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Sunday, March 31, 2013  
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Last question:

When fitting a scleral lens, which option are you more likely to use?

 Scleral (18-24mm)

 Mini-Scleral (15-17.9mm)

Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

I received a surprising number of responses to my March editorial in Contact Lens Spectrum on contact lens policies.1 Although we somewhat recently ran a feature story on the topic,2 the feedback reminds one how important this sort of policy can be to an office. We would like to hear more from you on this topic, and if you'd like to share your policy, we would appreciate seeing those as well.

1. http://www.clspectrum.com/articleviewer.aspx?articleID=108093
2. http://www.clspectrum.com/articleviewer.aspx?articleID=106333

Vistakon Introduces New 1-Day Acuvue TruEye Brand Contact Lenses (narafilcon A) in U.S.

Vistakon Division of Johnson & Johnson Vision Care, Inc. announced the U.S. introduction of 1-Day Acuvue TruEye Brand Contact Lenses (narafilcon A), a silicone hydrogel daily disposable lens currently being worn by over 1.3 million patients worldwide.

The lens features Hydraclear1 Technology, which attracts tear film to help maintain the natural ocular environment for all-day comfort; High O2 Consumption, allowing 100 percent corneal oxygen consumption at all points across minus and plus powers for white, healthy-looking eyes, and Class-1 UV-Blocking, offering patients the highest level of UV protection in a contact lens, blocking approximately 96 percent of UV-A rays and greater than 99 percent of UV-B rays that reach the lens.

1-Day Acuvue TruEye Brand Contact Lenses (narafilcon A) will gradually replace 1-Day Acuvue TruEye (narafilcon B), which was launched in the U.S. in 2010. A majority of the material properties of 1-Day Acuvue TruEye (narafilcon A) are similar to the narafilcon B product, but they are different products, according to the company. One key difference is that 1-Day Acuvue TruEye (narafilcon A) is available in two base curves (8.5 and 9.0) allowing more patients to be fit with this lens. In addition, 1-Day Acuvue TruEye (narafilcon A) has a DK/t of 118 for increased oxygen transmissibility with virtually no impact to modulus.

1-Day Acuvue TruEye (narafilcon A) will only be available in 90-packs. According to Vistakon, there will be a finite amount of time in which both the narafilcon A and narafilcon B products will be available in the U.S.

Information about the new lens is available by calling the company's customer service team at 1-800-874-5278.

B+L Files Registration Statement for Proposed IPO

Bausch + Lomb announced that it has filed a registration statement on Form S-1 with the U.S. Securities and Exchange Commission (SEC), through its holding company WP Prism, relating to the proposed initial public offering (IPO) of its common stock. The number of shares to be offered and the price range for the proposed offering have not yet been determined.

A registration statement relating to these securities has been filed with the Securities and Exchange Commission, but has not yet become effective. These securities may not be sold nor may offers to buy be accepted prior to the time the registration statement becomes effective.

Warburg Pincus, a global private equity firm, acquired the company in October 2007, for a total purchase price of approximately $4.5 billion, including approximately $830 million of debt.

GP Specialists Presents the iSight Family of Custom Lenses

GP Specialists announced the rebranding of their entire custom made to order (MTO) soft contact lens product line to iSight. Two years ago, GP Specialists, Inc. acquired American BioCurve, Inc. along with all assets and product lines including BioCurve MTO toric and sphere soft contact lenses.

Since the acquisition, the company has been enhancing its manufacturing processes and has recently launched several new products, including a new silicone hydrogel iSight SiHy custom contact lens. Now the company is re-introducing its enhanced contact lens designs and new products under a single unified brand name – iSight custom contact lenses.

The new iSight brand of soft contact lenses will offer a large portfolio of made to order products. The iSight family includes:

  • iSight DW Sphere and Toric contact lenses
  • iSight Gold Sphere and Toric contact lenses
  • iSight SiHy Silicone Hydrogel Sphere and Toric contact lenses
  • iSight MCL Multifocal Sphere and Toric contact lenses
  • iSight Aphakic contact lenses
  • iSight Pediatric contact lenses
For more information call 1(800) 899-0379 or visit www.gpspecialists.com.

Shire to Acquire SARcode Bioscience

Shire announced that it will acquire SARcode Bioscience Inc., a privately held biopharmaceutical company based in Brisbane, California. This acquisition continues to build Shire's presence in the ophthalmology therapeutic category and brings a new phase 3 compound, LIFITEGRAST, currently under development for the signs and symptoms of dry eye disease, into Shire's portfolio. Shire anticipates launching LIFITEGRAST in the United States as early as 2016 pending a positive outcome of the phase 3 clinical development program and regulatory approvals. Shire is acquiring the global rights to LIFITEGRAST and will evaluate an appropriate regulatory filing strategy for markets outside of the United States.

Under the terms of agreement, Shire will make an upfront payment of $160 million and SARcode shareholders will be eligible to receive additional undisclosed payments upon achievement of certain clinical, regulatory, and/or commercial milestones. The transaction is expected to close in the second quarter, subject to regulatory approval in the United States, and other customary closing conditions.

LIFITEGRAST, a small-molecule integrin antagonist, is believed to work by reducing inflammation through binding inhibition of the proteins lymphocyte function - associated antigen 1 (LFA-1) and intercellular adhesion molecule-1 (ICAM-1), influencing T-cell activation and cytokine (protein) release. The interaction between these two proteins plays a key role in the chronic inflammation associated with dry eye. T-cells are important components of the immune system that help control the body's response to a foreign or harmful substance or stimuli. LIFITEGRAST is administered via a preservative-free topical eye solution.

