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Sunday, January 12, 2014  
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Do you believe that using an artificial tear in a contact lens wearer (an "off-label" use compared with using a rewetting drop) puts the lens wearer at risk for increased complications?



Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO
As noted in our 2013 Annual Report on contact lenses (http://www.clspectrum.com/articleviewer.aspx?articleID=109320), daily disposables continued to show the most growth of any category of contact lenses in 2013. We also noted this trend in 2012. It will be interesting to see if the daily disposable category continues with this trend in 2014. An interesting question remains -- why has the United States market typically lagged behind many other markets in terms of the uptake of daily disposables? What makes the U.S. market different in this regard? If you have any thoughts on this, we would love to hear from you. Please email us at cltoday@pentavisionmedia.com.

WellPoint Enters Agreement to Divest of
1-800 CONTACTS Subsidiary

WellPoint announced it has signed a definitive agreement to sell its online contact lens retail subsidiary 1-800 CONTACTS to private equity firm Thomas H. Lee Partners. Additionally, the company has entered into an asset-purchase agreement for glasses.com and its virtual try-on technology with Luxottica. Each agreement is subject to customary closing conditions and each transaction is expected to close in the first quarter of 2014.

According to the Company announcement, in preparing for the coming changes to the health care system, the Company will focus on core growth opportunities across both commercial and government business segments. Proceeds from this transaction will support the Company's continued capital deployment strategies.

Financial terms of the transaction were not disclosed. In connection with the sale agreements, WellPoint expects to record an impairment charge in the range of $0.52 to $0.57 per share in the fourth quarter of 2013. As a result, WellPoint now expects GAAP net income of at least $7.88 per share for the full year 2013. Excluding the charge, WellPoint continues to expect adjusted net income of at least $8.40 per share for the full year 2013. This guidance includes no investment gains or losses beyond those recorded during the first nine months of 2013.

B+L Introduces the MoRoCCo VA App to United States

Bausch + Lomb announced the introduction of the MoRoCCo VA application (app) in the U.S., which is designed specifically to help eyecare professionals select the correct KeraSoft IC lens for their patients with keratoconus and other cornea irregularities.

Based on the successful MoRoCCo VA* fitting method, the innovative app guides the ECP through each stage of the lens fitting process. Using interactive screens, the app allows the ECP to directly enter data during each KeraSoft IC lens fitting assessment. The app then provides instantaneous feedback as to whether the fit is optimal or sub-optimal, and offers advice on logical next steps. Fitting data may be stored for both eyes in one session. Other benefits of the app include real time animations of lens behavior, viewing the fitting history for each patient at-a-glance, emailing lens orders to authorized laboratories, requesting technical support and more.

The MoRoCCo VA app is browser-based and is available at no cost. The app is designed for use on multiple electronic devices, including a PC, smart phone, tablet or other mobile device.

KeraSoft IC is available through authorized laboratories. KeraSoft IC is made of silicone hydrogel (Definitive material) for added comfort, and can be fully customized to fit the shape of keratoconic and post-surgical corneas. KeraSoft IC uses a patented design to "drape" over the cornea rather than using thickness of material to "mask" the irregularity. Its innovative design uses the latest technologies to create a soft contact lens that fits many unusually shaped corneas (including keratoconus, PMD, post-refractive and INTACS).

To learn more about the MoRoCCo app, visit kerasoftic.com/moroccoapp. For more information about KeraSoft IC, visit kerasoftic.com.

* MoRoCCo VA stands for Movement, Rotation, Centration and Comfort, characteristics that when optimal, give the best Visual Acuity when fitting the KeraSoft IC soft contact lens.

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.
Rose K Fitting Videos Now Available

Menicon America has three new Rose K fitting videos available online. Created in conjunction with Dr. Paul Rose, these new videos are step-by-step guides to fitting Rose K lenses. The presentations feature voice narration and can be fast-forwarded or rewound so you can watch whichever portions you need at your own pace. Each presentation also has a quiz at the end so you can test your knowledge.

These videos are available:

  • Rose K2 for keratoconus
  • Rose K2 NC for nipple cones
  • Rose K2 XL semi-scleral

All three videos can be viewed on the Rose K website at http://www.roseklens.com/page/rosek_105.php. Additional video fitting guides for Rose K2 PG and Rose K2 IC will be available later this year.

In the U.S., Rose K lenses are available from three authorized manufacturers: ABB Optical, Art Optical Contact Lens, Inc. and Blanchard Contact Lens, as well a number of authorized distributors.

