By Jaclyn Chang, OD

Residency trained optometrist Dr. Rosa Yang shares her knowledge on the ever-changing topic of specialty contact lenses in the following conversation with NewOptometrist.ca editor, Dr. Jaclyn Chang.

Dr. Rosa Yang

Jaclyn: What are the indications for scleral lens use?

Rosa: Scleral lens use has been growing and gaining more attention in recent years. The scleral lens vaults over the cornea and has increased comfort.

Previously, the primary indication for scleral lenses was corneal ectasia; the main one being keratoconus. Now we have learned about other benefits of scleral lenses, for example, patients with dry eye. Scleral lenses provide constant lubrication to the ocular surface. While dry eye is a multifactorial disease and scleral lenses aren’t for every patient with dry eye, there is a specific subgroup of patients who would benefit from them. These include patients with exposure, such as with a facial palsy.

Jaclyn: What equipment is necessary for fitting specialty contact lenses?

Rosa:  Topography is essential to the fitting of specialty contact lenses. When you think about managing glaucoma, you think about how important OCT is to glaucoma specialists. The analogy for a contact lens fitter is topography.

It is an effective method to assess ortho-K treatment, for example. While the patient may have optimal vision and the lens may appear well-fitted open-eye, this may not always correlate with optimal ortho-K treatment overnight. The treatment may be decentered but provides enough treatment through the optical center to give good vision. However, this does not equate to optimal treatment.

There is also value in topography with scleral lens fits. The amount of time needed to select the initial lens can be minimized. The topography can aid us in determining the initial sag of the lens. We have also learned that many scleras have toricity. Some topographers can map out scleral contour to help us decide if the patient would benefit from a toric peripheral design.

Jaclyn:  Can you talk a little bit about specialty soft contact lenses?

Rosa:   Sure, there are specialty or customized soft contact lenses for high prescriptions outside of range. For example, I had a patient whose prescription was -22D. We put this patient in a soft contact lens called Intelliwave. Keep in mind that this lens lasts for three months so the patient has to be diligent with cleaning.

Jaclyn: What is new in the world of fitting specialty contact lenses?

Rosa:  Profilometry is fairly new. With this, the topographer and the software are linked to the contact lens manufacturer. Normally, we would do a diagnostic fit, where you put a lens on the eye, check the fit, and then specify the change in parameters. Profilometry is a method in which the contact lens manufacturer can generate a lens with a specific parameter based on the topography itself.

Aberrometer is also a relatively new technology being implemented. Higher order aberrations (HOAs) can lower best corrected VA and quality of vision. HOAs can be measured and neutralized to improve vision in scleral lens wearers.

Jaclyn:  Great, thanks so much for that refresher and update!

 

Previous discussions with Dr. Rosa Yang: 

Perspectives on Myopia Control
Pursuing a Contact Lens Residency

JACLYN CHANG, OD

Editor NewOptometrist.ca

Dr. Jaclyn Chang graduated from the University of Waterloo (UW) with an Honours Bachelor of Science in Biomedical Sciences before continuing at Waterloo to complete her Doctor of Optometry degree. She is currently a practicing optometrist in Toronto.

Dr. Chang is committed to sharing information and bringing new resources to her colleagues. As a student, she sat on the Board of Trustees for the American Optometric Student Association, organizing events to connect students with industry. She was the Co-Founder/Co-President of the award-winning UW Advancement of Independent Optometry Club, the first club at UW dedicated to private practice optometry. Dr. Chang is also a passionate writer, who aims to make information accessible and easily digestible to her colleagues. She has published in Optometry & Vision Science and Foresight magazine and contributed to Optik magazine. She is excited to bring valuable resources to Canada’s next generation of optometrists with NewOptometrist.ca.


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By Jaclyn Chang, OD

I recently had the chance to discuss how myopic control can benefit our patients with contact lens residency trained optometrist, Dr. Rosa Yang.

Here is the conversation.

Dr. Rosa Yang

Dr. Yang pursued a post-graduate residency program in Cornea and Contact Lenses at the University of Waterloo.

She is the recipient of the Sheldon Wechsler Contact Lens Residency Award from the American Academy of Optometry and was awarded First Place in Clinical Poster from the Global Specialty Lens Symposium.

Dr. Yang has particular interests in myopia control (including ortho-K), dry eye and corneal disease management.

 

Jaclyn:  What myopia control options are available?

Rosa:  There are several options including the MiYOSMART spectacle lenses by Hoya, MiSight soft contact lenses or off-label use of soft multifocals, Atropine, and ortho-K.

