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Sunday, January 13, 2013  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

The term "Key Opinion Leader" is one that is frequently used, but I think it is important to take a minute to consider the term's use. At times, the term seems to be applied to people with significant credentials on a specific topic, which seems an appropriate application. At other times, the term seems to be applied in ways that relate more to a popularity contest, which makes me question how liberally the term gets used. As with any clinical topic, take a moment to consider not only the content, but also the credentials of those bringing the content to you.

Walmart and Sam's Club Introduce New Contact Lens Program Including a Private Label Offering

Walmart and Sam's Club announced that the retailers are launching an all-new online and phone contact lens program as well as reduced prices on many top contact lenses. This February, Walmart will also launch its own private Equate brand of contact lenses to give customers more contact lens options at low prices.*

The offering includes a new online and phone contact lens program. Walmart customers can now visit WalmartContacts.com or call 1-800-741-LENS (5367) and Sam's Club members can now visit SamsClub.com/contacts or call 1-800-749-LENS (5367) to place contact lens orders and have them delivered directly to their home. Free shipping is available on orders over $50 for Walmart Contacts and $45 for Sam's Club Contacts.

Independent optometrists operate private offices next to more than 3,000 Walmart Vision Centers and Sam's Club Optical Centers to provide eye exams, lens fitting and prescriptions by appointment and on a walk-in basis. In addition, Walmart and Sam's Club have on-site opticians in the Vision Centers and Optical Centers to assist with fitting glasses in store or in club.**

* Contact lenses are not available in Arkansas stores and clubs. Walmart Vision Centers are not available in Oklahoma, Delaware or Rhode Island.
** Note neither Walmart nor Sam's Club is licensed to make eye examinations as a dispensing company.

AVT Offers New Scleral Multifocal

Advanced Vision Technologies (AVT) announces the availability of the AVT Scleral Multifocal featuring a unique back aspheric, distance center, Tangent Carrier design, which offers a presbyopic option for all types of patients with normal or highly irregular corneas. Add powers are available from +1.00 to +3.00.

The AVT Scleral design incorporates adjustable tangent carrier angles to raise or lower the landing angle of the lens improving the alignment fitting relationship on the sclera.

The lens utilizes a simplified 18 Lens Fitting System featuring a series of sagittal values utilizing a combination of three central base curves, three tangent angle carriers and three diameters of 16.1, 16.6 and 17.1. All incorporate a large Optic Zone improving limbal clearance. Custom Diameters are also available.

For more information on Advanced Vision Technologies products and services, please call 888-393-5374, visit www.avtlens.com or contact keith@avtlens.com.

ABB CONCISE and Optical Distributor Group Announce Merger

ABB CONCISE and Optical Distributor Group (ODG) announced their merger which was effective December 28, 2012.

Customers will continue communicating with the same customer service and sales representatives with each company that they have prior to the merger. Business will remain as usual.

This merger brings together over 120 sales professionals. Together the companies supply more than 30,000 ECPs with brand name contact lenses, finished ophthalmic lenses, fully customizable GP and custom specialty soft lenses, and the services of ODG's full service automated Digital Eye Lab. They also offer pricing strategy tools, Business Reviews, Annual Supply Staff Training and e-commerce solutions.

There's Still Time! Register for GSLS 2013 Today.

The Global Specialty Lens Symposium is approaching fast. Plan to be there January 24-27, 2013, at the Rio All Suites Hotel and Casino, Las Vegas, Nevada. With an expert international faculty and a CE-accredited agenda, the 2013 GSLS will include a fundamentals pre-conference, insightful presentations by experts in the field, hands-on demonstrations of cutting-edge products, as well as scientific papers and posters and networking opportunities with your colleagues from over 30 different countries.

For more detailed information and registration visit www.GSLSymposium.com.

