Asia Cornea & Contact Lens Conference

Tears play a crucial role in maintaining the health and function of the ocular surface as they cover the surface of the eye. Their composition is complex. Compared to other bodily fluids, tears are easier to collect, non-invasive, and painless. These characteristics make tears an ideal source of biomarkers for diagnosing and monitoring various diseases, especially systemic metabolic disorders such as diabetes and its complications.

Diabetes is a metabolic disease, and there is currently no fundamental cure. Early diagnosis and monitoring of diabetes is crucial for patient treatment and prognosis. In recent years, biomarkers in tear fluid have garnered significant attention from researchers due to their unique advantages. Studies have shown that various metabolites are upregulated in the tear fluid of diabetic patients, related to the pathogenesis of diabetes. For example, niacin levels are elevated in the tears of diabetic patients. Additionally, the levels of the pro-inflammatory cytokine TNF-α in the tear fluid of patients with diabetic retinopathy (DR) are increased, which not only aids in the early diagnosis of DR but also helps predict the severity of the disease. The correlation between tear fluid levels of Nerve Growth Factor (NGF) and diabetic nephropathy, Neuropeptide Y (NPY) and diabetic peripheral microangiopathy, and MMP-9 and diabetic peripheral neuropathy (DPN) suggests the potential value of tear fluid biomarkers for the prediction and diagnosis of diabetic complications.

Despite the potential of tear biomarkers in the diagnosis and monitoring of diabetes and its complications, their clinical application still faces challenges. For instance, tear samples are often small and technically demanding to collect and detect, limiting their widespread use. However, with the advancement of analytical techniques, in the future, tear analysis is expected to become a routine tool for detecting the diagnosis and monitoring of diabetes and its complications, and to play a more important role in the management of diabetes.

Background: Myopia is an increasingly serious threat to the visual health of young people around the world, and the orthokeratology (OK) lens are widely accepted as one of the most effective means of controlling myopia, providing a safe and reversible solution to correct and slow the progression of myopia by wearing them at night. However, the fitting process is cumbersome and the effect varies between different doctors.The application of Artificial Intelligence (AI), especially Machine Learning (ML) and Deep Learning (DL), has brought innovative breakthroughs in this field. By analysing images and data information and recognising subtle patterns, they can make more accurate and faster judgments than optometrists.

Methods: We performed a comprehensive search of PubMed, Web of Science, Embase and Scopus using the keywords 'AI, artificial intelligence, machine learning, deep learning, natural language processing, computer vision, generative AI' combined with 'orthokeratology'. A total of 147 articles were found and 21 articles were included after full-text analysis.

Results: ML and DL built prediction models based on corneal topographic map, axial length (AL), spherical equivalent refractive error (SER) and other biological characteristics to achieve the accuracy and personalization of OK lens matching, and provide a more effective myopia prevention and treatment scheme for the clinic.

Discussion: We retrospectively analyzed the current status and potential transformative impact of the application of ML and DL in AI in the control of myopia with OK lenses. The application of ML and DL in the clinical practice of controlling myopia with OK lenses has improved the accuracy and efficiency of fitting, and has shown great potential in assisting optometrists to determine trial lenses, predict correction effects, and achieve personalized treatment. We emphasized its potential to improve market shortages, and also explored in depth the challenges of integrating it into clinical practice and research.

Objectives: To investigate the rate of axial elongation (AE) and associated factors in highly myopic children treated with dual reverse curve (RC) orthokeratology (ortho-k) lenses.

Methods: Chinese children aged 7 to 13 years, with myopia ≤ -5.00 D and astigmatism ≥ -2.00 D, were assigned to either a dual RC design targeted for full correction (study) or a conventional design with -4.00 D target (control). Both groups wore single-vision spectacles to correct residual refraction during the daytime. Generalized estimated equation (GEE) model analyses were used to examine the changes in AL and ChT over time and between groups, accounting for inter-eye correlations. Some participants discontinued lens wear for over one month due to microcysts, which was considered discontinuation effect. Another GEE model analysis using the data from all the visits was used to examine the risk factors for AE, adjusting for age, sex, treatment group, inter-eye correction, baseline AL and ChT, ChT changes, and discontinuation effect.

