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Sunday, March 18, 2012  
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Last week's question:
Over the last few years, have you observed a change in how often you see infiltrative keratitis in your contact lens wearing patients?

 1. Yes, I'm seeing it more frequently.

 2. I'm seeing it at the same rates as I've always seen it.

 3. No, I'm seeing it less frequently. 28%

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

Many of you have shared stories with me about ways in which you have given back to your communities. It is important to remember that there are many ways you can give back, including your time, services and resources. Many of you find great fulfillment in giving back and while you have never asked to be recognized, I am sure you have appreciated a genuine "thank you" from those who have benefited from your work. The editorial staff at Contact Lenses Today thanks you as well.

In Memoriam: Irvin M. Borish, OD, FAAO

The "Father of Modern Optometry," Irvin M. Borish, OD, FAAO, passed away on March 3 at the age of 99. Dr. Borish's textbook Clinical Refraction has served as a primary optometric education resource since it was published in 1949.

Dr. Borish was a pioneer in contact lens spherical and specialty designs and invented numerous devices for the evaluation and modification of rigid lenses. He served on the faculty of Northern Illinois College of Optometry, the Indiana University School of Optometry, and the University of Houston College of Optometry.

He was the recipient of numerous honors including being the first inductee into the National Optometry Hall of Fame. The American Optometric Association honored him with the Apollo Award and its Distinguished Service Award. From the American Academy of Optometry he received the William Feinbloom Award, the Eminent Service Award and the Max Schapero Memorial Lecture Award. A generous philanthropist, he donated over $100,000 to the American Optometric Foundation.

His impact on the profession of optometry is beyond measure.

In Memoriam: Nick Stoyan, NCLC

Nick Stoyan, NCLC, founder of Contex and developer of the OK3 and Contex E lens designs for orthokeratology, passed away at the age of 74. Nick, who started his career with The Plastic Contact Lens Company owned by Wesley Jessen, brought innovative concepts to contact lens design and fabrication. He held numerous patents for his inventions. Stoyan and others developed the first "reverse geometry" ortho-k designs. He is considered one of the pioneers in contact lens corneal reshaping.

He received numerous awards including the Founders' Award for outstanding contribution to the clinical aspect of the art or science of contact lens fitting from the American Academy of Optometry and the Excellence in Orthokeratology Award from the Orthokeratology Academy of America (OAA).

To honor him, the Stoyan family and Contex have set-up the "Nick Stoyan Memorial Orthokeratology Grant." The grant will be awarded to a 4th year optometry student with the best and most innovative orthokeratology project at the annual OAA meeting. Donations can be sent to: Nick Stoyan Memorial Orthokeratology Grant, c/o Contex, Inc., 4505 Van Nuys Blvd., Sherman Oaks, CA 91403.

Based on article by Cary M. Herzberg OD, FOAA, www.orthokacademy.com/blog/ accessed on 3/15/12.

Contact Lens Industry Continues to Expand in Five Key Asian Markets

The contact lens industry in Korea, Taiwan, Singapore, Malaysia and Hong Kong continues to flourish, closing 2011 with an 11% registered growth in total sales revenue and a new market value high of over $712 million USD. According to GfK retail audit findings across these five countries, Korea posted the best results with 20% growth in sales, followed by Taiwan at 12%. Singapore and Malaysia similarly reflected gains of 7% and 5% respectively.

GfK is one of the world's largest research companies, operating in over 100 markets. GfK is a sponsor at the MIDO International Optics Fair.

J&J Vision Care Supports Optometry Giving Sight

Johnson & Johnson Vision Care, Inc. has become a Silver National Sponsor of Optometry Giving Sight. Dr. Mary Anne Murphy, Chair of Optometry Giving Sight, welcomes the support of J&J Vision Care, noting that it is one of the world's leading health care companies with a strong commitment to citizenship and giving back to people in need.

Optometry Giving Sight is the only global fundraising initiative that specifically targets the prevention of blindness and impaired vision due to uncorrected refractive error — simply the need for an eye examination and glasses. For information on how you can support the efforts visit www.givingsight.org.

CooperVision Awarded Manufacturing Leadership 100 Award

CooperVision, Inc. is among the distinguished list of winning recipients of the eighth annual Manufacturing Leadership 100 (ML100) Awards. CooperVision was selected by Manufacturing Executive, the global community for manufacturing leadership and producer of the Manufacturing Leadership Summit and ML100 Awards program.

