a systematic review of the contact lens education …

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Sen et al. World Journal of Pharmacy and Pharmaceutical Sciences

A SYSTEMATIC REVIEW OF THE CONTACT LENS EDUCATION

FOR WORKING PRACTICES OF THE FUTURE

Amit Roychowdhury, Dhrubo Jyoti Sen* and Beduin Mahanti

Department of Pharmaceutical Chemistry, School of Pharmacy, Techno India University,

Salt Lake City, Sector-V, EM-4, Kolkata-700091, West Bengal, India.

ABSTRACT

The World Health Organization has identified a shortage of trained

human as one of the greatest challenges to increasing the availability of

eye care services and reducing preventable visual impairment around

the world. Increased prevalence of myopia and new strategies for

myopia management have raised the prospect of various interventions,

including contact lenses for therapeutic use as well as for refractive

correction. More personnel skilled in contact lens fitting will be needed

to address potential worldwide demand for these interventions. The

global need for increasing numbers of skilled personnel points to a

crucial role for educators in teaching the contact lens practitioners of the

future. Contact lens education delivery was already evolving prior to

COVID-19, and changes that are currently occurring may lead to

permanent differences in the way contact lenses are taught in future.

The International Association of Contact Lens Educators (IACLE) provides educators with a

standardized global curriculum, online resources and teaching technology that could also

serve as a model for wider ophthalmic education in future.

KEYWORDS: Contact lenses, Education, Educational technology, COVID-19, Research

Interests.

INTRODUCTION

The 2019 World Health Organization (WHO) World Report on Vision identified a shortage

of trained personnel as one of the greatest challenges to increasing the availability of eye care

services and reducing the prevalence of preventable visual impairment around the world. The

report identified the need to prepare for a projected consistent increase in numbers of those

WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES

SJIF Impact Factor 7.632

Volume 10, Issue 4, 1828-1840 Review Article ISSN 2278 – 4357

*Corresponding Author

Dr. Dhrubo Jyoti Sen

Department of

Pharmaceutical Chemistry,

School of Pharmacy,

Techno India University Salt

Lake City, Sector-V, EM-4,

Kolkata-700091, West

Bengal, India.

Article Received on

23 Feb. 2021,

Revised on 15 Mar. 2021,

Accepted on 05 April 2021

DOI: 10.20959/wjpps20214-18829


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requiring eye care, due to population ageing and lifestyle changes such as less time spent

outdoors and increased near-work. Scientists and clinicians devoting their research efforts to

the contact lens field witnessed with interest and acclamation the recent incorporation to the

Institute for Scientific Information (ISI) Journal Citation Reports (JCR) of two of the most

influential publications in this field: Eye & Contact Lens and Contact Lens & Anterior Eye.[1]

A further review of the evidence base for myopia control interventions concluded that

multifocal and orthokeratology contact lenses, or other modalities proven to slow myopic

progression, might become the standard of care for myopic children and adolescents. Recent

results from a 3- year randomized controlled clinical trial of a daily disposable, dual-focus soft

contact lens in myopic children6 led to the first indication for a myopia control contact lens by

the US Food & Drug Administration, following previous CE marking. Other therapeutic uses

for contact lenses are also emerging that might, in future, place further demands on contact lens

practitioners and require new skills. Examples in the public health area include ‗smart contact

lenses‘ for monitoring intraocular pressure and blood glucose levels, and for drug delivery. If

contact lenses are to be commonly prescribed for therapeutic applications, as well as for

correcting increasing numbers of people with refractive error, then this raises the question as

to who will fit them in order to address a potential worldwide demand for these interventions.

Will there be sufficient numbers of educators to teach students contact lens fitting skills if the

number of optometry schools increases? And how can the level of education provided be

standardized and maintained around the world? This review investigates the current status

and future requirements of global contact lens education in light of these developments.[2]

Types of contact lenses

Soft Contact Lenses

Rigid Gas Permeable (RGP) Contact Lenses

Extended Wear Contact Lenses

Disposable (Replacement Schedule) Contact Lenses

Lens Comparison

Specialized Uses of Contact lenses:

i. Orthokeratology (Ortho-K)

ii. Decorative (Plano) Contact Lenses.

