In my last column, I wrote on the need for primary and secondary prevention in dry eye disease, and here I present the flip side of the same argument. We all know how difficult it can be to motivate a mild to moderate dry eye patient to be compliant with the therapies we prescribe. In particular, when a patient has subclinical or mildly symptomatic meibomian gland dysfunction as a component of his/her dry eye disease, it is a challenge to encourage the patient to perform warm compresses and/or lid scrubs for any considerable duration of time, especially when the perceived benefit to the patient is minimal. Are we making a difference in doing this?

If we only knew which dry eye patients were going to go on to become the most severe dry eye patients, meaning, if only we understood progression and the factors associated with it, we could have a much better idea which patients should need more therapy earlier, more patient education, and more chair time. Instead of looking at the mild patients and waiting for them to progress, perhaps clinician-scientists need to look at the severe patients, and very carefully reconstruct their disease history.

Take this grass-roots approach and really talk to your severe dry eye patients. I am convinced the key to our future understanding of dry eye disease lies in the clinician's ability to find the pieces to this puzzle.

At last month's Global Specialty Lens Symposium, Contact Lens Spectrum Contributing Editor Michael Ward presented "Bacterial Contamination and Infectious Keratitis" as part of the Lens Care and Compliance Panel. He described the pathogenesis of microbial keratitis from a microbiologist's perspective. He noted that the cornea is rarely infected without trauma, local disease or contact lens wear; and that it will resist infection even if challenged with a heavy inocula (106) of bacteria without a full thickness corneal wound. Lastly, the tear-cornea interface often compromises bacterial virulence, preventing infection.

In his lecture, "Worldwide Trends in Lens Care: New Products for Now and in the Future," Philip Morgan brought attention to the fact that the rate of microbial keratitis among contact lens wearers has been consistent since Poggio's publication in 1989—despite the increasing market share of (primarily PHMB) multipurpose solutions.

The site includes:

• Information about patient cost-saving programs such as rebates for Allergan brands including Restasis, Lumigan .01%, Combigan, Alphagan P .1% and others
• Unbranded, easily printable materials, such as What to Expect If You Have Glaucoma, Importance of Taking Your Medicine and Dry Eye FAQs, to help educate patients on ocular diseases.
• Practice management tools such as questionnaires and trackers to help optometrists assess patients, get them started on treatment, and track their progress

On the website, optometrists can also sign-up for Allergan newsletters.

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DAC International Appoints Brierley President

DAC International announced the appointment of Peter Brierley as the company's President. Effective February 21, 2011, Peter will be taking over for Rod Keller who has acted as interim president following the retirement of Jim Drain last October. Rod will resume his role as Vice President of Engineering and Operations.

Peter brings broad experience in the manufacture and process development of turned and molded, contact lenses and implantable ocular devices. Over the past 40 years, Peter has taken leadership positions in innovative lens manufacturing at such companies as Bausch & Lomb, Dow Corning, Allergan Optical, and CooperVision.

PBA to Hold "Eyes on Capitol Hill" Event

Prevent Blindness America (PBA) will be holding the sixth annual "Eyes on Capitol Hill" event on March 2, 2011. This year's event consists of community leaders meeting with advocates and key government representatives on the Hill, a national call-in day and the Congressional Vision Caucus Reception.

The activities are part of the Prevent Blindness America spring advocacy campaign promoting vision and eye health within the Federal appropriations cycle.

While community leaders meet on Capitol Hill with congressional members, vision health advocates across the country are being asked to participate in the Prevent Blindness America National Call-in Day. Those concerned about vision programs and funding are asked to call their national representatives to ask them to make vision health a priority this year in Congress. To obtain information about your Representative's or Senator's phone numbers or e-mail addresses go to www.preventblindness.net/eoch.

The Eyes on Capitol Hill week will conclude with the Third Annual Congressional Vision Caucus (CVC) reception. The CVC is a bicameral and bipartisan coalition of more than 80 Congressional Members and five Senate Members. The event is co-sponsored by leading vision health organizations, including The American Academy of Ophthalmology, The American Optometric Association, The Association of Maternal and Child Health Programs, Lighthouse International, Lions Club International, National Industries for the Blind, The National Alliance for Eye and Vision Research, VisionServe Alliance, Vision2020 USA and The Vision Council.

I was quite pleased with responses to last week's poll. Nearly 80% of you indicated that you read the peer-reviewed literature at least sometimes (~40%) if not often (~40%)! That's remarkable and impressive. As a clinician-researcher, I feel it is critically important to do research on important clinical "in the trenches" issues as this is what ultimately should guide us in our care of the patient.

Last week's question:
How often do you read the scientific (peer-reviewed) literature?

 1. Often - Each month as the journals come out
   40%

 2. Sometimes - If there is a specific topic of interest to me
   40%

 3. Rarely - I usually rely on continuing education courses or trade journals
   16%
 4. Never - I only rely on continuing education courses or trade journals
   4%

Effect of Dual-Focus Soft Contact Lens Wear on Axial Myopia Progression in Children

In this prospective, randomized, paired-eye control, investigator-masked trial with cross-over study, researchers wanted to test the efficacy of an experimental Dual-Focus (DF) soft contact lens in reducing myopia progression.

The study participants included 40 children, 11-14 years old, with mean spherical equivalent refraction (SER) of -2.71+/-1.10 diopters (D). Dual-Focus lenses had a central zone that corrected refractive error and concentric treatment zones that created 2.00 D of simultaneous myopic retinal defocus during distance and near viewing. Control was a single vision distance (SVD) lens with the same parameters but without treatment zones. Children wore a DF lens in one randomly assigned eye and an SVD lens in the fellow eye for 10 months (period 1). Lens assignment was then swapped between eyes, and lenses were worn for a further 10 months (period 2).

The primary outcome was change in SER measured by cycloplegic autorefraction over 10 months. Secondary outcome was change in axial eye length (AXL) measured by partial coherence interferometry over 10 months. Accommodation wearing DF lenses was assessed using an open-field autorefractor.

In period 1, the mean change in SER with DF lenses (-0.44+/-0.33 D) was less than with SVD lenses (-0.69+/-0.38 D; P < 0.001); mean increase in AXL was also less with DF lenses (0.11+/-0.09 mm) than with SVD lenses (0.22+/-0.10 mm; P < 0.001). In 70% of the children, myopia progression was reduced by 30% or more in the eye wearing the DF lens relative to that wearing the SVD lens. Similar reductions in myopia progression and axial eye elongation were also observed with DF lens wear during period 2. Visual acuity and contrast sensitivity with DF lenses were not significantly different than with SVD lenses. Accommodation to a target at 40 cm was driven through the central distance-correction zone of the DF lens.

The researchers concluded that Dual-Focus lenses provided normal acuity and contrast sensitivity and allowed accommodation to near targets. Myopia progression and eye elongation were reduced significantly in eyes wearing DF lenses. The data suggest that sustained myopic defocus, even when presented to the retina simultaneously with a clear image, can act to slow myopia progression without compromising visual function.

Anstice NS and Phillips JR. Effect of Dual-Focus Soft Contact Lens Wear on Axial Myopia Progression in Children. Ophthalmology 2011 Jan 26. [Epub ahead of print]