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Sunday, January 8, 2012  
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Last question:
With the holiday season upon us, what ranks highest on your wish list?

 1. More options in daily disposables (e.g., other silicone hydrogels, expansion in toric and multifocal designs)

 2. Something that greatly reduces end-of-day dryness and discomfort for lens wearers

 3. A new multifocal contact lens that is ultra-comfortable and produces the best visual performance ever known to mankind

 4. A combination care and lens design system that magically reduces patient non-compliance

Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

New Year's wishes and resolutions are quite important to many of us. Please take note of your wishes in our 2011 end-of-year poll—most of you would prefer to have the ideal multifocal contact lenses atop of yours!

One thing I hear most frequently when traveling overseas is that we don't do enough to address our international "contact lens" colleagues. So, our CL Today resolution to fix this has been to add a new column to our email newsletter called "Views from Abroad." The column will be primarily written by Professor Brien Holden, who has had a tremendous impact on the practice of contact lenses through the years. In addition to Brien, we will be asking colleagues from across the globe to address the practice of contact lenses from these other perspectives. Stay tuned as this will prove to be most insightful.

Contamac Celebrates 25th Anniversary

Contamac Ltd announced it is celebrating its 25th Anniversary in 2012 with a series of special events scheduled throughout the year.

The company recently completed expansion and improvements totalling more than £2 million in its facility located in north Essex in the United Kingdom, including more than £400,000 in capital equipment investment.

The company was founded in 1987 with a range of contact lens materials, with its first foldable acrylic IOL material added in 1997. Contamac US was established as an affiliate company in 2002, followed by the introduction of the full range of Optimum GP materials in 2004. Contamac launched the first lathable silicone hydrogel material Definitive in 2008.

Brazzell Appointed Pharma Company's Chief Medical Officer

Ophthalmic industry veteran Kim Brazzell, Ph.D. is the new Chief Medical Officer of Mimetogen Pharmaceuticals. Dr. Brazzell will lead the development of Mimetogen's MIM-D3 pivotal program for the treatment of dry eye.

The Company previously announced in June 2011 that MIM-D3, a small molecule TrkA agonist, had successfully completed a 150-patient, multi-center Phase 2 trial for the treatment of dry eye.

Dr. Brazzell previously held several executive positions at Inspire Pharmaceuticals, including Executive Vice President, Medical and Scientific Affairs, Executive Vice President and Head, Ophthalmology Business and Senior Vice President of Ophthalmic Research and Development. Before joining Inspire, he served as Global Head of Clinical R&D and Senior Vice President, U.S. R&D, of Novartis Ophthalmics. He also built and managed the U.S.-based R&D group for Ciba Vision Ophthalmics, while serving as its Vice President, R&D, and served as Associate Director, R&D, at Alcon Laboratories, Inc.

Don't Miss the Global Specialty Lens Symposium, January 26 - 29, 2012

There is still time to register for the 2012 Global Specialty Lens Symposium at the Paris Hotel & Casino in Las Vegas. With an expert international faculty and a CE-accredited agenda, the 2012 GSLS will feature insightful presentations by experts in the field and hands-on demonstrations of cutting-edge products, as well as scientific papers and posters. COPE, JCAHPO and NCLE accreditation. Look for more detailed information in Contact Lens Spectrum and online at www.GSLSymposium.com.


FDA Issues Alert About Drug Name Confusion

The U.S. Food and Drug Administration (FDA) is alerting pharmacists and healthcare providers of potential injury due to confusion between the FDA-approved eye medicine Durezol (difluprednate ophthalmic emulsion) 0.05% and the unapproved prescription topical wart remover Durasal (salicylic acid) 26%.

There has been one report of serious injury when a pharmacist mistakenly gave an eye surgery patient Durasal, the salicylic acid—containing wart remover, instead of the prescribed Durezol eye drops, according to the FDA. Durezol is approved for treatment of inflammation and pain association with ocular surgery.

Several other cases were reported arising from confusion between Durezol and Durasal. In some cases, the error was discovered prior to the medication reaching the patient. There were also complaints received from practitioners concerning the similarity between the names Durezol and Durasal.