Soft contact lenses: Soft contact lenses are made of soft, flexible plastics that allow oxygen

to pass through to the cornea. Soft contact lenses may be easier to adjust to and are more


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comfortable than rigid gas permeable lenses. Newer soft lens materials include silicone-

hydrogels to provide more oxygen to your eye while you wear your lenses. Monthly soft

contact lenses are a staple for anyone involved in prescribing contact lenses. The lenses should

move a small amount with the blink, particularly on up gaze. A lens that moves excessively

may be uncomfortable and may result in variable vision, but if the patient is happy with it,

excessive movement is not a health problem.[3]

Figure 1: Contact lens.

Rigid gas permeable (RGP) Contact lenses: Rigid gas permeable contact lenses (RGPs) are

more durable and resistant to deposit build up, and generally give a clearer, crisper vision.

They tend to be less expensive over the life of the lens since they last longer than soft contact

lenses. They are easier to handle and less likely to tear. However, they are not as

comfortable initially as soft contacts and it may take a few weeks to get used to wearing RGPs,

compared to several days for soft contacts.[4]

Figure 2: Usage of contact lens.


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(Fig:1, Fig:2) Normally rigid contact lenses are pushed under the upper eyelid while blinking

as can be clearly seen on this photo. In most cases they remain in this lifted-up position until

the next blinking, if the eye is not moved too much. Otherwise, they slip down slowly

because of the gravitation and were lifted up with the next blinking.

Extended wear contact lenses: Extended wear contact lenses are available for overnight or

continuous wear ranging from one to six nights or up to 30 days. Extended wear contact

lenses are usually soft contact lenses. They are made of flexible plastics that allow oxygen to

pass through to the cornea. There are also a very few rigid gas permeable lenses that are

designed and approved for overnight wear. Length of continuous wear depends on lens type and

your eye care professional‘s evaluation of your tolerance for overnight wear. It‘s important for

the eyes to have a rest without lenses for at least one night following each scheduled

removal.[5]

Figure 3: Contact lens placing.

For those of us who want to wake up with crystal clear vision without having to search for

eyeglasses every time the alarm goes off, extended wear contact lenses could be the best option.

Contact lenses are broadly divided into two main categories, depending on how long they have

been approved to be worn before getting removed: Daily wear contact lenses, the ones that

need to be removed before going to bed Extended wear contact lenses, the ones which can be

worn overnight. The extended wear (EW) contact lenses are mostly thinner than the daily

wear soft contact lenses or are designed from a silicone hydrogel material. Silicone hydrogel

enables the extended wear lenses to breathe better by letting more oxygen to pass through the

lens to the eyes as compared to the regular soft contact lens. This serves as a great advantage

when a person intends to wear contact lenses for extended periods of time. Most of the


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extended wear contact lenses are approved to be worn for up to seven days of continuous

wear, depending on the recommendations of the ophthalmologist. There are some EW lenses

that are approved for continuous wear of up to 30 days. Extended wear contact lenses also

come in the form of gas permeable lenses. An essential point that needs to be emphasized is

that these schedules are the maximum recommended wearing schedules. There are many

people who find it hard to tolerate the EW lenses for such a length of time. While there are

others whose eyes cannot tolerate wearing contact lenses overnight.[6]

Depending on the condition and health of the eyes, the doctor will advise whether a person is

a suitable candidate for the overnight wear and how many days of continuous wear are suited

for an individual‘s eyes.[6]

Disposable (Replacement schedule) Contact lenses: The majority of soft contact lens

wearers are prescribed some type of frequent replacement schedule. ―Disposable,‖ as defined

by the FDA, means used once and discarded. With a true daily wear disposable schedule, a

brand-new pair of lenses is used each day. Some soft contact lenses are referred to as

―disposable‖ by contact lens sellers, but actually, they are for frequent/planned replacement.

With extended wear lenses, the lenses may be worn continuously for the prescribed wearing

period (for example, 7 days to 30 days) and then thrown away. When you remove your lenses,

make sure to clean and disinfect them properly before reinserting.

Figure 4: Lens Replacement.


