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Sunday, January 29, 2012  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

The modern contact lens practice is being challenged in many regards. Specialty contact lens fits are sometimes not being recognized by insurers for reimbursement. Contact lenses are being sold by "big box" stores for less than their original cost. Contact lens coursework within training programs is being cut. I certainly recognize the challenges of today's contact lens practice. Yet, the ability to provide sight when other refractive options fail keeps many of us passionate about contact lenses.

Record Attendance at GSLS

The Global Specialty Lens Symposium welcomed a record 460 eyecare practitioners from 31 countries to this year's conference in Las Vegas this weekend.

An expert international faculty covered in depth key topics including: competing theories of myopia control, management of irregular corneas, risk factors impacting safe contact lens wear, fitting presbyopes, the latest options for dry eye, contact lens comfort and more. A variety of free papers and posters were also presented.

In addition, 42 exhibiting companies had an opportunity to present their latest innovations both in the exhibit hall and during special sponsored sessions.

Look for highlights of the meeting in future issues of Contact Lens Spectrum.

Dakota Sciences Appoints Lenticon Distributor

Dakota Sciences and Laboratorios Lenticon (Lenticon) have entered into an exclusive agreement allowing Lenticon to manufacture and distribute the patented SoClear Lens Technology throughout Spain, Andorra and Chile.

The patented So2Clear Lens is a larger diameter GP that, when coupled with today's high Dk GP materials, delivers both comfort and excellent visual acuity, according to the company. The result is a lens that offers optimum centration, extreme stability and delivers clear, comfortable, healthy vision.

For further information or questions about So2Clear Lens availability in the markets served by Lenticon, please email comercial@lenticon.com or call +34 918042875.

CLSA to Hold 57th Annual Meeting in Newport Beach

The Contact Lens Society of America (CLSA) announced it will hold it's 57th Annual Education Meeting at the Newport Beach Marriott Hotel & Spa in Newport Beach, California on April 25-28, 2012. The meeting's theme will be: Improving Vision. Changing Lives.

Highlighting this year's meeting will be a 2-hour COPE and NCLE approved Practice Management Symposium, a 2-part general session on Management of Keratoconus and other Ectasia, a 3-hour Exam Review for the NCLE Advanced Examination, Fitting Kids with Contact Lenses, a session on the new Hybrid Lenses, news on fitting patients with Presbyopia, and much more.

For more information on the meeting, including registration and exhibit information, go to www.clsa.info, or contact CLSA at (800) 296-9776.

Optometry: Journal of the AOA Last Printed Edition

Seeking to keep the American Optometric Association (AOA) at the forefront of communication media changes and meet the needs of an evolving membership base, the AOA Board announced a new direction for the organization's publishing operation. Beginning in February, Optometry: Journal of the AOA will be available online only. The January 2012 issue will be the last one printed and mailed to AOA members.

In a letter to membership announcing the change, the organization cited projected dramatically increased costs as one reason for the decision.

According to the letter, the AOA intends to publish already-submitted articles online-only over the coming months, to honor commitments to authors already made. Elsevier will continue to host archived editions of the Journal at optometryjaoa.com as part of its commitment to subscribers.

Terrien's Marginal Degeneration
By Edgar Davila-Garcia, OD

This is a case of Terrien's Marginal Degeneration (TMD). TMD is a bilateral and asymmetric disease of the peripheral cornea of unknown etiology. The clinical signs are: peripheral corneal thinning, lipid deposition, vascularization and opacification. This condition causes ectasia and in some cases even corneal perforation. These photos are of a 37 year-old female patient suffering the condition in both eyes. The OD (top) is worse than the OS (lower). In this case the BCVA with eyeglasses is 20/100 OD and 20/30 OS.

We thank Dr. Davila-Garcia for his images and 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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Loretta B. Szczotka-Flynn, OD, PhD, MS, FAAO

An Update on Corneal Infiltrates

Two large retrospective chart reviews have been published, which provide more insight into infiltrative events during daily and extended wear. In August 2011, Chalmers et al (IOVS 2011) published a retrospective review of 3,549 SCL wearers (8-33 years of age) in which they captured 187 corneal infiltrative events (CIEs) in 168 wearers from January 2006 to September 2009. Age was a significant risk factor, peaking between 15 and 25 years. Less than 1 year of SCL use was protective (vs. longer years of wear). Use of multipurpose care products (2.86×), silicone hydrogels (1.85×), and extended wear (2.37×) were significantly associated with CIEs when controlling for confounding variables.