Results: Thirty participants completed the two-year follow-up (control: 20 vs study: 10). After two years, AE was comparable between groups (0.12 ± 0.05 vs 0.14 ± 0.07 mm). Thirteen participants who discontinued temporarily for over one month during the study period demonstrated greater AE than those who did not (0.19 vs 0.08 mm). At the end of the study, there was no significant difference in the mean ChT change between groups (10.4 ± 5.1 vs 15.8 ± 5.4 µm). GEE analysis indicated that older age, greater increases in ChT, and continuous treatment were significantly associated with less AE.

Conclusion: The dual RC ortho-k design targeted for greater refractive corrections achieved good myopia control efficacy in highly myopic children, comparable to the conventional design. Younger age, less increase in ChT, and temporary lens wear discontinuation (interruption) over one month during treatment may accelerate myopia progression.

Objective: Low-Level Red Light therapy has emerged as a potential non-invasive option for managing dry eye disease, yet its underlying mechanisms remain unclear. Thus, this study aims to investigate the impact of red light on the functionalities of human corneal epithelial cells (hCECs).

Methods: An immortalized human corneal epithelial cell line was used in this study. Cells were cultured in either normal osmolar media (315 mOsm/L) or hyperosmolar media (465 mOsm/L) and exposed to LED red light (RL, 620 nm with 2500 lux or 0.88 mW, 5 times at 5-minute intervals over 24 hours). There were 4 groups, cells in normal osmolar media (C-N), cells in hyperosmolar media (C-HS), cells exposed to LED light in normal osmolar media (RL-N), and cells exposed to LED light in hyperosmolar media (RL-HS). Cell viability (annexin V and propidium iodide), intracellular ROS production (DCFH-DA), mitochondrial ROS generation (MitoSox), and their inflammatory state (anti-HLA-DR antibody) were assessed through flow cytometry.

Results: The expressions of annexin V and propidium iodide on hCECs decreased significantly sorely in the RL-N compared to the C-N group (p < 0.022). Additionally, intracellular ROS levels increased significantly in the RL-N compared to the C-N group (p = 0.023). Mitochondrial ROS generation was significantly increased in RL-C and RL-HS groups compared to their controls (p < 0.027). HLA-DR expression decreased significantly in RL-HS compared to RL-N (p = 0.027), suggesting an anti-inflammatory effect of red light.

Conclusions: Low-Level Red Light may prevent cell death and enhance ROS production in hCECs under non-stressful conditions, potentially augmenting cellular functions. Exposure to RL may have a greater impact on mitochondrial activities given the significant increase in mitochondrial ROS generation in both RL-N and RL-HS groups. Further studies are needed to better understand intracellular pathways or underlying mechanisms of RL on hCECs.

Purpose: Antibiotics have been the conventional treatment for bacterial keratitis and their use has led to significant issues including antimicrobial resistance and allergic reactions. These problems have prompted the search for alternative therapies. We developed a biocidal corneal bandage that is free of antibiotics, utilizing photo-sensitive nanocomposites embedded in an enzyme-modified hydrogel. The nanocomposites and enzymes generate reactive oxygen species (ROS) to effectively disinfect bacteria. The nanocomposites release ROS when exposed to near-infrared light (NIR), and the enzymes within the hydrogel catalyze glucose present in tear fluid to produce additional ROS.

Methods: The treatment efficacy of this antibacterial bandage was evaluated through Multi-drug resistant Pseudomonas aeruginosa (MDR-PA) induced in vivo rabbit bacterial keratitis model. The colonies of bacteria were isolated from cornea of the rabbit (N=4) after treatment. The transparency of the cornea and defects of the corneal epithelial layer was also examined with slit lamp. Besides, studies on assessing the biosafety of the bandage the histology of cornea were conducted via H&E staining and Masson staining.

