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Sunday, March 30, 2014  
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Results from Last Question

One of the more common problems in scleral lens wear is fogging of the lenses. Which of the following scleral lens sizes do you find to be associated with MORE unwanted fogging?

 Larger diameter sclerals (> 16.5mm)

 Smaller diameter sclerals (< 16.5mm)

Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO
When we ask clinicians, most agree that increasing the replacement frequency of soft contact lenses is associated with improved comfort. Yet, what is very interesting is that there is very little contemporary literature that supports this notion. We have yet to see a clinical trial that addresses comfort related differences between daily disposable, two–week, and four–week lens replacement schedules, in particular with modern contact lens materials. Hopefully we will see more data on this topic in the future to support our clinical practice patterns.

Vision Source to Launch Sauflon’s Fresh Day Contact Lenses as Exclusive Brand
Vision Source announced the launch of Fresh Day silicone hydrogel family of contact lenses, manufactured by Sauflon. Fresh Day, a Vision Source exclusive brand, offers a full portfolio of daily disposable silicone hydrogel lenses, designed to improve patient outcomes through award winning, easy to fit, comfortable lenses while offering the convenience of daily disposables, at the cost of hydrogel lenses.

The product’s material features AquaGen technology to ensure a perfect balance of long lasting comfort and ocular health at a low cost, according to the companies. The contact lens material has a low modulus of 0.5 MPa and contains the highest water content of any silicone hydrogel daily disposable lens. In addition, Fresh Day has UV protection that filters harmful UVA and UVB rays and ensures 97 percent corneal oxygen consumption in order to provide long term ocular health. As a result, this lens offers high lubricity, flexibility, water content, and UV protection. These offerings, combined with spherical, for astigmatism, and multifocal contact lens designs caters to a variety of patients and their needs.

Fresh Day daily disposable, and Fresh 30 monthly silicone hydrogel contact lenses, will launch to 3,500 Vision Source network members at The Exchange 2014, Vision Source’s annual member’s meeting, running from April 9 to April 12 in Boston.

IACLE to Welcome New Fellows
More than 100 contact lens educators worldwide could soon be adding letters after their names having successfully completed the International Association of Contact Lens Educators’ latest Fellowship Exam.

Held every two years, IACLE’s Fellowship Exam took place in November 2013. Candidates with a successful outcome who have been IACLE members for 12 months or more can now apply to become Fellows of IACLE and use the affix FIACLE in recognition of their contact lens knowledge.

A total of 194 members from 28 countries sat the latest exam and just over half (53%) were successful. More than six in 10 candidates (62%) were from IACLE’s global priority countries. The Asia Pacific region fielded the most candidates, with 142 in total, followed by Americas and Europe/Africa-Middle East. India was the country contributing the largest number, with 47 educators taking part, followed by China with 38 and Korea with 24.

A majority of candidates (135) were educator members, working full-time or part-time at a recognized teaching institution, and 59 were associate members of whom 48 work in industry. Nine existing FIACLEs re-sat the exam to refresh and update their knowledge, and all were successful.

The 2013 Fellowship Exam was the 9th administration. The next exam will be held in 2015.

Vision Care Inventors and Entrepreneurs Wanted
Vision Care Inventing, LLC (VCI), is looking for vision care inventors and entrepreneurs with the official launch of its website, www.VisionCareInventing.com. VCI is a unique interactive knowledge based community dedicated to identifying, supporting, and promoting the most innovative and impactful eye care inventions and inventors.

VCI is the first and only community resource of its kind in the vision care industry. Visitors will learn about the future of vision care before the future surprises them. Each month, VCI’s website will feature two Inventions of the Month beginning in May. In addition, VCI’s website will feature a monthly podcast for visitors to hear stories told by major Inventors within the vision care industry. VCI’s website also contains an extensive Resource Center for individual inventors or companies to find seasoned talent to assist them in making their dream become a reality.

Ronald D. Blum, OD, Founder and CEO of VCI, believes that by helping to grow innovation within the vision care industry, everyone will benefit – especially patients. Dr. Blum adds that the website is intended to share knowledge gleaned from twenty plus years of personal experiences (good and bad) with inventing and growing young companies. In addition, the Resource Center provides access to some of the global relationships he cultivated during those years. He hopes to assist inventors and others who have a vision care idea but are uncertain of the steps needed to move it forward.

VCI’s Advisory Board includes: Richard Lindstrom, MD; Marguerite McDonald, MD, FACS; James Sheedy, OD, PhD; Ed Greene, and Rick Elias. The VCI Blog is maintained by Paul Karpecki, OD, FAAO and Dr. McDonald. Richard Clompus, OD, FAAO is in charge of the Inventor Podcast Series.

Toxic Keratitis
Edgar Davila-Garcia OD, FIACLE, FSLS, Bayamon, Puerto Rico

This is an example of toxic keratitis. This patient was diagnosed with an ectasia after lasik and wears scleral lenses. The patient was filling the bowl of the lens with a multipurpose solution instead of unpreserved saline. After retraining the patient on the proper care, insertion and removal of scleral lenses, the patient uses only unpreserved saline to fill the bowl of the lens and the problem resolved.

