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Sunday, February 6, 2011  
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Care Solution Corner
Susan J. Gromacki, OD, MS, FAAO

Last weekend, I had the absolute privilege of moderating the Lens Care and Compliance Panel at the Global Specialty Lens Symposium in Las Vegas. The international experts (Philip Morgan, Pauline Cho, and Michael Ward) educated the audience on leading-edge technologies and research on the topic of lens care.

Dr. Cho presented that biofilm (multicellular formations of organisms, including bacteria) research is important and increasing in popularity. Among contact lens wearers with diagnosed microbial keratitis, biofilms were found more frequently on a patient's lens case than on his contact lenses. And what's more, the transfer of the pathogens from case to eye is performed via the contact lens. To avoid such transmission, she advised cleaning the case every day with a contact lens cleaner/multipurpose solution and brush, then drying it; soaking the case weekly with just-boiled water; and replacing the case every month.

Ocular Surface Update
Kelly K. Nichols, OD, MPH, PhD, FAAO

In the recently published 2010 Annual Report on Contact Lenses (click here), I was surprised to see in the Quick Poll data that approximately 30% of responders to the question "When is the average incident age range at which time CL wearers first develop symptoms of dry eye?" answered 31-35 years, followed closely by 26-30 years of age. At first read, I would have expected the older age groups (36-40 years, 15% and 41+, 12%) to be much higher. However, in thinking about female contact lens wearers with dry eye symptoms, as well as those that finally discontinue lens wear due to dryness and discomfort, very likely the first symptoms occurred years before they quit wearing lenses.

In public health terms, primary prevention is the process of averting the occurrence of disease, secondary prevention means halting the progression of disease from the early, unrecognized stage, and tertiary prevention focuses on rehabilitation of present disease. The U.S. health care system spends millions of dollars on tertiary prevention, aka disease management. The statistic presented above indicates symptomatic dry eye may present earlier in our contact lens patients than previously thought, and thus our efforts in dry eye should be aimed at secondary prevention (early identification), or even better, primary prevention, before the disease occurs. Stay tuned for more on that topic in future editions.


Dr. Robert Mandell Retires from Consulting with ABB Concise

Robert B. Mandell, OD, PhD, retired in January after a 37-year career as a consultant to ABB Concise. Dr. Mandell retired from his 32-year career as a member of the University of California, Berkeley faculty in 1998, but continued to work on research and development by providing consultative services to ABB Concise.

Dr. Mandell, a prolific lecturer, educator and writer, particularly well known for authoring the textbook Contact Lens Practice, is also a pioneer in contact lens design and manufacturing. He developed the first one-piece bifocal contact lens without image jump for ABB Concise more than thirty years ago. His innovations include R&D on standards for contact lens edges, minus lenticular designs, prism principles, toric designs and many other aspects of contact lens manufacturing.

In 1988, he and Carl Moore, former Con-Cise president, co-developed a guide to calculate bitoric contact lens powers: the Mandell/Moore bitoric calculation formula, which is still used today.

Dr. Mandell is the recipient of numerous awards, such as the AOA Contact Lens Section Korb Award in 2006. He was inducted into the Optometry Hall of Fame in 2001 and the University of California Optometry Hall of Fame in 2009.


Acuminder Tool Helping to Change Contact Lens Wearing Behavior, According To Survey

Forgetting which day to change their contacts is most commonly cited by wearers as the reason for not changing them as instructed. However, according to a new survey of contact lens wearers, Acuminder, a complimentary online reminder tool, is helping them change their behavior.

Since its launch in 2007, nearly 40,000 contact lens wearers have registered for the free service (www.acuminder.com) which sends an automatic reminder via e-mail and/or cell phone text message on when to change contact lenses, and can now also prompt wearers on when to buy new contacts and when to schedule an eye exam. The Acuminder Tool was developed by Vistakon, Division of Johnson & Johnson Vision Care, Inc., but is open to all contact lens wearers.

Nearly 700 Acuminder users recently responded to a questionnaire about their contact lens wearing habits. Virtually all (95%) said they find the reminder tool useful in helping them remember when to change their lenses, with two-thirds (66%) noting that it has improved their contact lens replacement.

Prior to enrolling in the service, only 40% of survey respondents who wear two-week lenses self-reported that they changed their lenses at or less than every 14 days (average wear time: 19.9 days). Since using the reminder, 76% say they now change their lenses at or less than every 14 days (average days worn is 14.7).

Partnership Announces Inaugural Research Grants to Fight Childhood Blindness

The Pediatric Cataract Initiative has announced its inaugural small research grant recipients for treating and preventing vision loss in children.

The Initiative, a partnership of the Bausch + Lomb Early Vision Institute and Lions Clubs International Foundation (LCIF), will provide two research grants of U.S. $50,000 each to:

  • Lumbini Eye Institute to study the cost and clinical effectiveness of a comprehensive pediatric cataract surgery follow-up system in western Nepal and adjacent northern Indian states. The outcomes are expected to have a wide-ranging effect on follow-up regimens in developing nations worldwide.
  • Calabar Teaching Hospital to investigate the burden and causes of severe visual impairment and blindness among children in the Cross River State of Nigeria. This is believed to be the first large-scale study of the root causes of childhood blindness in Africa.
The Pediatric Cataract Initiative utilizes the resources of Bausch + Lomb's Early Vision Institute and LCIF to identify, fund and promote innovative methods of overcoming this challenge for the long-term benefit of children, their families and their communities.

For additional information, visit www.PediatricCataract.org or follow the Initiative at www.twitter.com/PCInitiative and www.Facebook.com/PediatricCataract.

