CONTACT LENSES TODAY

March 7, 2004

Contact Lenses Today® is edited by Dr. Joseph T. Barr and the staff of Contact Lens Spectrum. This week CLToday® reaches over 10,000 readers in 74 countries.

Case Series Illustrates Problems with Ortho-k in Kids
In the March issue of Ophthalmology, Hong Kong researcher Dr. Dennis S. C. Lam reported that children who wore orthokeratology contact lenses overnight developed corneal ulcers and suffered some vision loss. He reported on six cases of corneal ulcers in children aged nine to 14 years, seen at his clinic from March 1999 to June 2001. All wore the lenses at night for eight to 12 hours and the infections occurred three to 36 months after the start of the regimen and all experienced some degree of vision loss after the ulcers healed. Dr. Lam believes that the overnight wear deprived the cornea of oxygen, boosting the risk of ulcer and infection.

ARBO Releases Results of CL Complication Study
The Association of Regulatory Boards of Optometry (ARBO) has released the initial results of its initiative to document complications caused by contact lenses dispensed without a valid prescription. The organization started the program one year ago and is leading the effort to gather and document information to help the state attorneys general, FDA and FTC better understand the extent and severity of contact lens complications associated with invalid prescriptions. In 2003, ARBO received 116 reports including signs and symptoms of stinging, neovascularization, foreign body sensation, burning, short-term vision loss, permanent vision loss and more. If you have information of your own, download ARBO's Contact Lens Complication Form at http://www.arbo.org, fill it out and send it in. ARBO compiles the information for this ongoing study and will periodically update its Summary of Results through its Web site and through articles in professional and trade journals.

NEW FOCUS NIGHT & DAY PLATINUM GUARANTEE
We're so confident that NIGHT & DAY is the best contact lens your patients will ever wear, we'll give you back more than your money. We'll give you back your time. Return the lenses and receive full credit for the boxes plus a $40 credit toward future purchases.* (http://www.cibavision.com)

* For full details, call your CIBA Vision sales representative to obtain the Platinum Guarantee return form.
--ADVERTISING

Researchers Share Hope for New Uveitis Therapy
Researchers at the National Institutes of Health (NIH) conducted a preliminary clinical trial and found that an investigational treatment for uveitis has many fewer side effects than existing therapies. They published their findings in a recent issue of the Journal of Autoimmunity, where they stated that once monthly intravenous infusions with an immune therapy drug (daclizumab) controlled uveitis and that seven of 10 patients tolerated the therapy well over the course of four years. In laboratory studies, investigators from the National Eye Institute, collaborating with researchers from the National Cancer Institute, found that daclizumab showed promise in treating an experimental model of uveitis. Preliminary results are encouraging and clinical trials are proceeding.

FDA Approves Santen Fluoroquinolone
The FDA just approved Santen Pharmaceutical Co., Ltd.'s new ocular anti-infective medication, levofloxacin ophthalmic solution 1.5% (Iquix) for the treatment of bacterial corneal ulcers. According to the company, Iquix is active against a broad spectrum of Gram-positive and Gram-negative ocular pathogens. In two randomized, double-masked, multi-center controlled clinical trials, Iquix achieved a clinical cure rate of 73% to 87%. The most frequently reported adverse events (occurring in approximately 8% to 10% of patients) were headache and a taste disturbance following instillation. As with Santen's other prescription ophthalmic pharmaceutical agents, Vistakon Pharmaceuticals, LLC is the exclusive U.S. distributor for Iquix.

Abstract: Intrastromal Corneal Rings May be Beneficial in Some Keratoconic and CL Intolerant Patients
A 51-year-old keratoconic man presented to a clinic for a contact lens refit. He had undergone surgical insertion of intrastromal corneal rings in his right eye seven months earlier in an attempt to obtain acceptable vision without contact lenses. The resulting corneal shape after surgery presented some complications, but the patient was able to achieve 20/25-vision and adequate comfort in his right eye with a piggyback contact lens system. Upon reviewing this information, researchers at the University of California at Berkeley found that insertion of intrastromal corneal rings may be beneficial in patients who have early keratoconus or who are contact lens intolerant. However, patients who have more advanced keratoconus aren't likely to achieve adequate vision after the surgery and will require a contact lens. They concluded that when successfully fit, contact lenses over intrastromal corneal rings can improve vision significantly.

Hladun L, Harris M. Contact Lens Fitting Over Intrastromal Corneal Rings in a Keratoconic Patient. Optometry 2004 Jan;75(1):48-54.

Editor's Commentary: Overnight Orthokeratology Danger?
The article in Ophthalmology about children aged nine to 14 having photodocumented central corneal ulcers that cause permanent vision loss is gut wrenching. The North American experience with overnight corneal reshaping to date has been quite good and safe with only a case or two reported, and I've heard of no cases of vision loss. The Hong Kong case series does not reveal the types of materials used in the lenses on these unfortunate children. We know that in the United States, we only use the highest Dk materials. And the FDA requires that the U.S. corneal reshaping practitioner receive training. It behooves all of us who perform this procedure to use the highest Dk/t material-design combinations and to monitor patients closely to prevent adverse events and to be prepared to treat infection rigorously if it occurs.

Fitting Tip: Back to Basics
When evaluating a GP lens, be sure to check with white light before you put in fluorescein. As soon as you put in the dye, you've greatly increased the tear volume and the positioning of the lens will then be altered. It may not lid attach, for example, with this excess tear volume, even though it actually would with normal tear volume. In fact, you may want to view without the slit lamp so that the bright light itself doesn't cause reflex tearing, which would also increase the tear volume.
--John Mark Jackson, OD, MS, FAAO
Memphis, Tenn.

The Global Orthokeratology Symposium (GOS) is Approaching
(July 22-25, 2004 Toronto, Canada)
Get the tools to implement orthokeratology in your practice.
http://www.gos2004.com
--ADVERTISING

Report adverse contact lens reactions here: http://www.accessdata.fda.gov/scripts/medwatch/ or call (800) FDA-1088.

Send your favorite tips to tips@cltoday.com -- if your tip is selected as 'Best of the Month,' you'll receive a free golf shirt (see http://www.CLToday.com for details). Please include your full name, degree or title and city/state/country.

Visit Contact Lens Spectrum ( http://www.clspectrum.com ) for interactive clinical posters, issue archives and discussion forums. Visit Contact Lenses Today for our Best Fitting Tips and Photo Clinic, sponsored by Ocular Sciences.

CLToday Services: Subscribe; Change or Remove your e-mail address; submit news to news@cltoday.com; or, fax 1-215-643-3902.