As a clinician, I think it is good to be aware of all the options so you can choose the most appropriate option for your patient.

Jaclyn: How do you choose one myopia control option over another for a patient? Is it very individual to that patient’s comfort level and particular case?  

Rosa: I don’t want to oversimplify, but, yes, there are selection criteria where we weigh one option over another. These include prescription, the parents’ budget, and the underlying eye condition.

A big factor is also how comfortable the patient is with handling contact lenses. Do they want to handle the contacts themselves or is it something that the parents might want to be more involved with? For the latter, ortho-K might be the better option because it’s mainly done at home at night.

For a patient who doesn’t want to wear hard contact lenses or glasses, and if the parents are hesitant about putting their kids on a medication (Atropine), soft contact lenses are the option we would be considering.

The only FDA approved soft contact lens for myopia control is MiSight, but it is limited by the fact that it is not available with astigmatism. In patients who have astigmatism, multifocal soft contact lenses can be used to implement the peripheral defocus effects.

Jaclyn: Under what circumstances might you select specifically designed spectacle lenses (like  MiYOSMART) for the patient?

Rosa: Some patients have been wearing spectacles and would like to continue wearing them. For them, it makes sense to keep them in myopia control lenses like MiYOSMART.

There are also patients who are uncomfortable pursuing contact lenses (i.e. they have trouble handling CLs, they are poor CL candidates) or the parents are uncomfortable having their kids on long-term atropine drops, then we would consider spectacles.

MiyoSmart lenses may also have larger prescription ranges than the contact lenses.

Jaclyn: When would you initiate myopia control treatment? Do you monitor until you see progression or initiate at the onset of myopia?

Rosa: Currently there is no consensus amongst clinicians, but when I see evidence of fast progression, then I initiate myopia control. Average progression is -0.50D per year, so anything above that might urge me to start myopia control; sometimes you may want to monitor a little bit more to see.

There are also clinicians that see myopia control as a preventative treatment that should be used more widely, especially considering the global myopia pandemic, so it’s a grey area.

Jaclyn: Are there certain things that we can say to our patients to help them better understand the importance and benefit of myopia control treatment? How can we help them understand the health implications associated with myopia?

Rosa: This is a very good question, because this is a topic that I discuss with every parent when we talk about myopia control. I tell them that the reason we pursue myopia control is not just the high prescription itself, it’s not just the inconvenience of having really thick glasses, it’s the ocular health implication.

“When you have a high prescription, the eyeball is usually more elongated, which means that the tissues in the eyeball get stretched out and are thinner; this predisposes them to certain ocular health complications, some of which are vision threatening. There is a higher risk of retinal detachment, maculopathy, and glaucoma.”

When I emphasize this, parents usually understand. With myopia control, it’s very important that parents understand what you’re doing, why you’re doing it, and how you’re doing it.

Jaclyn: Thanks for that – hearing the way that other doctors counsel always helps me with how I counsel my patients. Education makes such a big difference to patient care. 

Rosa: Yes, exactly, with myopia control, sometimes parents wonder why their child’s prescription still increases. That’s why with myopia control, it’s very important to have a consultation.

The management we’re doing is not to stop myopia, it’s to slow down the progression of myopia; regardless, the child is still going to progress.

Another thing to realize, for example, with ortho-K, is that some parents may think that once you wear the ortho-K lenses, that the prescription is completely gone, so explaining the process and treatment is very important.

Jaclyn: Thank you so much Dr. Yang! This gives our audience some things to think about and implement into everyday practice. 

Previous discussions with Dr. Rosa Yang: 
Pursuing a Contact Lens Residency: 

JACLYN CHANG, OD

Editor NewOptometrist.ca

Dr. Jaclyn Chang graduated from the University of Waterloo (UW) with an Honours Bachelor of Science in Biomedical Sciences before continuing at Waterloo to complete her Doctor of Optometry degree. She is currently a practicing optometrist in Toronto.

Dr. Chang is committed to sharing information and bringing new resources to her colleagues. As a student, she sat on the Board of Trustees for the American Optometric Student Association, organizing events to connect students with industry. She was the Co-Founder/Co-President of the award-winning UW Advancement of Independent Optometry Club, the first club at UW dedicated to private practice optometry. Dr. Chang is also a passionate writer, who aims to make information accessible and easily digestible to her colleagues. She has published in Optometry & Vision Science and Foresight magazine and contributed to Optik magazine. She is excited to bring valuable resources to Canada’s next generation of optometrists with NewOptometrist.ca.


