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Sunday, March 16, 2014  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO
One of the more common complications with scleral contact lenses is midday fogging. My good friends, Jan Bergmanson and Pat Caroline, have estimated that it may occur in 20-30% of scleral lens patients. Unfortunately we do not understand the etiology of this common problem. We would like to hear your thoughts on midday fogging in scleral lens patients. Please email me directly at jnichols@optometry.uh.edu.

B+L Launches PeroxiClear

Bausch + Lomb (B+L) announced the introduction of PeroxiClear 3% hydrogen peroxide cleaning and disinfecting solution.

PeroxiClear solution is a unique formula that contains Triple-Moist Technology, which helps to provide up to 20 hours of moisture,1 according to the company. PeroxiClear provides the disinfection efficacy you expect from a hydrogen peroxide solution, but neutralizes in only four hours, as compared to six with other peroxides.

PeroxiClear solution will be available in major retailers starting in April and May 2014, including Target, Rite-Aid, K-Mart, Walmart, Walgreens and CVS. It will be available at most retailers nationwide by June 2014.

1. High-resolution/accurate-mass (HR/AM) mass spectrometry was used to detect and quantitate the relative amounts of surfactant retained on lenses from PeroxiClear and Clear Care solutions after 20 hours of wear. PureVision2, Acuvue Oasys, and Air Optix Aqua lenses were soaked in solutions for 12 hours prior to patients wearing lenses for 20 hours.

J&J Vision Care Expands Parameters for Acuvue Oasys for Astigmatism

Johnson & Johnson Vision Care, Inc. announced that effective April 15, 2014, Acuvue Oasys Brand Contact Lenses for Astigmatism will be available in more parameters, providing doctors with a range of options to provide coverage for 98 percent of spherical and astigmatic patients.1

Effective April 15, parameters are being expanded to include -6.00 to +6.00 in 0.25D steps (Cylinders: -0.75, -1.25, -1.75, -2.25; Axis: Full circle in 10 o steps) and from -6.50 to -9.00 in 0.50 steps Cylinders: -0.75, -1.25, -1.75, -2.25; Axis: Full circle in 10o steps).

With the introduction of these new parameters, the company also announced that effective March 31, 2014, diagnostic lenses for Acuvue Advance Brand Contact Lenses for Astigmatism will no longer be available from Johnson & Johnson Vision Care, Inc.

1. Data on file, Johnson & Johnson Vision Care, Inc. 2013

New Retaine HPMC Lubricant Eye Drops Available in Multi-Dose Preservative-Free Bottle

OCuSOFT Inc. introduces Retaine HPMC Lubricant Eye Drops now available in a patented multi-dose, preservative-free delivery system.

Retaine HPMC Lubricant Eye Drops is a preservative-free Hypromellose Ophthalmic Solution (0.3%) that provides immediate relief to soothe dry, irritated eyes by resembling natural tears, according to the company. Utilizing a patented proprietary airless pump system that prevents harmful bacteria from entering the bottle and contaminating the solution, Retaine HPMC enables delivery of multiple sterile doses to the eye without preservatives that can be damaging to the sensitive ocular surface. Most solutions intended for multiple use require the addition of preservatives, but Retaine HPMC has a three month stability after opening with guaranteed sterility.

Retaine HPMC in its multi-dose bottle allows for lower cost of treatment and is only available from OCuSOFT. Retaine HPMC joins a growing line of Retaine brand eye care products which are discounted to practitioners for direct dispensing to the patient. The program serves to not only increase practice revenues but provide added convenience and savings to patients.

For more information, call (800) 233-5469 or visit www.ocusoft.com.

CooperVision Names Ferrigno President, North America

CooperVision, Inc. has appointed Bob Ferrigno as President, North America effective February 2014. Mr. Ferrigno has overall responsibility for guiding the organization’s future strategies and direction for the region.

The role was formerly held by Andrew Sedgwick, who was named Executive Vice President of Commercial Strategy and Business Development for CooperVision last year.

Prior to joining CooperVision, Mr. Ferrigno was with Becton Dickinson (BD), a global medical technology company, for 32 years. During his distinguished career with BD, he held numerous positions with increasing levels of responsibility including Vice President of Global Expansion, Vice President of Global Strategic Marketing and Vice President of Research and Development. In addition, Mr. Ferrigno served 12 years in general management positions, including having responsibilities for the European pre-analytical systems in the United Kingdom, and as the General Manager for international business for the company’s women’s health & cancer business.

Paraoptometric Community Service Award Nominations Sought

Do you know a paraoptometric that serves both the patients in his or her office and is active in their community? The Paraoptometric Resource Center (PRC) of the American Optometric Association is seeking nominations for the 2014 Community Service Award. The award is given to the paraoptometric who demonstrates a commitment to helping improve his or her community and a dedication to the profession of paraoptometry.

Individuals may nominate themselves for this award, or can be nominated by other professionals. Criteria for judging include the individual’s involvement in community service within the optometric practice and the community, as well as the individual’s personal and professional goals of community service.

The recipient will be presented a plaque of recognition, a $100 personal cash award, and a $100 award to the charity of the recipient's choice during the PRC Awards Celebration being held Friday, June 27, 2014 during the 117th Annual AOA Congress & 44th Annual AOSA Conference: Optometry's Meeting in Philadelphia, Pennsylvania.

