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Sunday, February 19, 2012  
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Last week's question:
Are you using contact lenses (e.g., orthokeratology, soft multifocal) for myopia control in children?

 1. Not at all

 2. Occasionally

 3. Frequently

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

As we have noted in our prior content, there are issues that are challenging the contact lens market. However, with all of the responses over the last couple weeks, it also reminded me of the potential future to come. There are technologies coming that may lead to dramatic changes in the care of the contact lens patient. Things like health status monitoring contact lenses, lenses that change an attribute dynamically given the patient's needs, in addition to combination products amongst other things. Hopefully this bright potential future will lead to enthusiasm for contact lenses than overshadows any potential challenges in the market place.

CLAO Announces Symposium: Silicone Hydrogel Lenses — Ten Years Later

A unique scientific symposium entitled Silicone Hydrogel Lenses — Ten Years Later, sponsored by the Contact Lens Association of Ophthalmologists (CLAO) and Eye & Contact Lens journal (ECL) will be held at the Riverside Hotel, Ft. Lauderdale, Florida, on May 4-5, 2012, just prior to the AVRO Meeting. The purpose of this Symposium is to review the developments in silicone hydrogel lenses over the past decade and to present cutting edge research in the field.

Internationally renowned contact lens researchers from around the world will be invited to participate in this special event. Each expert presenter will be submitting a paper based on their presentation at the Symposium and on their area of expertise within the subject. After the peer-review process, these papers will be published in a special issue of ECL. This Special issue compilation will serve as the most current and comprehensive stand-alone reference on this important subject of silicone hydrogel contact lenses.

The conference is supported through an unrestricted educational grant to CLAO from Johnson & Johnson Care, Inc.

For more information or to register for the meeting, visit the CLAO website at www.clao.org or call 877-501-3937.

New Report from PBA on Public Vision Health Programs

Prevent Blindness America (PBA) has released its latest report based on multi-year cooperative agreements with the Centers for Disease Control and Prevention (CDC) entitled "The Vision Connection: Integrating Vision into State Health Programs." The report includes examples of successful partnerships between PBA affiliates and public health entities in their respective states. Affiliates in states such as Georgia, Ohio, Texas and the tri-state area of New York, New Jersey and Connecticut, provide details on the positive effect that vision health initiatives and programs can have on communities across the country.

A PDF of the report is available at: http://www.preventblindness.net/site/DocServer/PBA_-_The_Vision_Connection_-_Integrating_Vision_into_St.pdf?docID=2641

Eyemaginations Launches Vision Simulator iPad App

Patient education provider Eyemaginations announces the launch of a new eyecare app for the iPad. The new app, known as the LUMA Vision Simulator features on-screen drawing functionality and gives the user the ability to markup images as well as view disease progressions and point-of-view scenes side-by-side on one screen. The LUMA Vision Simulator enhances patient education by allowing eyecare providers to explain the most of common diseases of the eye. In addition, when used with Apple's Airplay, users of the new LUMA Vision Simulator are able to share the iPad screen images wirelessly to a television when used with AppleTV.

As with the other six eyecare apps available from Eyemaginations, the LUMA Vision Simulator was designed to help doctors be innovated, efficient and effective. According to the company, the full suite of apps is perfect in the reception area to engage and educate patients via iPad.

All of the LUMA Eyecare Apps are available for download in iTunes. They are free to all Eyemaginations LUMA clients and as a free demo for all others.

Ocusoft Names McCallister Director of Professional Relations — Skin Care

Ocusoft, Inc., an ophthalmic research, development and supply company, is pleased to announce the addition of Grey McCallister as Director of Professional Relations — Skin Care.

In her new role, McCallister will be tasked with the sales, marketing and promotion of Ocusoft products that cross over to dermatology as well as working with Ocusoft distributors. Many of the Company's products are already being used in the dermatology market, including a botulinum toxin enhancer, Zytaze.

McCallister graduated from the University of Alabama with both an undergraduate and Master's degree and joins the Ocusoft management team with over five years of pharmaceutical sales and marketing experience in dermatology.

