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Sunday, February 3, 2012  
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Last question:
What is the primary reason why you fit scleral contact lenses?

 A. Keratoconus

 B. Irregular cornea due to refractive surgery

 C. Ocular surface disease

 D. Corneal dystrophy/degeneration

Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

As you have probably heard, influenza in the United States is quite widespread this year. As of the week of January 19, 2013, over 80% of cases are of the influenza type A, most of which appear to be of the H3N2 variant (63%). The good news is that the flu vaccine appears to be relatively effective against the flu, assuming we and our patients have been vaccinated. However, no vaccine is 100% effective and we know that there are still many people who do not get vaccinated. Stay vigilant in the care of yourself and your patients in this regard. Simple things like staying home when symptomatic and washing hands can help prevent further spread.

Successful 2013 GSLS Concludes - 2014 Dates Announced

Over 500 attendees from 32 countries spent 2 ½ days enjoying a conference jammed with comprehensive education from an international faculty, updates on the latest innovations from 46 exhibiting companies, and opportunities to network with their colleagues at the Global Specialty Lens Symposium. The annual meeting focuses on the latest techniques and technologies for the successful management of ocular conditions using today's specialty contact lenses. This year's program was designed to cover every aspect of the specialty lens practice, from fundamentals to post-surgical fitting and patient management issues.

Key topics covered in depth by the 40 faculty members included research on myopia control, the latest in our understanding of corneal shape, management of irregular corneas, fitting presbyopes, large diameter lens complications, an update on corneal cross-linking, lens care and risk factors impacting safe contact lens wear, and much more.

The inaugural GSLS Award of Excellence was presented to Brien Holden, PhD, DSc, OAM. This award is presented to an individual who's lifetime achievements and contributions have advanced the field of contact lenses. Professor Holden is a world leader in vision science, eye health and blindness prevention. His contributions extend across research, education, public health and social enterprise. He has generated over $1 billion in research, education and humanitarian funds over the last 20 years and been described as "the most influential optometrist of our generation."

A variety of free papers were presented and over 50 clinical and scientific posters were submitted. Winners of the 2013 poster awards were announced: Investigation of Myopic Periphery Affecting Choroidal Thickness (IMPACT): 1-Month Results by Dustin Gardner, OD, et al; Use of Daily Wear Multifocal Contact Lenses in the Treatment of Convergence Excess by Erin Kindy, et al; Toric Haptics in Scleral Lens Design: A Case Series by Muriel Schornack, OD, FAAO and Eye Surface Profiler: A New Quality in The Measurement of Anterior Eye Surface by D. Robert Iskander, PhD, DSc.

Watch for the March edition of Contact Lens Spectrum for a recap of this dynamic meeting.

The 2014 Global Specialty Lens Symposium is set for January 23-26 and will once again be held at the Rio Hotel in Las Vegas. More information will be available through Contact Lens Spectrum and the website as plans and agenda are solidified.

The Eye Show London 2013 Cancelled

The Event Director for The Eye Show London, Dawn Kime, announced via the show's website that the event has been cancelled. The show, due to open February 12, was planned to include conference sessions and an exhibition which was to include over 100 exhibitors per the listing posted on the site.

According to the announcement, the show management is devastated that this will have caused inconvenience and cost to the exhibitors, speakers and visitors who have preregistered to attend, and the people who have supported The Eye Show.

Neurotrophic Keratopathy
By Gregory W. DeNaeyer, OD, FAAO

Pictured is the right eye of a 69-year-old patient who had corneal scarring, neovascularization, and neurotrophic keratopathy secondary to previous Herpes Zoster ophthalmicus. Unaided visual acuity of his right eye is count fingers. The patient was currently using Genteal gel q.i.d. and Optive (Allergan) t.i.d. in his right eye. He also takes Acyclovir 400mg b.i.d. after having previous Zoster-related uveitis.

Neurotrophic keratopathy occurs after loss of nervous innervation to the cornea that can result from a viral infection such as Herpes Simplex or Herpes Zoster. Neurotrophic keratopathy can also manifest after radiation treatment or directly from a tumor. Corneas that have lost innervation may develop superficial punctate keratitis (SPK) or a persistent epithelial defect (PED). Treatment depends on severity but may include lubrication, bandage contact lens, tarsorrhaphy, or amniotic membrane transplantation. A full-thickness corneal transplant in a patient who has a neurotrophic cornea is often avoided secondary to an increased risk of graft failure.

For more on this patient, visit http://www.clspectrum.com/articleviewer.aspx?articleID=106726.

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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Ronald K. Watanabe, OD, FAAO

Got Glare?