Online Registration Opens for 37th BCLA Clinical Conference

The British Contact Lens Association (BCLA) has opened online registration for the 37th BCLA Clinical Conference and Exhibition, to be held June 6-9, 2012 at Manchester Central, UK. Those who register before March 8 will receive an early bird discount on their chosen delegate package. BCLA members will receive an even greater discount, up to 45% off a full delegate package for those who have been members for five consecutive years or more.

In association with its 2013 exhibitors, the BCLA is offering 100 free weekend packages that include a Saturday and Sunday delegate pass, one Gala Dinner ticket and Saturday night accommodation at a designated hotel. For terms and conditions of all offers, additional information on the conference and registration, visit www.bcla.org.uk

Vision Source Announces Greenwood as President and COO

Vision Source announced that Jim Greenwood assumed the position of President and Chief Operating Officer effective January 7. Greenwood joins the executive team after serving as CEO of Concentra, a national health care company and a subsidiary of Humana Inc., for more than five years. He will report to Vision Source CEO and Founder Glenn Ellisor, OD.

A Baylor University graduate, Greenwood's career in healthcare started in 1993 when he joined Concentra's predecessor company as Chief Financial Officer. Greenwood also serves on the Board of Directors for Epic Health Services, Inc. and the Baylor University Healthcare Administration Program's Advisory Council.

B+L Licenses New Technology with Potential to Treat Ocular Redness

Bausch + Lomb acquired an exclusive global license to a new platform technology that may lead to a faster, more effective and longer lasting treatment for ocular redness, or hyperemia.

According to the company, the technology employs a different mechanism of action to relieve ocular redness than currently available redness relief products, using a uniquely formulated low dose of brimonidine. Licensed from Eye Therapies, LLC, a privately held biopharmaceutical company, the technology was developed in collaboration with Ora Inc., a private research organization.

Currently marketed ocular redness relief therapies are often associated with problems such as tachyphylaxis, a decreasing response to a drug following its initial use. This can potentially lead to overuse of these medications and a subsequent rebound effect, where symptoms return stronger upon discontinuation of a drug.

In a Phase 2 study, the new technology appeared effective in reducing ocular redness based on both clinician assessment and patient reporting. The company reports that the rebound vasoconstriction associated with currently available treatments was not observed in this study. Additionally, onset of action was shown to be rapid (within five minutes), with a duration of effect lasting at least four hours. The formulation was found to be safe and well tolerated as dosed in the study, with no serious adverse events reported.

Your Interesting Case Photo Here

Have you seen an interesting case lately? Would you like to share it with your colleagues? An image from that case could appear in this column next week!

We welcome photo submissions from our 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.

Susan J. Gromacki, OD, MS, FAAO

New Year's Resolutions for our Practice

Data shows that most Americans do not make New Year's resolutions, and 36% of us that do break them before the end of January.1 However, according to this same research, people who make resolutions are ten times more likely to achieve their goals.

Whether we have been practicing for one or 60 years, there is always room for improvement. For example, a more thorough knowledge of the individual contact lens care systems, their formulations, and their instructions helps us monitor our patient's compliance and diagnose the contribution of the lens, solution, and/or patient responsibility in the event of a complication.

How to improve? Listen carefully during continuing education meetings; many speakers sprinkle anecdotes from their practices into their academic lectures. Meet with your sales representatives. Of course, they are paid to promote their products, but the good ones realize that presenting the science behind their innovations goes a lot further with doctors than catch-phrases and marketing pitches. Lastly, keep up with the journals, including both trade and peer-reviewed. (This is always the most difficult one for me, as there seems to be a perpetual stack sitting on my desks at both home and office.) Our mission at Contact Lens Spectrum is to bring to you clinical information about new advances in the contact lens field, including lens care and compliance which are areas that I cover. At the very least, make an effort to read CL Today every week; it presents timely information in a concise fashion—and is always a quick read!

Happy New Year to all of you, and I wish you continued success and prosperity in 2013.

