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Sunday, March 4, 2012  
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Last week's question:
What is the biggest issue with patients extending their contact lens wearing period beyond the manufacturer's recommended replacement schedule?

 A) Symptoms such as discomfort and dryness

 B) Non-infectious complication (e.g., giant papillary conjunctivitis)

 C) Infectious complication

 D) None — many of my patients extend their wearing schedules without any problems

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

About six months ago, we polled you regarding your fitting trends for your soft lens wearers who present needing presbyopic correction for the first time (http://www.cltoday.com/issues/CLToday_081411.htm). As noted in the data, about one-third of you would fit this patient in monovision as opposed to multifocal contact lenses. Having experienced this clinical situation recently, it made me rethink this issue. What drives many of you to still fit this sort of patient in monovision as opposed to a multifocal contact lens? If you have comments, we'd love to hear from you. Please email us at cltoday@wolterskluwer.com.

Vistakon Launches 1-Day Acuvue Moist for Astigmatism

Vistakon, Division of Johnson & Johnson Vision Care, Inc., announced the U.S. launch of 1-Day Acuvue Moist brand contact lenses for astigmatism, a new daily disposable soft toric contact lens for individuals with astigmatism.

The lens features a proprietary blink stabilized design, which harnesses the natural pressures of a blinking eye to help keep the lens in place and quickly realign the lens if it rotates out of position, providing wearers with consistent, all-day vision, according to the company. The lens settles within one minute, thus reducing chair time and the need for further progress evaluations.

The lenses are made using Lacreon Technology, a process that permanently embeds a water holding ingredient, similar to that found in natural tears, into the proven Etafilcon A material of the 1-Day Acuvue brand.

With over 1,500 SKUs (12 axes, 4 cylinders) at distance parameters of +4.00D to -9.00D, 1-Day Acuvue Moist for astigmatism has the widest power range available of any daily disposable toric contact lens, allowing 95% of patients to be fit in the 1-Day Acuvue Moist family of lenses, even if they have astigmatism, as reported by the company.

Information is available by visiting www.jnjvisioncare.com.

Ocusoft Introduces Lens Care System

Ocusoft, Inc. has entered into a joint venture agreement with Essentia Pharma, LLC to introduce and market the Ocusoft Lens Care System, a simple, effective cleaning system for soft contact lenses. The company reports that the Ocusoft Lens Care System's convenient 3-in-1 system deep cleans, stores and disinfects with the efficacy of 3% hydrogen peroxide while ensuring comfort with a lubricating agent and no added preservatives.

The company further states that the Ocusoft Lens Care System is ideal for all soft contact lenses but is especially beneficial for silicone hydrogel lenses which are prone to reduced wettability and subsequent microbial contamination. Patients with sensitive eyes, contact lens induced dry eye or poor contact lens retention time may also benefit from using the Ocusoft Lens Care System.

Ocusoft, Inc. is limiting retail availability in order to assist doctors in the promotion of their practice. This decision fits with Ocusoft's goal of expanding the range of products and services available through practitioners. The result of such expansion is greater patient convenience and compliance as well as an increase in practice revenue.

Special discount pricing is available to doctors for dispensing from their office. Alternatively, patients may order direct at www.ocusoft.com. For more information, visit www.ocusoft.com or call (800) 233-5469.

B+L Adds Range of Powers to PureVision2 HD for Astigmatism

Bausch + Lomb (B+L) announced that it is expanding the range of powers to its PureVision 2 for Astigmatism line of contact lenses. The range currently available is Plano to -6.00D (.25D steps) sphere power, and -0.75D, -1.25D, -1.75D cylinder powers. The expanded range will be launched in two waves.

The first wave, planned for March 1, 2012, will extend the sphere powers offered from Plano to -9.00D (.50D steps above -6.00D), and cylinder powers of -0.75D, -1.25D, -1.75D, and -2.25D in 10° increments around the clock.