Similarly, Chalmers and other colleagues (OVS 2012 Epub) performed a retrospective, multicenter case-control study at five academic eye care centers. They identified 166 patients with symptomatic CIEs and known extended wear (EW) status and each case was matched to three controls each who had received eye care near the time of the patients with CIEs. Among daily wear users, use of reusable SCLs (12.46×) (i.e. daily disposables were protective), silicone hydrogel lenses (1.99×) and younger age were associated with an increased risk. Of >50 different lens types and >10 solution brands involved in CIEs, no specific lenses or care products were associated with increased risk. Among all cases, EW was also a risk factor (3.98×).

These two studies show the importance of retrospective research to highlight important associations that should be further studied in prospective clinical studies. Jointly, these two studies point to younger age (in particular teens and young adults), silicone hydrogel lens wear, and extended wear, as important risk factors for corneal infiltrates that deserve continued attention in research and development.

Chalmers RL, Wagner H, Mitchell GL, Lam DY, Kinoshita BT, Jansen ME, Richdale K, Sorbara L, McMahon TT. Age and other risk factors for corneal infiltrative and inflammatory events in young soft contact lens wearers from the Contact Lens Assessment in Youth (CLAY) study. Invest Ophthalmol Vis Sci. 2011 Aug 24;52(9):6690-6.
Chalmers RL, Keay L, McNally J, Kern J. Multicenter Case-Control Study of the Role of Lens Materials and Care Products on the Development of Corneal Infiltrates. Optom Vis Sci. 2012 Jan 5. [Epub ahead of print]

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Guest Contributor: Heiko Pult, PhD, MSc, FAAO, FBCLA, FEAAO

Keys to Success with Contact Lenses, A German Perspective

I was recently at the largest trade show in Munich and was able to interview my German colleagues to capture their personal impression as to what key-factors are associated with contact lens success.

The main key factor reported was "wearing comfort" followed by "presbyopia correction" and "safety." The clinicians I interviewed felt that silicone hydrogel lenses (SiHy) often improve contact lens wearing comfort, but claimed that even so 30-50% of their lens wearers still experience discomfort due dry eye symptoms. They feel that new materials with better 'lubricity' might be promising in reducing friction during the blink and improving comfort.

Fitting multifocal lenses was reported to still be challenging but the larger choice of different multifocal lens types now available, especially from some smaller companies, was mentioned as improving fitting success.

My German colleagues recognized SiHys as generally being a more healthy material option than traditional hydrogels but the occurrence of infiltrates and keratitis still seems to be unchanged in their minds. Many clinicians felt that daily disposable silicone hydrogel lenses might reduce infiltrates and adverse events, even though there were still questions in my colleagues' minds about continued compliance and hygiene. Hopefully continuing discussions will lead to further insights about contact lens practice across the globe.

Heiko Pult, PhD, MSc, FAAO, FBCLA, FEAAO
Optometry and Vision Research, Weinheim, Germany
Contact Lens & Anterior Eye Research Unit, School of Optometry and Vision Sciences, Cardiff University, UK

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Confocal Microscopic Observations of Stromal Keratocytes in Soft and Rigid CL Wearers

Researchers in Japan wanted to determine the density of corneal stromal cells in wearers of soft contact lenses (SCLs) and rigid gas-permeable (RGP) contact lenses (CLs).

The keratocyte density (KD) was measured at different depths of the stroma by confocal microscopy. In study 1, 32 wearers of rigid gas-permeable (RGP) lenses and 30 wearers of SCLs were studied. Forty volunteers with no history of CL wear were studied as controls. In study 2, 16 volunteers with no history of CL wear were divided into two groups; seven subjects wore RGP lenses (oxygen transmissibility, Dk/L, 35) and nine subjects wore SCLs (Dk/L, 34). All subjects were asked to wear the CLs daily for six months.

In study 1, the KDs in the anterior stroma (AST) and the posterior stroma (PST) of the cornea were significantly lower in the RGP lens group than in the control group. The KD in the SCL group was significantly lower at all depths of the cornea than that of the control group. In study 2, the KD in the AST of the RGP lens group was significantly lower after one month of CL wear. The KD in the AST and PST of the SCL group was decreased significantly at one month, and all layers were decreased by 10% to 20% six months after wearing CLs. At five weeks after discontinuation of SCL wear, the KD in all layers was not significantly different from that at the baseline.

The researchers concluded that the change in the KD was greater in CL wearers than in volunteers with no history of CL wear and also greater in SCL wearers than in RGP lens wearers. Analysis of the KD by confocal microscopy may be a useful method for evaluating the effect of CL wear.

Ohta K, Shimamura I, Shiraishi A, Ohashi Y. Confocal microscopic observations of stromal keratocytes in soft and rigid contact lens wearers. Cornea. 2012 Jan;31(1):66-73.

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