CONTACT LENSES TODAY

March 28, 2004

Contact Lenses Today® is edited by Dr. Joseph T. Barr and the staff of Contact Lens Spectrum. This week CLToday® reaches over 10,000 readers in 74 countries.

Internet/Mail-Order Provider Offers Alternative
According to Florida-based contact lens retailer Visus LLC, by dispensing its proprietary VISUS 2 disposable contact lenses with online, fax and voice reorder capabilities for your patients, you can control the purchase price and keep 100% of the profits. The company recommends converting branded products to VISUS 2 to differentiate your practice from others. In a recent promotional e-mail regarding compliance with the Fairness to Contact Lens Consumers Act, the company states that by dispensing its lenses, you can assume that you'll lose 0% of contact lens replacement orders to alternative sources.
Visus is now offering its trial lens program, which allows practitioners to obtain 90 single blister lenses delivered in two practical inventory systems for convenience. Fit 50 revenue six packs in the next three months and the trial lens set is free and the price per six pack will be fixed at $8 through December 31, 2004. You can also elect to return the trial lenses for full credit at any time before the end of the 90-day term. To find out more, visit http://www.visus.net.

New Option for Baby Boomers
After reviewing clinical trial data collected at the 12-month follow-up visit in which the NearVision Conductive Keratoplasty (CK) demonstrated effectiveness in significantly improving patients' near vision, the FDA has granted Refractec, Inc. approval for its ViewPoint CK System for improving near vision for presbyopic baby boomers. The ViewPoint CK System performs the NearVision CK procedure, which uses radio waves to reshape the cornea and bring near vision back into focus. According to Refractec, the procedure is minimally invasive and painless and takes less than three minutes in the doctor's office with only eyedrop anesthesia. NearVision CK is laser free; it uses a probe thinner than a strand of hair that releases radiofrequency energy. It's typically performed on just one eye, improving near vision without compromising the patient's binocular distance vision. NearVision CK is indicated for the temporary improvement of near vision in emmetropic presbyopes and hyperopic presbyopes.

Add some exciting color to your patients' day . . .
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Visit http://www.ecp.acuvue.com to learn more about all ACUVUE Brand products.
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Examining the Safety of Contact Lens Wear in Diabetics
In the February issue of Diabetes Technology and Therapeutics, researchers shared their results in comparing one eye from each subject of 254 diabetic patients and 254 nondiabetic patients who wear soft disposable contact lenses for daily wear. The overall incidence of complications was 49.8% among diabetics and 48% among nondiabetics. They found no significant difference in complications, corneal abrasions, corneal staining or experience of pain between daily wear contact lens wearers with and without diabetes.

Barbados Eye Studies Group Reports Cataract Findings
Investigators with the Bardados Eye Studies Group followed nearly 3,000 Barbadian-born adults for nine years and found that the overall incidence of lens changes was significantly higher in blacks (46%) than in whites (35%). The risk of new cataracts (taking into account the effects of age and sex) was 80% higher in blacks than in whites. The study's lead author, Dr. M. Cristina Leske from Stony Brook School of Medicine in New York, says that the high risk of cataracts in blacks may be related to the higher prevalence of diabetes, abdominal obesity and high blood pressure in black populations than in white.

Abstract: Contact Lenses After Penetrating Keratoplasty
Researchers examined the types of lenses used, fitting methods, visual outcomes and complications of 35 eyes in 30 patients wearing contact lenses for visual rehabilitation after penetrating keratoplasty (PK). The optical indications for lens fitting after PK included irregular astigmatism (63%), spherical anisometropia (57%) and astigmatic anisometropia (54%). The mean best corrected visual acuity improved from less than 20/40 with spectacles alone to better than 20/30 when using a contact lens. Punctal occlusion and lubrication helped to improve contact lens tolerance. Complications associated with contact lens use were minor and responded generally well to conservative treatment measures. The researchers concluded that contact lenses can improve visual function in patients who have irregular astigmatism and anisometropia after PK.
Wietharn BE, Driebe WT Jr. Fitting Contact Lenses for Visual Rehabilitation After Penetrating Keratoplasty Eye & Contact Lens 2004 Jan;30(1):31-33.

Editor's Commentary: Feedback and Commentary on Toric Lenses
Jan Boehringer, OD, PhD, of Rue du lac 39 1800 Vevey, Switzerland says, "After the second failed attempt at fitting soft torics, I will switch to a front toric RGP if the cornea is spherical."
Jill Turner, OD, of North Miami Beach, Florida, says, "It depends on the Ks, base curve, diameter and design (front or back toric) of the previous lenses. Some of the happiest contact lens wearers are those who were told that they could never wear contact lenses because their old doctor couldn't fit them."
I assume that means that Dr. Turner keeps trying. We have had other feedback regarding continuing until a good soft toric fit is found. Certainly the past literature isn't crystal clear on back versus front toric designs. But it is logical that back torics should work better on more highly toric corneas and that front torics should work better on nearly spherical corneas. Also, central versus whole cornea toricity may be an issue. Certainly against-the-rule torics may work better in double thin zone designs than with-the-rule torics, but all of these rules aren't hard and fast. And if an overrefraction doesn't provide good vision or an overkeratometry or overvideokeratography is distorted, then another design is preferred.

Fitting Tip: Astigmatic Wisdom
A patient recently referred to our office presented wearing a CPE design bitoric GP with 5.00D of corneal cylinder. The current lens gave the best acuity of 20/40+ and the patient complained that his vision fluctuated. Topography revealed the location of the corneal astigmatism as relatively central, with a near-spherical periphery. Because of the location of the astigmatism, the patient was successfully refit with an aspheric design, which centered perfectly and gave 20/20 stable acuity. Take home:
1. Patients who have centrally located astigmatism can often be fit with spherical or aspheric designs, which can be especially convenient if the required toric can't be done with an SPE design
2. Without corneal topography, how would you ever know?
-- Brad Geidd, OD
Orlando, Fla.

Plan Now for the Global Orthokeratology Symposium (GOS) (July 22 to 25, 2004 Toronto, Canada)

The only worldwide meeting focused solely on orthokeratology/corneal reshaping.
http://www.gos2004.com

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