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Sunday, March 27, 2011  
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Materials & Designs
Ronald K. Watanabe, OD, FAAO
Another contact lens property that can affect comfort is modulus. When silicone hydrogels (SiHy's) were introduced, modulus became an important consideration when selecting and fitting these lenses. First generation SiHy's were significantly stiffer than traditional hydrogels, with modulus values roughly 3 times that of pHEMA (1.5 vs. 0.5 MPa). Occasional findings with these lenses were increased movement, edge fluting, CLPC, SEALs, mucin balls, and decreased comfort. However, when the lens fit optimally, comfort was good, and these complications did not develop. Yet, with few parameter options, there were many patients who could not wear these lenses due to the effects of high modulus.

Newer SiHy's have been formulated with lower modulus values, and even the first generation balafilcon A material was reformulated with 28% lower modulus to improve clinical performance. This has allowed these lenses to fit a wider range of eyes, but they still must fit a bit more precisely, and there may be patients on the ends of the bell curve who will not be comfortable with these lenses. Careful observation of the fitting characteristics of higher modulus lenses can improve their short- and long-term success. After all, if a patient can wear a well-fit GP lens comfortably, they should be able to wear even high modulus soft lenses comfortably when fit appropriately.
Research Review
Loretta B. Szczotka-Flynn, OD, PhD, MS, FAAO
We have always suspected that the purchase of contact lenses without a prescription, i.e. usually plano tinted lenses, are associated with an increased risk of complications. However, this has been difficult to prove because the denominators in that category are difficult to determine. Other than a few case series in the U.S. published in the last 20 years that provide detail on such patients and complications presenting to tertiary care centers,1-3 I am not aware of any definitive study that was able to document a clear increased risk of any complication, including microbial keratitis (MK), for patients that obtain tinted contact lenses without a prescription in the U.S.

Recently, a study conducted in twelve French University Hospitals was able to document such a relationship. Sauer et al4 identified 256 patients that had MK from 2007-2009. They defined cosmetic contact lens wearers separately from non-cosmetic contact lens wearers - which I presume refer to patients prescribed contact lenses for refractive error in the latter category. Indeed, they state that the cosmetic contact lenses were rarely dispensed by eye care professionals are these patients were therefore less likely to be instructed on appropriate lens use and basic hygiene rules. These cosmetic contact lens wearers had a 12.3 X increased risk for MK compared to other contact lens wearers. Additionally, 60% of cosmetic contact lens related MK (versus 13% of other contact lens related MK) had a final visual acuity less than 20/200.

Hopefully this is enough evidence to convince agencies around the world to regulate the use of all contact lenses so that they are only dispensed by licensed eye care practitioners.

1. Snyder RW, Brenner MB, Wiley L, Yee RW, Gradus MS, Mackman GS. Microbial keratitis associated with plano tinted contact lenses. CLAO J. 1991 Oct; 17(4):252-5.

2. Steinemann TL, Pinninti U, Szczotka LB, Eiferman RA, Price FW Jr. Ocular complications associated with the use of cosmetic contact lenses from unlicensed vendors. Eye Contact Lens. 2003 Oct; 29(4):196-200.

3. Steinemann TL, Fletcher M, Bonny AE, Harvey RA, Hamlin D, Zloty P, Besson M, Walter K, Gagnon M. Over-the-counter decorative contact lenses: Cosmetic or Medical Devices? A Case Series. Eye Contact Lens. 2005 Sep; 31(5):194-200.

4. Sauer A, Bourcier T; the French Study Group for Contact Lenses Related Microbial Keratitis. Microbial keratitis as a foreseeable complication of cosmetic contact lenses: a prospective study. Acta Ophthalmol. 2011; Mar 15 [Epub ahead of print}]
NEWS

The Vision Care Institute Unveils New Educational Program for Practicing Optometrists

The Vision Care Institute, LLC announced that it has launched a new educational program for practicing optometrists. The one-day course offers practicing optometrists premiere education to help them achieve higher levels of success in their practices.

Held at The Vision Care Institute headquarters in Jacksonville, Florida, the one-day course covers an update on the latest in contact lens research, training on new technologies, as well as a review of emerging trends and best practices.

The course is available at no cost to participants. Upcoming course dates include: May 12-13, May 19-20, June 2-3, June 9-10, and September 22-23.

Space is limited and available on a first come, first served basis. For more information and/or to register, please contact your Vistakon sales representative or email theinstitute@vcius.jnj.com.

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Nowakowski Named Dean of the UAB School of Optometry

Rod W. Nowakowski, OD, PhD, has been named dean of the University of Alabama at Birmingham School of Optometry. Nowakowski, who has been serving as interim dean of the school since December 2009, was selected after a nationwide search.

Nowakowski earned his doctor of optometry degree from UAB in 1975. Upon graduation, he joined the faculty as chief of the Low Vision Rehabilitation Service. He later became director of the Ocular Disease and Low Vision Service within the school. In 2000, he was named chief of staff for UAB Eye Care, a leadership position responsible for all clinical activities of the school.

Nowakowski earned a doctoral degree in medical genetics in 1989 and is the local principal investigator for the National Ophthalmic Disease Genotyping Network. He is a member of the Board of Directors of the Association of Schools and Colleges of Optometry, a Fellow of the American Academy of Optometry and a member of the American Optometric Association, the Alabama Optometric Association and the American Society of Human Genetics.


Ocusoft Introduces Ocudox Convenience Kit

Ocusoft, Inc. announced the introduction of prescription-only Ocudox Convenience Kit, for the treatment of acute eyelid conditions. The Ocudox Convenience Kit contains Ocudox (Doxycycline Hyclate 50 mg, 60 Capsules, USP), Ocusoft Lid Scrub Plus Extra Strength Pre-Moistened Pads (30 Ct.) and Tears Again Advanced Liposome Spray (15 mL). According to the company, each component in the Ocudox Convenience Kit was carefully selected as a result of requests from doctors seeking a simple yet effective treatment option specific to acute cases of lid disease.

