I must admit, I like the "big box" stores. I shop at them frequently, for probably the same reasons as most everyone else: price and convenience. I have filled in at my colleagues' professional practices within some of these locations and have been impressed. So let it be known that this column is not personal, but rather, informational.

It is estimated that almost half of today's contact lens care products are purchased at three leading "big box" retailers: Kmart, Walmart, and Target.¹ This may or may not surprise you. But what may surprise you, is that one of them (Walmart) decided to remove Clear Care (CIBA Vision) from its shelves recently. It only makes sense that a retailer that carries its own, private label ("generic") brand would eventually eliminate some of its competition. But at what cost? Clear Care (along with other premium solutions like Biotrue from Bausch + Lomb, Opti-Free RepleniSH from Alcon and RevitaLens OcuTec from Abbott Medical Optics) plays an important role in our armamentarium as contact lens practitioners. Many of our patients (approximately 14.6% of over 30-35 million CL wearers in the United States alone)^2,3 benefit from the use of this product. Why, I ask, should a mass retailer remove such an important clinical product from its shelves?

The answer is because it can. They can choose to carry and sell whatever they want to; that's a retailer's prerogative (it's ours, too, for that matter). Where they cross the line is if and when they make recommendations – which, in my opinion, is prescribing – on which solutions to substitute. And some stores have done just that.

What can we do? We and our patients could contact corporate headquarters to communicate how this decision affects eye care. Individually and collectively (through our professional organizations like the AAO and AOA) we could boycott shopping at such locations. On a local level, we should inform each and every Clear Care patient that his or her care system is no longer available at Walmart. And lastly, we should continue to prescribe, rather than recommend, our patients' care systems, educating each patient why our chosen solution is optimal.^4,5 With this extra knowledge in tow, our patients will be less likely to let business decisions alter how they care for their contact lenses.

We at Contact Lenses Today will continue to keep you informed on this issue, as well as any others that may affect how we practice contact lens care.

1. Smythe JL. What's in a Solution Name? Contact Lens Spectrum. May 2003.
2. AC Nielsen, Solution Use in 2010 Year to Date, Percentage by Brand. December 25, 2010.
3. Nichols JJ. Marking an Industry Anniversary. Contact Lens Spectrum. March 2011.
4. Gromacki SJ. Promoting Adherence to Your Prescribed Care Regimen, Part 1. Contact Lens Spectrum. December 2009.
5. Gromacki SJ. Promoting Adherence to Your Prescribed Care Regimen, Part 2. Contact Lens Spectrum. February 2010.

I write this after spending the day at one of the "new" seven wonders of the world, Chichen Itza, Mexico. Just walking through this sacred place causes one to reflect on the significant sacrifice and sheer "contribution" of the original builders. In today's fast paced world, it is rare to create or be part of something long-lasting, when newer and better are just around the corner.

This week the report of the International Meibomian Gland Workshop was published in IOVS. This two year process, sponsored by the Tear Film and Ocular Surface society through generous industry support, will provide an evidence based framework to move basic, clinical, and translational research, and ultimately clinical care in ocular surface disease, forward.

And while this event represents a large group effort, and one not without toil, it may only reflect a snapshot of the field today with a blueprint for tomorrow. Indeed, this "contribution" is more like one of the many limestone rocks on the way up the Chichen Itza steps, a small but contributory part to the big picture of ocular surface disease.

The report and executive summary are available in PDF open access at www.iovs.org with weblinks at www.tearfilm.org. A free two-page pull-out summary of the report will be included in the May issues of Contact Lens Spectrum, Optometric Management, and Ophthalmology Management compliments of TFOS.

MGD Redefined: International Workshop on MGD Report Available

The Tear Film & Ocular Surface Society (TFOS) reported the conclusions and recommendations of the International Workshop on Meibomian Gland Dysfunction (MGD). The Workshop was conducted to provide an evidence-based evaluation of meibomian gland structure and function in health and disease. The just issued Report required over two years to complete and involved the efforts of more than 50 leading clinical and basic research experts from around the world.