This wave will be followed by a second wave planned for May 1. In the second wave, plus powers up to +6.00D (.25D steps) will be added to the range. The entire range will be available in same four cylinder powers, -0.75D, -1.25D, -1.75D, to -2.25D in 10° increments around the clock.

PureVision2 HD For Astigmatism lenses feature HD Optics, which, according to the company, provide consistently crisp, and clear vision for patients with astigmatism. The lens also incorporates Auto Align Design, a unique stabilization system optimized to deliver consistently crisp, clear vision all day, every day with excellent stability and comfort. The company reports that the lenses achieve a high level of comfort through ComfortMoist technology, a unique lens design and innovative packaging solution that creates a cushion of moisture around the lenses.

For more information about PureVision2 HD contact lenses, please visit www.purevision2.com or call (800) 233-5469.

Iris Coloboma
By Gregory W. DeNaeyer, OD, FAAO

The first photo shows a patient who has an iris coloboma, which presents as a keyhole notch in the inferior quadrant of the iris. An iris coloboma is a congenital defect secondary to failure of the optic fissure to close during embryonic development. Other types of colobomas can include notched defects of the ciliary body, retina, and choroid. Patients who have a coloboma may also have other malformations including a cleft palate/lip.

Unfortunately, an iris coloboma can degrade optics, and it leaves the patient susceptible to photophobia and glare. It can be corrected surgically, as was the case for the patient in Figure 2. An alternative to surgery would be to fit the patient in a prosthetic contact lens. Prosthetic lenses for this condition perform best with a black backing to completely block light verses cosmetic colored contact lenses that are translucent.

Snell, RS. Lemp, MA. Clinical Anatomy of The Eye. Blackwell Scientific Publications, Inc. 1989.

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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Susan J. Gromacki, OD, MS, FAAO

What's in the "Brown Bottle" of Hydrogen Peroxide?

How do you answer your savvy patient who asks if he can substitute the hydrogen peroxide found in the large brown bottle for the contact lens care system you have prescribed?

We eyecare professionals are well-aware that this substitution should not be made. Here are the reasons why. First of all, the peroxide in "brown bottles" available in most pharmacies or retail outlets is not cleared by the FDA for ophthalmic use. This is achieved by subjecting a product to extensive clinical trial testing as well as analytical (preclinical) testing, which includes shelf-life stability and disinfection efficacy amongst other things. In addition, it is not purified or sterile.

The "brown bottle" peroxide is not ophthalmic grade, which means that there is no quality standard to ensure minimal impurities. These peroxides also contain stabilizers that have not been approved for ophthalmic use, and as such may not be compatible with contact lenses or the eye. After neutralization, the lenses would be soaking in solution that still contains these impurities and stabilizers. Additionally, "brown bottle" peroxides are not buffered; the pH of the peroxide in the "brown bottle" can be as low as 3.5, quite different than the pH of the tears (7.4-7.6).

Lastly, the ophthalmic hydrogen peroxides may contain surfactants—which aid in the cleaning and comfort of contact lenses. The "brown bottle" H2O2 does not contain them.

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Guest Columnist: Brian Tompkins, BSc Hons FCOptom, FBCLA
Northampton, United Kingdom

The State of Contact Lens Practice in the UK

I have a real difficulty in seeing the state of UK CL practice other than from my own perspective, as like many independent practitioners, I only see my own "bubble" of day-to-day life.

A patient (-9.00/-5.00 cyl, 30 year GP wearer) asked me this morning if I saw "normal people?" I answered immediately "yes," but then thought longer. I realized that she was the third complex case I had seen, and a lot of the patients today seemed to have been keratoconic, long standing GP wearers (originally not ours) with signs of corneal exhaustion or ortho-K patients.

So why do I seem to attract the "Fun Ones" and not the -2.00 simple disposable soft lens wearers?

Maybe because we have success in the majority of cases and the word spreads. Or, maybe the simple ones are not as particular as to where they go and are more lured by advertising of "Free This" or "Free That" (we work on a strict fee for time basis) and cannot see the need to go to a "Specialist."