Results: The living colonies of the bacteria amount in cornea from rabbit model exhibited a significant reduce to (6+/-1%) (MDR-PA) after treated with the bandage. Cornea treated with the bandage exhibited more transparency and less edema compared to the infected cornea. Bandage treated cornea indicated a faster re-epithelialization compared to infected cornea. Besides, the histological staining indicated that no damage to corneal tissue was caused by treatment with the bandage.

Conclusions: The result of reduced bacterial colonies indicated that the treatment with the bandage has potential in eliminating drug-resistant bacteria on an infected cornea. Besides, the maintenance of the corneal transparency and promoted healing of corneal epithelial layer suggested that biosafety of the bandage. The in vivo results suggested that our bandage has the potential to be a treatment alternative for bacterial keratitis.

Objective: Optometry students and ECPs often face challenges in CL learning. Firstly, accessing updated contact lens information, particularly in the Hong Kong market, where data is scarce and scattered. Traditional methods like random searches or product handbooks are inefficient. Secondly, the conventional peer-dependent rigid lens learning model lacks flexibility and limits students\' learning experiences. To address these issues, we developed an integrated contact lens learning platform to provide a comprehensive and interactive resource for contact lens education.

Methods and Results:

The developed platform features:

Search Engine: Updated information on over 350 contact lenses and ophthalmic solutions, tailored for the Hong Kong market.
Interactive Case Studies: Three healthy eyes with varying degrees of WTR corneal astigmatism (1.06D, 3.20D, and 6.33D) were fitted with RGP lenses of different designs and parameters. If spherical lenses failed to achieve an optimal fit, bi-toric lenses were used. These fittings were documented through videos and photographs, graded, and commented on by five experienced RGP practitioners. Data was integrated into the platform.
Additional Learning Resources: Clinical procedure videos and self-study questions.

To evaluate the platform\'s efficacy in CL teaching, two quizzes on lens-fitting grading using recorded videos were administered to students following didactic teaching, with and without platform use. Student feedback was collected via questionnaires. Among the 26 students who participated, 65.4% improved their lens-fitting grading accuracy with platform use, showing a mean accuracy increase of 19.8±26.5% (P<0.05). Most students preferred the platform over conventional teaching alone, and all found it valuable to their learning.

Conclusion: The platform enables students and ECPs to access updated contact lens product information and provides various learning tools, including rigid contact lens case series allowing for interactive learning. This enhances their educational experience and equips them with the latest product knowledge, ultimately benefiting their future practice as optometrists.

Biography

Anna graduated as an optometrist from Aston University, UK and worked in practice for several years before moving to Visioncare Research Ltd. She joined Hydron R&D in 1997 as International Clinical Manager, and then Johnson and Johnson Vision Care in 2000 where she was UK Professional Affairs Manager until 2004. After a few years dividing her time between private practice, medical writing, research and consultancy to the contact lens industry, Anna worked at Johnson and Johnson Vision from 2009 until 2018 in Global Medical Affairs. Anna joined CooperVision in 2019 as Director of Global Medical Affairs. She is Past President and Fellow of the British Contact Lens Association, and Fellow of the American Academy of Optometry. Anna has presented on contact lens and anterior eye related topics around the globe, and authored numerous publications, including being part of the teams that reviewed, synthesised and summarised evidence on contact lenses to develop the BCLA CLEAR™ (Continued Learning Evidence‐based Academic Report) global consensus publications, including the paper on presbyopia and multifocal contact lenses in 2024. She serves as a reviewer for several key vision science, anterior eye and contact lens peer-reviewed journals.

Abstract

It is estimated that around 2 billion people struggle with presbyopia globally, and while research shows that soft multifocal contact lenses (MFCLs) perform well, the number of presbyopes being prescribed them is relatively low. Concerns from eye care professionals include chair time and fit success rates, although it is known that in addition to improving patients’ vision and quality of life, MFCLs can also help to build a practice.