"This report will have a significant impact on the diagnosis and treatment of lid disease and evaporative dry eye. It is intended to be a stimulus for future MGD research that will benefit the clinical care of patients around the world for years to come," said Kelly Nichols, OD, MPH, PhD, Associate Professor, Ohio State University and Chair of the MGD Workshop Steering Committee.

The MGD Report was published by the Association for Research in Vision and Ophthalmology in a special issue of Investigative Ophthalmology & Visual Science (IOVS) and made available to scientists and clinicians worldwide. A downloadable version of the document may be obtained through a link on the TFOS website (www.TearFilm.org). Complete or partial translations of the report will be offered in numerous languages, including English, Dutch, French, German, Greek, Italian, Japanese, Polish, Portuguese, Spanish, Turkish and Russian.

TFOS received funding for the MGD workshop from Laboratoires Théa, Pfizer, Inspire, Bausch + Lomb, TRB Chemedica, Santen Pharmaceutical, Allergan, Alcon, Johnson & Johnson, Advanced Vision Research, Senju, CIBA Vision and SOOFT Italia.

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Lagado's Tyro and Onsi GP Materials Receive Expanded Indications from FDA

Menicon Co., Ltd announced that Lagado Corporation's Tyro (hofocon A) and Onsi (onsifocon A) gas permeable contact lens materials have received an expanded indication from the U.S. Food and Drug Administration (FDA) for managing irregular corneal conditions (in non-diseased eyes) for keratoconus, pellucid marginal degeneration, post penetrating keratoplasty, post radial keratotomy and post LASIK surgery.

With oxygen delivery (Dk 56) and superior hydrophilic surfaces, Onsi has been used for patients with refractive errors including myopia, hyperopia, astigmatism, and presbyopia.

The expanded indication positions Tyro as an option for the management of certain irregular corneal conditions requiring high oxygen delivery (Dk 97) and surface performance properties, according to the company. Tyro is supplied to custom lens laboratories in standard as well as large diameters blanks of 17mm, 21mm and 25mm.

For more information, visit www.lagadocorp.com.


EyeXam App for iPhone Exceeds One Million Downloads - Now Available for iPad

Global EyeVentures, LLC, announced that its EyeXam iPhone application exceeded one million downloads and is now available for the iPad. EyeXam features a self-guided, patent-pending method for assessing one's own visual acuity at distance and near, color vision plates, an Amsler grid, and information about eye care products.

With a broad user base, EyeXam has proven to be a valuable tool for patients looking for eye related information, and is a high value asset for industry vendors seeking to reach the app users, according to Nikki Iravani, OD, Founder and CEO of Global EyeVentures.

EyeXam is sponsored by several industry companies including Alcon, All About Vision, Crystalens (Bausch + Lomb), Focus Laboratories, Vision Service Plan, and Vision Source.

EyeXam is available for free download through the App store: http://itunes.apple.com/us/app/eyexam/id357290178?mt=8.


Report Shows CL Industry Growth Across Five Major Markets in Asia in 2010

The contact lens industry continued to perform well in 2010, registering a healthy 12 percent growth and more than USD 623 million in sales across the five combined markets monitored by GfK Asia: Hong Kong, South Korea, Singapore, Malaysia and Taiwan. According to GfK's full year retail audit findings, all these markets expanded in value within the range of 9 to 12 percent.

Daily replacement contact lenses continued to dominate with 46 percent of the total industry sales value. However, a key driver and currently strongest growth segment of the industry is the silicone hydrogel lens. All five markets showed rising market share of this contact lens type though at different rates of adoption. While over a fifth of contact lens revenue generated in Singapore, Malaysia and Hong Kong last year came from silicone hydrogel, this proportion was significantly lower in Taiwan and South Korea.

GfK Asia is part of the global GfK Group and has over 25 years of experience providing reliable retail and technology market data in Asia. The GfK Retail Panel is a regular audit monitoring sales of specific products and product categories, using a range of Internet, retail outlets and companies to provide trade and industry highly accurate and up-to-date information on various segments of the market.

