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Sunday, March 24, 2013  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

Each March for the last three years, we've surveyed you about your impressions of the frequency of contact lens-related infiltrative keratitis in terms of your beliefs about how much you are seeing it in clinical practice. Here are the results from those Quick Polls.
  More Frequent     The Same     Less Frequent    
2013     33% 40% 27%
2012 32% 40% 28%
2011 44% 25% 31%

As you can see from the data, 2012 and 2013 appear to be remarkably similar in terms of the estimated rates. None-the-less, about one-third of respondents still believe that they are seeing infiltrative keratitis more frequently in their contact lens wearing patients. We need further research to both confirm these estimates, and to understand clinical and etiological factors associated with the condition.

UltraHealth: High Dk Silicone-Hydrogel/Rigid Gas Permeable Lens Available from SynergEyes

SynergEyes, Inc. recently launched UltraHealth, its next generation hybrid contact lens for patients with irregular corneas and keratoconus. UltraHealth is designed for emerging, mid-stage, and advanced keratoconus. The design concept is in the form of reverse geometry including a combination of a soft skirt (Dk 84) and central RGP material (Dk 130). The design creates a central area of vault, which is available in several vault heights to assure excellent corneal clearance. The silicone hydrogel skirt is available in three curves (flat, medium, steep) to assure centration and patient comfort.

According to the company, with proper fitting, the proprietary soft lift curve assures cornea clearance with no hard landing zone, thereby enhancing patient comfort. The reverse geometry design allows the lens to achieve the vault required to contain the cone with a flatter base curve than a standard geometry design, resulting in an optimized lacrimal lens, and requiring a lower minus lens power. The flatter BCR also allows the centration of UltraHealth to be less dependent on the location of the cone. A better centration in concert with a lower power acts to reduce aberrations and increases the quality of the patient's vision. The combination of the new lens design and advanced material provides high oxygen (Dk) permeability. The high Dk is ideal for compromised corneas to minimize corneal stress.

UltraHealth is now available in the United States and Canada, and from more than 24 distributors in 40 countries.

ABB Concise Quarterly Soft Contact Lens Retail Price Monitor Includes WalMart and 1800 Contacts Pricing

ABB Concise's quarterly Soft Contact Lens Retail Price Monitor, now in its ninth year, is designed to help eyecare practitioners understand the dynamics of pricing soft contact lenses using annual supply discounts. Starting in Q1 2013, the Retail Price Monitor compares ECP retail pricing of soft contact lenses against online competitors 1800 Contacts and WalMart online separately.

The company hopes, that by making this information available, accounts will see how important it is for them to continue focusing their practices' efforts on selling annual supplies and utilizing manufacturer rebates to remain competitive. The Price Monitor also reflects manufacturer price and rebate changes.

To help with the strategy of selling annual supplies, ABB CONCISE offers tools such as their Annual Supply Tutorial for practice staff training, Annual Supply Comparison Worksheet, and Annual Supply Contact Lens Savings Plan worksheet. For more information on any of the annual supply tools or to obtain a copy of the new Q1 2013 Soft Contact Lens Retail Price Monitor, please email marketingrequest@abbconcise.com or contact your ABB CONCISE sales representative.

Aciex Enters Into Collaborative Research Agreement with Portola to Develop Dual Syk/JAK Inhibitors for Ophthalmic Indications

Aciex Therapeutics, Inc. has entered into a collaborative research agreement with Portola Pharmaceuticals, Inc. that provides Aciex with exclusive rights to develop Portola's small molecule dual Spleen Tyrosine Kinase (Syk)/Janus Kinase (JAK) inhibitors for ophthalmic indications. The two companies will target development of drugs to treat topical ophthalmic diseases, including ocular allergy, dry eye and other inflammatory eye conditions, for which there is a strong scientific rationale for Syk and JAK inhibition. Under the terms of the agreement, Aciex will lead clinical development activities for ophthalmic indications but both companies will fund and participate in development activities related to the programs. Portola retains the right to develop these compounds for non‑ophthalmic indications.

Soft CL Edge Lift
By Ane Murueta-Goyena Larrañaga, MOptom. Bilbao, Spain

A young male was using a piggy-back system because of a penetrating keratoplasty surgery. He was comfortable with his lenses (12 hours/day wear), but he felt some dryness during the day. He was using artificial tears on PRN basis, but he couldn't achieve complete relief.

Upon examination, I observed that the soft contact lens edge was lifted off from the cornea and it was resting on the lid margin. The soft CL needs to be refitted.

Describing lid margin's sensitivity might be difficult, and patients may report that as dryness.

