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Sunday, January 15, 2012  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

Training students can be one of the most rewarding elements in your career, whether it be at an academic institution or in your clinical practice. Good students will challenge you, question you, and ask for rationale in the decisions made when caring for the patient. It certainly keeps one accountable! If offered the opportunity, I would encourage you to welcome students to your practice. Rather than view it as burden, use it as an opportunity to change your perspective and ensure you are still on the right track. You might be surprised that they will actually teach you things as well.

In Memoriam: Joe B. Goldberg

Joe B. Goldberg, 91, a pioneer in the contact lens industry, died January 9, 2012. Dr. Goldberg received his Doctor of Optometry degree in 1941 from the Pennsylvania State College of Optometry in Philadelphia.

Dr. Goldberg was an early innovator in the development of the contact lens manufacturing industry. His first manufacturing site was Conforma Labs in Norfolk, VA. Later the business expanded to Columbus, OH; Providence, RI, and Baltimore, MD. He sold Conforma Laboratories to Dow Corning in 1977, but returned to contact-lens manufacturing in 1983, forming GBF Inc. which he sold in 2003.

Dr. Goldberg was the first president and a founder of the Contact Lens Manufacturing Association (CLMA). He was a Past President of the Virginia Optometric Association, a member of the American Optometric Association (AOA), the British Contact Lens Association, a Fellow of the Contact Lens Section of the AOA, and a diplomat in the AAO's Contact Lens Section. He was a member of the American Academy for the Advancement of Science and served on the Board of Trustees at Pennsylvania State College of Optometry.

He wrote hundreds of articles on contact lenses and a textbook entitled "Biomicroscopy for Contact Lens Practice," published in 1970. He lectured at colleges and universities worldwide. Goldberg was internationally recognized for his development of aspheric contact lenses for patients needing bifocals and keratoconus lenses and was among the leaders in the development of GP contact lenses. His patients will always remember him for his devotion to fitting the most difficult and challenging cases. In 1958, The Sporting News recognized Dr. Goldberg's progressive skills when catcher Hank Foiles became the first Major League baseball player to wear contacts. Even President Ronald Reagan wore Dr. Goldberg's lenses.

Dr. Goldberg received numerous prestigious awards, including in 1998 the Pioneer Award from the AOA's Contact Lens and Cornea Section. Only two people have received this award: Dr. Goldberg and the late Dr. Newton K. Wesley. The AOA called Dr. Goldberg a "true leader and pioneer."

Above based on obituary from The Virginian Pilot.

B+L Announces Availability of KeraSoft IC Contact Lenses

Bausch + Lomb (B+L) announced the availability of KeraSoft IC silicone hydrogel contact lenses in the United States. KeraSoft IC lens technology, available to B+L through a global licensing agreement with UltraVision CLPL, allows for custom-made contact lenses by authorized laboratories for patients with irregular corneas, including keratoconus.

KeraSoft IC lenses are designed to fit irregular corneas, including keratoconus, post laser refractive surgery, Pellucid Marginal Degeneration, and other complex corneal irregularities. Each KeraSoft IC lens is custom-made for a patient's exact needs, and KeraSoft IC lenses can offer increased wear time and improved comfort for patients, according to the company. KeraSoft IC lenses are a patented combination of the latest technologies in silicone hydrogel materials using geometries from complex mathematics to offer comfortable wear and excellent vision and have been recognized with the UK's Queen's Award for Enterprise and Innovation.

Eye care professionals who are interested in KeraSoft IC lenses for their patients should visit www.KeraSofttraining.com to complete the necessary training to enable fitting of KeraSoft IC lenses. Upon completion of the online training, eye care professionals can contact Art Optical, the first lab channel partner, for trial set information and to place KeraSoft IC orders. To contact Art Optical, eye care professionals should call 800-253-9364 for Ordering and 800-566-8001 for Consultation. In the coming months, additional lab channel partners are expected to announce their ability to provide KeraSoft IC lenses.

Time Is Running Out! Don't Miss the GSLS, 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 and register online at www.GSLSymposium.com.

