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Sunday, February 24, 2013  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

With all of today's technology becoming introduced so quickly into clinical practice, it can feel hard to keep up. One thing I was reminded of in my contact lens practice is the value of not only corneal curvature maps, but also measures of elevation of the anterior and posterior surface. Measures of anterior corneal elevation can be particularly helpful in specialty contact lens fitting, while measures of posterior corneal elevation are thought to be particularly helpful in early disease detection. Don't forget to use these critical measures in your challenging patients.

Unilens Introduces Disposable C-Vue HydraVUE Multifocal Silicone Hydrogel Contact Lenses

Unilens Vision Inc. announced the launch of its new silicone hydrogel disposable C-Vue HydraVUE Multifocal contact lens for monthly replacement. The new product continues to incorporate Unilens' highly developed, patented multifocal design technology in a silicone hydrogel material, which offers the benefit of higher oxygen transmissibility for better eye health.

The new monthly replacement lenses, which are available in High and Low ADD Power Ranges (from +6.00 to -10.00), will be sold exclusively to independent eye care professionals. Unilens will provide eye care professionals with an attractive and user-friendly display cabinet and trial program with a 120-Day Performance Guarantee on the lenses.

For more information on the lens and other Unilens products, visit www.unilens.com.

Hands-Free Communication; Google Glass Looking for Explorers

Google announced an opportunity for "Explorers" to acquire their own Google Glass and become among the few who have access to an early version of their mobile computing brainchild.

The glasses have a small display screen attached above the right eye to a special light-weight rim. The Glass responds to voice commands for functions from internet searches to video and photo shoots, and then you can tell it to send the information - all hands free.

Through a promotion announced last week, those whose applications are chosen will receive an invitation to become a Glass Explorer. Chosen Explorers will each need to pre-order a Glass Explorer Edition for $1500 plus tax and attend a special pick-up experience, in person, in New York, San Francisco or Los Angeles.

Applications must be 50 words or less and can include up to five photos and a 15 second video. Application deadline is February 27, 2013 and chosen Explorers will be contacted mid-to-late March. For complete rules see http://www.google.com/glass/start/how-to-get-one/. Another page of the site has a video of the Google Glass experience: http://www.google.com/glass/start/how-it-feels/.

Contact Lenses 2020 – What's in Store for the Future?

This month's Contact Lens Spectrum lead feature article focuses on the future of the contact lens. This look ahead by Eric Papas, PhD, MCOptom, DipCL, FAAO, shows myriad ways that contact lenses are evolving and expanding their use.

Also look for features on Problem Solving Soft Toric Contact Lenses, The Essential Role of Patient Education in a Growing Practice and Solving the Rubik's Cube of Daily Disposables. Our regular columns present a variety of information on contact lens-related topics including Materials and Design, GPs, Care and Compliance, Dry Eye Diagnosis and Treatment, the Business Side of CLs and more.

Look for this month's issue in the mail or visit our website, www.clspectrum.com, to view online.

The following are some of the comments we received from readers in response to last week's editorial requesting examples how to handle sticky situations encountered in everyday practice.

Thoughts on "Heard the Stories Before"
Situation: The long-time patient whose child was fitted in contact lenses and already purchased a year's supply who later "decides" they don't want to wear contact lenses
Response: If the lenses are standard lenses, I'll take back the boxes if they are not defaced, and return them for credit. The fitting fee stands.

Situation: How about the irregular cornea patient who you've spent hours fitting in a very specialty contact lens, who then wants to purchase the contact lens over the internet?
Response: Most of those cannot be purchased that way.

Situation: Then there is the patient who complains about a contact lens fitting fee, when their prescription "did not change."
Response: There are extra tests involved in contact lens wear: refractions over the lenses, binocular testing, lid flipping, etc., which are in addition to a general exam. These are extra services and are charged. VSP in fact, wants us to charge them.

Situation: And who can forget the patient who had an eye exam "elsewhere" who simply wants to you to give them a contact lens prescription?
Response: When one takes on a patient for any service, we become responsible for the eye health of that patient. That's why ophthalmologists redo tests even if referred by other ophthalmologists. I cannot "just" examine for a contact lens Rx. I have to do the entire exam, and I tell the patient this.
Stewart Gooderman, OD
San Francisco, CA

Rude Patients
And then there is the longtime patient that arrives and states her glasses are broken or lost and she is out of contacts. She is wearing old technology, but doesn't want to change. To get her to see to drive home, you give her a week's supply of dailies and explain you will order her HEMA lenses. No, she states I'll take this down the street where they are $2 less a box. I guess good service isn't worth anything.
Alexander R. Crinzi, OD
Depew, NY

