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Sunday, January 5, 2014  
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Do you see subconjunctival hemorrhages more frequently in contact lens wearers than in non-contact lens wearers?



Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO
Welcome to 2014! We have an exciting new year planned ahead of us with new content and columnists. We'd like to thank our long-time columnists, Drs. Loretta Szczotka Flynn and Ron Watanabe, for their years of service to Contact Lenses Today. At the same time, we'd like to welcome new Contact Lenses Today columnists, Drs. Dave Kading and Barry Eiden to our line-up. We look forward to wonderful year in contact lenses.

Essilor CLS Introduces Expert Progressive Contact Lens in USA

Essilor Contact Lens Specialists (Essilor CLS) announces the arrival of Expert Progressive Multifocal GP contact lenses now available within the United States. According to the company, the Expert contact lens is a vision advancement for contact lens patients with presbyopia; a progressive lens that is uniquely designed, allowing no compromise of near or distance vision while providing crisp, clear intermediate vision.

Per the company announcement, with a patented Slab Off Technology, this new lens is designed with a 360° uniform edge thickness making it the most comfortable translating gas permeable lens available. It is exclusively made with Bausch + Lomb Boston materials and is only available through Essilor CLS.

The lens is available with a base curve of 7.20mm to 8.60mm in 0.05mm steps and an overall diameter of 8.50mm to 10.00mm in 0.50mm steps in powers ranging from 15.00D to +10.00D in 0.25D steps with add powers of +1.00D to +3.50D in 0.25D steps.

Eyecare professionals are invited to a special celebration to launch this new lens design during the upcoming Global Specialty Lens Symposium at booth #303, January 23-26, 2014. Please visit www.gslsymposium.com for further information on attending this comprehensive international eyecare meeting.

X-Cel Adds a Custom Soft Lens Design for Irregular Corneas

X-Cel Contacts introduces the Flexlens ARC (Atypical Refractive Correction) custom soft lens as the latest addition to their toolbox of irregular cornea designs. This lens will be manufactured at X-Cel’s state-of-the-art manufacturing facility in Duluth, Georgia, allowing for quick turnaround time, superior quality and consistent reproducibility.

The Flexlens ARC is a custom soft lens design that fits like a regular toric contact lens. With no need to worry about peripheral curves or any other parameter that may complicate the fit, the Flexlens ARC is easy to fit, thus reducing chair time, according to the company. This lens utilizes a standard back surface fitting curve, precise axis, cylinder, and an enhanced center thickness to stabilize the correction over an aberrated cornea.

The Flexlens ARC is indicated for the correction of various ocular conditions including keratoconus, pellucid marginal degeneration, corneal transplants, post refractive surgery and/or any irregular cornea conditions. For additional information, contact an X-Cel Consultant at 1-800-241-9312 or xcelinfo@walman.com

Still Time to Register! Don’t Miss the 2014 Global Specialty Lens Symposium.
Register today to attend the Global Specialty Lens Symposium to be held January 23 - 26, 2014 at the Rio All Suites Hotel and Casino in Las Vegas, Nevada. Brought to you by Contact Lens Spectrum, this 3 1/2 day comprehensive meeting focuses on the latest techniques and technologies for the successful management of ocular conditions using today's specialty contact lenses. It includes insightful presentations by international experts in the field, hands-on demonstrations of cutting-edge products and valuable continuing education credits.

Visit www.GSLSymposium.com for more information and registration.
Paragon Vision Sciences Announces New Management Team

Paragon Vision Sciences, Inc. announced a major reorganization and a new management team. The changes, effective immediately, will fundamentally reorganize the company's corneal reshaping, specialty GP and lab channel businesses to increase brand awareness, improve profitability and strengthen competitiveness on a global platform. With the growing prevalence of a worldwide myopia epidemic, the Company will also accelerate the expansion of Paragon CRT and other innovative products and services by strategic integration within countries around the world.

At the heart of the reorganization is the formation of a strong and vibrant management team, led by Joe Sicari, President and CEO of Paragon, which includes: Natalie Stevens; Vice President, Chief Financial Officer; Goretty Alonso-Amigo, PhD, Vice President, Science and Technology; Pam Scoggins, Vice President, Global Marketing; Josh Cummings, Director, Ocular Device Production; Greg Kline, Senior Vice President, Sales and New Business Development, North and Latin America; Rich Jeffries, Vice President, Sales and New Business Development, Western U.S. and Asia/Pacific; Rafael Martinez, Vice President, Sales and New Business Development, Europe, Middle East and Africa; and Ken Kopp, Director, Clinical and Professional Services.

2nd International Congenital Cataract Symposium to be Held in NYC in March

The 2nd International Congenital Cataract Symposium, hosted by Emory University, will be held in New York City on March 7, 2014. This symposium will bring together some of the world's leading vision scientists, epidemiologists, and pediatric ophthalmologists to discuss ways of improving the management and visual outcomes of children with congenital cataracts. Childhood/congenital cataracts are a leading cause of preventable childhood blindness in many developing countries.

Lions Clubs International Foundation (LCIF; www.lcif.org ) is helping to promote the event and the organization’s “Pediatric Cataract Initiative” program grants (with their partner, Bausch + Lomb), have helped to sponsor several of the researchers presenting information at this Symposium.

The symposium offers 7.50 AMA PRA Category 1 Credit(s). The Course Director is Scott Lambert, MD and more information is available at https://cmetracker.net/EMORY/Catalog#Mar.

Overuse of Cosmetic Lens
Jaime Ibanez, OD, Villavicencio, Columbia

This is an image of an inflammatory, immunologic reaction caused by overuse (over 12 hours continuous daily wear) of cosmetic soft contact lenses.

