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Sunday, March 8, 2015  
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Results from last poll:

Which of the following do you think is associated with the greatest increase in contact lens deposition?

 High material ionicity

 High water content

 Infrequent replacement schedule

 Poor contact lens care

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

With the recent industry activity in the cosmetic lens category, it made me wonder what the frequency of the distribution of normal iris color is in the population. Sure, we all have our relative “guess” from our clinical experience, but what are the actual numbers on this? Further, what is the most desired cosmetic change that can be made? We look to provide you some information on these topics in the coming weeks, but would also like to hear your thoughts on the topic as well. Please email them to

Alcon Adds Plus Powers to Air Optix Colors

Alcon has extended the line of Air Optix Colors contact lenses to include plus power lenses for patients with hyperopia across the full range of nine colors.

Air Optix Colors contact lenses launched in the U.S. in June 2014. They are the first monthly replacement, daily wear color lenses available in the U.S. on a silicone hydrogel platform, allowing up to six times more oxygen through the contact lens compared to the leading, older technology color contact lens.1

Air Optix Colors contact lenses are available with an 8.6 mm base curve and a 14.2 mm diameter. The contact lens power range now includes +6.00D to -6.00D (0.25D steps; including plano) and -6.50D to -8.00D (0.50D steps). The contact lenses are available in nine colors, from subtle to vibrant, including Gray, Blue, Green, Pure Hazel, Brown, Sterling Gray, Brilliant Blue, Gemstone Green and Honey.

There is no refit required for current Air Optix Aqua contact lens wearers.2

1. Based on the ratio of lens oxygen transmissibilities; Alcon data on file, 2013.
2. Alcon data on file, 2013.

New Contact Lens Case for Clear Care Solution

Alcon has released to the market a new, more consumer-friendly contact lens case with marked packages of Clear Care Solution. The new contact lens case is blue and white, with lens baskets differing in color to help consumers more easily differentiate between left and right lenses before and after cleaning. Lens baskets in the new case now have tabs to enable easier opening of the lens baskets.

Clear Care Solution users have been shown to demonstrate the most compliant lens care habits, based on a global compliance score that includes hand washing, topping off, case care and case replacement.1

Marked packages with the new contact lens cases will be on store shelves for most major retailers in March.

1. Alcon data on file, 2014

Oasis TEARS PF Introduced

OASIS Medical Inc. has introduced a preservative-free lubricant eye drop conveniently delivered in a 10mL bottle, Oasis TEARS PF.

Lubricant eye drops, which are packaged in traditional multi-use bottles, contain preservatives to prevent microbial growth. Preservative-free lubricant eye drops are commonly packaged in unit-dose vials. These vials are small plastic one-time-use containers. Oasis TEARS PF Preservative-Free lubricant eye drops are packaged in an innovative ophthalmic multi-use bottle that prevents contamination through the use of a patented closing tip, valve and air venting system that prevents microbial entry into the bottle. This propriety system keeps Oasis TEARS PF sterile for up to 90 days after opening, according to the company.

Continuing the company’s tradition of partnering with eye care providers to bring the highest level of patient care and practice support, OASIS Medical is bringing Oasis TEARS PF Preservative Free bottle to eyecare providers nationwide. Ophthalmic and Optometric practices that are interested in offering Oasis TEARS to dry eye patients can contact

Shire Submits NDA for Approval of Lifitegrast for Treatment of DED

Shire plc announced that the company has submitted a New Drug Application (NDA) with the U. S. Food and Drug Administration for its investigational compound lifitegrast for the treatment of signs and symptoms of dry eye disease in adults.

The NDA submission is supported by the totality of evidence from four clinical trials with more than 1,800 patients. These included one Phase 2 study, two Phase 3 efficacy and safety studies, and one long-term Phase 3 safety study.

Lifitegrast is a novel small-molecule integrin inhibitor. It binds to the integrin LFA-1 (lymphocyte function-associated antigen-1), a cell surface protein found on leukocytes, and blocks the interaction of LFA-1 with its cognate ligand ICAM-1 (intercellular adhesion molecule-1). ICAM-1 is over-expressed in corneal and conjunctival tissues in dry eye disease. LFA-1/ICAM-1 interaction contributes to the formation of immunological synapses resulting in T-cell activation and migration to target tissues.

I like to try out all the new soft lens products that become available, but what to do when that lens is not available yet in plus, high minus, or multifocal? I wanted to see if the claim of amazing comfort was true regarding a new fitting set that arrived yesterday. Alas, there was no lens in my RX (plus with multifocal). How could I try this myself so I can personalize fitting the lens on patients?

I decided to wear a -.50 lenses from the fitting set OU, then wear my progressive spectacles over the contact lens. It was true – 15 hours later I was still wearing the lenses with amazing comfort. My vision was just a bit less than normal with the mild over-minus, but this method allowed me to prove to myself the comfort claim made by the manufacturer.

