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Sunday, February 2, 2014  
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Last Question:

Which of the following is your patient most likely to do?

 Fill their contact lens prescription elsewhere

 Buy a year's supply of contact lenses from your office

 Buy a partial year's supply of contact lenses from your office
Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO
I was reminded recently when seeing a patient that they often forget or are unaware of many behaviors that make contact lens wear safe. This patient said she swims in her monthly soft lenses at least three times per week (and reuses her lenses). She claimed that no one had ever told this was not a safe behavior, as it increases the risk for infection. We kept the patient in her monthly lenses, but also fitted her in daily disposables for use when she swims. While the safest bet is to not wear contact lenses during swimming, this may not always be practical.

Another Successful GSLS Concludes

The Global Specialty Lens Symposium welcomed nearly 500 eyecare practitioners from 31 countries, 42 states and Puerto Rico to this year's conference in Las Vegas last weekend.

An expert international faculty covered in depth key topics including: myopia management, management of irregular corneas, contact lens discomfort, fitting presbyopes, and more. A variety of free papers and posters were also presented

Highlights included:

  • The 2014 Global Specialty Lens Symposium Award of Excellence Lecture given by Donald R. Korb, OD, entitled “The Odyssey of Contact Lens Discomfort: The Journey to Resolution."
  • Irregular Cornea Troubleshooting Panel which included Patrick J. Caroline, FAAO, FCLSA; Langis Michaud, OD, MSc, FAAO; Gregory DeNaeyer, OD, FAAO; Ann Pyck, Optometrist; Lynette Johns, OD, FAAO; Loretta Szczotka-Flynn, OD, PhD
  • A report on the findings of the Tear Film & Ocular Surface Society (TFOS) International Workshop on Contact Lens Discomfort from Jason J. Nichols, OD, MPH, PhD, José M. González-Méijome, OD, PhD, FAAO and William L. Miller, OD, PhD, FAAO

In addition, 46 exhibiting companies had an opportunity to present their latest innovations both in the exhibit hall and during special sponsored sessions.

Plan now to attend North America's largest specialty contact lens event in 2015. Next year's Global Specialty Lens Symposium is slated for Bally's Hotel and Casino in Las Vegas on January 22-25, 2015. Watch for details in Contact Lens Spectrum and at www.GSLSymposium.com.

SynergEyes Launches New Duette Lens for Presbyopes

SynergEyes, Inc. introduces its newest lens – Duette Progressive, designed to deliver exceptional vision at all distances for presbyopes from emerging to advanced.

Duette Progressive features a dual-aspheric optic design, which includes a center-near add zone with a choice of three add powers to give the practitioner greater control over the visual outcome. The lens also features an 84 Dk silicone hydrogel skirt around the 130 Dk center, which is made of UV-blocking materials. The Duette platform delivers all-day tear exchange and lens movement to make it an extremely comfortable and healthy lens option, according to the company.

The lens is fit with a straightforward, empirical fitting approach that minimizes the amount of chair time required and the company relates that practitioners are reporting successful outcomes with very few follow-up visits.

Duette Progressive lenses are available to patients only through the independent eye care professional. The empirical fitting approach enables practitioners to begin fitting Duette Progressive lenses with no investment in fitting sets while delivering a much improved first lens experience for the wearer. For more information, visit www.synergeyes.com/professional.

Valenti Joins IDOC Board of Directors

Past president of Bausch + Lomb, North America, Vision Care, Peter Valenti, III, has been appointed to the IDOC Board of Directors. In this role, Valenti's national perspective and experience will provide invaluable guidance to IDOC as the health care industry continues its evolution with the Patient Protection and Affordable Care Act (ACA).

Valenti brings more than two decades of experience in several health care industries to the IDOC Board of Directors. He has collaborated with both doctors and patients over the years, as past president of Bausch + Lomb, a position he held until 2013, and also at Johnson & Johnson Vision Care as vice president, Global Strategy, and vice president, U.S. Marketing.

