I recently had a patient that had a "lost" gas permeable lens show up in the eye three days later, and another patient that had multiple gas permeable lenses "lost" in the upper fornix at the same time for days without symptoms. I wondered what has been reported in the literature on this topic. I was not surprised to find multiple case reports since 2003 on migrated rigid lenses, most that lead to complications.

Each of the case reports below describe a migrated or "lost" gas permeable lens that resulted in an upper palpebral conjunctival mass. Most cases also resulted in ptosis. In two of the cases the interpalpebral lens was imaged on MRI.^1,2 Three of the cases required surgery to remove the retained lens.^1-3 Some lenses were retained longer than three years before signs and symptoms began.^1,4

These cases remind us to double evert all patients that report a lost gas permeable with no idea of its whereabouts, whether symptomatic or not, even many years after the "loss."

1. Hammons M, Gayre G, Hammons D, Dutton J. Intrapalpebral migration of a rigid gas-permeable contact lens resulting in an eyelid mass. Ophthalmology. 2003 Sep;110(9):1781-3.
2. Tossounis CM, Saleh GM, McLean CJ. The long and winding road: contact lens-induced ptosis. Ophthal Plast Reconstr Surg. 2007 Jul-Aug;23(4):324-5.
3. Hayasaka Y, Hayasaka S, Nagaki Y, Endo Y. An eyelid mass caused by a migrated hard contact lens. Eye Contact Lens. 2003 Oct;29(4):250-1.
4. Zola E, van der Meulen IJ, Lapid-Gortzak R, van Vliet JM, Nieuwendaal CP. A conjunctival mass in the deep superior fornix after a long retained hard contact lens in a patient with keloids. Cornea. 2008 Dec;27(10):1204-6.
5. Perera L, Izadi S, Radford R. Bilateral upper lid encysted contact lenses. Acta Ophthalmol. 2008 Sep;86(6):701-2.

Comfort is a complex and sometimes elusive quality of contact lenses. There are many factors that contribute to comfort, including material characteristics, design features, solution properties, environment, compliance, and ocular health. While some of these factors are out of our control, materials and designs can be selected to optimize lens comfort. There is a wide variety of soft and GP materials with varying properties currently available. Of the various material properties, surface wettability (wetting angle, or WA) is one that is readily available and can be useful when trying to improve comfort.

Wettability is a measure of how well a liquid film spreads across a surface. Depending on the methodology, a lower WA implies that a patient's tears might more readily coat the surface of a lens, which might allow the upper lid to more easily move across the lens surface, making the lens feel more comfortable. Conversely, a poorly wetting lens might create more resistance to lid movement, which could be less comfortable.

Wetting agents and plasma treatment can temporarily enhance WA, while surface evaporation can worsen it. There are several methods for measuring wetting angles, so when comparing materials, be sure the WAs were derived from the same methodology.

In future columns, I'll discuss other material properties and design features that contribute to comfort.

Alden Optical Expands Phoenix Program

Alden Optical, Inc., manufacturer of custom made-to-order soft and GP contact lenses, announced that it has expanded the popular Phoenix Program to include a significant number of additional lenses recently discontinued by the major contact lens manufacturers.

The Phoenix Program was developed in 2010 to provide practitioners with a solution when faced with discontinued soft sphere brands. Alden Optical offers lenses in polymacon, methafilcon, Benz 3X and Benz 5X in any base curve/diameter combination and with spherical powers of +/- 30.00D. With the Phoenix Program, the eyecare practitioner contacts Alden Optical or an Authorized Distributor with the patient's Rx and current brand with specifications. Alden Optical will custom manufacture a very close replacement to the original lens and ship it within two business days.

For more information, including a complete conversion guide, visit http://aldenoptical.com/products/custom-soft/sphere/phoenix.

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CO Announces Future Faculty Program

The Association of Schools and Colleges of Optometry (ASCO) announced its new Future Faculty Program, funded by a generous grant from Walmart. The program's goal is: "To provide graduate students with an opportunity to gain the knowledge and skills to enhance their success in an optometric academic environment as career-long, productive faculty." This represents a major initiative by ASCO to address its strategic priority for Faculty Promotion and Development.

This highly competitive program will be offered to 15 graduate students in its first year, with plans to expand the following year. Applicants must be enrolled in a full-time graduate program at an ASCO member institution and demonstrate a strong interest in pursuing a career in academic optometry. Drs. Shilpa Register and David Troilo will serve as the Co-Chairs, who will develop and implement the program. The program will be centered on the unique and important issues that graduate students face as they embark on a career in optometric education. Participants will be mentored in this process by the program leadership.

The Future Faculty Program will be held in conjunction with ASCO's Summer Institute for Faculty Development, on July 16-17, 2011, at the Eric P. Newman Center of the University of Washington Medical Center in St. Louis, Missouri. Applications are available to the schools and colleges of optometry.