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Young Optometry residents in conversation

By Jaclyn Chang, OD

As graduates approach the final stretch of optometry school, the decision to spend an additional year immersed in a residency program might come into view for some near-to-be optometrists.

Dr. Rosa Yang

While a residency provides the advantage of specialized training in a unique clinical setting, it may also defer the process of landing a job or starting your own practice.

Dr. Rosa Yang graduated from the University of Waterloo School of Optometry in 2019.  She interned at various clinics in Canada and in the USA, including Houston Eye Associates in Texas, where she worked closely with ophthalmologists specializing in cataract, glaucoma, and corneal diseases.

Dr.Yang pursued a post-graduate residency program in Cornea and Contact Lenses at the University of Waterloo.

Dr. Jaclyn Chang discussed Dr. Yang’s residency experience.

Jaclyn:  I really admire anyone who has done a residency and I’ve never heard anyone say they regret doing one. Can you comment on the opportunity that residency provides? 

Rosa:  For sure! Residency gave me the platform to meet people and experience a variety of opportunities. I was able to connect with eyecare specialists not just in Canada, but on an international level. Some of them became my mentors and friends. Now, when I need help to tackle a difficult case, they are my go-to people.

I have always loved teaching and residency allowed me to TA in labs and provide clinical supervision for students. I got to write case report, oral presentations, and conference posters. Through the process of preparing for them, I feel like I became a stronger critical and independent thinker – these are important traits for a clinician to have. I also travelled to so many places to attend conferences – I think I flew to five difference places in half a year, imagine how many more places I could have gone to if COVID did not happen.

Overall, it is such an enriching year with memories that I will never forget!

Jaclyn: That’s awesome! How did you feel about jumping in and doing things that we didn’t necessarily have a lot of experience with? For example, teaching, being a clinical supervisor and presenting at conferences.

Rosa: Of course, I was nervous. I am the type of person who thinks I need to be 100% prepared and execute with perfection.  That is not how real life works. More often, you learn along the way, but only if you have a good attitude and put in the hard work. I feel extremely lucky and thankful of my residency mentors. They have always believed me even when I doubt myself. Their encouragements have meant a lot to me and I think have been monumental for my growth!

Jaclyn: Can you talk a little bit about why you decided to go into residency?

Rosa: In my fourth year, I worked with a corneal ophthalmologist. Many of his patients had dysfunctional lives because they had corneal diseases and saw very poorly. With surgeries, many of them saw vision improve, but I wondered “I don’t do surgeries, is there anything that I can do for these patients?” The surgeon often told his patients “I do surgeries, but there are these special contact lenses that will probably make your vision even better. I don’t do them, but I will send you to the right people.” The surgeon was referring to us – optometrists, and he reminded me that specialty contact lens is a niche thing that optometrists do.

Then, I was mentored by a specialty contact lens optometrist. We saw a patient who had keratoconus. He started out desperate and very hopeless – he was struggling with his vision and he was told by several doctors that the only option was corneal transplant. We told him about scleral lenses and I can never forget the change in his facial expression the moment he looked around the room after we inserted the lens. The change was a total 180. I thought, this is something I really want to do.

Jaclyn: It’s cool how people who we encounter throughout our school, especially our supervisors in fourth year, really influence us on where we want to go.

Thank you so much for your insight. It’s always great to learn more about residency and your experience is very encouraging to other prospective students. I can’t wait for you to share your expertise with us on how we can better incorporate specialty contact lenses into our practice with our next talk!

JACLYN CHANG, OD

Editor NewOptometrist.ca

Dr. Jaclyn Chang graduated from the University of Waterloo (UW) with an Honours Bachelor of Science in Biomedical Sciences before continuing at Waterloo to complete her Doctor of Optometry degree. She is currently a practicing optometrist in Toronto.

Dr. Chang is committed to sharing information and bringing new resources to her colleagues. As a student, she sat on the Board of Trustees for the American Optometric Student Association, organizing events to connect students with industry. She was the Co-Founder/Co-President of the award-winning UW Advancement of Independent Optometry Club, the first club at UW dedicated to private practice optometry. Dr. Chang is also a passionate writer, who aims to make information accessible and easily digestible to her colleagues. She has published in Optometry & Vision Science and Foresight magazine and contributed to Optik magazine. She is excited to bring valuable resources to Canada’s next generation of optometrists with NewOptometrist.ca.


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