Record COPE accreditation for BCLA 2011

The 35th British Contact Lens Association (BCLA) Clinical Conference and Exhibition has received COPE accreditation for a record 13 hours of continuing education (CE), with a further three hours pending approval.

BCLA 2011 will take place in Manchester from May 26–29.

• Clinical Spotlight: Non-spectacle Correction of Presbyopia: the Holy Grail for Eyecare Practitioners
• Oxygen – featuring keynote speaker, Dr. Joe Bonanno (USA)
• The Alliance of Compliance – featuring keynote speaker Dr. Kathy Dumbleton (UK) Corneal Dystrophy – featuring keynote speaker Professor William Ayliffe (UK) Therapeutics Academy – featuring Professor John Flanagan (Canada)
• Increasing the Safety and Comfort of Contact Lens Wear by Professor Mark Willcox (Australia)
• Clinical Spotlight: Myopia Control...How Far Have We Gone?
• Contact Lenses and General Health – chaired by Dr. Lisa Keay (Australia)

For more information and to register for BCLA 2011, visit www.bcla.org.uk.

In our recent discussion of infiltrative keratitis, we've looked at the frequency of this complication and noted that 56% of practitioners felt it was being seen at the same rates or even on the decline, while 44% felt they were seeing it more frequently. This past week, we've asked about your impressions of four factors commonly associated with infiltrative keratitis in contact lens wearers. Overwhelmingly, respondents think that patient non-compliance is the most significant factor associated with this complication—to a much greater extent than contact lens material characteristics, care solution characteristics and even overnight lens wear.

As I have said numerous times, clinical experience is a critical first step in identifying a clinical problem, but clinical research is the way to solve the problem. Putting this all together, I think it is important that we maintain perspective before getting ahead of ourselves on the issues surrounding infiltrative keratitis. For example, I have heard numerous opinions about specific contact lenses and care solutions thought to be associated with infiltrative keratitis. While some of this discussion could turn out to be true, we must consider this information anecdotal until properly designed and controlled studies address the issues at hand.

Last week's question:
Which of the following factors do you feel most strongly relates to infiltrative keratitis in your contact lens wearers?

 1. Contact lens material characteristics
   5%


 2. Multipurpose care solution characteristics
   11%


 3. Overnight contact lens wear
 
  19%

 4. Patient non-compliance with lens care or wear
   65%

Class I SCL Prevents UVB-Induced Ocular Effects in the Rabbit In Vivo

UVB radiation from sunlight is known to be a risk factor for human cataract. The purpose of this study was to investigate the ability of a Class I UV-blocking soft contact lens to protect against UVB-induced effects on ocular tissues of the rabbit in vivo.

Eyes of rabbits were exposed to UVB light for 30 min (270-360 nm, peak at 310 nm, 1.7 mW/cm(2) on the cornea). Eyes were irradiated in the presence of either a UV-blocking senofilcon A contact lens, a minimally UV-blocking lotrafilcon A contact lens, or no contact lens at all. Effects on the cornea and lens were evaluated at various times after exposure.

Eyes irradiated with no contact lens protection showed corneal epithelial cell loss plus lens epithelial cell swelling, vacuole formation, and DNA single-strand breaks, as well as lens anterior subcapsular opacification. The senofilcon A lens protected nearly completely against the UVB-induced effects, whereas the lotrafilcon A lens showed no protection.

The researchers concluded that the results indicate that use of a senofilcon A contact lens is beneficial for protecting ocular tissues of the rabbit against the harmful effects of UVB light, including photokeratitis and cataract.

Giblin FJ, Lin LR, Leverenz VR, Dang L. A Class I (Senofilcon A) Soft Contact Lens Prevents UVB-induced Ocular Effects, including Cataract, in the Rabbit in vivo. Invest Ophthalmol Vis Sci. 2011 Mar 18. [Epub ahead of print]