The ML100 Awards honor manufacturing companies and individual manufacturing leaders who help shape the future of global manufacturing. The judges evaluated nominations on four criteria: process impact, business impact, strategic impact, and use of technology. In addition, the judges based their selection on projects that have helped set each company apart from the competition; delivered a clear and compelling return on investment; and have rethought and reengineered how they source, produce, and deliver products to customers in dynamic global markets.

CooperVision's supply chain initiative provided the flexibility to anticipate and respond to changing global and local market conditions through improved visibility and access to accurate information. Following its implementation, the company has seen improved forecast accuracy, inventory turns increase 20%, and service levels rise 10 points in key product families.

Eye Allergies Disrupt Daily Activities, Survey Shows

For many vision corrected individuals, eye allergy symptoms such as itchy, watery, or red eyes often keep them from enjoying daily activities, affect their appearance, and impact their performance at work, at school, and during sports, according to a survey conducted by Harris Interactive on behalf of Vistakon Division of Johnson & Johnson Vision Care, Inc.

According to the online survey of 755 eye allergy sufferers ages 18 and over who wear glasses, contact lenses, or both, more than two in five (41%) say they suffer from mild to moderate eye allergy symptoms on a daily basis. To help allergy sufferers better understand and manage their condition, copies of a free educational brochure titled Eye Health and Allergies are available to eyecare professionals free of charge. To receive bulk copies for your office, please email your request, making sure to include your name and mailing address, to eyeallergybrochure@rprny.com.

Keratoconus with GP Lens
By Sergey Cusato, OD, FIACLE, São Paulo, Brazil

This shows a patient with keratoconus and a corresponding visual acuity of 20/400 in the affected eye. The lens shown is a high Dk aspheric GP with four peripheral curves.

We thank Dr. Cusato for his images and 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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More Opinions on Monovision vs. Multifocals

I have personally been a contact lens wearer for 45 years, including the last 15 as a very happy monovision wearer. If I had to claim a specialty, it would be contact lenses in general and the fitting of presbyopia in particular.

I have fit literally hundreds of monovision patients. I try to look at every patient objectively to determine that person's best option(s). Some of those patients do succeed with multifocal lenses under my care, which would typically be after a trial at monovision. However, at this point in time for most of my patients, I do not have the confidence that they will enjoy nearly the success in any of the current multifocals vs. an appropriate, customized monovision fit. Can a practitioner build a successful multifocal practice? Absolutely. But, do I believe that the current best-possible functional outcome for most patients would be multifocal lenses as compared to monovision under my care? Not yet.

Here are the inherent advantages to monovision vs. multifocals as I see them:
— Unlike the blur resulting from multifocals, any bothersome blur that is the result of the monovision correction can be corrected situationally (i.e. distance, near, intermediate) with a simple over-correction. As a matter of fact, a significant number of my patients purchase single vision glasses for night driving or in their favorite sunglasses style. Even though most patients will not need extra glasses, many patients are very happy with this option which results in additional spectacle Rx sales.
— Assuming there are good BVAs in each eye, virtually any prescription is correctable with monovision.
— Often the patient can continue in his current, successful lens type by simply having one lens adjusted for the appropriate near range.
— Generally, the cost of monovision is less to the patient.
— We, as practitioners, understand the optics of single vision, soft spherical or toric contact lenses. Who among us truly understands the mumbo jumbo of all the multifocal optics jargon and explanations for how they work? I know, "If it works, it works!", but I still feel a bit uneasy about acting confident about something that I am really not confident about.
— Blurring from monovision is much more easily quantified and corrected, resulting in less stress and chair time for the practitioner and the patient.

It would be interesting to see a poll based upon number of fits and years in practice. I suspect that we would get a quite different response. I would like to ask my multifocal-fitting colleagues if they would allow themselves to be given a multifocal IOL whose optics are similar to multifocal contact lenses. Think about it.
David P. Ditto, OD
Nicholasville, KY

I try multifocal lenses first on all patients without significant astigmatism. Some cannot adapt to multifocals and actually like monovision better (I do warn them about loss of or altered depth perception), which is still surprising to me. I have yet to fit a patient with high astigmatism (over -1.25 DC) with a multifocal toric lens as I try to keep all patients in at least a monthly disposable.
Lorelei F. Zeiler, OD
Caledonia,ON, Canada

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Kelly K. Nichols, OD, MPH, PhD, FAAO

Steroids and Ocular Surface Disease

One of the most common questions I get from the audience at dry eye/MGD lectures is about the use of steroids in the management of ocular surface disease. Surprisingly, there are not many published studies with recommendations regarding dosing, duration, formulation, and concurrent management strategies. In addition, there is still hesitancy to use steroids for ocular surface disease—usually described by non-users as safety-based concerns (e.g. IOP spikes, risk of cataract development). Compliance is also cited as a reason to not use steroids—compliance with the prescribed treatment plan, as well as possible use of the remaining steroid by the patient in an unapproved manner some time down the road.