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―Disposable‖ refers specifically to lenses that are replaced every two weeks or less depending

on the wear schedule prescribed by your optometrist or doctor. Disposable lenses are usually

prescribed in multi-packs, providing several weeks supply at a time.[7]

Lens comparison: The American Optometric Association has more detailed information

about contact lenses including a lens comparison chart.

Figure 5: Lens comparison.

Specialized uses of contact lenses: Conventional contact lenses correct vision in the same

way that glasses do, only they are in contact with the eye. Two types of lenses that serve a

different purpose are orthokeratology lenses and decorative lenses.

i. Orthokeratology (Ortho-K): Orthokeratology, or Ortho-K, is a lens fitting procedure

that uses specially designed rigid gas permeable (RGP) contact lenses to change the

curvature of the cornea to temporarily improve the eye‘s ability to focus on objects. This

procedure is primarily used for the correction of myopia. Overnight Ortho-K lenses are

the most common type of Ortho-K. There are some Ortho-K lenses that are prescribed

only for daytime wear. Overnight Ortho-K lenses are commonly prescribed to be worn

while sleeping for at least eight hours each night. They are removed upon awakening and

not worn during the day. Some people can go all day without their glasses or contact

lenses. Others will find that their vision correction will wear off during the day.[8]


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Figure 6: Lens of eye on contact lens.

The vision correction effect is temporary. If Ortho-K is discontinued, the corneas will return to

their original curvature and the eye to its original amount of myopia. Ortho-K lenses must

continue to be worn every night or on some other prescribed maintenance schedule in order

to maintain the treatment effect. Your eye care professional will determine the best

maintenance schedule for you. Currently, FDA requires that eye care professionals be trained

and certified before using overnight Ortho-K lenses in their practice. You should ask your

eye care professional about what lenses he or she is certified to fit if you are considering this

procedure.

ii. Decorative (Plano) Contact lenses: Decorative contact lenses change the look of your

eyes. They may not correct your vision. They can temporarily change your brown eyes

to blue or make your eyes look like cat eyes or vampire eyes for Halloween. Did you

know that these decorative contact lenses are actually medical devices? The U.S. Food

and Drug Administration oversees their safety and effectiveness, just like contact lenses

that correct your vision. Just like corrective contact lenses you should never buy contact

lenses from a street vendor, beauty supply store, flea market, novelty store or

Halloween store—and you should always have a prescription.


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Figure 7: Contact lens verities.

These coloured contact lenses require a strict eye testing and prescription prior to their use,

similar to that of corrective contact lenses. Purchasing from a street vendor, novelty store, flea

market or beauty supply store, damage the cornea and could lead to vision loss.[9]

International association of contact lens educators (IACLE): a global network of

educators: The joint Public Health and Environmental Vision Section (PHEV) and World

Council of Optometry (WCO) Symposium: International Optometry: Public Health, Education,

and Personnel Issues convened at the American Academy of Optometry 2019 and 3rd World

Congress of Optometry, addressed the education and personnel resources needed to reduce

vision impairment and prevent vision loss. The WCO Global Optometric Education Summit

at the Congress heard that meeting eye care needs and ensuring good quality education required

a global curriculum, educators to deliver it and people to lead.11 Founded in 1979, the

International Association of Contact Lens Educators (IACLE) fulfils these roles in contact

lens education. IACLE aims to increase the number of qualified contact lens educators and

improve the quality of contact lens teaching, thereby increasing the number of skilled contact

lens practitioners throughout the world and facilitating the use of contact lenses worldwide, in

partnership with industry. A 2018 survey of IACLE members showed 92% were extremely or

very likely to recommend other contact lens educators to join IACLE, and providing the

resources needed to teach contact lenses was seen as the principal benefit of membership; the

six-module, 33-lecture online IACLE Contact Lens Course was the highest rated IACLE

resource for satisfaction and importance, and the most widely used.15 Tools for assessing

students‘ practical skills and how to use technology in teaching were among the resources that

members would like IACLE to provide in the future.