To download a nomination form, go to http://www.aoa.org/Documents/optometric-staff/Community_Service_Nom-Form-2014.pdf . Completed nomination forms should be submitted via e-mail with attachments to PRC@aoa.org or faxed to (314) 991-4101 by March 31, 2014.

MRSA Corneal Ulcer
Stephanie Woo, OD, FAAO, Lake Havasu, AZ

This ulcer was unaffected by Vigamox, Durezol, Viroptic, Natamycin, and Zymaxid. Corneal culture resulted in MRSA identification. Patient is currently taking Vancomycin drops Q2hrs.

We thank Dr. Woo for this image and we welcome photo submissions from our other 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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S. Barry Eiden, OD, FAAO

The unmet promise with high oxygen transmission SiHy lenses… Is there yet hope that contact lens materials can positively influence the risk of microbial keratitis?

In my last column I reported on the tear film’s natural defense mechanisms and the potential negative impact of contact lens wear. Today let’s take a more optimistic position. Authors from the University of California Berkley School of Optometry reported on their work that examined risk factors for microbial keratitis (MK) and the potential influences of contact lens materials on MK.1 They stated that the introduction of silicone hydrogel lens materials with increased oxygen transmission to the ocular surface has not significantly altered the incidence of MK.2,3 They further described how contact lenses can predispose the cornea to infection based on the fact that the lens is a conduit for microbial entry into the eye, attachment and biofilm formation, and other microbial adaptations that could provide microbes the time and opportunity for virulence. The lens also disrupts the tear-film ocular surface interface, and the lens material can suppress corneal epithelial innate defense responses to microbial antigens. Additionally, contact lenses can also interfere with normal epithelial proliferation and differentiation that may compromise barrier function. Finally the authors state that contact lens interference with host defenses seem to takes time (several days) suggesting that, with current materials, lens effects on innate defenses (and microbial virulence) are more likely to be prevalent with overnight or extended wear.

So where is the silver lining to this apparently very dark cloud? It is in the opportunity for future contact lens material development. The authors state that future lens materials could make a significant difference in reducing the risk of microbial keratitis by preventing microbial access and adaptation to the ocular surface, and preventing lens effects in compromising the corneal epithelium. They felt that it remains to be determined if silicone hydrogel materials will be part of that equation.

1. Evans DJ, Fleiszeg SM. Microbial Keratitis: Could Contact Lens Material Affect Disease Pathogenesis? Eye Contact Lens. Jan 2013; 39(1): 73-78.
2. Dart JK, Radford CF, Minassian D, Verma S, Stapleton F. Risk factors for microbial keratitis with contemporary contact lenses: a case-control study. Ophthalmology. 2008;115(10):1647–54. 54, e1-3.
3. Stapleton F, Keay L, Edwards K, Naduvilath T, Dart JK, Brian G, et al. The incidence of contact lens-related microbial keratitis in Australia. Ophthalmology. 2008;115(10):1655–62.

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David Kading, OD, FAAO

This is the second in a series of articles highlighting designs and innovative technology from our industry partners including some of the specialty contact lens laboratories.

Explore Your Soft Side

Contamac has some exciting news coming out in 2014. If you do not know, Contamac is a company that originated in Great Brittan. They have been in the U.S. for several years and have been doing a great job. They released the Definitive 74 material several years ago as the first silicone hydrogel soft lens material that is fully customizable. We have seen this material in many of the great custom soft lenses over the last couple of years. In recent news, they have announced that they will be releasing the Definitive 65. This material will have an added stability and durability allowing for thinner lens designs and increased parameter integrity for their multi-paks. Additionally the Definitive 50 is being added to the family of materials. This material will have a higher modulus allowing for even thinner lens designs. These lenses will have Dk of 62 and 50 respectively. I have seen great benefits of custom soft lenses in my practice. Having additional material options like these and others will significantly help to advance our options for patients.

If you have any comments or ideas please contact me on twitter @davekading. Happy Fitting

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How Contact Lens Comfort May Be Influenced by Psychiatric and Psychological Conditions and Mechanisms

End-of-day soft contact lens awareness, dryness and discomfort are common related problems and may be associated with lens surface dryness and soiling as well as signs of ocular discomfort. Similar symptoms may be reported by patients who do not have obviously degraded lenses or ocular signs of discomfort. This review examines some psychiatric and psychological conditions and mechanisms which may predispose toward or enhance the likelihood of these symptoms occurring and becoming a problem. For example, conditions such as depression, anxiety and stress may lower the threshold for the perception of discomfort. Chronic ocular inflammation associated with contact lens wear may result in neuroplastic lowering of nociceptive thresholds and enhancement of the perception of discomfort. End-of-day tiredness and reduced levels of demand from top-down activity may make it harder to maintain goal-relevant attention and the associated ability to inhibit sensory stimuli (such as lens awareness) that would otherwise not capture attention. Lens surface lubricity experienced on lens insertion may be higher than normal for corneal or conjunctival surfaces and create expectations of very high comfort levels, which are not apparent after lens surface dehydration, soiling or other lens changes have accumulated during the day. Psychiatric and psychological conditions and mechanisms may not only contribute to the perception of discomfort, when the lens and ocular condition appear normal but also may contribute to the perception of discomfort, when lens surface drying and soiling are evident and/or discomfort such as chronic ocular inflammation is apparent.

McMonnies CW. How contact lens comfort may be influenced by psychiatric and psychological conditions and mechanisms. Clin Exp Optom. 2014 Feb 18. doi: 10.1111/cxo.12122. [Epub ahead of print]

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