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Katherine M. Mastrota, MS, OD, FAAO

Tear Osmolarity and Pterygia

A December 2012 study published in Cornea measured tear osmolarity, tear ferning, fluorescein breakup time, Schirmer scores and conjunctival impression cytology in patients with pterygium as compared to normals. Pteryium patients had significantly higher tear osmolarity, lower tear ferning scores and lower goblet cell density as compared to normal. The authors continue on to suggest that pterygia appear to induce unfavorable conditions of increasing tear osmolarity that possibly triggers alterations in tear crystallization and goblet cell density.1

A subsequent 74 patient study in the Journal of Ophthalmology corroborated that abnormal tear film function is associated with ptergyium.2 The authors of this study provided evidence that pterygium excision improved tear osmolarity and tear film function. Patients whose ptergium did not reoccur after surgery had improved dry eye scores (as determined by Schirmer scores and tear breakup times) as compared to those patients whose ptergium reoccurred (after 18 months). Interestingly, tear osmolarity deteriorated (increased) again in patients who had a recurrence of their pterygium.

1. Julio G, Lluch S, Pujol P, Alonso S, Merindano D. Tear osmolarity and ocular changes in pterygium. Cornea. 2012 Dec;31(12):1417-21.
2. Türkyilmaz K, Oner V, Sevim MS, Kurt A, Sekeryapan B, Durmus M. Effect of pterygium surgery on tear osmolarity. J Ophthalmol. 2013;2013:863498.

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Susan J. Gromacki, OD, MS, FAAO


Biofilms are aggregates of microorganisms and substrates that allow the bacteria to adhere to each other and to surfaces. They are more difficult to kill than single planktonic (free floating) cells of the same organism, and as a result, are more likely to cause infection. Research has shown that all of the soft contact lens care systems tested generally were efficacious against all of the planktonic bacteria utilized. However, when the bacteria were allowed to form biofilms, solution efficacy was greatly reduced for most of the solutions. In the referenced article, the only solution that consistently maintained disinfection efficacy against bacterial biofilm formed on contact lenses was hydrogen peroxide. We look forward to seeing forthcoming information regarding changing guidance from the Food and Drug Administration about this important component associated with testing and approval of contact lens care solutions.

Szczotka-Flynn LB, Imamura Y, Chandra J et al. Increased resistance of contact lens-related bacterial biofilms to antimicrobial activity of soft contact lens care solutions. Cornea. 2009 Sep;28(8):918-26.

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Vision Performance with a Contact Lens Designed to Slow Myopia Progression

Recent research suggests multizone/dual-focus (DF) lens corrections may aid in controlling the progression of myopia. Recently, such a soft contact lens has become commercially available in Hong Kong (MiSight, CooperVision). The purpose of the current study was to evaluate the visual acceptability of this new lens design.

In a double-masked, randomized, crossover trial, 24 subjects (aged 18 to 25 years) wore MiSight contact lenses and Proclear Multifocal +2.00 diopters Add D (MF) soft contact lenses. Patient-reported outcomes (0 to 100 scale) and objective measures of visual performance were acquired for best-spectacle distance correction (BC) and with each contact lens after 1 week of daily use at HIHC (high illumination-high contrast) at distance and LILC (low illumination-low contrast) at distance, intermediate, and near.

There were no significant differences in HIHC distance acuity between BC and either the DF or MF lens and no difference between the DF and MF lenses. However, when measured under LILC, there were significant mean differences between each study lens and BC viewed at distance and intermediate. The LILC logMAR visual acuity was not significantly different between the DF and MF lenses at any viewing distance. Although average visual quality and ghosting ratings for both DF and MF study lenses were significantly lower than habitual under all conditions, there were no significant differences between the DF and MF lenses (p = 0.448).

The researchers concluded that good acuity, similar to that attainable with typical MF lens correction, is attainable with a new contact lens designed to control myopia progression. However, like other contact lenses that contain multiple refractive zones, some decrease in visual performance may be experienced.

Kollbaum PS, Jansen ME, Tan J, Meyer DM, Rickert ME. Vision Performance With a Contact Lens Designed to Slow Myopia Progression. Optom Vis Sci. 2013 Jan 31. [Epub ahead of print]

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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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For more information on Contact Lenses Today including archives of previous issues, please visit our website at www.cltoday.com. For the latest articles on contact lenses, important clinical information and helpful tools related to the contact lens practice visit the Contact Lens Spectrum website at www.clspectrum.com.

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