Should we be this worried? Corneal transplant patients are given steroid drops essentially for life to reduce inflammation and hopefully reduce rejection. Non-steroid users may argue that the risk/benefit ratio for a transplant patient favors the use of steroid, while in ocular surface disease, steroid use may be an undue risk. However, those of you who have treated a moderate to severe dry eye patient with steroids realize pulsed therapy can be very beneficial. Newer topical and ointment-based steroids should be considered as realistic options in the overall management of ocular surface disease patients across disease severity.

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Susan J. Gromacki, OD, MS, FAAO

The Development of a New CL Multipurpose Solution

At the Global Specialty Lens Symposium in January, Dr. Jason Nichols noted that three new multipurpose contact lens care solutions were launched during a recent one-year period. What makes this particularly impressive is the amount of time, effort and capital required from industry to develop and launch a new care solution.

Typically the process takes between 3 and 5 years. It begins with internal laboratory-based testing of the new solution components (e.g. wetting agents) and then their integration with the other solution ingredients (e.g. buffers and surfactants) until a final formulation is identified. The balance between the components must be delicate, as the solution must demonstrate adequate disinfection, compatibility with contact lens materials and the eye, stability, and safety.

The formulation is then tested for disinfection efficacy, as defined by the United States Food and Drug Administration (FDA) and the International Standards Organization. Next, a toxicology evaluation is performed, analyzing ocular biocompatibility with different lens types; cytotoxicity; sensitization potential; acute oral toxicity; and mutagenic potential. Then, the formulation undergoes clinical testing. Currently, the FDA recommends 270 human subjects with representative lens materials representing FDA Groups I, IV, and 4 silicone hydrogels. Although the FDA's 510(k) Guidance Document currently states that a care system only needs to demonstrate "substantial equivalence" to one that is currently on the market, industry's goal is, of course, to provide new care products that are superior to the older ones--and in most cases, they have done just that.

For more details on how these solutions are developed see http://cls.visioncaredev.com/articleviewer.aspx?articleID=106076.

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Colored Cosmetic Contact Lenses: An Unsafe Trend in the Younger Generation

These researchers wanted to identify the microbiological profile and evaluate the clinical course and outcomes in patients who developed severe infectious keratitis after colored cosmetic contact lens wear.

This case series included 13 patients who developed severe infectious keratitis after colored cosmetic contact lens wear. A detailed history regarding contact lens availability and storage and handling techniques was taken. All patients underwent standard diagnostic microbiological evaluation followed by culture-guided topical antimicrobial therapy.

Of 13 patients, eight were male and five were female, with mean age at presentation of 19 +/- 3.8 years. All patients were emmetropic, and lenses were worn solely for cosmetic purposes. Seven lenses were dispensed without prescription or fitting from an unlicensed optical shop, five patients had shared lenses with friends/relatives, and one patient obtained the lens from the garbage. None of the patients followed the recommended contact lens handling and storage techniques. The causative microorganisms included Pseudomonas aeruginosa (54%), Staphylococcus aureus (25%), and Staphylococcus epidermidis (17%), with one case of viral keratitis. In 62% of cases, ulcer size was >/=5 x 5 mm and post-treatment corrected visual acuity was 6/24 or less. All patients responded well to topical antimicrobials, and none required surgical intervention.

The authors concluded that over-the-counter use of decorative lenses as a cosmetic aid is rapidly increasing. Easy and unmonitored availability of these cosmetic lenses is followed by severe sight-threatening complications in young emmetropic individuals.

Singh S, Satani D, Patel A, Vhankade R. Colored Cosmetic Contact Lenses: An Unsafe Trend in the Younger Generation. Cornea. 2012 Feb 28. [Epub ahead of print]

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Important Links:
To report adverse contact lens reactions visit: http://www.accessdata.fda.gov/scripts/medwatch/ or call (800) FDA-1088.
To report possible grievances related to the Fairness to Contact Lens Consumers Act or associated Contact Lens Rule visit: https://www.ftccomplaintassistant.gov/.

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