Art Optical Introduces "Lunch @ the Lab" Seminar Series

Utilizing the capabilities of their new onsite Technical Training Center, Art Optical announces a series of lunch time seminars to be held monthly in 2014. "Lunch @ the Lab" will be held on the final Wednesday of every month from 12:30-1:30 pm EST at the Art Optical Technical Training Center.

The "Lunch @ the Lab" Seminar Series will incorporate both lecture-based and hands-on practical training and each session will focus on timely topics of interest to specialty contact lens practitioners. The first seminar will be held on January 29, and complimentary lunch will be provided. To review the topics scheduled for upcoming seminars and to register, visit http://artoptical.com/register/.

SynergEyes Launches Concierge Service

SynergEyes, Inc. has launched a new service to help ensure doctors' success with Duette contact lenses, the only hybrid contact lenses on the market. SynergEyes' "Concierge Service" uses online technology to not only train doctors and their staff in identifying and fitting candidates for Duette lenses, but to also virtually attend patient dispensing. The program is available to all practices placing their first Duette order and there is no charge to take advantage of the service.

In addition to three Skype or FaceTime training sessions, SynergEyes' "Concierge Service" includes assistance in the initial lens orders, plus support before and after the first few patient visits. A telephone hotline is also part of the "Concierge Service."

The Company states that their goal is to start new accounts with all the information and assistance they need to fit the broad spectrum of patients that should be wearing Duette lenses and in so doing help practices grow. Their consultation team remains ready to provide clinical support at the completion of the "Concierge Service."

More information is available at www.SynergEyes.com.

Euromcontact Issues Statement on Classification of Fluorescein Strips

According to Euromcontact, the European Federation of National Associations and International Companies of Contact Lens and Lens Care Manufacturers, the discontinuation of availability of fluorescein strips has been recorded in some Member States. This is due to the fact that the classification of these products as a medical device or as a medicinal product is not clear. Some producers of fluorescein strips therefore decided to stop selling these products to avoid any regulatory issues.

At the end of December 2013, the UK authorities stated that to avoid shortage of supply, they will not take formal regulatory action to stop fluorescein strips with a CE mark being used as medical device until a decision about these products has been made at European level. Euromcontact welcomed this position and called on Member States to act with pragmatism when considering the use of fluorescein strips. Failing to do so would have major impact on the availability on the market of such products.

In addition, Euromcontact called on the Commission Borderline and Classification Expert Group to adopt a decision to classify these products for this intended use as medical devices and not medicinal products. Should these products become medicinal products, European and third-countries' manufacturers would very likely stop production due to the high administrative and costly procedures associated with medicinal products market authorization. Helmer Schweizer, Euromcontact President, stated that as fluorescein strips are well-established products and have been CE marked as medical devices for many years, the Commission and expert groups of Member States should clearly acknowledge this and allow this classification at their meeting in March 2014.

Euromcontact members include National Associations of Manufacturers, representing Netherlands, France, Germany, Italy, Spain, Switzerland and the United Kingdom; the global companies Alcon, AMO Ltd., Bausch + Lomb, Ciba Vision, CooperVision, Johnson & Johnson Vision Care Menicon; and the European Federation for the Contact Lens Industry (EFCLIN).

Phthisis Bulbi
Edward Boshnick, OD, Miami, Florida

This keratoconus patient underwent a corneal transplant 3 months prior to this visit. This was the second transplant. The first transplant was rejected. Shortly after the second transplant was performed, the patient developed an endophthalmitis which required a vitrectomy. During this procedure the anterior chamber collapsed. The end result was a dead eye. Interestingly, his insurance paid for the transplant and additional surgeries but would not pay for a specialty scleral contact lens.

We thank Dr. Boshnick 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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Katherine M. Mastrota, MS, OD, FAAO

More on Tea Tree Oil

In my last Dry Eye segment I discussed Tea Tree Oil (TTO) and the data gaps that surround its use in patient therapy for therapeutic management of Demodex blepharitis. Natural TTO contains approximately 100 constituents. As noted, commercial TTO is regulated by the International Organization of Standardization (ISO4730:2004) and must contain a specific range of 15 major ingredients. In a timely study, Tighe et al aimed to establish the ingredient in TTO with the most effective acarical property. The authors found that Terpinen-4-ol is the most active ingredient in TTO exerting Demodex mite-killing effects.1 It remains unclear how Terpinen-4-ol exerts its miticidal effect. Interestingly, other studies have shown that Terpinen-4-ol is also the most active ingredient in TTO exerting antibacteria,2 antifungal3 and anti-inflammatory effects.4