We thank Ane Murueta-Goyena Larrañaga for this image and 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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Katherine M. Mastrota, MS, OD, FAAO

Eyelid Laxity in Keratoconus

The association between floppy eyelid syndrome and keratoconus (KCN) has been well established, but the converse relationship has not yet been examined and was the objective of a study to be published in Cornea in March 2013.1 The study also investigates the prevalence of obesity and obstructive sleep apnea (OSA) in KCN patients.

The study was composed of KCN patients with age-, sex-, race-, and body mass index-matched controls. Extensive eyelid laxity measurements were performed on both groups. Increased eyelid measurements of the vertical lid pull, lower lid pull, medial canthal tendon distraction, and palpebral width were found in the KCN group compared with the matched control group and a more rubbery tarsus, increased corneal diameter and increased exophthalmometry measurements were also found. The prevalence of OSA and obesity were higher in the KCN patients versus the normal population. These findings may be along the spectrum of floppy eyelid syndrome. The high prevalence of OSA in KCN patients is an important association that carries an increased risk of death from any cause and stroke.

1. Pihlblad MS, Schaefer DP. Eyelid Laxity, Obesity, and Obstructive Sleep Apnea in Keratoconus. Cornea. 2013 Mar 6. [Epub ahead of print]
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Susan J. Gromacki, OD, MS, FAAO

Caring for Soft Prosthetic Contact Lenses

In my practice, I am often called upon to fit prosthetic soft contact lenses for patients with medical conditions such as aniridia, photophobia, and leukocoria. Although challenging, it does provide great professional satisfaction to know that I made a difference in my patients' lives.

There are few companies that produce soft prosthetic lenses, and their recommendations for care are all slightly different—and have changed since my last Contact Lens Spectrum column on this topic. (http://www.clspectrum.com/articleviewer.aspx?articleID=12589) While at the Global Specialty Lens Symposium in January, I visited the booths of the three companies exhibiting there and obtained care recommendations for their prosthetic lenses. They are as follows:

  • Adventure in Colors: AOSEPT (Alcon), Clear Care (Alcon), Biotrue (Bausch + Lomb), and Complete (Abbott Medical Optics)
  • Alden: any multipurpose solution or hydrogen peroxide system
  • Medcorp International: any hydrogen peroxide system
More details will follow in an upcoming Contact Lens Spectrum column.

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A Randomized, Multicenter Phase 3 Study Comparing 2% Rebamipide (OPC-12759) with 0.1% Sodium Hyaluronate in the Treatment of Dry Eye

The group of researchers wanted to investigate the efficacy of 2% rebamipide ophthalmic suspension compared with 0.1% sodium hyaluronate ophthalmic solution for the treatment of patients with dry eye.

This was a randomized, multicenter, active-controlled parallel-group study whose participants included 188 patients with dry eye. Following a 2-week screening period, patients were allocated randomly to receive 2% rebamipide or 0.1% sodium hyaluronate, administered as 1 drop in each eye 4 or 6 times daily, respectively, for 4 weeks.

The main outcome measures were 2 primary end points: changes in the fluorescein corneal staining (FCS) score to determine noninferiority of 2% rebamipide and changes in the lissamine green conjunctival staining (LGCS) score to determine superiority. Secondary objective end points were Schirmer's test results and tear film breakup time (TBUT). Secondary subjective end points were dry eye-related ocular symptoms (foreign body sensation, dryness, photophobia, eye pain, and blurred vision) score and the patients' overall treatment impression score.

In the primary analysis, the mean change from baseline in FCS scores verified noninferiority, indicated significant improvement, and, in LGCS scores, verified the superiority of 2% rebamipide to 0.1% sodium hyaluronate. Values for the Schirmer's test and TBUT were comparable between the 2 groups. For 2 dry eye-related ocular symptoms-foreign body sensation and eye pain-2% rebamipide showed significant improvements over 0.1% sodium hyaluronate. Patients had a significantly more favorable impression of 2% rebamipide than of 0.1% sodium hyaluronate; 64.5% rated treatment as improved or markedly improved versus 34.7%, respectively. No serious adverse events were observed.

The researchers concluded that administration of 2% rebamipide was effective in improving both the objective signs and subjective symptoms of dry eye. Those findings, in addition to the well-tolerated profile of 2% rebamipide, clearly show that it is an effective therapeutic method for dry eye.

Kinoshita S, Oshiden K, Awamura S, Suzuki H, Nakamichi N,Yokoi N. A Randomized, Multicenter Phase 3 Study Comparing 2% Rebamipide (OPC-12759) with 0.1% Sodium Hyaluronate in the Treatment of Dry Eye. Ophthalmology. 2013 Mar 12. [Epub ahead of print]

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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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