The impact of COVID-19: Education has been especially affected by the COVID-19

pandemic, with reports of institutions around the world closed to students and moving towards


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online teaching. A review of the socio-economic implications of the pandemic identified

education as one of the service provisions sectors most affected. Surveys in April 2020

investigated the impact of COVID19 on academic activities in optometry and ophthalmology

training. A majority of optometry educators in India (94%) had switched to e-learning mode,

with most teaching, learning and assessment carried out using video conferencing tools,

dedicated educational portals and social media apps. In ophthalmology, before the pandemic

nearly half of educators worldwide (48%) did not use any e-learning. During the COVID-19

pandemic, there was a statistically significant increase in the use of all e-learning

alternatives.[10]

A total of 433 people were e-mailed and asked to complete a simple questionnaire hosted

through the university‘s online survey engine. During the four days of the survey, full responses

were received from 100 wearers, a return of 23 %. Eighty-nine (89 %) of the group reported

that they were living in a ‗lockdown‘ situation (e.g. working from home and/or self-isolating)

with the remainder (11 %) working and living normally. Of the lockdown group, 20 (22 %)

reported using their contact lenses about the same as usual, five (6%) were using their lenses

more than usual with the remaining 64 patients (72 %) wearing their lenses less than normal.

Of those living normally, six (55 %) were using their lenses as normal with five (45 %) wearing

their lenses less. Given that the clear majority of lens wearers in lockdown are using their lenses

less than in normal times, it is pertinent to consider the key reasons for this. The most common

explanation was that there was simply a perception of ‗less need‘ for contact lenses for those

currently at home (75 % of those reporting reduced wear) often reported as being because (a)

wearers use lenses when meeting friends or socializing (which is not currently possible), (b)

contact lens wear is associated looking and feeling appropriately dressed for work (which is

presently suspended) or (c) lens use is considered to be particularly beneficial in a ‗distance-

orientated‘ world rather than an indoors situation. Other reasons for reduced contact lens wear

during lockdown included concern about infection due to contact lens use (8 %), saving money

(5 %), glasses bring currently more convenient (3 %), limiting lens use in the case of supply

problems (3 %) and giving eyes a rest (2 %). Three percent of subjects did not provide a reason

for their reduced lens use. For those using their lenses more in lockdown, this was due to taking

greater exercise (two respondents), and one respondent each reporting a general ‗greater need‘

and contact lenses being more convenient in the warm weather. For the locked-down/reduced

wear group, the reasons for the change to wearing patterns were very similar for the two main

lens groups reported: soft daily disposable wearers (65 % of respondents) and soft daily wear


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reusable wearers (32 %). This work found that a great majority of respondents are currently

locked-down with most of this group using their contact lenses on a reduced basis, principally

due to a decreased need given the change to their day to day circumstances and environment.

It would be reasonable to speculate that with the ending of the lockdown in the coming weeks,

contact lens use will increase as lives return to normal and the benefits of contact lens wear

again become apparent to the wearer base.

Recent findings: Today‘s students of contact lens practice will be tomorrow‘s contact lens

practitioners, and so it is important to consider the effects the pandemic will have on their

education. In May 2020, IACLE conducted a survey to determine the impact of COVID-19

specifically on contact lens education: how much education was already conducted online, and

how educators and institutions planned to adapt their teaching in the future.

METHODS

An online survey of 28 closed and open questions was sent to 546 contact lens educators

(educator members of IACLE). The survey was conducted in English and Spanish, with

translations into Simplified Chinese, Korean and Bahasa provided as a guide to completion.

Questions covered demographic information about respondents and their institutions, the

current situation in light of COVID-19, technology and resources used, and future education

provision.[11]

RESULTS

A total of 214 responses from educators in 32 countries were received by the cut-off date,

representing a 39% response rate. Results were analysed by region and for countries with the

highest IACLE membership (China and India), as well as on a global basis. Teaching was the

principal activity for the majority of respondents (65%), with 29% working mainly in clinical

practice. A majority (73%) said their principal location was a university/college and others

cited clinical practice (13%), industry (8%) or hospital settings (5%).


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Figure 8: Usage of contact lens.

Responses to the question: ‗What percentage of your total contact lens teaching would you

estimate was conducted online prior to COVID-19 restrictions?

Figure 9: Usage of contact lens in lockdown.

