This week's column is a report from the Global Specialty Lens Symposium (GSLS), written by my two Residents, Dr. Christen Kenrick and Dr. Brittney Mazza.

There are numerous benefits of GP lens designs for the correction of visual distortions induced by irregular corneas. However, some patients just cannot adapt to the feel of GP lenses. Other options for these patients include scleral lenses, hybrid designs and piggyback systems. A less common alternative is soft contact lenses designed especially for keratoconus and irregular corneas. There are at least a dozen such lenses from which to choose and during residency we've had personal success in fitting some of these designs. Our patients have reported improved initial comfort, convenient handling and fewer office visits.

At the GSLS in January, Bausch and Lomb announced a licensing agreement to market KeraSoft, a silicone hydrogel soft lens for keratoconus by UltraVision CLPL. KeraSoft was originally developed in 1994, and the latest version, KeraSoft IC, is a silicone hydrogel specifically designed for irregular corneas. Corneal topography is used to design the lenses, and practitioners can customize several lens parameters when ordering. This lens is expected to be available in some global markets later this year. This is another option to add to an already good array of soft contact lenses for irregular corneas.

A colleague from the Department of Dermatology at my institution asked me about using UV filtering contact lenses to protect the eye during phototherapy treatments where goggles were not practical to be worn. One study from the UK assessed UV filtering capabilities of several contact lenses and found them adequate for UV-B filtration but inadequate for filtering UV-A.¹ Indeed, some dermatologic treatments utilize UV-A as part of photochemotherapy. Exposure to UV-B and UV-A radiation is associated with cellular photochemical damage (nearly all UV-C radiation is filtered by the atmosphere) but it's thought that exposure to UV-B radiation causes crystalline lens opacification.

Two articles have nicely summarized the UV filtering capabilities and protective features of modern silicone hydrogel lenses. Walsh et al measured the transmission curves of several contact lenses and found the Class 1 UV absorbing polymers of Acuvue Advance and Oasys to perform the best and close to their manufacturer reported transmission curves.² For example Acuvue Oasys filters 100% of UV-B between about 290-350 nm, Oasys also had a 50% cutoff wavelength closest to the desired UV–visible boundary of 400 nm.²

Chandler et al assessed the ability of Oasys lenses to prevent UV-B induced damage to the anterior segment in rabbits. They applied a daily dose of UV-B (1.667 J/cm2) for five days that approached the reported threshold for developing permanent cataract after a single application on pigmented rabbit eyes. They evaluated the expression of matrix-metalloproteinases (MMPs) and apoptosis in the cornea; ascorbate in the aqueous humor; and crystalline lens apoptosis. In all assays, the eyes wearing the Oasys lens has significantly fewer pathological changes compared to eyes wearing non-UV filtering lenses.³

Therefore, class I UV-blocking contact lenses are capable of protecting the ocular surface and anterior segment against UV-B-induced pathologic changes and there is rationale for using these lenses during intentional or unintentional UV-B (but not UV-A) exposure.

1. Otman SG, El-Dars LD, Edwards C, Ansari E, Taylor D, Gambles B, Chalmers I, Anstey AV. Eye Protection for Ultraviolet B Phototherapy and Psoralen Ultraviolet A Patients. Photodermatol Photoimmunol Photomed. 2010 Jun;26(3):143-50.
2. Walsh JE, Koehler LV, Fleming DP, Bergmanson JP. Novel Method for Determining Hydrogel and Silicone Hydrogel Contact Lens Transmission Curves and Their Spatially Specific Ultraviolet Radiation Protection Factors. Eye & Contact Lens 33(2): 58–64, 2007.
3. Chandler HL, Reuter KS, Sinnott LT, Nichols JJ. Prevention of UV-Induced Damage to the Anterior Segment Using Class I UV-Absorbing Hydrogel Contact Lenses. Invest Ophthalmol Vis Sci. 2010; 51:172–178

B+L Voluntarily Recalls Soothe Xtra Protection Eye Drops

Bausch + Lomb (B+L) is conducting a voluntary recall of its Soothe Xtra Protection (XP) eye drops (expiration dates: February 2011 through August 2012). Soothe XP is only available within the United States.

B+L chose to initiate this recall based on testing which showed specific lots of the Soothe Xtra Protection (XP) product were out of specification for preservative efficacy prior to their listed date of shelf-life expiration. According to the company, there have been no adverse events reported for this product which have been attributed to preservative efficacy.