This presentation will demonstrate how CooperVision’s Binocular Progressive System™ found in MyDay® multifocal, and now clariti® 1 day multifocal, meets the needs commonly identified by eye care professionals and their presbyopic patients: excellent vision, comfort and health. Leveraging expertise in optical design and successful prescribing practices, the daily disposable, silicone hydrogel, MFCLs feature the innovative 3-add approach that caters to all levels of presbyopia with effective, simple fitting, optimal visual acuity at all distances, and comfortable wear.

Additionally, findings from recent publications will highlight that meeting presbyopes’ vision needs is strongly correlated with wanting to wear MFCLs and is more important than comfort needs, and that overall vision satisfaction on dispensing is a good indicator of vision satisfaction and intention to purchase after 1 week of wear to help indicate the likeliness of success.

Biography

Dr Thomas Lam completed his undergraduate training with first-class honours in Optometry from PolyU. He was awarded a PhD scholarship to pursue his study on proteomics and animal myopia. He is among the first to pursue global retinal protein profiling and novel protein regulations in the chick myopia model using a mass spectrometry approach. Dr Lam started his academic career in 2008 as a Lecturer in the School of Optometry in PolyU and obtained his first competitive research grant from the RGC in the following year. In 2010, he relocated to Singapore and helped establish the first BSc Optometry degree programme offered by the University of Manchester (UK). He returned to Hong Kong in 2012 and he is currently an Associate Professor of the School of Optometry and serves as Director of PolyU Shenzhen centralized animal facility and Associate Director of PolyU centralized animal facility.

Dr Lam has a good mix of academic and clinical experience. He obtained his fellowship of the American Academy of Optometry (FAAO) in 2009. He has more than 15 years experience in clinical supervision in various optometry clinics locally and overseas. He also actively serves in the profession as an editorial board member of international journals, an organizing committee member of international conferences, a councilor of The Hong Kong Society of Professional Optometrists (HKSPO), and a member of The Optometrists Board of Hong Kong, The Government of the Hong Kong Special Administrative Region. He is currently a PI of Centre for Eye and Vision Research (CEVR), HK Science Park, Research Centre for SHARP Vision, PolyU, Research Centre for Chinese Medicine Innovation (RCMI), PolyU and Shenzhen Research Institute, PolyU.

Abstract

Dry eye disease (DED) presents substantial challenges in clinical diagnosis and management, impacting individuals of all age groups, with a notable prevalence among Asian patients. This presentation will provide an overview of our recent clinical findings regarding the prevalence of DED in the local population, highlighting the urgent need for effective diagnostic and therapeutic strategies. Additionally, we will elucidate our novel approach in developing a tear proteomics strategy utilizing label-free mass spectrometry to evaluate the human tear proteome. By employing tear samples from our DED clinical study, alongside corneal cell cultures, we were able to identify potential new biomarkers and gain new insights into the mechanism of DED. This non-invasive tear proteomics technique has proven instrumental in assessing treatment outcomes in DED eyedrop therapy, safety concerns associated with orthokeratology lens wear, and facilitating disease detection in retinopathy of prematurity (ROP). Our findings underscore the critical role of integrating advanced molecular techniques to tackle clinical challenges related to dry eye and other ocular conditions. In addition, challenges and future perspectives for translational research in developing molecular biomarkers for clinical application will be discussed.

Biography

Luke obtained his Bachelor of Optometry degree from the University of New South Wales, Australia and has over 35 years’ experience in the profession. Luke leads the Medical Affairs function for Johnson & Johnson Vision Care Asia Pacific, responsible for the scientific evidence strategy in the Asia Pacific region.

Luke is Vice President of Optometry Australia, New South Wales/Australian Capital Territory division and has held a range of senior optometric leadership and management positions throughout his career, including 4 years as President of Optometry Australia, New South Wales/Australian Capital Territory, 8 years as a member of the Optometry Registration Board of Western Australia and 13 years as National Chairman of Optometry Aid Overseas..