Ocusoft Lid Scrub Plus Extra Strength "Leave-On" Eyelid Cleanser offers anti-bacterial properties to effectively eradicate seven different strains of bacteria including MRSA and Staph epi1, per the company. Tears Again advanced Liposome Spray is a cool, refreshing mist which provides moisture to soothe and relieve irritated eyelids. The Ocudox targets acute conditions and 60 capsules are provided for variable dosing as determined by the practitioner.

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


Vistakon Names Ball Associate Director and Routhier Manager of Medical Affairs

Vistakon, Division of Johnson & Johnson Vision Care, Inc., has named W. Lee Ball, OD, FAAO, Associate Director, and Janelle Routhier, OD, FAAO, Manager, Medical Affairs. In their new roles, Dr. Ball will be responsible for providing strategic direction and leadership for Medical Affairs and Dr. Routhier will be responsible for clinical and technical aspects of Acuvue brand contact lenses. They will report to Sheila Hickson-Curran, BSc (Hons), MCOptom, FAAO, Director, Medical Affairs.

A graduate of the University of Houston College of Optometry, Dr. Ball brings over 10 years of hospital-based, academic and private practice optometry experience to Vistakon. For the past year, he has served as part of the company's Professional Affairs Consultant (PAC) team.

Before joining Vistakon, Dr. Ball was in private practice in Boston and adjunct clinical faculty member at the New England College of Optometry. He was also a member of the staff at Beth Israel Deaconess Medical Center, the teaching hospital of Harvard Medical School.

Dr. Routhier is a graduate of the Michigan College of Optometry, where she went on to complete a Cornea and Contact Lens Residency. Before joining Vistakon, she was Adjunct Clinical Faculty at the Michigan College of Optometry and in optometric practice.


Menicon Opens Facility in Singapore

Menicon Singapore, a subsidiary of Menicon Co., Ltd., has opened its new R&D and manufacturing facility. The US$97 million dollar, 6,000-square-meter facility is the company's first manufacturing facility in the world producing daily disposable contact lenses, and will also house Menicon's first R&D center in Asia outside Japan.


CooperVision Announces Regional Sponsorship of Optometry Giving Sight

CooperVision announced that it will become a Platinum Regional Sponsor of Optometry Giving Sight in Asia Pacific and Latin America. The sponsorship is in addition to the support it already provides to the charity in Australia, where it is a Silver National Sponsor, and to contributions made in Southeast Asia and Latin America.

Dr. Juan Carlos Aragón, President of CooperVision for these regions, said that he has the utmost admiration for the leadership role that Optometry Giving Sight is playing by mobilizing resources from the global eye care profession and industry to help eliminate refractive error blindness - and for the eye care professionals who have made the organization their International Charity of Choice.

Optometry Giving Sight disbursed more than $US1.1 million to 18 refractive error projects in 16 countries in 2010, according to Clive Miller, Global CEO of the organization.


SynergEyes Continues Sponsorship of NKCF

SynergEyes, Inc. announced that it will continue to be a major sponsor of the National Keratoconus Foundation (NKCF), a Patient Outreach and Education Program of the non-profit organization Discovery Eye Foundation, with a contribution of $20,000.

As a part of the company's sponsorship of the NKCF, the ClearKone lens will be featured in two upcoming issues of the NKCF newsletter, and SynergEyes will sponsor three patient education seminars in 2011 to continue providing pertinent information to potential patient candidates.



This month at www.siliconehydrogels.org: Ethnic differences in ocular physiology, tear mixing and contact lens-related adverse events, risk factors for inflammatory and mechanical events, and our synopsis of the 2010 meeting of the American Academy of Optometry.
Editor's Commentary
Jason J. Nichols, OD, MPH, PhD, FAAO
As we have now transitioned into spring, it's important for us to consider doing some "spring cleaning" in both our personal and professional lives. There are many ways we can do this in practice. Work with staff to clean your office and practice, and particularly your desk. Get rid of expired contact lenses and care solutions. Re-evaluate your examination and billing forms. Consider upgrading or replacing old equipment. And, why not take the time to learn something new about the profession or clinical practice?
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Abstract
Work Productivity Loss in Patients with Dry Eye Disease: An Online Survey

Researchers wanted to assess the impact of dry eye disease (DED) on productivity.

A cross-sectional, web-based survey was administered to 9034 individuals who are part of the Harris Interactive Online dry eye panel. Patients (>/=18 years of age) were included if they were currently employed, a United States resident, had a patient-reported physician-diagnosed dry eye, and scored 13 or higher on the Ocular Surface Disease Index (OSDI).

Work productivity and impairment in daily activity was measured using the validated Work Productivity and Activity Impairment (WPAI) Questionnaire. Comparisons were made across disease severity groups: mild, moderate, severe.

Reduced productivity while at work was reported by patients in all three severity groups. Patients with moderate (18%) and severe (35%) disease had significantly greater reductions in productivity than patients with mild (11%) disease, P < 0.05. Impairment in ability to perform daily activities was significantly greater among respondents with severe disease (34%) than respondents with moderate (19%) or mild (12%) disease, P < 0.05.

The researchers concluded that DED is associated with work productivity loss and impairment of daily activities. These results should be interpreted in the context of limitations related to online survey research.

Patel VD, Watanabe JH, Strauss JA, Dubey AT. Work productivity loss in patients with dry eye disease: an online survey. Curr Med Res Opin. 2011 Mar 21.


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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