Per B+L, the company has chosen to voluntarily recall all lots of Soothe XP eye drops in the interest of patient safety. Product which is out of specification near the end of shelf-life may present insufficient protection against inadvertent microbial contamination during storage and usage of the product. Potential adverse events may include: burning, stinging, eye redness or eye discomfort. Patients are advised to contact their doctor if they have any of these symptoms.

The company is conducting an ongoing investigation to determine why these specific lots of Soothe XP eye drops were out of shelf-life specification. Only Soothe Xtra Protection (XP) eye drops are affected by this recall; Soothe Preservative Free eye drops and Soothe Night Time Ointment continue to be available.

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BCLA Calls for Hot Topics

Having received a record number of paper and poster submissions for BCLA 2011, May 26-29, 2011 in Manchester, the British Contact Lens Association (BCLA) is anticipating a similar response to its current call for Hot Topics. Launched in 2010 as a new submission category, BCLA Hot Topics proved a popular addition to the scientific program at last year's event.

Hot Topics subject matter should be highly topical and could be a new fitting strategy, way of grading, proposed risk factor or revolutionary instrument or technique. Presenters will each have 10 minutes to outline the issue before fielding an open discussion. The deadline for 2011 submissions is April 8.

For each conference submission, including Hot Topics, accepted by the Academic Committee, the first author will be entitled to a £100 voucher, redeemable against a full delegate package for BCLA 2011. A list of accepted Hot Topics will also be included in the Association's journal, Contact Lens & Anterior Eye. For more details and to submit, visit www.bcla.org.uk

Allergan Supports PBA Through Advocacy Programs

Allergan has awarded an advocacy grant to Prevent Blindness America (PBA) to provide funding for The Eye Care Advocacy Network (Eye CAN). Eye CAN is being designed to be the advocacy home for PBA encouraging local community members and leaders to promote vision and eye health through legislation and advocacy.

The Eye CAN website will provide recognition for advocates, and will include federal and state legislative updates. The site will also serve as a location for advocates to share success stories and provide words of advice to help build a strong and dedicated team of eye health advocates. Advocates who participate in activities, such as responding to alerts, sending letters or calling Members of Congress, can post a note on the EYE-DID area of the website.

For more information on and how you can become a supporting partner or a vision health advocate for PBA, please visit www.preventblindness.org/advocacy or call (800) 331-2020.

Last week's Editorial and Quick Poll results related to reading and review of the scientific and non-scientific literature. Regardless of the type of publication, another important aspect regarding the literature is authorship. There are many things that are being discussed in this regard including issues of what warrants authorship, ghost writing of articles, and the credibility and impact of journals.

Do Swimming Goggles Limit Microbial Contamination of Contact Lenses?

Wearing goggles over contact lenses while swimming is often recommended by eye care professionals. Limited data are available to assess this recommendation. The purpose of this study was to examine whether wearing goggles while swimming limits bacterial colonization on contact lenses and whether the type of lens worn affects contamination rates.

Twenty-three subjects underwent two swimming sessions at an ocean (salt water) pool (Maroubra Beach Rock Pool, Sydney, Australia). Silicone hydrogel (Ciba Focus Night and Day) or hydrogel lenses (Ciba Focus Daily) were inserted into subjects' eyes before 30 minutes of swimming sessions, and subjects used modified goggles to mimic goggled and non-goggled conditions. At the end of each session, lenses were collected for microbial investigation. Viable bacterial colonies were classified as gram positive and gram negative and enumerated. The level of bacterial colonization on contact lenses between goggled and non-goggled conditions and between the two lens materials were compared.

The range of colony forming units recovered from goggled lenses was 0 to 930 compared with 0 to 1210 on non-goggled lenses. The majority of subjects (16/23) had more microorganisms in the non-goggled condition than when wearing goggles (p = 0.03). Gram negative organisms were found in three non-goggled lenses. No significant difference was shown in the number of bacteria isolated from silicone hydrogel and hydrogel lenses (p > 0.6) irrespective of wearing goggles. Water samples had consistently higher numbers of bacterial counts than those adhered to the lenses; however, no association was found between the number of bacteria in the water sample and those found on the contact lenses.

The researchers concluded that, consistently, fewer bacterial colonies were found on the goggled contact lens, thus suggesting goggles offer some protection against bacterial colonization of contact lenses while swimming. These data would support the recommendation encouraging lens wearers to use goggles while swimming.

Wu YT, Tran J, Truong M, Harmis N, Zhu H, Stapleton F. Do Swimming Goggles Limit Microbial Contamination of Contact Lenses? Optom Vis Sci. 2011 Feb 3.