The 2014 Optometric Business Conference hosted by IDOC will be held from April 3-6 in Atlanta, GA. An international Fulbright Scholar and expert on age-related macular degeneration, a chief economist with Morgan Stanley and a leading authority on the Affordable Care Act are just a few of the presenters who will be at the 2014 Optometric Business Conference. All independent ODs and their staff are welcome to attend. For more information, visit www.idoc.net.

Registration Opens for BCLA

With online registration now open, 100 sponsored two-day packages on offer and a new mobile app launching soon, the countdown to the BCLA’s “take-away” themed 2014 conference has begun.

All delegates will be able to build their own schedule prior to the four-day event, which for the first time will run from Friday to Monday, June 6-9. The initial program, which will be regularly updated, can now be viewed at www.bcla.org.uk. A mobile conference app will be available to download from the BCLA website or iTunes from February, enabling delegates to make appointments directly with exhibitors.

BCLA members with a minimum of two consecutive years of membership qualify for a loyalty discount and can save up to 45% on the full delegate rate, if booking by the early bird deadline of March 28. Those who join the Association prior to booking on March 28 will still save almost 25%. For the first time, there will be a special two-day package for delegates wanting to attend on just the Sunday and Monday. Rates plus terms and conditions can be found in the online.

Once again, in association with its exhibitors, the BCLA is offering 100 delegates the chance to attend two days of the conference for free. The sponsored delegate package includes a Sunday and Monday delegate pass, entry to the ‘Unceremonious Event’ on the Sunday night and Sunday night accommodation at a designated hotel. For full terms and conditions, visit the website.

AOA Optometrists Can Enroll Staff as Associate Members

Approximately 75,000 optometric staff members across the country have the opportunity to access exclusive American Optometric Association (AOA)-member benefits, thanks to a motion approved in 2013 that allows eye care professionals working for AOA-member ODs to become AOA associate members.

This new prospect ensures access to all Paraoptometric Resource Center member benefits and services at no membership cost to the paraoptometric and no added membership cost to the AOA-member optometrist. It also opens the door to expanded education and training for new optometric staff members.

The Commission on Paraoptometric Certification (CPC) status will not be affected by this change; the CPC will continue to operate without any changes.

To enroll staff:
1. Log in to www.aoa.org
2. Under the “Optometrist” tab, click on “My Profile/My AOA”
3. Click on the "Manage Staff" tab
4. Enter information for each staff person (non-OD)

For questions or assistance, contact the AOA Paraoptometric Resource Center at prc@aoa.org or call 800-365-2219, ext. 4108.

Boris Severinsky, MOptom, Jerusalem, Israel

This is an image of a patient with keratoglobus. Please note limbal steepening and superior cornea neovascularization (arrows).

We thank Boris Severinsky 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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David Kading, OD, FAAO

Multifocal Lens Optics: ERROR ERROR (part 2)

Last time in Materials and Design (http://www.cltoday.com/new/issue_011914.asp) we discussed utilizing topography to discover that the line of sight does not always run through the center of the cornea. This misalignment is problematic for multifocal contact lens wearers because they are do not look through the intended optics of their lenses.

Here are three quick ways to discover if your patient’s line of sight is off:
1. Utilizing your pupilometer (yes that binocular looking thing in your optical that you have not used since your dispensing class in school), if the little light reflection does not show up in the center of the patient’s pupil,
2. If the cross-hair on your topographer print out is NOT in the center of the pupil ring,
3. If the patient’s pupil is not centered in your crosshair when you are doing autorefraction.

If your patient has any of these misalignments and is not getting the visual acuity that you expected, you may want to ensure that your patient is in a near center aspheric design. Near aspheric designs are more forgiving than distinctive concentric rings and easier to modify the power profile for patients. An alternative for patients with very large angles is to switch them into segmented bifocal GP lenses. Good luck and happy fitting.

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S. Barry Eiden, OD, FAAO

Compliance to Contact Lens Case Care – It’s Just a Matter of Education

A study was conducted to discover if there was a relationship between the efficacy of written instructions pertaining to contact lens case hygiene and rate of contact lens case contamination.