Practitioners and patients are encouraged to scrutinize packaging and labeling information carefully and to report any potential for confusion arising from similar drug names to the FDA's MedWatch Safety Information and Adverse Event Reporting program. In this context, any side effects associated with the use of Durezol or Durasal should be especially noted and reported.

Complete and submit the report online at www.fda.gov/MedWatch/report.htm. Download the form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178.

Company to Develop Drug Delivery Sytem

A microinjection technology that will use hollow microneedles to precisely target therapeutics within the eye is being developed by an Atlanta-based start-up company, Clearside Biomedical.

The technology was developed in collaboration between the research groups of Mark Prausnitz, a Regents' professor in Georgia Tech's School of Chemical and Biomolecular Engineering, and Henry Edelhauser, a professor in the Department of Ophthalmology at Emory School of Medicine. Research leading to development of the technology was sponsored by the National Institutes of Health (NIH).

The technology developed by Georgia Tech and Emory uses a hollow micron-scale needle to inject therapeutics into the suprachoroidal space located between the sclera and the choroid. Preclinical research has demonstrated that fluid can flow between the two layers, where it can spread out to the entire eye, including structures such as the retina that are now difficult to reach. Clearside received funding from a venture capital fund to work on development of the procedure.

Pseudodendrite in Patient with Herpes Zoster Ophthalmicus
By Gregory W. DeNaeyer, OD, FAAO

This picture shows a pseudodendrite in a 71-year-old patient who presented with Herpes Zoster Ophthalmicus (HZO).

Approximately 65% of patients who have HZO will have corneal involvement.1,2 Herpes Zoster can affect the cornea in a number of ways including direct viral infection, antigen-anibody reactions, vasculitis, and neurotrophic keratitis.2 Pseudodentrites that form are raised, plaque-like lesions of swollen epithelial cells that are without ulceration and are thought to result directly from the virus.2 These of course need to be differentiated from dendrites that result from herpes simplex that are ulcerated and have terminal bulbs. Management of pseudodendrites involves only observation and palliative treatment with lubrication.


1. Liesegang TG. Corneal complications from herpes zoster ophthalmicus. Ophthalmology. 1985 Mar;92(3):316-24.
2. Kaufman HE, Barron, BA, McDonald, MB. The Cornea 2nd Edition. 1998 Butterworth-Heinemann 283-288.

For more on this patient, including management and discussion, see http://www.clspectrum.com/articleViewer.aspx?articleID=104542.

We welcome photo submissions fromour 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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Brien Holden, PhD, DSc, OAM, FAAO

It Doesn't Get Any Bigger

Bandage contact lenses that prevent blindness, silicone elastomer aphakic contact lenses that allow babies and very young children to see, and contact lenses for keratoconus are literally sight savers—and the clinicians that have the patience and skill to work with them are indeed "saints." However, for the sheer magnitude of impact—myopia control is without doubt the most exciting application of contact lenses ever.

With more than a billion myopes expected to be able to afford contact lenses in the next 10 years, the need and the obligation to get this one right is immense. In a recent issue of IOVS (arguably the top eye research Journal), the results for year 1 of a 3 year clinical trial on anti-myopia contact lenses were published. With a lens designed specifically to reduce peripheral hyperopia while maintaining clear central vision, a 35%-40% reduction in rate of myopic progression was achieved—which subsequent research will show is maintained. It is expensive to research, plan and run the type of studies needed and there may be regulatory struggles, but to me, it seems industry's "vision" is the main problem. Shouldn't we have a commercially available lens by now? If I was a contact lens company, I would not sell a contact lens that did not have a myopia reduction feature. Watch this space though—new alliances could transform our world.

Until then, the 5 point plan should be 1) use ortho-K or 2) fit soft distance center bifocal contact lenses—but check that the level of central visual blur or doubling is "acceptable," 3) use myopia control specs when not in contact lenses or bifocals and 4) promote good hygiene—outdoor activity and a bright light and good posture for reading. Finally (5), I encourage you to read Richard Anderson's website to keep up. He presents evidence-based opinions and good balanced editorial (www.myopiaprevention.org).

