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Sunday, March 3, 2013  
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Last question:
What approximate percent of your patients fill their glasses prescription online?

 A. 0-10%

 B. 11-20%
 C. 21-30%

 D. > 30%

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

It is important to point out that there is often a misperception of the general public about the funding of biomedical and health-related research in the United States. While "the industry" does fund research into basic etiological insights into disease, a significant amount of funding comes from the National Institutes of Health, which has an annual budget of $31 billion. The US federal budget sequestration process includes across the board defense and domestic budget costs totaling $1.2 trillion set to occur over 10 years. There is no doubt sequestration will impact many aspects of our daily lives in addition to long-term insights that biomedical and health-related research provide us and our patients.

B+L Names Bertolini President and CFO

Bausch + Lomb (B&L) has named Robert Bertolini as President and Chief Financial Officer effective immediately. In this capacity, he will oversee the company's Finance, Information Technology and Global Quality and Operations (GQO) functions. Bertolini, who assumes CFO responsibilities from Brian J. Harris, will report to B+L's Chief Executive Officer, Brent Saunders.

Bertolini previously was Executive Vice President and Chief Financial Officer at Schering-Plough Corporation from 2003 until its merger with Merck & Co. in 2009. During his tenure, Bertolini worked as a business partner with the chief executive officer in all aspects of transforming the company's operations.

Earlier in his career, Bertolini spent 20 years at PricewaterhouseCoopers LLP, where he held positions of increasing responsibility, ultimately becoming partner and leading the Global Pharmaceutical Industry practice.

Bertolini earned his bachelor's degree in economics at Rutgers, the State University of New Jersey, and is a Certified Public Accountant. He is a current board member of Actelion Pharmaceuticals and Charles River Labs, and a former board member of Genzyme Corporation.

Alcon Names Akerman Head, Global Professional Affairs

Dwight Akerman, OD, has been appointed Head, Global Professional Affairs for Alcon's Global Vision Care Franchise. Dr. Akerman will report to Eric Bruno, Global Franchise Head, Vision Care.

In his new role, Akerman will be responsible for creating the vision, strategy and roadmap for Professional Affairs globally. He will also provide thought leadership, scientific and technical guidance, and be the voice/mindset of eyecare professionals to the Global Vision Care Franchise to ensure that their products and services better meet the changing demands of the eyecare marketplace.

Akerman has served as the head of Professional Affairs & Clinical Research for Wesley Jessen Corporation, Global Head of Medical Marketing for Novartis Pharmaceuticals Ophthalmic Business Unit, Director of Professional Affairs, Americas Region for CIBA Vision, and most recently, Director of Professional Affairs for U.S. Vision Care.

Akerman has been widely published and is a frequent speaker on cornea, contact lens, business and management topics. He graduated from the Illinois College of Optometry and is a Diplomate of the American Academy of Optometry Cornea, Contact Lenses and Refractive Technologies Section. Akerman has also earned the status of Fellow of the International Association of Contact Lens Educators and Fellow of the British Contact Lens Association.

Menicon Introduces the Rose K2 XL Semi-Scleral Lens

Menicon announced the latest addition to the Rose K family of lens designs for irregular cornea, the Rose K2 XL. This semi-scleral lens was designed and developed by Paul Rose and will complement existing Rose K family of designs by employing the same system of simple fitting rules as the Rose K corneal rigid lenses.

Currently sold in 88 countries, the Rose K family of lenses consists of the original Rose K, Rose K2 (keratoconus), PG (post graft), IC (irregular cornea), and NC (nipple cone), with the addition now of Rose K2 XL.

Practitioners will be able to obtain the Rose K2 XL and all other Rose K designs from Art Optical, ABB-Concise, Blanchard Contact Lens Inc., Les Laboratoires Blanchard, or from their Rose K distributing laboratory.

For more information, please contact your Rose K lab or Menicon America.

Vistakon to Discontinue Three Acuvue Brands from Its U.S. Product Portfolio

Vistakon Division Johnson & Johnson Vision Care, Inc. announced it will be discontinuing three of its older brands in 2013.

Acuvue Brand Contact Lenses, the product that revolutionized the industry in 1987, will no longer be available in select base curves and parameters in the U.S. as of July 1, 2013. All 9.1 base curves and 8.4 and 8.8 base curves of parameters from -6.50 to -11.0 are being discontinued. Products with 8.4 and 8.8 base curves and parameters ranging from -0.50 to -6.00 will continue to be available. All parameters of Acuvue Brand Contact Lenses Bifocal and Acuvue 2 Colours Brand Contact Lenses will be discontinued as of December 31, 2013.

Aragon to Chair Optometry Giving Sight Global Development Board

Optometry Giving Sight announced that Dr. Juan Carlos Aragon, Senior Vice President, Americas Region for CooperVision, will be the inaugural Chair of the organization's new Global Development Board (GDB).

The GDB has been created at the request of the Board to be a key driver of strategic growth and development in relation to fundraising.