Say YEStoday and Help Give Sight to Millions

Optometry Giving Sight invites optometrists and the optical community to Say YEStoday again this year and help raise funds to help give sight to the millions still in need. There are 670 million people who are blind or vision impaired simply because they cannot access an eye examination and pair of glasses.

Funding the establishment of community based vision centers will provide vision care to local communities for the long-term. Trained eye care professionals working in the vision centers will continue to provide vision care to their community for many years to come.

This year, optometrists can Say YEStoday by making a donation online at www.givingsight.org. Practices can also get involved by putting up a poster of a 'vision center' and inviting patients to 'buy a brick' and make a donation. Patients can personalize their brick and stick it onto the poster. Large and small posters are available by calling Optometry Giving Sight at 1-888-OGS-GIVE or by requesting one online.

In 2010 funds raised by Optometry Giving Sight donors helped to provide ongoing funding to eight vision centers and train 683 eye care professionals across 16 countries. This year they hope to double that number.

For more information contact Optometry Giving Sight by calling 1-888-OGS-GIVE, email usa@givingsight.org or visit www.givingsight.org.

February Contact Lens Spectrum

Check out the cover story in this month's issue of Contact Lens Spectrum, Advanced Technology in Contact Lens Practice. In it Robert Davis, OD, FAAO and S. Barry Eiden, OD, FAAO explore how key technologies incorporated into contact lens practice can help improve specialty lens fitting success rates.

Other feature articles include Prescribing Multifocal Contact Lenses by Clarke D. Newman, OD, FAAO; Advances in Corneal Transplant Surgery by Carrie Lembach, DO and Gregory W. DeNaeyer, OD, FAAO; and Different Management Options for Keratoconus by Natalie Corey, OD and Susan Kovacich, OD, FAAO.

Look for your issue in the mail to read these and other informative articles or review issue on line at: www.clspectrum.com/thismonth.aspx.
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Vision Expo Announces Student Programs

Vision Expo is rolling out a robust student program in 2011 with a variety of freebies, discounts, and exclusive offers.

Optometry students may register at no charge for Vision Expo East and may attend education courses at no cost. Students must present their student ID at the Conference office to find out which complimentary courses are open for them to sit in. Students are also invited to attend several complimentary networking events: Opening Night Celebration at Marquee Nightclub; Student Welcome Lunch; 25th Anniversary Cocktail Reception, co-celebration with Eyecare Business magazine and more.

Second, third and fourth-year Optometry students have an opportunity to win a $1,000 grant to attend either International Vision Expo East 2011 in New York City or International Vision Expo West 2011 in Las Vegas this September. At the time a student submits an essay they must indicate if they plan to attend either conference. Vision Expo will host a student focus group at each of these shows and the student will be required to attend a focus group at the show of their choice.

For details on these and all student programs, visit the Student Page.

I recently became aware of an interesting article in our sister publication, Optometric Management. In the article, the author discusses trends in practitioners' "reading habits" as they relate to our profession and associated topics and practice trends (click here).

Relative Peripheral Refractive Error and the Risk of Onset and Progression of Myopia in Children

Researchers set out to investigate whether relative peripheral hyperopia is a risk factor for either the onset of myopia in children or the rate of myopic progression.

The risk of myopia onset was assessed in 2043 non-myopic third-grade children (mean age +/- SD = 8.8 +/- 0.52 years) participating in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study between 1995 and 2007, 324 of whom became myopic by the eighth grade. Progression analyses used data from 774 myopic children in grades 1 to 8. Foveal and relative peripheral refractive error 30 degrees in the nasal visual field was measured annually by using cycloplegic autorefraction. Axial length was measured by A-scan ultrasonography.

The association between more hyperopic relative peripheral refractive error in the third grade and the risk of the onset of myopia by the eighth grade varied by ethnic group (Asian children odds ratio [OR] = 1.56, 95% confidence interval [CI] = 1.06-2.30; African-American children OR = 0.75, 95% CI = 0.58-0.96; Hispanics, Native Americans, and whites showed no significant association). Myopia progression was greater per diopter of more hyperopic relative peripheral refractive error, but only by a small amount (-0.024 D per year; P = 0.02). Axial elongation was unrelated to the average relative peripheral refractive error (P = 0.77), regardless of ethnicity.

The researchers concluded that relative peripheral hyperopia appears to exert little consistent influence on the risk of the onset of myopic refractive error, on the rate of myopia progression, or on axial elongation.

Mutti DO, Sinnott LT, et al. Relative peripheral refractive error and the risk of onset and progression of myopia in children. Invest Ophthalmol Vis Sci 2011; 52: 199-205.