Fera Pharmaceuticals Launches OTC Puralube Ophthalmic Ointment for Dry Eye

Puralube Ophthalmic Ointment, is now available from Fera Pharmaceuticals. When the original manufacturer of Puralube discontinued the product, according to the company, Fera received many requests to bring the product back. Fera also currently markets several prescription ophthalmic ointments including Bacitracin, Garamycin and Ilotycin, as well as Neptazane tablets.

Fera is launching Puralube, a preservative free ophthalmic ointment (active ingredients: 85% white petrolatum; 15% mineral oil), in a 3.5 g tube as well as a carton of twenty 1 g tubes. It will be available through retail, wholesale and mail order pharmacy.

For more information visit www.ferapharma.com.

Eye Health & Allergies Brochure Available

Spring is particularly frustrating for contact lens wearers. In a survey conducted by the Asthma & Allergy Foundation of America (AAFA), the leading patient advocacy organization for people with asthma and allergies, nearly half (45%) say that their eye-related allergy problems often prevent them from wearing their contacts, and one in ten (12%) admits to having stopped wearing their contacts because of allergies.

To help allergy sufferers better understand and manage the condition, AAFA offers a free educational brochure titled Eye Health & Allergies. The brochure, supported by 1-Day Acuvue Moist, provides patients with useful information on how eye allergies occur, common signs and symptoms, and practical advice on how to treat and prevent eye allergies. This brochure also includes helpful information about eye allergies and contact lenses, including advice on the benefits of daily disposable contacts.

Eyecare professionals can request a PDF for use on their website as well as order a complimentary set (50 brochures) for their practice by emailing eyeallergybrochure@rprmc.com. Requests should include name and complete address, including zip code.

Pediatric Congenital Cataract Symposium To Be Held in NYC

Emory University School of Medicine, Department of Ophthalmology is presenting the International Pediatric Congenital Cataract Symposium on March 11, 2011 at the Yale Club of New York City.

The discussion will focus on future directions for research in the treatment of children with congenital cataracts. The faculty will present the 1-year outcome data from the Infant Aphakia Treatment Study, an NIH-sponsored randomized clinical trial comparing the use of contact lenses and intraocular lenses to optically correct infants following unilateral cataract surgery. International experts will also discuss the current treatment of congenital cataracts in developing countries.

For information and online registration, visit www.emory.edu/CME.

This month at www.siliconehydrogels.org: Children and contact lenses, myopia progression, use of silicone hydrogels for patients with epidermolysis bullosa, and our synopsis of silicone hydrogels at the 2009 ARVO meeting.
Editor's Commentary
Jason J. Nichols, OD, MPH, PhD, FAAO

As many of you know and are learning, many companies have or are removing eye drop samples, primarily ophthalmic antibiotics (e.g., fluoroquinolones) from your practices. While your ability to prescribe these medications remains the same, the primary reason behind this change is that these agents are commonly being used "off-indication" as many of them were originally approved for bacterial conjunctivitis. While many of us are frustrated by this decision, in my opinion, it's really not the fault of the involved companies.

This situation has more to do with the current regulatory climate, associated federal agencies and product approvals, claims, and labeling. While there are many areas that you could argue need further regulation in terms of drugs or devices, I am not sure that this is one of them. For pharmaceutical companies to obtain approvals based on clinical trials in patients with bacterial keratitis (instead of bacterial conjunctivitis) would significantly slow the approval for these drugs. In my opinion, this is one instance in which the pendulum has just swung too far.

CLToday Quick Poll
Last week's question:
Where do pharmaceuticals fall in your treatment algorithm for dry eye in cosmetic contact lens wearers?

 Pharmaceuticals are among the first treatments I use.

 I try pharmaceuticals only after other options have failed.

 I don't/won't prescribe pharmaceuticals for dry eye in contact lens wearers.

Comparison of Symptoms after Viewing Text on a Computer Screen and Hardcopy

Computer vision syndrome (CVS) is a complex of eye and vision problems experienced during or related to computer use. Ocular symptoms may include asthenopia, accommodative and vergence difficulties and dry eye. CVS occurs in up to 90% of computer workers, and given the almost universal use of these devices, it is important to identify whether these symptoms are specific to computer operation, or are simply a manifestation of performing a sustained near-vision task.

This study compared ocular symptoms immediately following a sustained near task. Thirty young, visually-normal subjects read text aloud either from a desktop computer screen or a printed hardcopy page at a viewing distance of 50 cm for a continuous 20 minute period. Identical text was used in the two sessions, which was matched for size and contrast. Target viewing angle and luminance were similar for the two conditions. Immediately following completion of the reading task, subjects completed a written questionnaire asking about their level of ocular discomfort during the task.

When comparing the computer and hardcopy conditions, significant differences in median symptom scores were reported with regard to blurred vision during the task (t = 147.0; p = 0.03) and the mean symptom score (t = 102.5; p = 0.04). In both cases, symptoms were higher during computer use.

The researchers concluded that symptoms following sustained computer use were significantly worse than those reported after hard copy fixation under similar viewing conditions. A better understanding of the physiology underlying CVS is critical to allow more accurate diagnosis and treatment. This will allow practitioners to optimize visual comfort and efficiency during computer operation.

Chu C, Rosenfield M, Portello JK, Benzoni JA, Collier JD. A comparison of symptoms after viewing text on a computer screen and hardcopy. Ophthalmic Physiol Opt. 2011 Jan;31(1):29-32.

Important Links:
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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