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Sunday, March 25, 2012  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

Earlier this month, we conducted a repeat Quick Poll on your impressions of the frequency of occurrence of infiltrative keratitis in your contact lens wearing patients. We conducted this identical Quick Poll in March 2011—one year ago. At that time, 44% of you reported that you felt that you were seeing infiltrative keratitis more frequently in your lens wearing patients these past few years. As noted in the last issue, this year the number of you reporting more frequent observations of infiltrative keratitis dropped—down to 32%. Regardless, if these numbers are reflective of an increased frequency of infiltrative keratitis, it certainly warrants proper investigation.

Next TFOS International Workshop to Focus on Contact Lens Discomfort

The Tear Film & Ocular Surface Society (TFOS) is currently initiating organization of its 3rd international workshop, the TFOS International Workshop on Contact Lens Discomfort (CLD). Such discomfort may be the leading cause of patient dissatisfaction with, and discontinuation of, contact lens wear throughout the world. The mission of the TFOS CLD Workshop may be analogous to those of the previous TFOS Workshops (i.e. Dry Eye [DEWS] and Meibomian Gland Dysfunction [MGD] Workshops).

The Workshop Steering Committee will include: Jason Nichols (USA; Chair), Mark Willcox (Australia; Vice-Chair), David Sullivan (USA; Organizer), Joseph Ciolino (USA), Jennifer Craig (New Zealand), Gary Foulks (USA), Lyndon Jones (Canada), Kelly Nichols (USA), Chris Purslow (United Kingdom) and Fiona Stapleton (Australia). The Steering Committee will finalize the mission, select additional Workshop participants (~ 50 experts from around the world), establish detailed objectives and decide upon the timeline. TFOS anticipates launching this Workshop within the next few months. For more information, please contact Dr. David Sullivan at david.sullivan@schepens.harvard.edu.

CooperVision Wins 2012 REBRAND 100 Global Award

CooperVision was recognized by REBRAND 100's Eighth Annual Global Awards with a "Best of" award for excellence in brand repositioning. Global strategic branding firm Siegel+Gale collaborated with the company on its new brand strategy and visual identity. The REBRAND 100 is the first and highest worldwide recognition of its kind.

CooperVision's revitalized brand clearly defines what makes the company unique and valuable. The brand platform features a striking visual identity based on watercolors, providing an unexpected departure from the industry's standard brand concept. According to the company, the new design, a fresh and original take on the concept of moisture and color, celebrates the refreshing perspective contact lens wearers enjoy with CooperVision lenses. This design concept can be seen throughout CooperVision's website, www.coopervision.com.

New Edition of Clinical Ocular Anatomy and Physiology Now Available

The new, 19th Edition of Clinical Ocular Anatomy and Physiology has been published. It is edited by optometric ocular anatomist Dr. Jan PG Bergmanson. Chapter authorships include prominent members of the vision science community and the text contains original diagrams and micrographs. This most up-to-date text on the subject of ocular morphology and function is used by many optometric teaching institutions in their teaching programs.

The book costs $78 plus shipping. To purchase, contact the Texas Eye Research and Technology Center at 713 743 1931.

Calcific Band Keratopathy
By Edward Boshnick, OD, Miami, FL

This patient suffers from calcific band keratopathy. This image represents the fourth cornea that this patient received. The corneal surgeons she has visited do not recommend that she undergo additional surgeries, and as such, she is in the process of being fit with scleral lenses.

We thank Dr. Boshnick for his image 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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Ronald K. Watanabe, OD, FAAO

Multifocals for Astigmats

Multifocals continue to be one of the biggest opportunity areas for contact lens fitting, as we have noted from Contact Lenses Today Quick Polls on the topic (http://www.cltoday.com/issues/CLToday_010812.htm & http://www.cltoday.com/issues/CLToday_110611.htm). One segment of the presbyopic population that may be missing out is the astigmatic group. Their vision will be somewhat compromised with soft (non-toric) multifocals, and they may be unable or unwilling to adapt to GP multifocals. For these patients, soft toric multifocals can work quite well, and there are many great options in this category today, some are mentioned below.