Joining Dr. Aragon on the GDB will be: Claude Darnault – Chief Sustainability Officer, Essilor; Dr. Glenn Ellisor – CEO, Vision Source; Dr. Tony Hanks – Founder and Chairman, Eyecare Plus (Australia); Rob Lynch – CEO, VSP Global; Andrea Saia – Board member, Coca Cola Enterprises; Dr. Al Ulsifer – FYI Eye Doctors; and Dr. Rick Weisbarth – VP Professional Affairs, Alcon.

CooperVision Launches a New Website for U.S. Military Personnel; Proceeds to Help the Wounded Warrior Project

CooperVision, Inc. announced the launch of a new website in partnership with the Armed Forces Optometric Society (AFOS), reinforcing the global contact lens manufacturer's continued commitment to serving the U.S. military community. By logging onto www.coopervision.com/armedforces, military members and their families can purchase CooperVision's contact lenses affordably and be assured guaranteed delivery wherever they are located around the world.

For every box of CooperVision Biofinity, Avaira and Proclear 1 day contact lenses purchased through the website, CooperVision will donate $1 to the Wounded Warrior Project (WWP). The WWP takes a holistic approach when serving the military community and their families to nurture the mind and body, and encourages economic empowerment and engagement.

AFOS was created in 1970 to advance the science of eye care throughout the world. Today the society has more than 1,200 military and federal doctors of optometry across the country and internationally.

Tony Hough, BA, MBA
Cambridgeshire, UK

We received the following commentary from Tony Hough, BA, MBA related to Care Solution Corner columns on the evolving FDA standards for lens care systems published in Contact Lenses Today in October 2012 and February 2013.

Right about now, if you are a member, you will find the new British Contact Lens Association (BCLA; www.bcla.org.uk) contact lens standards leaflet arriving on your doormat. Writing this, I thought the approach to silicone hydrogels seemed worth a note especially following comments by Susan Gromacki in your newsletters of October 28, 2012 and February 10, 2013.

In ISO 18369-1:2006 a new fifth category for material classification is introduced, headed Enhanced Oxygen Permeable Materials (e.g. silicone hydrogel). This category in this standard has no content – it is waiting for further work. It is a placeholder standard – watch this space, as it were. But published ISO, ANSI and European Standards should not be about 'watch this space' – they should represent the consolidated results of established technology and methods; empty headings relating to information or methods which may accrue in the future do not belong in published standards. Oddly, the 'enhanced' oxygen permeability is a mere 30 ISO (hectoPascal) units – about 39 traditional units.

Then we look at the proposed further subdivision, summarized by Susan in your February 10 newsletter; it is necessary to know about the ionicity and if the material is surface treated. But we already have all of this in the existing system. For example, in the original BCLA standards leaflet published in 2000, one of the example materials is Focus Night & Day which I describe as Lotrafilcon A I 5 m; where Lotrafilcon A is the USAN name, "I" means it is non-ionic low water content, "5" means it has Dk 101 to 150 ISO units and the lowercase "m" at the end tells us it is surface treated such that the chemistry of the surface is different to the chemistry of the bulk. If we confine ourselves to contact lens interest does the proposed new structure tell us any more? It seems to me that the introduction of the fifth category as an empty placeholder was premature; the proposed further subdivision simply takes us back to the four we first thought of and which are established in the collective thinking of ECPs. We need to wait, probably for quite some time, to enable the technologies which surround silicone hydrogel materials to become properly established before we attempt to rewrite international standards, especially if the 'new' content adds little to our knowledge base.

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Guest Columnists: Crystal Remington, OD and David Murakami OD, MPH; Ronald K. Watanabe, OD, FAAO

GSLS 2013 Report

This week's column is authored by my two Residents in Cornea and Contact Lenses: Dr. Crystal Remington and Dr. David Murakami.

Here are four lenses that were introduced at this year's Global Specialty Lens Symposium, each with its own unique features and advancements.

  • iSee (GP Specialists) is a new orthokeratology option that is capable of treating increased levels of myopia. Based on the Fargo design, it utilizes a more aggressive treatment zone to reduce up to 10 D of myopia.
  • UltraHealth (SynergEyes), the newest hybrid lens, brings together a high-Dk silicone hydrogel skirt and high Dk reverse geometry GP center in an irregular cornea design with a wide range of sagittal vaults, skirt curves, and powers.
  • Custom Stable (Valley Contax) is a new line of scleral contact lenses meant for normal, presbyopic and diseased corneas in 15, 16 and 18 mm. Custom Stable features NIMO power mapping analyzer, digital radius edge profile (DREP) to improve edge comfort, and laser etching for personalization.
  • The Europa Scleral lens (Visionary Optics) is an evolution of the Jupiter design. Its 'Universal Fit Technology' incorporates a larger optic zone, a new four curve peripheral design, and a reverse geometry curve in an 18 mm diameter to optimize scleral landing and corneal vault.

Loretta B. Szczotka-Flynn, OD, PhD, MS, FAAO

Advancements in Ocular Surface Imaging May Aid Keratoconus Diagnosis

With advancements in ocular surface imaging, there are new diagnostic methods that have promising ability to diagnose keratoconus.

