and tendons as strong, but
lightweight interactions of materials. Collaboration
with Zeiss then led to breakthroughs in lens design
by fusing lens materials into frames, he said.
BOOK REVIEW:
The Retinal Atlas, 2nd Edition
by Bailey Freund, David Sarraf, William Mieler and Lawrence Yannuzzi.
Published by Elsevier 2017.
REVIEWED BY A/PROF ANDREA VINCENT*
It has been a long time since I have been seduced
by a text book. But a quick flick through the pages
of The Retinal Atlas quickly became an absorbing
two hours.
Blame it on our busy lives and the digital
revolution, but we are rapidly becoming attuned
to 30 second soundbites, 140 characters and
e-tocs. Rapid advances in technology are
constantly changing our understanding of eye
diseases and the way in which we perceive and
manage them, so many textbooks have a short
shelf-life. The Retinal Atlas, 2nd Edition, however,
is a textbook which challenges and revolts against
this. As a reference textbook predominantly
consisting of images of retinal disease (and
optic nerve disorders for good measure), this is a
diagnostician’s dream.
The stellar cast of editors and contributors have
ably updated Lawrence Yannuzzi’s 1st Edition.
Short synopses of clinical features, epidemiology
and aetiology (longer than a tweet, but succinct
and concisely written) accompany a feast of
images. All imaging modalities are covered, with
colour codes for image type and fundus photos,
including wide-field, autofluorescence, fluorescein
angiography (FFA), OCT (often with a histological
correlate), ICG, and occasional ancillary images of
ocular or systemic associations. Post-treatment
images are present where relevant. Two pages
describe and illustrate OCT angiography, but FFA
images predominate, with only occasional OCT-A
images – notably in MacTel2 and age-related
macular degeneration (AMD) - present throughout
the book.
Often the ‘art of medicine’ is as simple as
experience and pattern recognition; that gestalt
that allows us to categorise the underlying cause,
eg. vascular vs inflammatory, genetic vs toxicity.
Armed with a book like this, the very clearly
indexed and delineated chapters enable the
Nike Vision Vapourwing sports sunglasses
All styles include responsive comfort, that grips
when the athlete sweats, and flexible arms that
conform to the shape of the wearer’s face for
stability and fit. The eyewear also features advanced
ventilation with an auto-adjusting nose pad that
is said to eliminate fog. Each style also includes an
expanded lens for increased coverage that acts as a
protection barrier and minimises stress-causing light
leaks, allowing the runner’s eyes to stay relaxed and
focused, said the companies.
“For decades, the strict optical 0.09D standards for
sunglasses have constrained designers to use only
simple spheres and torics for the optical surfaces in
their premium products. Zeiss has adapted advanced
freeform design and manufacturing techniques
developed for ophthalmic and precision optics to
achieve 0.06D optical performance for general,
complex-shaped surfaces. This extra freedom has
been exploited by the creative team at Nike and
frame-manufacturer Marchon to simultaneously
optimise the fit, the aerodynamics and the aesthetics
of their new line of premium athletic eyewear
without compromising optical performance,” said
Steve Sprat, lens designer for the project. ▀
See associated story on GenOp’s luxury focus p8.
observer to target
and peruse relevant
images for many
diagnostic dilemmas.
Any eye professional
who looks at the
retina; from the
student, the resident
studying for finals, and the generalist, to the rare
diseases guru can find solace amongst these pages.
Comprehensive sections cover common conditions
such as diabetic retinopathy and AMD. There are
detailed chapters on paediatrics, oncology and
surgical retina and complications. The nematode
section is truly fascinating and indicative of coverage
of more singular entities. One omission, however,
was manifestations of the Zika virus, demonstrating
the speed at which our knowledge grows. Each
chapter ends with a ‘suggested reading’ list, which
is predominantly journal-based and necessary for
further insight into aetiology, diagnostic tests or
management plans.
For those not wholly ready for a complete digital
detox, the book includes an online companion,
which can be viewed on your mobile. The Retinal
Atlas website follows exactly the same format
as the book, with a useful search function, and
is easily navigated. The instructional blurb states
you can view enhanced images, but a quick review
of some topics showed the content to be near
identical. The images are high quality resulting in
some lag downloading them.
The book, however, is truly desirable, (albeit
large at 1173 pages long and weighing 3.5kg), and
likely to develop a patina acquired from regular
perusal from students to experts alike. ▀
*Associate Professor Andrea Vincent heads a team researching the
genetics of retinal and corneal dystrophies, keratoconus, glaucoma
and lid abnormalities at the Department of Ophthalmology at the
University of Auckland. She is also a consultant ophthalmologist
at Greenlane Eye Clinic and Retina Specialists in Auckland, a
section editor for Clinical and Experimental Ophthalmology and a
board member of the Ophthalmic Research Institute of Australia.
16 NEW ZEALAND OPTICS March 2017