Vision Source Enters Social Media Space

Doctors, Staff, Members and Employees can now follow the latest news from Vision Source by either receiving "tweets" through Twitter, viewing videos on the official Vision Source You Tube Channel, and/or becoming a Fan on the company's Facebook and LinkedIn Pages.

Content will be focused towards Vision Source news, communications among members, happenings, etc. They will be updated regularly, and will feature the latest comprehensive Partner product offerings and promotions throughout the year. Doctors, Staff and all Members will also be kept up-to-date on practice-building service offerings, as well as hands-on educational opportunities and new world class marketing tools.

To become a fan of Vision Source on Facebook, visit http://www.facebook.com/VisionSource?sk=app_190322544333196. On You Tube, visit https://www.youtube.com/user/VisionSourceLP, and to follow Vision Source on Twitter, visit https://twitter.com/#!/VisionSourceLP.

Contamac US Announces Ongoing Grant to the National Keratoconus Foundation

Marty Dalsing, President of Contamac, US, announced the establishment of a new grant in support of the non-profit National Keratoconus Foundation. The grant, which will be ongoing, will support the launch of Bausch + Lomb's KeraSoft contact lenses for keratoconus. These lenses, recently licensed for release in North America, are manufactured exclusively in Contamac's Definitive Silicone Hydrogel material.

For every KeraSoft lens prescribed in North America, Contamac will donate a portion of the Definitive material sales as an unrestricted grant to the National Keratoconus Foundation. Only B+L authorized contact lens laboratories will be eligible to fulfil this special offer.

For information on the work of the National Keratoconus Foundation, visit www.nkcf.org.

PBA Calls for Applications for 2012 Investigator Awards

Prevent Blindness America (PBA) announced the call for applications for its 2012 Investigator Awards. The Investigator Awards are research grants provided to public health projects that seek to put an end to unnecessary vision loss and blindness. Since its inception, the program has awarded more than $1 million to eye and vision research projects.

The deadline for the ninth annual Prevent Blindness America Investigator Awards is March 30, 2012. Grants are for a one-year period, up to $30,000 and reviewed by a panel of scientists in coordination with the Association for Research in Vision and Ophthalmology (ARVO). The Awards will commence on July 1, 2012.

Applications will be accepted in the following priority areas in adult vision, children's vision, or eye injury. For more information on the 2012 Investigator Awards, please call (800) 331-2020 or visit preventblindness.org/investigator-awards.

By William Townsend, OD, FAAO

This individual has conjunctivochalasis, a common anterior segment condition that is characterized by one or more redundant conjunctival folds that are parallel to the eyelids and situated between the globe and the lower eyelid. Elschnig and others described this condition as early as 1908, but the term conjunctivochalasis was first used by Hughes in 1942 when he reported that patients who have this condition often report sharp, intermittent pain that occurs primarily on down gaze. It differs from chemosis in that it does not spontaneously resolve.1 Yokoi et al reported that the most common symptoms and signs associated with conjunctivochalasis were irritation, lacrimation, blurred vision, ocular fatigue, discharge, dryness, and subconjunctival hemorrhage.2

For more on this patient, including assessment and management, see http://www.clspectrum.com/articleViewer.aspx?articleID=104621.

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.

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Loretta B. Szczotka-Flynn, OD, PhD, MS, FAAO

Unregulated Contact Lens Sales and Complications

Cosmetic contact lenses can be bought over the internet with no prescription required. The American Academy of Optometry and the American Optometric Association issued a joint position statement on the dangers of this practice last year (http://www.aaopt.org/content/docs/Joint%20Statement%20AOAAAO%20Circle%20Contact%20Lenses_07272010.pdf). Complications from the sale of these unregulated devices are rarely reported, however a recent case report highlights a severe and unusual keratitis from such a cosmetic contact lens wearer with other similar cases also reported in the literature.

Ray and Lim (2012) report on a 14-year-old cosmetic contact lens user in Singapore who purchased cosmetic lenses online (which they state is a fairly common practice among teenagers) and experienced a paracentral polymicrobial corneal ulcer. The cultures from corneal scrapings and contact lenses demonstrated heavy growth of Chryseobacterium meningosepticum and Delftia acidovorans - two rare organisms in contact lens associated microbial keratitis.