Descemet's Detachment
By Gregory W. DeNaeyer, OD, FAAO

This picture shows a 79-year-old male who had a peripheral detachment of Descemet's membrane in his right eye. The patient had previous cataract surgery and a one-day post-operative wound repair of his affected eye four months before his referral. The patient's visual acuity OD was count fingers and he had severe corneal swelling.

Descemet's detachment is a separation of Descemet's membrane from the posterior stroma following a traumatic event. If the separation is peripheral and without much edema, then no action is necessary except for frequent follow-up visits. However, a larger detachment that leads to significant swelling needs to be repaired for the patient to regain visual function.

Kaufman, H. Barron, B. McDonald, M. The Cornea, 2nd Ed. Butterworth-Heinemann 1998.

For more on this patient, see www.clspectrum.com/articleviewer.aspx?articleID=104737.

We 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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Extended Wear Trial Run

In an informal patient survey done the week after New Years, I found that most of my young daily wear patients wore their lenses overnight on New Year's Eve. This was especially so in the twenty something singles group and college kids. All were in high oxygen lenses and handled the extended wear very well.

A question came to mind, how many patients wear their lenses overnight on occasions like this for the very first time? Besides New Year's Eve, other times would be camping (dirty environment) and sleepovers (forgot my case). I've always recommended my patients to experiment with an overnight EW trial (with appropriate lenses) even if they don't plan on that as a regular method. I usually say to keep them in on a normal Thursday night to see how it works. Knowing ahead of time that keeping the lenses in is OK greatly diminishes any stress over "should I keep them in" and "will my eyes hurt in the morning."

Mark Greenwell, OD
Papillion, NE

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Guest Columnist: Ashley Wallace-Tucker, OD, FAAO; Kelly K. Nichols, OD, MPH, PhD, FAAO

Pediatric Dry Eye Disease: Part 1

For those of you who see children in your office on a regular basis, you would probably agree that it is not an uncommon occurrence for children to present with vague symptoms of red, watery, itchy, and/or irritated eyes. I would also venture to guess that dry eye is not on the top of your differential diagnoses list.

Pediatric dry eye is often misdiagnosed as an infection or allergic event for two primary reasons: children are unable to properly articulate their symptoms and eyecare providers tend to disregard this condition as a potential diagnosis because of its perceived low prevalence in the pediatric population. Although we have very little data on pediatric dry eye disease, we know that it is a result of a variety of underlying causes such as autoimmune/inflammatory diseases, congenital disorders, corneal/lid disorders, malnutrition, systemic medications, diabetes, and certain environmental factors.1

Remember the following with pediatric patients:
1. Establish a thorough medical and family medical history.
2. Use a "grown-up" ocular exam. Many of the diagnostic tests utilized in adults, including Schirmer's test and the use of vital dyes, can be safely and effectively utilized in children.
3. Remember the contraindications, i.e. topical corticosteroids and tetracyclines.1

Early detection and proper referral for any underlying condition are key to the management of these patients.

1. Alves M, Dias AC, Rocha EM. Dry eye in childhood: epidemiological and clinical aspects. Ocular Surface. 2008 Jan;6(1):44-51.
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Guest Columnist: Marco van Beusekom, BOptom
The Netherlands

View from Below Sea Level

The Netherlands is in many ways a unique country also when it concerns contact lenses. It is country where everybody can fit contact lenses as there is no legislation overseeing who can fit contact lenses. This question will probably never be answered, but is the high penetration of contact lenses in the Netherlands despite the fact that there is no legislation or is it thanks to this fact? Still, the Dutch do have a very high penetration of contact lenses and also a wide base of GP lens wearers as well.

Looking at the latest report on the prescribing trends in a lot of countries (Contact Lens Spectrum, January 2012), once again we see the Netherlands having a large proportion of RGP fits (20%) and also a relatively large proportion of ortho-k wearers (6%). The latter is definitely a trend, since more and more practitioners in the Netherlands use orthokeratology as a way to compete with internet and other practitioners, although ortho-k was not invented by the Dutch. Although the argument of myopia control is used by only a few, in the near future this argument will be used more often.