The normal human cornea has a three-dimensional distribution of birefringence. Polarization sensitive optical coherence tomography (PS-OCT) has been developed that allows measurement and imaging of three tissue parameters simultaneously: reflectivity, retardation, and slow optic axis orientation in which conventional cross sectional, as well as en face images of thee parameters can be derived.1 The observed birefringence patterns in normal corneas can be used as standard patterns for comparisons with pathologic changes. It has been observed that in keratoconus corneas, the normal birefringence pattern is heavily distorted due to stacked collagen fibril lamellae of different orientations. This birefringence pattern has been used to discriminate keratoconus corneas from normals.

In 2007, Götzinger investigated 5 keratoconic corneal buttons with PS-OCT.2 The instrument measured backscattered intensity (conventional OCT), retardation, and (cumulative) slow axis distribution simultaneously. Three-dimensional data sets of the polarizing parameters were recorded, and two-dimensional cross-sectional images as well as en face images of the distribution of these parameters at the posterior corneal surface were derived. The results were compared to similar maps obtained from normal corneas. They found that compared with normal corneas, the retardation and slow axis orientation patterns were heavily distorted in keratoconus corneas. The observed changes in the cornea's birefringence properties indicated a change in the arrangement of collagen fibrils in the corneal stroma that is associated with keratoconus.

In the current issue of IOVS, Fukuda investigated the tissue properties of keratoconic and normal corneas in vivo using PS-OCT with the aim of discriminating early keratoconus.3 They evaluated 31 eyes with keratoconus, seven eyes suspicious for keratoconus, and 25 normal eyes and measured: average en face phase retardation of the posterior surface of the cornea, curvature, videokeratographic parameters, regular and irregular astigmatism, pachymetry map, and elevation. Each parameter was assessed to evaluate the diagnostic power to detect keratoconus and keratoconus suspects. In normal controls, the center of the en face phase retardation map showed low and homogeneous birefringence, but in keratoconic corneas the birefringence increased with disease severity. They concluded that the average of en face phase retardation of the posterior surface of the cornea was increased in keratoconus patients, and that this was sensitive enough to discriminate keratoconus suspects; they suggested that it might be useful for detecting subclinical keratoconus in the future.

1. Hitzenberger CK, Götzinger E, Pircher M. Birefringence properties of the human cornea measured with polarization sensitive optical coherence tomography. Bull Soc Belge Ophtalmol. 2006;(302):153-68.
2. Götzinger E, Pircher M, Dejaco-Ruhswurm I, Kaminski S, Skorpik C, Hitzenberger CK.Imaging of birefringent properties of keratoconus corneas by polarization-sensitive optical coherence tomography. Invest Ophthalmol Vis Sci. 2007 Aug;48(8):3551-8.
3. Fukuda S, Yamanari M, Lim Y, Hoshi S, Beheregaray S, Oshika T, Yasuno Y. Keratoconus diagnosis using anterior segment polarization-sensitive optical coherence tomography. Invest Ophthalmol Vis Sci. 2013 Feb 19;54(2):1384-91.

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Posterior Corneal Shape Changes In Myopic Overnight Orthokeratology

The researchers wanted to evaluate changes in the shape of the posterior cornea at the end-of-the-day based on anterior corneal topography and corneal thickness during myopic overnight orthokeratology (OK) over 14 nights' wear of reverse geometry gas-permeable (GP) contact lenses.

Eighteen subjects (aged 19 to 32 years) with low myopia and astigmatism were fitted with reverse geometry lenses (BE; Capricornia Contact Lens Pty Ltd) for myopic OK, which were worn overnight only for a 14-day period. A separate group of 10 subjects (aged 19 to 32 years) with low astigmatism wore J-Contour conventional GP lenses (Capricornia Contact Lens Pty Ltd) for one night. Corneal topography (Medmont E-300) and total corneal thickness (Holden-Payor optical pachometer) across the horizontal meridian were measured at baseline and approximately 8 to 10 hours after lens removal on days 1, 4, 7, and 14 of overnight OK lens wear and after one night of GP lens wear for the control group. Posterior corneal apical radius of curvature and asphericity (Q) were calculated using an in-house program based on the anterior corneal ellipse curve and corneal thickness.

Myopia reduced from -2.64 +/- 0.99 diopters (mean +/- SD) to -0.39 +/- 0.49 diopters during 14 days of overnight OK lens wear. In the OK lens-wearing eyes, there were no statistically significant changes in posterior corneal apical radius of curvature during 14 days of overnight OK. However, there were statistically significant increases in posterior corneal Q on days 4 and 7. In the conventional GP lens-wearing eyes, there were no statistically significant changes in either posterior corneal apical radius or Q after overnight lens wear.

The researchers concluded that the results of this study support the current hypothesis that the OK refractive effect is achieved primarily through remodeling of the anterior corneal layers, without overall corneal bending.

Yoon JH, Swarbrick HA. Posterior corneal shape changes in myopic overnight orthokeratology. Optom Vis Sci. 2013 Mar;90(3):196-204.

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