Occasionally, I'll have a patient with unusually large pupils who comes in complaining of nighttime glare with their contact lenses. Invariably, they are wearing a disposable lens of some sort, and often they have a high minus refractive error. The lens may be well-centered, but the patient is unhappy. This is because the limited optic zone diameter can encroach on the pupil when in its most dilated state, allowing unfocused light going through the junction and carrier zone to enter the eye. This is particularly true for high minus and plus powered lenses where the optic zones are even smaller due to lenticulation required to keep lens profile thickness to a minimum.

In these cases, the patient may need a custom lens. There are many custom laboratories that can adjust a number of soft lens parameters, including the optic zone. A couple of things to keep in mind: (1) a larger OZD will create more central or peripheral thickness depending on lens power, and a larger lens diameter may be needed to allow sufficient lenticulation; (2) the increase in sagittal depth due to the larger OZD will require flatter lens curvatures to provide a proper fitting relationship. The bottom line is that you should not hesitate to call a custom lab and design a special lens for your patients in need.

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

Scleral Lens Research

The recent Global Specialty Lens Symposium meeting in Las Vegas was filled with plentiful and practical methods and tips for fitting scleral and semi-scleral lenses. New scleral lens fitting sets were launched, and fitting complications were reviewed by many speakers. It's obvious that the majority of specialty contact lens fitters are moving in the direction of fitting scleral and semi-scleral lenses on both irregular and regular corneas. A common theme of the meeting was how to treat "mid-day foggy vision" with scleral lenses, usually assumed to be due to entrapped posterior lens debris. In fact, one excellent free paper presented by William Miller OD, PhD from University of Houston addressed this exact issue.

Although the literature has a good amount of research demonstrating the therapeutic use of scleral lenses as prosthetic devices, there is little published research on the contributing factors and management options for scleral lens complications. One can find case series of the successful use of both scleral and cornea-scleral lenses in irregular cornea patients,1-4 but I could not find any published data on the incidence, prevalence or risk factors for common scleral lens complications. As seen at the meeting, lots of research is going on in these areas and I encourage all the authors to publish their findings. For now, the rest of us interested fitters should attend these cutting edge meetings and learn from others.

1. Pecego M, Barnett M, Mannis MJ, Durbin-Johnson B. Jupiter Scleral Lenses: the UC Davis Eye Center experience. Eye Contact Lens. 2012 May;38(3):179-82.
2. Schornack MM, Baratz KH, Patel SV, Maguire LJ. Jupiter scleral lenses in the management of chronic graft versus host disease. Eye Contact Lens. 2008 Nov;34(6):302-5.
3. Romero-Jiménez M, Flores-Rodríguez P. Utility of a semi-scleral contact lens design in the management of the irregular cornea. Cont Lens Anterior Eye. 2013 Jan 3. [Epub ahead of print]
4. Schornack MM, Patel SV. Scleral lenses in the management of keratoconus. Eye Contact Lens. 2010 Jan;36(1):39-44.

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Coinfection with Acanthamoeba and Pseudomonas in Contact Lens-Associated Keratitis

These researchers reported on a case of coinfection with Acanthamoeba and Pseudomonas aeruginosa in a case with contact lens-associated keratitis.

A 20-year-old woman presented to the emergency department of the hospital with a 4-day history of progressively increasing pain, redness, photophobia, mucopurulent discharge, and diminution of vision in her right eye. She was being treated for contact lens-related Pseudomonas keratitis in another hospital before presentation. Gram stain of corneal scrapings revealed gram-negative bacilli. Both Gram stain and 10% KOH wet mount showed the presence of Acanthamoeba cysts. Microbiological cultures obtained from contact lenses and contact lens storage case showed the presence of Pseudomonas aeruginosa and Acanthamoeba. Topical therapy was started in the form of hourly gentamycin 1.3%, cefazolin 5%, chlorhexidine 0.02%, propamidine 0.1%, polymyxin B 30,000 IU eye drops, and neosporin (neomycin, bacitracin, polymyxin) eye ointment four times a day. Symptomatic improvement was observed within 48 hours, along with a decrease in the density of infiltrates and a reduction in the anterior chamber reaction. Repeat corneal scrapings on day 10 showed Acanthamoeba but no bacilli. Progressive resolution of the infiltrate was noted during the next few days. Epithelialization was complete by day 24, following which the amoebicidal therapy was tapered during the next 4 weeks. Complete resolution of keratitis was achieved after 7 weeks of treatment. The authors concluded that both P. aeruginosa and Acanthamoeba are potentially devastating causes of microbial keratitis. The case highlights the importance of considering the possibility of a concurrent infection in cases with contact lens-related keratitis.

Sharma R, Jhanji V, Satpathy G, Sharma N, Khokhar S, Agarwal T. Coinfection with Acanthamoeba and Pseudomonas in Contact Lens-Associated Keratitis. Optom Vis Sci. 2013 Feb;90(2):e53-5.

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