Do we fit only GPs? Absolutely not! Although it has been a slow start, silicone hydrogels definitely have found their way to our Dutch practices. But when it comes to daily disposables, we still have a very low share. This may be related to the low percentage of people wearing contact lenses part time in the Netherlands.
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Susan J. Gromacki, OD, MS, FAAO

Caring for the KeraSoft IC Soft Lens for Keratoconus

The recent 2012 Global Specialty Lens Symposium in Las Vegas highlighted many of the recent technological advances in specialty contact lenses. Included among these was a new soft lens for keratoconus, the KeraSoft IC (UltraVision CLPL, Bausch + Lomb, Art Optical). I recently accessed Art Optical's KeraSoft IC Patient Instruction / Wearer's Guide to review specific recommendations unique to this lens's care.

The instruction guide instructs patients to digitally rub their lenses to clean them. Interestingly, it specifies that lenses must be rubbed between the fingers rather than in the palm of the hand. It also states, "Caution: Lenses that are chemically disinfected may absorb ingredients from the disinfecting solution which may be irritating to the eyes. A thorough rinse in fresh, sterile rinsing solution prior to placement on the eye should reduce the potential for irritation."

In addition, the guide recommends the following products for care:
Daily Cleaner: Opti-Free Daily Cleaner (Alcon)
Rinsing Solution: Opti-Free PureMoist (Alcon)
Disinfecting Solution: Opti-Free PureMoist (Alcon)
Lubricant/Rewetting Drops: Opti-Free Express (Alcon)
Enzymatic/Protein Cleaner: Opti-Free Supraclens (Alcon)
Oxidation Systems: 3% H2O2 with neutralizing disc

For comprehensive lens care instructions, please access the complete text: http://www.artoptical.com/files/documents/resources/Intelliwave_Patient_Instruction_-_Efrofilcon_A_1.pdf.

Clarification: The Care Solution Corner article of January 22, 2011, reported on a recent study, Impact of a Rub and Rinse on Solution-Induced Corneal Staining. The CLT article contained this statement: "...it must be emphasized that in this study, the rub and rinse step was performed before lenses were applied to eyes." The study authors wish us to clarify this. They noted that the rub and rinse step was performed on new lenses after they were removed from their blister pack prior to soaking and overnight storage. The lenses were then applied to eyes after the overnight storage period.

We apologize for any possible confusion.

Peterson RC, Fonn D, Woods CA et al. Impact of a rub and rinse on solution-induced corneal staining. Opt Vis Sci 2010;87(12):1030-1036.
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Association of CLAC with Changes in the Morphology of Meibomian Glands

Researchers wanted to observe morphological changes in the meibomian glands of patients with contact lens-related allergic conjunctivitis (CLAC) and to assess the relations between the morphological changes and eyelid and tear film parameters.

They observed subjects in four groups: 64 eyes of 64 contact lens (CL) wearers with CLAC, 77 eyes of 77 CL wearers without CLAC, 55 eyes of 55 patients with perennial allergic conjunctivitis (perennial AC), and 47 eyes of 47 healthy volunteers. The following tests were performed: slit-lamp examination, measurement of tear film breakup time, grading of morphological changes in meibomian glands (meiboscore) as assessed by non-contact meibography, grading of meibomian gland distortion in meibography, tear production as assessed by Schirmer's I test, and grading of meibum expression.

The mean score for meibomian gland distortion was significantly higher in the CL wearers with CLAC than in the CL wearers without CLAC (p < 0.0001); it was also significantly higher in the non-CL wearers with perennial AC than in the non-CL wearers without perennial AC (p < 0.0001). There was no significant difference between the mean scores for meibomian gland distortion of the non-CL wearers with perennial AC and the CL wearers with CLAC (p = 0.27). The score for meibomian gland distortion was significantly positively correlated with the meibum score in the CL wearers with CLAC and with the meiboscore in the CL wearers without CLAC.

The authors concluded that CLAC is associated with an increase in meibomian gland distortion. Allergic reaction, rather than CL wear, appears to be responsible for the increase in meibomian gland distortion in patients with CLAC.

Arita R, Itoh K, Maeda S, Maeda K, Tomidokoro A, Amano S. Association of contact lens-related allergic conjunctivitis with changes in the morphology of meibomian glands. Japanese Journal of Ophthalmology. 2012 Jan;56(1):14-9.
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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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