From time-to-time, we have printed a "Top 10 List" of items in the contact lens field that are most buzz worthy, topical, or are in need of discussion. Items in the past have included, amongst other things, options for myopia control, drug delivery, dry eye, material-solution issues, and threats or obstacles to the growth of contact lenses in practice. It is helpful for us to ask for your thoughts in this regard. What would you place on your Top 10 List? Please send me your thoughts (jnichols@optometry.uh.edu).

Allergan, Inc. announced the launch of Refresh Optive Advanced, a new over-the-counter artificial tear option for patients suffering from dry eye symptoms. Refresh Optive Advanced is a lipid-enhanced tear with the low blur and comfort of an aqueous tear. It features a comprehensive, triple-action formulation that works on all three layers of the tear film to reduce tear evaporation, hydrate and lubricate for dry eye symptom relief.

With its comprehensive, triple-action formulation, Refresh Optive Advanced stabilizes the tear film layer resulting in relief from dry eye symptoms, according to the company. It contains a lipid that reinforces the lipid layer, hydrates and increases volume to the aqueous layer, and provides advanced lubrication and protection to the mucin layer. It also penetrates the surface to provide osmoprotection to the corneal epithelial cells from excessive salt levels. Due to its optimized lipid content, Refresh Optive Advanced does not separate. Instead, it provides consistent stability resulting in no shaking prior to use.

Refresh Optive Advanced is available in 10 mL bottles and can be found at retail locations where over-the-counter eyecare products are sold.

To find out more information about Refresh Optive Advanced, please visit www.refreshbrand.com.

TearScience, Inc. announced that it has received U.S. Food and Drug Administration (FDA) clearance for the next generation product of its LipiFlow Thermal Pulsation System, a medical device that treats evaporative dry eye by liquefying and evacuating obstructions in meibomian glands located in the eyelids. The second generation product includes a more robust graphical user interface and provides the ability for physicians to treat both of a patient's eyes simultaneously.

The new LipiFlow console incorporates an enhanced graphical user interface by controlling pressure and displaying the treatment temperature, pressure sequence and treatment time remaining. It also allows users to store a record of the treatment on the device and on electronic medical record servers, eliminating the need to manually document the treatment in patient records.

The product will be commercially available in March 2012. Those currently using TearScience's first generation LipiFlow will be upgraded to the new system.

For additional information, visit www.tearscience.com.

The deadline for applications for 2012 Fellowship of the British Contact Lens Association (BCLA) has been extended to April 30 to allow members more time to apply.

Since the fellowship program was launched in 2006, a total of 133 professionals from the international community of the contact lens industry and practice have become BCLA Fellows following viva voce assessment at the annual BCLA Clinical Conference.

For further details about BCLA Fellowship and to apply, visit www.bcla.org.uk.

In the latest edition of Healthy Vision with Dr. Val Jones, her guest Dr. Jeffrey Anshel explains how digital devices affect our eyes and what we can do to help prevent or reduce the development of vision-related problems when using them. He identifies some of the common problems he sees in how computer work stations are set up and offers advice on how proper monitor placement and lighting can help reduce many potential eye and/or vision problems. He also offers tips on what we can do to minimize or prevent eye strain discomfort and fatigue from computer or small device use.

Healthy Vision with Dr. Val Jones is devoted to educating and improving the eye health of Americans. The program is supported by Acuvue Brand Contact Lenses. Free podcasts of the series can be found in the iTunes Store (for best results, search for the show by its complete title in LifeMinute.TV Health) and on BlogTalk Radio (www.blogtalkradio.com/healthyvision).

A patient who had dry eyes while wearing soft lenses was fit into a cornea-scleral lens. He now enjoys 20/15 vision and clear, comfortable vision all day with no dry eye complaints

We thank Dr. Woo for her image and 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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CARE SOLUTION CORNER
Susan J. Gromacki, OD, MS, FAAO

Cleaning and Disinfecting GP Contact Lenses for Keratoconus

At the 2012 Global Specialty Lens Symposium in Las Vegas last week, I asked educators, clinicians, and industry members the following question: regarding gas permeable (GP) contact lens care, are there any differences in your recommendation for patients with keratoconus (KC) versus those with healthy corneas? Most everyone I surveyed reported no differences.

There are a few recommendations from industry. First, the SynergEyes ClearKone lens requires either Clear Care (Alcon) or Oxysept UltraCare (Abbott Medical Optics) for disinfection and non-preserved saline for rinsing. In addition, scleral lenses also need unique care. But for corneal and corneal-scleral lenses, there are some things we can do to provide an optimal GP lens-wearing experience. First of all, this is a diseased cornea; it is important to keep KC lenses clean. A digital rubbing step (in the palm of the hand) is non-negotiable. Enzymatic treatment may be required. New GP lenses should include plasma treatment to provide an initial clean, wettable surface. (Recall that a non-abrasive cleaner should be used during the life of the treatment, approximately 6 months.) Avoid tap water, even for rinsing, to eliminate potential exposure to Acanthamoeba.

As we all know, it is often difficult to achieve 20/20 vision in KC, even with GP lenses. Every scratch and deposit on the lens—not to mention any corneal scarring or desiccation—can decrease VA even further. So recommend appointments at least every 6 months to ascertain a good lens fit, lens condition, and ocular health.

Perhaps, with increased understanding of the KC disease process and solution biochemistry, there will be care systems and regimens tailored specifically for keratoconus in the future. As for now, it is important to remember that caring for a KC lens means caring for a KC patient.