Mark Greenwell, OD
Papillion, NE

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David Kading, OD, FAAO

The Allergies Are Coming! The Allergies Are Coming!

It’s almost time for Spring allergies. How are you preparing yourself now? How can a contact lens material help your patients? We have always talked about the benefit of single use lenses for our allergy patients. But what if your patient is a two-week or a one-month wearer? Well, why not have them go into a single use lens during the tough month or months? Thanks to our industry partners, single use lenses come in packs of 30, maybe for this very reason. A monthly supply of single use lenses can really push your patient through the challenging periods where they may just abandon contact lens wear all together. What a better way for us to keep ‘em happy!

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Guest Columnist: Amy Dinardo, OD, MBA, FAAO

From the Contributing Editor, Susan J. Gromacki, OD, MS, FAAO: The following poster, by Amy Dinardo, OD, MBA, FAAO and Evan Andrews, BS, won First Place, Clinical Poster, at the 2015 Global Specialty Contact Lens Symposium.

Comparing Hydrogen Peroxide (H2O2) Care Systems

A thorough independent examination of widely available H202 care systems confirms that there are differences between them – particularly in case design and neutralization.

Three care systems were identified: B+L Peroxiclear, Alcon Clear Care, and Sauflon One Step (also marketed under private labels). Forty-two samples were taken for each care system over an 8-hour neutralization period. Peroxide concentration was calculated from titration with aqueous potassium permanganate.

Results are as follows:

  • Alcon Clear Care and Sauflon One Step demonstrated similar H2O2 concentrations and neutralization rates (p > 0.05) over eight hours. Whereas B +L PeroxiClear exhibited significantly higher H2O2 concentration (p < 0.0001) and a slower rate of neutralization, particularly over the course of the first hour. For more information, click here refer to the graph in the poster.
  • For both Alcon Clear Care and Sauflon One Step, there was a rapid decrease in H2O2 concentration over the first 30 minutes. They both exhibited approximately a 70% (or a 24,000 ppm decrease) in hydrogen peroxide concentration within the first 10 minutes.
  • For all three care systems, H2O2 concentration was at a “safe” and “comfortable” level (<100 ppm) for insertion at 4 hours1. However, going “off-label” for those care systems approved for a 6 hour neutralization (Clear Care and Sauflon One Step) is not recommended.
  • The Sauflon One Step care system is unique in that the platinum catalyst disc is located on the bottom of the case. Therefore, neutralization will begin to occur as soon as the case is filled with H2O2 solution as opposed to other systems in which the lenses and platinum catalyst disc are submersed in the H2O2 solution simultaneously. If patients do not submerse their lenses in the Sauflon case promptly, their lenses may not be exposed to optimal levels of hydrogen peroxide.

For more information, please review poster at .

1. Paugh JR, Brennan NA, Efron N. Ocular response to hydrogen peroxide. Am J Physiol Opt. Feb 1988; 65(2): 91-98.

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Prevalence of Canaliculitis After Smartplug Insertion During Long-Term Follow-Up

The purpose of this study was to evaluate the long-term prevalence of canaliculitis associated with the use of SmartPlugs.

This retrospective study included 42 eyes of 25 dry eye patients at our institution who received a SmartPlug insertion between 2004 and 2008. Irrigation of the lacrimal system was performed in all patients prior to SmartPlug insertion to ensure the patency of the system. The median follow-up time was 7.9 (5.6-10.5) years after plug insertion.

Six patients (seven eyes) of 25 patients (42 eyes) developed canaliculitis. The prevalence of canaliculitis per patient was 24%, and the prevalence of canaliculitis per SmartPlug was 16.6%. The median time from SmartPlug insertion to the onset of canaliculitis was 4.7 (1.4-6.0) years. The median age of the affected patients was 61.5 (36-74) years. Five of these patients were women and one was man. The pathogens were identified as Actinomyces in four eyes and as Staphylococcus aureus in three eyes. In five patients (six eyes), the canaliculitis was resolved by the application of topical antibiotics and repeated lacrimal irrigations with antibiotics and povidone-iodine. In one patient, a canaliculotomy was necessary to cure the condition.

The late onset of complications after SmartPlug insertion requires long-term observation to identify the majority of complications associated with SmartPlugs. In our patients with a follow-up of up to 10.5 years, the use of SmartPlugs was associated with the highest prevalence of canaliculitis published thus far.

Klein-Theyer A, Boldin I, Rabensteiner DF, Aminfar H, Horwath-Winter J. Prevalence of canaliculitis after smartplug insertion during long-term follow-up. Br J Ophthalmol. 2015 Feb 26. pii: bjophthalmol-2014-306290. [Epub ahead of print]

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