Sankaridurg P, Holden B, Smith E, et al. Decrease in rate of myopia progression with a contact lens designed to reduce relative peripheral hyperopia: one-year results. Invest. Ophthalmol. Vis. Sci. December 9, 2011 vol. 52 no. 13 9362-9367.

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Susan J. Gromacki, OD, MS, FAAO

Special Traditions

As I reflect back on this past holiday season, special celebrations are so important for bringing joy into our lives. These include not only family holidays but also office traditions, like the annual summer picnic, turkey giveaway, or evening holiday dinner at the local country club. It is gratifying to see how much joy these gestures bring to some of our employees (and to us as well)!

Along the same lines, each patient care visit is a unique experience for each and every one of our patients. In particular, the initial contact lens insertion, removal, and care training session may be what form his lasting impression of our practice. Although he may be one of 2000 or more patients we see over the course of the year, this may be his one and only eyecare appointment for the next year or two. It is our responsibility to make it a positive, productive, and dare I say, a special, experience for him.

All the best to you and your loved ones for a happy and prosperous New Year.

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Kelly K. Nichols, OD, MPH, PhD, FAAO

Recruiting Dry Eye Patients

Clinical trials are the gold standard study methodology that can be used to implement evidence-based changes in clinical practice. That being said, amongst other things, recruitment for clinical trials can be difficult. In most instances, practitioners with a proven track record of having been involved in clinical trials, peer education, and practicing in a high-level, high-performance practice usually serve as clinical sites for studies, in addition to some university-based practices. Existing patients of the practice are routinely recruited for studies, yet frequently, an existing patient base is not enough. New patients can be recruited; however, success with new patients is not guaranteed, nor is the rate at which they present to the practice.

I was recently searching "dry eye disease" on the Internet and came across a website that was a recruitment tool for dry eye studies. The site listed a few clinical trials, briefly described the generic recruitment requirements, and guided the reader to complete a five-question screening survey. Following completion, the reader is asked for his ZIP code and several sites (based on distance) were listed with a link to send my contact information. In opening the host site homepage, I came across a list of "clients"—several of which could be dry eye (or ocular surface disease) study sponsors.

The take-home points are two-fold—the Internet can be a tool in dry eye patient recruitment, both for studies and generally building your practice. That being said, some recruitment tools may not be initially transparent, which makes the informed consent process, and all efforts to remove bias, critical.

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Hand Hygiene Prior to Contact Lens Handling is Problematical

The goal of these researchers was to establish guidelines for contact lens wearers' hand hygiene practices which achieve a balance between minimizing risk of infection and reasonable expectations on the ability of patients to follow them. Researchers obtained evidence from publications via PubMed, Advanced Medline Search, Cochrane Reviews, Google Scholar and using the key words hand hygiene, washing and contact lens.

Guidelines for effective hand washing and the effort involved vary according to the level of hygiene required, researchers found. High levels of noncompliance with hand hygiene practices, even among healthcare workers, gives an indication of how important the level of bother involved when following guidelines can be in contributing to noncompliance.

Researchers concluded better patient education to improve hand washing techniques as well as patient attitudes toward hand hygiene are needed to reduce high noncompliance levels. In order to maximize adoption rates, the guidelines distilled from this review attempt to strike a balance between technique redundancy and the associated higher levels of hygiene achieved, and the possibility that the perception of too much bother involved could reduce participation rates. The guidelines were expanded by including suggested explanatory information in the expectation that helping patients understand why the recommendations are made will increase their adoption.

McMonnies CW. Hand hygiene prior to contact lens handling is problematical. Contact Lens & Anterior eye: the Journal of the British Contact Lens Association 2011.

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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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For more information on Contact Lenses Today including archives of previous issues, please visit our website at www.cltoday.com. For the latest articles on contact lenses, important clinical information and helpful tools related to the contact lens practice visit the Contact Lens Spectrum website at www.clspectrum.com.

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