Luke is a passionate proponent of the use of evidence-based data in optometric practice and presents extensively on contact lenses and contact lens practice.

Abstract

Optometry is a collegial profession. Eye care professionals (ECPs) are influenced by the professional judgement of their peers in ensuring they deliver the most advanced standards of patient care. An independent research agency conducted a series of surveys that investigated accepted professional beliefs of eye care professionals (ECPs) from around the world, in relation to contact lens practice.

More than 1000 ECPs were surveyed across 6 markets (US, UK, Japan, China, South Korea, Brazil) to gain insights on key perceptions.

Although many ECPs beliefs align with expectations based on current evidence, there are misconceptions in a number of areas of optometric practice. We will present the accepted professional beliefs in relation to; the role of oxygen transmissibility related to contact lens comfort and multifocal contact lens fitting. We will also provide an analysis of the evidence to provide guidance for best practice on these aspects of contact lens practice.

Biography

Noel A. Brennan, MScOptom, PhD, FAAO, is an internationally recognized scientist, author, inventor, and educator. Currently, a research fellow at Johnson & Johnson, he formerly served on the academic staff at the University of Melbourne and was a visiting scholar at Stanford University's Division of Ophthalmology, Department of Surgery, courtesy of a Senior Fulbright scholarship, before directing an eponymous boutique research consulting firm for a number of years. A recognized expert in the field of contact lenses, he now devotes his time to unraveling the mysteries of myopia through optical design, experimentation, data collation, and modeling. He is the designer of the Abiliti 1-Day Soft Therapeutic Lenses for Myopia Management, a named inventor on over 25 US patents, and is coauthor of over 400 papers, including peer-reviewed scientific manuscripts, refereed conference abstracts, educational articles, and industry reports.

Abstract

Myopia management can be confusing for clinicians. Which treatment is best? How does a practitioner compare the different treatments? Are quoted percentage values really meaningful? We have been on a quest for nearly decade to lay out an evidence-based approach to understanding these questions. The following elements have been built over this time to generate a comprehensive interpretation: axial length is the preferred metric for assessing progression; efficacy follows a pattern of absolute rather than percentage reduction in progression; there is an initial ‘boost’ of efficacy during the first year; 3-year efficacy is reliably double 1-year efficacy; there is a 15% reduction per annum in axial elongation in untreated myopes, and also in treated myopes after the first year of treatment. Combining these details leads us to predict that 6-year efficacy will be triple 1-year efficacy (expressed as mm reduction in axial elongation) and 12 years of a treatment would result in quadruple the 1-year efficacy. The maximum expected reduction in myopia progression over a decade would fall under 2D for the best treatments currently available. These predictions apply to group averages and individual variation is large. Better models are needed to predict progression during treatment of individual patients.

Advances in Myopia Management and Optimizing Intervention Strategies

Prof. Yang Xiao, MD, PhD
Professor, Chief Physician of Ophthalmology, Doctoral Supervisor and Director of Department of Refraction and Myopia Control, Zhongshan Ophthalmic Center (ZOC), Sun Yat-Sen University

Biography

Prof. Yang is currently the deputy leader of Optometry and Vision Science Group, Ophthalmology Branch, and Chinese Medical Society. Her research interests include orthokeratology, myopia control, and pediatrics ophthalmology. Yang has obtained more than 20 research funds on projects and has been published in professional journals in these fields. Prof. Yang is a fellow of the International Association of Contact lens educators (FIACLE), a fellow of the International Academic Orthokeratology and Myopia Control (FIAOMC ), and the Fellowship Chair, Asia Section of IAOMC.