The Proclear Multifocal Toric is the only lens in this category with free diagnostic lenses. Using CooperVision's Balanced Progressive Technology, it is available in a very wide parameter range. There are many other excellent options from smaller independent laboratories. For example, Unilens' new CVUE Advanced HydraVUE Toric Multifocal is a monthly replacement option made with the Definitive silicone hydrogel material. It features their patented multifocal design with an adjustable central add zone diameter. It is also available in several base curve/diameter combinations, sphere powers up to ±20 D, cylinder powers up to -4.00 D, any cylinder axis, and add powers up to +3.00 D. The first lens is warranted with full exchange and cancellation privileges, and subsequent non-warranted lenses are ordered in multi-packs. Other laboratories that offer silicone hydrogel toric multifocals include Art Optical, Metro Optics, and X-Cel Contacts to name just a few. So, please reconsider the use of a soft lens toric multifocal—your patients may thank you for it.
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Guest Columnist: Luciano Bastos, MD, Porto Alegre, RS Brazil

The Contact Lens Market in Brazil

The interest in contact lenses in Brazil declined in the 1990's with the advent of laser refractive surgery but the market seems to be regaining now after years of slowed growth. The great problem practitioners face is perceived unfair competition. Specifically, patients often prefer to order their disposable lenses through the internet or buy them in an optical store rather than pay for the examination and cost of the contact lenses. This is one of the reasons I believe that practitioners have a growing interest in GP and scleral contact lenses. It is important to educate contact lens specialists so they can fit contact lenses with confidence, and also to educate the public on the benefits of contact lenses and as well as the importance of regular eyecare.

There are numerous manufacturers that market various contact lenses in Brazil, especially soft contact lenses. In respect to the future of contact lenses in Brazil, our market has a strong potential for large growth, mainly because the easier access to credit with decreasing interest rates. I am sure that the potential is enormous and a good way to reach this new market is escalating public awareness via things like the larger contact lens companies investing in advertising and social media. We look forward to growing the contact lens market in Brazil as we emerge as one of the world's major economies.
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Loretta B. Szczotka-Flynn, OD, PhD, MS, FAAO

Can Heat and Rubbing Lead to Corneal Warpage?

Charles McMonnies and colleagues examined the role of elevated corneal temperature in the development of rubbing/massage-related corneal deformation. They postulate that warm compresses — in the management of meibomian gland dysfunction or chalazion — could contribute to such adverse responses.

With reference to reports of corneal deformation associated with meibomian gland dysfunction, chalazion, dacryocystoceles and post-trabeculectomy, the authors claim raised corneal temperature helps to explain corneal deformation which develops in association with rubbing or massage. When combined with warm compresses or other methods of heat delivery to the eye, the elevation of corneal temperature appears to explain how meibomian gland dysfunction treatment involving warm compresses and massage could induce rubbing-related deformation. They note an increased risk exists for patients with a concurrent habit of rubbing their eyes abnormally in response to allergic itch.

Should clinicians begin to monitor patients for corneal deformation whose management involves ocular massage? The authors make an interesting argument that follow-up using corneal topography is suggested when massage is prescribed, especially when used in conjunction with heat application.

McMonnies CW, Korb DR, Blackie CA. The role of heat in rubbing and massage-related corneal deformation. Cont Lens Anterior Eye. 2012 Feb 4. [Epub ahead of print]
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A Preservative-and-Fluorescein Interaction Model for Benign MPS-Associated Transient Corneal Hyperfluorescence

Multipurpose contact lens solution (MPS)/preservative-associated transient corneal hyperfluorescence has been suggested to represent corneal injury. To determine the validity of this assumption, the molecular-level interactions of common disinfectants in soft contact lens MPS and the corneal epithelium using an in vitro model were assessed.

A liposome-based model of the corneal epithelial surface was developed and used to assess the interactions of polyhexamethylene biguanide (PHMB), polyquaternium-1 (PQ-1), and fluorescein with membrane components and the effects of PHMB and PQ-1 on membrane integrity. The fluorescence anisotropy (a measure of interactions between molecules) was determined. Liposome integrity was assessed by measuring the liposome melting point temperature.

Free fluorescein did not associate with the liposome (P > 0.4). Both fluorescein-tagged PHMB and PQ-1 associated with liposomes (P < 0.002 and P </= 0.01, respectively); however, only PHMB induced free fluorescein association with membrane components. At physiological temperature, no significant shift in the melting point temperature was observed when liposomes were exposed to PHMB from 0 to 100 ppm (P > 0.05). In contrast, exposure of >7 ppm PQ-1 disrupted the liposomes.

The researchers concluded that, based on this study, PHMB-to-liposome bilayer interaction is non-destructive, even at concentrations 100 times higher than found in commercially available MPS products. In contrast, PQ-1-to-liposome bilayer interaction led to liposome disruption. This study presents molecular-level evidence to support that preservative-associated transient corneal hyperfluorescence is a benign transient phenomenon and its evaluation clinically may be an ambiguous strategy for determining biocompatibility and cell surface integrity.

Bright FV, Merchea MM, Kraut ND, Maziarz EP, Liu XM, Awasthi AK. A Preservative-and-Fluorescein Interaction Model for Benign Multipurpose Solution-Associated Transient Corneal Hyperfluorescence. Cornea. 2012 Mar 9. [Epub ahead of print]
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