For additional information, please review: http://www.clspectrum.com/articleViewer.aspx?articleID=106171 and http://www.clspectrum.com/articleViewer.aspx?articleID=106545

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Which is worse: dry eye, blindness, or fear of death?

Did you know that twice as many people fear blindness over death,¹ and that dry eye patients would be willing to trade years of life to not experience dry eye symptoms?² Well, if you've ever walked through a casino in Las Vegas, as I did for the recent Global Specialty Lens Symposium, you know first-hand how irritating cigarette smoke can be, especially for someone who suffers from dry eye, as well as the negative health effects of smoking. What you may not realize is that smoking can have a detrimental effect on tear film composition. Tear proteins are different in smokers, and this correlates with an increase in dry eye symptoms.³ Another study found that smoking reduced TBUT, tear secretion and corneal sensitivity—these measures worsened with increased cigarette consumption.⁴

Smoking cessation is a conversation patients generally prefer to avoid (cue eye roll)! What most smokers don't know is that their habit increases the potential for central vision loss and blindness, and directly contributes to their dry eye symptoms. I've had several patients express thanks for helping them quit because they were introduced to this information during a simple 30 second discussion in my office. So ignore that eye roll and have this important conversation with your patients. Not only will you improve their dry eye symptoms, you might just be talking to that greater sector of the population who fear blindness more than death, and change their life.

1. http://www.ncbi.ie/news/press-releases/2008-03-07_twice-as-many-people-fear-blindness-more-than-premature-death
2. Schiffman RM, Walt JG, Jacobsen G, Doyle JJ, Lebovics G, Sumner W. Utility assessment among patients with dry eye disease. Ophthalmology. 2003 Jul;110(7):1412-9.
3. Grus FH, Sabuncuo P, Augustin A, Pfeiffer N. Effect of smoking on tear proteins. Graefes Arch Clin Exp Ophthalmol 2002. Nov;240(11):889-92
4. Yoon KC, Song BY, Seo MS. Effects of smoking on tear film and ocular surface. Korean J Ophthalmol 2005 Mar; 19(1): 18-22.

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VIEWS FROM ABROAD
Guest Columnists: Takashi Kojima, MD; Murat Dogru, MD; Kazuo Tsubota, MD; Catherine Oshima, MD

A Japanese Perspective

In Japan, either 2-week disposable or 1-day disposable soft contact lenses (CLs) have become the preferred lenses among contact lens wearers. From the viewpoint of contact lens material, the market share of silicon hydrogels is increasing. We expect that these trends will continue. While most of CL wearers use multi-purpose solution for disinfection, we still encounter many contact lens-related corneal infections, including Acanthamoeba keratitis. Inappropriate use of disinfectants is thought to be the cause of corneal infection. Continual patient education of the proper handling and care of CLs is essential.

In March 2011, Japan experienced a devastating natural disaster. We found that many victims were CL wearers who faced a shortage of contact lenses and eyecare services. Our department supported sufferers wearing CLs by sending new disposable contact lenses. During this process, we experienced several problems; such as most CL wearers did not know their CL power exactly. As ophthalmologists living in Japan, we need to investigate the problems faced during the evacuation from the disaster area for CL wearers or visually impaired persons, learn from the situation, and prepare for such an event that may possibly occur again in the future.

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Researchers wanted to evaluate the influence of cone location and corneal cylinder on GP corrected visual acuities and residual astigmatism in patients with keratoconus.

In this prospective study, 156 eyes from 134 patients were enrolled. Complete ophthalmologic examination including manifest refraction, best spectacle visual acuity (BSCVA) and slit-lamp biomicroscopy was performed, and corneal topography analysis was done. According to the cone location on the topographic map, the patients were divided into central and paracentral cone groups. Trial RGP lenses were selected based on the flat Sim K readings and a 'three-point touch' fitting approach was used. Over contact lens refraction was performed, residual astigmatism (RA) was measured and best-corrected RGP visual acuities (RGPVA) were recorded.

The mean age (+/-SD) was 22.1+/-5.3 years. 76 eyes (48.6%) had central and 80 eyes (51.4%) had paracentral cone. Prior to RGP lenses fitting mean (+/-SD) subjective refraction spherical equivalent (SRSE), subjective refraction astigmatism (SRAST) and BSCVA (logMAR) were -5.04+/-2.27D, -3.51+/-1.68D and 0.34+/-0.14, respectively. There were statistically significant differences between central and paracentral cone groups in mean values of SRSE, SRAST, flat meridian (Sim K1), steep meridian (Sim K2), mean K and corneal cylinder (p-values<0.05).

Comparison of BSCVA to RGPVA shows that vision has improved 0.3logMAR by RGP lenses (p<0.0001). Mean (+/-SD) RA was -0.72+/-0.39D. There were no statistically significant differences between RGPVAs and RAs of central and paracentral cone groups (p=0.22) and (p=0.42), respectively. Pearson's correlation analysis shows that there is a statistically significant relationship between corneal cylinder and BSCVA and RGPVA, however, the relationship between corneal cylinder and residual astigmatism was not significant.

The researchers concluded that cone location has no effect on the RGP corrected visual acuities and residual astigmatism in patients with keratoconus. Corneal cylinder and Sim K values influence RGP-corrected visual acuities but do not influence residual astigmatism.

Nejabat M, Khalili MR, Dehghani C. Cone location and correction of keratoconus with rigid gas-permeable contact lenses. Cont Lens Anterior Eye. 2012 Feb;35(1):17-21.

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