Researchers retrospectively analyzed data from 16 contact lens studies where six silicone hydrogel contact lens designs and seven contact lens care solutions were tested in similar protocols. Verbal instructions regarding case hygiene (rinse case with lens care solution, not tap water) were given in nine studies, while the same instructions were given verbally and in written format in seven studies. Contact lens cases were used for 1 month and collected for microbial analysis at the 1- and 3-month visits. The rate of case contamination and the types of microbes contaminating cases were evaluated. A survey on contact lens, lens care solution, and lens case hygiene was completed at 1- and 3-month visits and compliance with case hygiene instructions was determined.

The outcomes found that subjects given verbal and written instructions for contact lens case hygiene were more likely to be compliant than those only given verbal instructions (odds ratio 2.19, p < 0.001). The overall contact lens case contamination rate was 79% and the use of tap water to rinse cases was associated with significantly greater risk for Gram-negative bacterial contamination vs. those that did not use tap water rinse (30% vs. 10%, p < 0.001).

The conclusion of the study was that patients will demonstrate much better contact lens case hygiene when given the most effective education regarding such behavior which would include both verbal and written instructions. Additionally, patients should be clearly instructed NOT to utilize tap water to rinse their contact lens cases.

Education is always a key element of compliance. Simply telling patients what to do is often ineffective. Explaining the reasons why we prescribe care methods and materials allows our patients to understand the risks of non-compliant behavior. The use of written materials (either in print or in electronic media) will further reinforce and improve the efficacy of our efforts. These principles can be applied to other aspects of contact lens compliance in our practices.

Tilia D, Lazon de la Jara P, Zhu H, Naduvilath TJ, Holden BA. The Effect of Compliance on Contact Lens Case Contamination. Optom Vis Sci. 2014 Jan 9. (Epub ahead of print)

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Dry Eye in the Beaver Dam Offspring Study: Prevalence, Risk Factors, and Health-Related Quality of Life

The purpose of this cohort study was to estimate dry eye prevalence in the Beaver Dam Offspring Study (BOSS), including a young adult population, and investigate associated risk factors and impact on health-related quality of life.

The BOSS (2005-2008) is a study of aging in the adult offspring of the population-based Epidemiology of Hearing Loss Study cohort. Questionnaire data on health history, medication use, risk factors, and quality of life were available for 3275 participants. Dry eye was determined by self-report of frequency of symptoms and the intensity of those symptoms. Associations between dry eye and risk factors were analyzed using logistic regression.

The prevalence of dry eye in the BOSS was 14.5%, 17.9% of women and 10.5% of men. In a multivariate model, statistically significant associations were found with female sex (Odds Ratio (OR), 1.68; 95% Confidence Interval (CI), 1.33-2.11), current contact lens use (OR, 2.01; 95%CI, 1.53-2.64), allergies (OR, 1.59; 95%CI 1.22-2.08), arthritis (OR, 1.44; 95%CI, 1.12-1.85), thyroid disease (OR, 1.43; 95%CI, 1.02-1.99), antihistamine use (OR, 1.54; 95%CI, 1.18-2.02), and steroid use (OR, 1.54; 95%CI, 1.16-2.06). Dry eye was also associated with lower scores on the Medical Outcomes Short Form-36 (ß=-3.9, p<0.0001) as well as on the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) (ß=-3.4, p<0.0001) when controlling for age, sex, and comorbid conditions.

The authors concluded that the prevalence of dry eye and its associated risk factors in the BOSS were similar to previous studies. In this study, DES was associated with lower quality of life on a health-related quality of life instrument and the vision-specific NEI-VFQ-25.

Paulsen AJ, Cruickshanks KJ, Fischer ME, Huang GH, Klein BE, Klein R, Dalton DS. Dry Eye in the Beaver Dam Offspring Study: Prevalence, Risk Factors, and Health-Related Quality of Life. Am J Ophthalmol. 2014 Jan 2. [Epub ahead of print]

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To report adverse contact lens reactions visit: http://www.accessdata.fda.gov/scripts/medwatch/ or call (800) FDA-1088.
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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