1. Tighe S, Gao YY, Tseng SC. Terpinen-4-ol is the most active ingredient of tea tree oil to kill Demodex mites. Transl Vis Sci Technol. 2013 November; 2(7): 2. Published online 2013 November 13. doi: 10.1167/tvst.2.7.2
2. Carson CF, Hammer KA, Riley TV. Melaleuca alternifolia (tea tree) oil: a review of antimicrobial and other medicinal properties. Clin Microbiol Rev. 2006;19:5062.
3. Hammer KA, Carson CF, Riley TV. Antifungal activity of the components of Melaleuca alternifolia (tea tree) oil. J Appl Microbiol. 2003;95:853860.
4. Hart PH, Brand C, Carson CF, et al. Terpinen-4-ol, the main component of the essential oil of Melaleuca alternifolia (tea tree oil), suppresses inflammatory mediator production by activated human monocytes. Inflamm Res. 2000;49:619626.

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Susan J. Gromacki, OD, MS, FAAO

Mascara and Scleral GP Contact Lenses

In the past few weeks, I have diagnosed three similar presentations in my scleral contact lens-wearing population. A relatively new, hitherto successful scleral gas permeable (GP) contact lens wearer in her 50s-60s presents complaining of blurred vision. All patients were compliant with lens care and wearing schedule.

Initially, I considered all potential differentials: tear film debris, corneal compromise, poor fit, change in refraction, etc. But one look with the biomicroscope confirmed the diagnosis: makeup deposition on the front surface of the contact lens. Two of the three patients' lenses exhibited the vertical streaks characteristic of a mascara wand, while the third patient's lens demonstrated the sparkly appearance of her eyeliner.

Since typical daily cleaners are unable to remove the density of this deposition, I utilized my modification unit to provide a thorough in-office elimination and polishing. So why does this happen more frequently with scleral lenses? A makeup wand can more easily graze their front surface because they are thicker (approximately 2-5X) and protrude more (300 microns corneal clearance, on average) than their corneal GP and soft lens counterparts. I also educate patients that, although it is typically recommended to apply cosmetics after inserting contact lenses,1 if they are adept at lens application, mascara (and only mascara) may applied first--or discontinued altogether.

1. Weisbarth RE and Henderson B. Hydrogel lens care regimens and patient education. In: Bennett ES and Weissman BA, eds. Clinical Contact Lens Practice. Lippincott, Williams & Wilkins, Philadelphia, Pennsylvania; 2005: 409.

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Scleral Contact Lenses for Visual Rehabilitation after Penetrating Keratoplasty: Long Term Outcomes

The purpose of this study was to evaluate the success rate of highly gas permeable scleral contact lenses (SCL) for visual rehabilitation after penetrating keratoplasty (PK), over a period of up to 9 years.

A total database of 31 consecutive patients fitted with SCL between January 2004 and December 2009 was retrospectively reviewed. Demographic data, etiology prior to lens fitting, visual outcomes, follow up time and complications were analyzed.

All eyes were fitted due to inadequate spectacle-corrected vision after successful penetrating keratoplasty or failure of other contact lens modalities. Out of 31 patients fitted, 28 (33 eyes) continued to wear SCL for periods between 0.5 and 8.8 years. The mean duration of follow-up after contact lens fitting was 5.22.2 years. The mean age of corneal graft was 17.611.4 years (range 4.3-42), and the mean interval between PK and initial contact lens fitting was 12.210.7 years (range 0.7-36.0). The average steepest keratometry of our cohort was 55.07.5 diopter (D) and the refractive astigmatism was 8.04.4 D. The mean contact lens corrected visual acuity (BCVAcl) was 0.780.25 (range 0.3-1.2). Twenty-three (82%) patients achieved a functional vision of 0.5 or more. During the studied period, ten (30.0%) eyes presented at least one graft rejection episode and two eyes (6%) had an episode of microbial keratitis. Corneal transplants of 20 years or more show a higher rate of refits due to ectasia recurrence.

The researchers concluded that scleral lenses should be considered as lens of choice in eyes with complex corneal geometry, as besides visual rehabilitation, their use may delay or prevent further surgical involvement.

Severinsky B, Behrman S, Frucht-Pery J, Solomon A. Scleral contact lenses for visual rehabilitation after penetrating keratoplasty: Long term outcomes. Cont Lens Anterior Eye. 2013 Nov 30. pii: S1367-0484(13)00306-8. doi: 10.1016/j.clae.2013.11.001. [Epub ahead of print]

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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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