Responses to the question: ‗What percentage of your total contact lens teaching would you

estimate will be conducted online by the end of 2020?‘

Figure 10: Contact lens responses.


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Responses to the question: ‗How do you plan to adapt your contact lens teaching in future in

light of the COVID-19 pandemic?‘

Future education provision: Most educators expected to change their teaching in the post-

COVID situation and in varying ways, most commonly to provide more online lectures

(76%) and new methods to deliver practical education (63%) (Figure 3). Around half of

educators were also planning to introduce new teaching platforms and more online student

assessment. Some anticipated that their contact time with students would be reduced and that

students‘ contact time with patients would also be reduced. The survey revealed a variety of

logistical challenges to providing contact lens education online, from the difficulty in

measuring learning outcomes (59%) and monitoring students (54%), to limited interaction and

feedback (57%). Internet connectivity was also an issue for a substantial proportion of

educators globally (41%), rising to 58% in India compared to 24% in the Europe/Africa –

Middle East region.[12]

DISCUSSION

The IACLE survey shows that contact lens educators have adapted their teaching towards more

online education in light of the COVID-19 pandemic and anticipate substantial increases in the

proportion of their total teaching time conducted online, representing a major shift in the

educational landscape. Since education delivery was already evolving prior to COVID-19,

changes that are currently occurring seem likely to lead to permanent differences in the way

contact lenses are taught in the future. IACLE is already active in those countries where

myopia rates are currently highest and in developing contact lens markets. It provides educators

with a standardized global curriculum, online resources and teaching technology that could

also serve as a model for wider ophthalmic education in the future.

CONCLUSION

This study exemplifies that all the contact lens users who participated have shown some degree

of non-compliance in their contact lens care. The poorest level of compliance observed was in

the care of lens accessories like contact lens case and solution. Although it is difficult to

improve the patient behavior to the ideal level, as primary eye care practitioners, we have to

emphasize all the lens care instructions and reinforce the same at follow-up visits to minimize

lens contamination and a possible ocular complication. The COVID-19 pandemic has had a

major impact on educational institutions worldwide that are teaching the contact lens

practitioners of the future. As the contact lens community strives to bring the focus back to


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contact lenses, the results of this survey suggest the way forward for education, and

consequently for contact lens practice and for the industry, in a post-COVID world.

REFERENCES

1. World Health Organization (WHO) World Report on Vision. October, 2019.

https://www.who.int/publications/i/ item/world-report-on-vision (Accessed 15/09/20).

2. Holden BA, Fricke TR, Wilson DA et al. Global prevalence of myopia and high

myopia and temporal trends from 2000 through 2050. Ophthalmology, 2016; 123:

1036–1042.

3. Pan CW, Dirani M, Cheng CY et al. The age-specific prevalence of myopia in Asia: a

meta- analysis. Optom Vis Sci, 2015; 92: 258–266.

4. Twa MD. COVID-19 pandemic driven innovations in optometric education. Optom Vis

Sci , 2020; 97: 831–832.

5. Singh KN. Myopia epidemic post-coronavirus disease 2019. Optom Vis Sci, 2020; 97:

911– 912.

6. Thompson Reuters ISI. Journal Citation Report, Product Description Page. Philadelphia,

PA: 282 Thompson Scientific, 2006.

7. Thompson Reuters ISI. Glossary of Thompson Scientific terminology. Philadelphia,

PA: 284 Thompson Scientific, 2006.

8. Efron N, Brennan NA, Nichols JJ. Citation analysis of the contact lens field. Optom Vis

Sci., 2012; 286(89): 70-79.

9. Lansingh VC, Carter MJ. Does open access in ophthalmology affect how articles are

288 subsequently cited in research? Ophthalmology, 2009; 16: 1425-1431.

10. Chen H, Chen CH, Jhanji V. Publication times, impact factors, and advance online

publication 290 in ophthalmology journals. Ophthalmology, 2013; 120: 1697-1701.

11. Morgan P.B., Efron N. Demographics of UK contact lens prescribing. Cont Lens Anterior

Eye, 2008; 31: 50–51.

12. M.D. Twa; COVID-19 pandemic-driven innovations in optometric education Optom Vis

Sci, 2020; 97(10): 831-832.

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