So what does this mean for the future? I think that the bread and butter patients will continue as now, by and large looking for a "deal" where possible and so will seek the best options to suit their needs... The "McDonalds" Contact Lens Option.

I feel that the gourmet side of contact lens fitting will continue with practitioners who are passionate, dedicated and forever striving to be better masters of our art—the top chefs! And as time goes on, my hope is that the younger chefs will take over from the grand old masters as they learn the art and skills of specialty contact lens fitting.

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Guest Columnist: Anita Ticak OD, MS; Kelly K. Nichols, OD, MPH, PhD, FAAO

Dry Eye: Should We Evaluate Our Water Intake?

Another young, otherwise healthy graduate student sits in my exam chair, utterly baffled by her sudden onset of dry eye with the start of grad school.

My questions, related to computer use, late hours, and water intake, are met with a blank stare. Our daily environment, as well as diet, can impact our ocular health status. Remembering back to optometry school, certainly our diets changed, as well as water intake, especially the non-caffeinated variety. The Institute of Medicine states that an adequate intake (AI) for men is 3 liters (13 cups) and AI for women is 2.2 liters (about 9 cups) per day. Sadly, my student patient might get half that.

A recent pilot study at Pacific University Optometry School (http://www.clspectrum.com/articleviewer.aspx?articleid=105802) looked into this issue. Twenty-nine subjects were surveyed, 17 of which were identified with dry eye. The subjects were asked to drink a specific amount of water every day for two weeks and document the actual consumption. The results of the study suggest that increased water intake helps relieve the symptoms associated with dry eye syndrome in some patients (13 of the 17 were identified as 'normal' at study completion). While this study and the literature regarding dry eye and water intake is limited, the concept of increasing hydration through water intake makes sense.

Water intake is always among the first questions I ask my patients, and I often remind my dry eye patients to drink adequate water. A reminder to keep a glass of water filled while settling down for TV, or buying a 32oz water bottle to keep track of daily intake can help.

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Quality of Life of Myopic Subjects with Different Methods of Visual Correction

The purpose of this study was to evaluate different aspects of the visual-related quality of life using the National Eye Institute Refractive Error Quality of Life (NEI RQL)-42 questionnaire in low and moderate myopic subjects corrected with different refractive treatments including laser-assisted in situ keratomileusis (LASIK), orthokeratology (OK), soft contact lenses (SCLs), and spectacles.

The NEI RQL-42 questionnaire was administered to 217 subjects at one single clinic. All the questions consisted of 13 different subscales that were analyzed separately. The results from subjects with -1.00 to -3.00 diopter myopia corrected with LASIK (n=41), OK (n=37), SCLs (n=44), or spectacles (n=45) were compared with each other and with emmetropic subjects (n=50).

Statistically significant differences among all groups were found in all subscales, except for satisfaction with correction (P=0.135). The average decrease in quality of life compared with emmetropes were -7.1% (P=0.021) for LASIK, -13.0% (P<0.001) for OK, -15.8% (P<0.001) for spectacles, and -17.3% (P<0.001) for SCLs.

The authors concluded that although all patients in each group were considered to be successfully visually corrected, quality of life related to vision was markedly different in certain NEI RQL-42 categories. LASIK showed the lowest average decrease in quality of vision compared with emmetropes. OK was comparable with LASIK in independence of visual correction, and SCL wear was superior to LASIK and OK lens wear in glare.

Except for glare and diurnal fluctuations, contact lenses (SCL and OK) were comparable with or superior to spectacle correction

Queiros A, Villa-Collar C, Gutierrez AR, Jorge J, Gonzalez-Meijome JM. Quality of Life of Myopic Subjects With Different Methods of Visual Correction Using the NEI RQL-42 Questionnaire. Eye Contact Lens. 2012 Mar;38(2):116-21.

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