We thank Dr. Ibanez for this image and we welcome photo submissions from our other readers! It is easy to submit a photo for consideration for publishing in Contact Lenses Today. Simply visit http://www.cltoday.com/upload/upload.aspx to upload your image. Please include an explanation of the photo and your full name, degree or title and city/state/country

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Materials & Designs
David Kading, OD, FAAO

Excellent Candidates

I was recently emailed a question regarding boosting contact lens patient numbers. Although this sounds like a practice management tip, I think that now more than ever this is a material and designs topic. As we start the new year, I would challenge you to grow your contact lens practice by informing nearly every patient that "You are an excellent candidate for contact lenses." For the unsuspecting patient who has not thought of contact lenses as an option, this will yield a surprise: "I am?" Many times they elect to not make a switch to contact lenses, but surprisingly it opens up dialogue for us to tell our patients about the latest design and material innovations.

Patients who drop out of lenses often times do so because the lenses that they were wearing did not work, not because they do not want to wear them. With the innovations in materials, orthokeratology, scleral designs, the single use modality, and toric and multifocal designs we have a tool box that is full with pleasant surprises. The definition of a specialty patient is someone who either REALLY needs contact lenses (keratoconus, etc.) or someone who is a challenge (dry eye, astigmatic presbyope, etc.). With our stellar industry partners bringing new innovations, these specialty patients are more than ever “excellent candidates.”

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S. Barry Eiden, OD, FAAO

Keratoplasty for Keratoconus – “Should we go all the way?”

Researchers in Australia retrospectively reviewed outcomes of 73 consecutive patients with keratoconus, managed with Deep Anterior Lamellar Keratoplasty (DALK) or Penetrating Keratoplasty (PK), between 2000 and 2010, by a single surgeon.1 Data were collected on baseline parameters, best-corrected visual acuity (BCVA) in logarithm of the mean angle of resolution (logMAR), subjective refraction, graft survival, and complications.

Thirty-one (42.5%) eyes underwent a DALK, and 42 (57.5%) eyes underwent a PK. All PK-operated and 29 out of 31 (93.5%) DALK-operated eyes remained clear at the last review. Postoperative complications were significantly more frequent after PK (57.1%) than after DALK (26.5%; P = 0.0197). The mean BCVA was not significantly different for DALK (0.14 logMAR, SD 0.2) versus PK (0.05 logMAR, SD 0.11). Subjective refraction and method of visual correction (spectacles or contact lenses) were similar for each group.

The researchers’ conclusions were that DALK-operated patients in this study showed similar graft survival, fewer postoperative complications, and equivalent refractive outcomes. No significant difference in the mean BCVA was noted between DALK and PK cases.

These results are in agreement with numerous other recent studies2,3 suggesting that DALK may be a preferred first surgical choice over PK for patients requiring keratoplasty for keratoconus. Although DALK is preferred over PK due to lower complication rates, it is still an invasive procedure and other less invasive treatments for keratoconus such as contact lenses, cross linking and intracorneal ring segments should be used unless contraindicated or ineffective.

1. Macintyre R, Chow SP, Chan E, Poon A. Long-term Outcomes of Deep Anterior Lamellar Keratoplasty Versus Penetrating Keratoplasty in Australian Keratoconus Patients. Cornea. 2014 Jan; 33(1) 6-9.
2. Kim MD, Chung TY, Chung ES. A retrospective contralateral study comparing deep anterior lamellar keratoplasty with penetrating keratoplasty. Cornea. 2013 April; 32(4) 385-9.
3. Amayem AF, Hamdi IM, Hamdi MM. Refractive and visual outcomes of penetrating keratoplasty versus deep anterior lamellar keratoplasty with hydrodissection for treatment of keratoconus. Cornea. 2013 Apr;32(4):e2-5.

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Review of Complications Associated with Contact Lenses from Unregulated Sources of Supply

The objective of this study was to review existing studies and case reports regarding complications associated with contact lenses (CLs) from unregulated sources of supply and to identify any relevant trends

A systematic literature search was performed to locate publications concerning complications associated with CLs obtained from unregulated sources of supply.

A total of 23 articles were identified that represent 70 individual cases. All eight of the pre-2006 case reports originated from the United States and the United Kingdom, whereas from 2006 onwards, only two of the 15 reports came from these locations. Over-the-counter supply accounted for 73% (51/70) of cases, whereas 17% (12/70) were borrowed or shared lenses and 6% (4/70) lenses were obtained through the Internet. Nearly, three quarters of patients (30/42, 71%) waited longer than 48 hours after the onset of symptoms before seeking medical attention; ten patients waited longer than a week, and five longer than a month. Microbial keratitis (MK) was reported in 43 (61%) patients, with permanent damage occurring in 72% (31/43) of patients followed to conclusion. Known risk factors associated for MK were present in all cases irrespective of whether the patients developed MK.

The authors concluded that there are various reasons to presume that the unregulated supply of CLs might result in the use of inappropriate lenses, increase the risk of poorer lens hygiene, and militate against the prompt treatment of any consequent complications. There is some indication that the introduction of regulations to control the supply of plano CLs has alleviated the level of complications.

Young G, Young AG, Lakkis C. Review of Complications Associated with Contact Lenses from Unregulated Sources of Supply. Eye Contact Lens. 2013 Nov 27. [Epub ahead of print] Source: Visioncare Research Ltd (G.Y., A.G.H.Y.), Farnham, United Kingdom; and Johnson & Johnson Vision Care Inc. (C.L.), Jacksonville, FL.

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Important Links:
To report adverse contact lens reactions visit: http://www.accessdata.fda.gov/scripts/medwatch/ or call (800) FDA-1088.
To report possible grievances related to the Fairness to Contact Lens Consumers Act or associated Contact Lens Rule visit: https://www.ftccomplaintassistant.gov/.

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