Hybrid Lens on Cross-Linked Cornea
By Boris Severinsky, MOptom, Jerusalem, Israel

These images show a sterile infiltrate under the "junction" of a hybrid lens fitted over a cross-linked cornea. Note a cross-link related mild corneal haze.

We thank Boris Severinsky 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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Ronald K. Watanabe, OD, FAAO

So Many One-Days!

I recently fit a patient with a new daily disposable (DDCL), the Safigel 1 Day, a new lens that incorporates sodium hyaluronate (HA) within its matrix. HA is a viscoelastic polymer that is naturally found in the aqueous and vitreous humors, and is becoming more frequent in dry eye products. It can theoretically make the eye feel less dry by better maintaining on-eye hydration. I then did a search for DDCLs and was surprised to find 19 different brands available in the U.S. Some other newer brands that I was not as familiar with include:

  • C-Vue 1 Day ASV (Unilens): wavefront applied aspheric design
  • DayStar (Marietta): improved visual acuity and contrast sensitivity design
  • Definition AC Everyday (Optical Connection): aberration control optical design
  • Elite AC Daily Disposables (Ocu-Ease): aberration control optics
  • Eyedia Fresh Daily Disposable (Clearlab): aspheric optics, hioxifilcon A material
  • Soflens Daily Disposable Toric for Astigmatism (B+L): HD optics and Lo-torque design
With DDCLs becoming more popular in the U.S. market, it is no wonder that the options are increasing. Though I really like the DDCL options currently available through the larger manufacturers, I think it is great that we have other options that may also give our patients excellent vision and comfort.

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Guest Columnist: Danielle Alperin, OD; Loretta B. Szczotka-Flynn, OD, PhD, MS, FAAO

Evaluating the Ocular Surface in Keratoconic Patients

When working with keratoconic patients, it is easy to only focus on their cones. Paying more attention to the other aspects of the ocular surface (e.g. cornea, conjunctiva, and tears) may allow us keep our keratoconic patient's eyes healthier.

In a recent article by Cho and coworkers,1 they attempted to gain a better understanding of this relationship by analyzing corneal sensitivity, tear quantity, tear osmolarity, and impression cytology in subjects who have asymmetric keratoconus as determined using the Rabinowitz-McDonnell test. They determined that there was a decrease in corneal sensitivity, Schirmer values, and goblet cell density in keratoconus and subclinical keratoconus (eyes with no clinical signs of the disease) subjects when compared to controls. This could confirm the suspicion that keratoconus is really a bilateral disease even when clinically it looks to be unilateral. The decrease of corneal sensitivity may be a sign of progression and give some insight into the pathogenesis. Surprisingly, there was no difference in tear osmolarity between the groups as would be expected in eyes with ocular surface disease according to the DEWS workshop. While the osmolarity is the same, the authors are quick to point out that the fluid does not necessarily contain the same inflammatory mediators or proteins.

While we currently don't have a way to improve corneal sensitivity or goblet cell density, these characteristics can be helpful in knowing the extent of the keratoconus and what we could expect from the subclinical eye. Overall, this research indicates that ocular surface changes are important when diagnosing/treating keratoconus, and that practitioners should consider these tests in their clinical regimen when treating emerging and current keratoconic patients.

1. Jin Cho, Kyong, Jee Won Mok, Min Yeong Choi, Ja-yeon Kim, and Choun-Ki Joo. Changes in Corneal Sensation and Ocular Surface in Patients with Asymmetrical Keratoconus. Cornea 32.2 (2013): 205-10.

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Contribution of Soft Lenses of Various Powers to the Optics of a Piggy-Back System on Regular Corneas

This study aims to report on the measured in vivo contribution of soft lenses of various powers to the optics of a piggyback system (PBS).

This prospective, non-dispensing clinical study was conducted on regular wearers of contact lenses who showed regular corneal profiles. Subjects were masked to the products used. The study involved the use of a spherical soft lens of three different powers in a PBS, used as a carrier for a rigid gas permeable lens. Baseline data were collected and soft lenses were then fitted on both eyes of each subject. Both lenses were assessed for position and movement. Over-refraction was obtained. Soft lens power contribution to the optics (SLPC) of a PBS system was estimated by computing initial ametropia, lacrymal lens, rigid lens powers and over-refraction. A set of data on one eye was kept, for each subject, for statistical analysis.

Thirty subjects (12 males, 18 females), aged 24.4 (+/-4.5) years, were enrolled. The use of plus powered soft lenses enhanced initial RGP lens centration. Once optimal fit was achieved, all lenses showed normal movement. SLPC represented 21.3% of the initial soft lens power when using a -6.00 carrier, and 20.6% for a +6.00. A +0.50 did not contribute to any power induced in the system. These results are generally in accordance with theoretical model developed in the past.

The researchers concluded that on average, except for the low-powered carrier, the use of a spherical soft lens provided 20.9% of its marked power. To achieve better results, the use of a plus-powered carrier is recommended.

Michaud L, Brazeau D, Corbeil ME, Forcier P, Bernard PJ. Contribution of soft lenses of various powers to the optics of a piggy-back system on regular corneas. Cont Lens Anterior Eye. 2013 Mar 16. [Epub ahead of print]

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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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