We thank Dr. Davila-Garcia for this image and we 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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David Kading, OD, FAAO
This is the third in a series of articles highlighting designs and innovative technology from our industry partners including some of the specialty contact lens laboratories.

Something Good from Colorado

Colorado based AccuLens has more than 30 years experience in the contact lens manufacturing business. They remain state-of-art with manufacturing as well as their designs. Through R&D at the University of Colorado, they incorporate fitting experience, technology, and an “old fashion” touch to their lenses. Although they do lens designs of all types, like other labs, they have been emphasizing scleral lenses more and more. They report that they can incorporate toric haptics, quadrant specific designs, front torics (which they can dot or truncate), and fenestrations when needed. Through their unique quadrant specific fitting system, their toric periphery design and/or their soft edge technology, their lenses should be able to comfortably fit even the most complex of eyes. They design lenses for the most advanced corneal conditions, but they also design sphericals, torics or a near add pupil depended multifocal for patients with normal corneas. AccuLens reports that they have a very simplified fitting system that incorporates optic zone and corneal diameter. They claim it is the “easiest fitting system in the industry.”

If you have any comments or ideas please contact me on twitter @davekading. Happy Fitting!

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S. Barry Eiden, OD, FAAO

Contact Lens Options for Keratoconus Continue to Expand. Today Keratoconus ≠ Rigid Corneal Lenses!

For many years most practitioners promoted the concept that virtually all patients who suffered from keratoconus would require contact lens correction utilizing rigid corneal lenses. Without a doubt rigid corneal lenses provide excellent visual outcomes based on their ability to “mask” corneal irregularity in the disease. However, clinicians realize that their overall success in managing keratoconus has been limited in many cases by numerous issues, of which #1 would be poor comfort and lens wearing tolerance.

A recent study evaluated the relative performance of a keratoconic hybrid lens design and corneal rigid gas permeable (RGP) lenses. The researchers evaluated a number of performance indicators at a 2-month point following lens dispense to 40 subjects. Results indicated that there was no significant difference in visual acuity measurements between the hybrid and RGP, however a number of other key performance indicators were found to show a difference in performance. The hybrid lens design demonstrated superiority in overall vision-related quality of life based on the NEI Visual Functioning Questionnaire 25 (P<0.001), comfort (P<0.001) and foreign body sensation (P<0.013). Regarding lens tolerance, the hybrid lens demonstrated borderline superiority (P<0.085).

The purpose of this research review was not to suggest that any one particular contact lens design is superior to others in the management of keratoconus. The intent was to demonstrate that an array of lens designs is now available to address the vision needs of these patients including corneal gas permeable lenses, intralimbal lenses, scleral lenses, piggyback or tandem systems, soft keratoconic lenses and hybrid keratoconic lenses. Each design has specific and often unique attributes that can address challenges faced by our keratoconic patients. We as contact lens practitioners with special interest and experience in treating the disease need to understand when specific contact lens designs are most appropriate for an individual patient.

Hashemi E, Shaygan N, Asqari S, Rezvan F, Asqari S . ClearKone-SynergEyes or Rigid Gas Permeable Contact Lenses in Keratoconic Patients: A Clinical Decision. Eye & Contact Lens. 2014 March 40(2): 95-8.

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Ocular Surface Prosthesis for Keratoglobus and Terrien Marginal Degeneration

This case report describes the challenges in fitting corneas using the prosthetic replacement of ocular surface ecosystem (PROSE) device in a unique case of bilateral keratoglobus (KG) with Terrien marginal degeneration (TMD).

KG and TMD are uncommon corneal ectatic conditions, characterized by protrusion and thinning of the cornea. Optical correction with spectacles is limited, as this may not provide the best-corrected visual acuity because of irregular corneal astigmatism. Corneal gas-permeable lenses can provide optimal vision, but they have poor fitting characteristics in advanced stages. The PROSE device has the advantage of masking the irregularity of the cornea with a tear lens and a contact lens power that provides a smooth refractive surface. This case report describes the fitting aspects of the PROSE device in a case diagnosed with KG and TMD. A generous vault allows the PROSE device to sink into the conjunctiva more, causing impingement, but a PROSE with higher vault is required as corneal clearance decreases with wear time. Corneal thickness measurements during the trial can give a better idea of corneal edema expected after prescribing the PROSE device. Optical coherence tomography is a useful tool for measuring diurnal changes in the corneal thickness and vault over a period in such challenging cases.

The authors concluded that modification of not only the vault but also the haptic and total diameter of the device is required to achieve an optimal fit. Though challenging, successful fitting of the scleral lens in ectatic corneas is attainable, with the aid of anterior imaging and spline technologies.

Mahadevan R, Fathima A, Rajan R, Arumugam AO. An Ocular Surface Prosthesis for Keratoglobus and Terrien Marginal Degeneration. Optom Vis Sci. 2014 Jan 31. [Epub ahead of print]

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