1. http://proactivechange.com/resolutions/statistics.htm
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Katherine M. Mastrota, MS, OD, FAAO

Reading Speed and Dry Eye Disease

The final month of 2012 brought a very interesting report in Optometry and Vision Science investigating reading speed and contrast sensitivity in Ocular Surface Disease Index-confirmed mild, moderate and severe dry eye patients. Although contrast sensitivity was not significantly different between DED patients and controls, it was found that DED patients exhibited slower reading speeds than the control subjects. Interestingly, as patient DED severity increased, reading speed decreased. The authors concluded that this finding is consistent with patient-reported symptoms and provides direct evidence for the impact of DED on reading performance. Furthermore the study findings suggest that reading speed may be used to monitor treatment benefit in DED1 Reading speed was measured with the Wilkins Rate of Reading Test. The Wilkins Rate of Reading test has shown that people with visual discomfort make more errors and have a slower rate of reading than controls.2

1. Ridder WH 3rd, Zhang Y, Huang JF. Evaluation of Reading Speed and Contrast Sensitivity in Dry Eye Disease. Optom Vis Sci. 2013 Jan;90(1):37-44. [Epub ahead of print]
2. Wilkins AJ, Jeanes RJ, Pumfrey PD, Laskier M. Rate of reading test: its reliability and its validity in the assessment of the effects of coloured overlays. Ophthalmic Physiol Opt. 1996 Nov;16(6):491-7.

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Topical Azithromycin and Oral Doxycycline Therapy of MGD: A Comparative Clinical and Spectroscopic Pilot Study

Meibomian gland dysfunction (MGD) is a common clinical problem that is often associated with evaporative dry eye disease. Alterations of the lipids of the meibomian glands have been identified in several studies of MGD. This prospective, observational, open-label clinical trial documents the improvement in both clinical signs and symptoms of disease as well as spectroscopic characteristics of the meibomian gland lipids after therapy with topical azithromycin ophthalmic solution and oral doxycycline treatment.

Subjects with symptomatic MGD were recruited. Signs of MGD were evaluated with a slit lamp. Symptoms of MGD were measured by the response of subjects to a questionnaire. Meibum lipid-lipid interaction strength, conformation, and phase transition parameters, and meibum protein content were measured using Fourier transform infrared spectroscopy and principal component analysis. Terpenoids, short-chain CH3 moieties, lipid oxidation, wax, cholesterylesters and glycerides were measured with a proton nuclear magnetic resonance (H-NMR) spectrometer.

Topical therapy with azithromycin and oral therapy with doxycycline relieved signs and symptoms and restored the lipid properties of the meibomian gland secretion toward normal. Compared with 4 weeks of azithromycin treatment reported in our previous study, oral doxycycline treatment was slightly less effective in improving foreign body sensation and the signs of plugging and secretion. In subjects with clinical evidence of MGD, changes in ordering of the lipids and phase transition temperature were brought closer to normal with azithromycin treatment than doxycycline treatment. Treatment with doxycycline but not azithromycin restored the Fourier transform infrared spectroscopy-principal component analysis scores and relative area of the H-NMR resonance at 1.26 ppm. Both doxycycline and azithromycin treatment restored the levels of the relative areas of the H-NMR resonance at 5.2 and 7.9 ppm to normal levels. The levels of meibum protein and meibum lipid oxidation were not influenced by azithromycin or doxycycline treatment.

The researchers concluded that the mechanism of action of doxycycline may be different from that of azithromycin in therapy of MGD. They also noted that when carotenoids in meibum are low, as in MGD, the tear film is unstable and patients have the signs and symptoms of dry eyes. When carotenoids are restored with azithromycin and doxycycline treatment, tear film stability is restored and patients no longer have the signs and symptoms of dry eyes.

1. Foulks GN, Borchman D, Yappert M, Kakar S. Topical azithromycin and oral doxycycline therapy of meibomian gland dysfunction: a comparative clinical and spectroscopic pilot study. Cornea 2013 Jan(1);32:44-53.
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