Abstract

Myopia management is a rapidly moving field, with ongoing research providing more and more evidential strategies for comprehensive intervention. Efforts have been made, attempting to improve efficacy of treatments. The task of this presentation is to (1) give an overview of recent advances in this landscape, including optical interventions such as orthokeratology, low-concentration atropine, and emerging therapies such as Low-Level Red-Light Therapy (RLRL), as a background and (2) our work relevant to myopia management, which will be clarified in four main subjects: first, impacts of optics-induced visual signals on myopia control efficacy, and development and validation of the index, Areal Summed Corneal Power Shift (ASCPS), for early prediction and optimization; second, our explorations in optimizing optical interventions based on ASCPS, including orthokeratology, multifocal soft lenses, and defocus RGP lenses; third, our explorations in improving myopia control efficacy by using combined treatment strategies, including combined orthokeratology with low-concentration atropine and combined RLRL with orthokeratology as a promising potential for children who respond poor to orthokeratology; and fourth, future directions and our ongoing researches.

Biography

Prof. Nichols is also an internationally recognized clinician-scientist with long-standing track record of research development, oversight, and scientific discovery. He has over 180 publications and an h-index of 50. He maintains an ocular surface research group with full scale capabilities for conducting clinical and basic research receiving funding from the National Eye Institute (NEI). His research unit employs state-of-the art facilities and equipment for the study of dry eye, meibomian gland disease, and pharmaceutical and medical device development and testing. He has served on numerous medical/advisory boards and boards of directors. His awards include three Ezell Fellowships, the Korb award, the Borish and Max Schapero Awards, the Fry Medal and Westheimer lecturer, and he is a Distinguished Scholar and Fellow of the National Academies of Practice. Lastly, he is editor-in-chief of Contact Lens Spectrum, the world's leading journal on contact lenses.

Abstract

The contact lens industry continues to experience steady growth due to a variety of factors. This course will provide a comprehensive overview on the past and present of the contact lens industry and how we can use these evolving technologies to optimally improve patient care. The learning objectives are to understand the historical development and current state of the contact lens industry, including trends in fitting and usage patterns in various global markets. Current contact lens materials and design and attributes, including their impact on the patient and clinical practice will be discussed. This will include contact lens attributes impacting both ex-vivo and in-vivo performance which might be used to address clinically relevant issues such as contact lens discomfort, myopia, inflammation, infection, or distribution pattern with a nod toward futuristic approaches to solving these clinical problems.

What does the future for contact lenses look like? A gaze into the crystal ball

Lyndon Jones, PhD, DSc, FRSC, FCAHS, FCOptom, FAAO, FIACLE, FBCLA
Professor, School of Optometry and Vision Science and University Professor and Director of the Centre, Ocular Research & Education (CORE) at the University of Waterloo

Biography

Lyndon Jones is a Professor at the School of Optometry and Vision Science, University Professor and Director of the Centre for Ocular Research & Education (CORE) at the University of Waterloo. His research interests primarily focus on the interaction of novel and existing contact lens materials with the ocular environment, dry eye and the development of novel materials for ocular drug delivery. He has authored over 500 refereed and professional papers, one text-book and given over 1200 invited lectures at conferences worldwide, in over 40 countries.

Abstract

A major impediment to the growth of the contact lens market remains the fact that contact lenses induce end-of-day dryness symptoms in some 50% of wearers. This results in poor comfort for the last 2-3 hours of the day in a substantial number of people and is a major driving force behind contact lens dropout, which occurs in some 20-25% of all patients who commence lens wear. Over the last few years, contact lens manufacturers have developed a number of novel approaches to improve end-of-day comfort. In addition to these developments, the potential applications for contact lenses have attracted interest from companies considering their use for bio-sensing, drug delivery and even entertainment, achieve solutions to problems within their own areas.

This presentation will review the current knowledge of what drives the comfort of lens wear for an individual, review current and potential future methods to manage contact lens discomfort and review potential future uses of contact lenses aside from vision correction. The technologies covered will include such diverse areas as ocular drug delivery, disease diagnosis and management, and sophisticated imaging and augmented reality opportunities.

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