Another case in Taiwan demonstrates the importance of trial fitting before the dispensing of prescription contact lenses. Tseng et al reported on an 18-year-old experienced hydrogel lens wearer who purchased a new box of daily disposable lenses from a retail store without a prescription and without proper fitting. After a day of wear during significant computer use, the patient presented emergently with bilateral corneal erosions.

These cases continue to reinforce that contact lenses are prescription devices that should only be supplied with a prescription after a proper fitting has been completed.

Ray M, Lim DK. A Rare Polymicrobial Keratitis Involving Chryseobacterium meningosepticum and Delftia acidovorans in a Cosmetic Contact Lens Wearer. Eye Contact Lens. 2012 Jan 4. [Epub ahead of print]
SS, Yang WW, Hsiao JC. Bilateral corneal erosion due to retail purchase of unfitted prescription contact lenses: a case report. Tseng Cornea. 2008 Dec;27(10):1179-81.

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Ronald K. Watanabe, OD, FAAO

Happy New Year!

2011 had several great material and design developments, including a new custom latheable silicone hydrogel material, new hybrid lens designs and materials, and several new designs for normal and irregular corneas. The upcoming Global Specialty Lens Symposium is always a great venue to learn about new contact lens technology. This year's meeting includes a session on the impact of materials, designs, lens care and patient factors on contact lens safety that should be quite interesting.

In daily eyecare practice, we should always be cognizant of the impact on ocular health of the various types of lenses that we fit. Even daily disposable lenses can cause problems if the lens is not fit properly or the patient is not educated well enough on the proper use of their lenses. Irregular cornea patients are already at risk due to corneal compromise, so we must fit the patient with the best possible lens design with the most appropriate material to do as little to the ocular surface as possible. I am appreciative of those who develop new products for us to use, and I look forward to what 2012 will bring.

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Effect of Contact Lens Material on Cytotoxicity Potential of Multipurpose Solutions Using Human Corneal Epithelial Cells

Multipurpose solutions (MPS) are used daily to clean and disinfect silicone hydrogel (SiHy) contact lenses. This in vitro study was undertaken to identify the potential for interaction between MPS, SiHy surface treatments, and lens materials, which may lead to changes in the response of human corneal epithelial cells (HCEC) to MPS-soaked lenses.

The MPS tested were ReNu Fresh (formerly known as ReNu MultiPlus; ReNu), OptiFree Express (OFX), OptiFree RepleniSH, SoloCare Aqua, and Complete Moisture Plus. The SiHy materials evaluated were lotrafilcon A, lotrafilcon B, comfilcon A, galyfilcon A, and balafilcon A (BA). MPS-soaked lenses were placed on top of adherent HCEC. The effect of MPS dilutions (0.1 to 10% final concentration in medium) was also characterized. Cell viability, adhesion phenotype and caspase activation were studied after 24-hours cell exposure. OFX released from lenses was determined using UV absorbance.

A significant reduction in viability (between 30 to 50%) was observed with cells exposed to lenses soaked in ReNu and OFX. A significant downregulation of alpha(3) and beta(1) integrins, with integrin expression ranging from 60% to 75% of control (cells with no lens), was also observed with OFX and ReNu-soaked lenses. With the exception of BA, all other lenses soaked in OFX resulted in significant caspase activation, whereby over 18% of cells stained positive for caspases. Minimal caspase activation was observed in cells exposed to ReNu and Solo soaked lenses. For both OFX and ReNu, exposing cells to at least a 5% dilution had a significant effect on viability and integrin expression. While Complete and Solo did not lead to reduction in viability, cells exposed to a 10% dilution showed reduced integrin expression down to less than 70% of control value. Comparing cell response to diluted MPS solutions and various MPS-soaked lenses showed that it is not possible to reliably use cell response to MPS dilution alone to assess MPS biocompatibility.

The authors concluded that their results demonstrate that the reaction of HCEC to MPS are affected by the type of lenses the MPS is released from and may potentially be influenced by the surface treatment (or lack of it) of SiHy materials.

Gorbet MB, Tanti NC, Crockett B, Mansour L, Jones L. Effect of contact lens material on cytotoxicity potential of multipurpose solutions using human corneal epithelial cells. Molecular Vision. 2011;17:3458-67.

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