Contamac recently introduced Optimum HR 1.51 and Optimum HR 1.53, GP materials which offer a unique balance of properties resulting in high refractive index materials that meet all the demands for a full range of presbyopic add power (+0.50D more aspheric multifocal add power). According to the company, the materials offer not only a high index of refraction, but also favorable levels of oxygen permeability and high stability, providing new opportunities to produce novel designs.
     Optimum HG allows for enhanced visual acuity, reduced thickness in higher prescriptions and expansion of optical zones in current designs. The company states that the material provides an increase of 16-23% in achievable power, in both plus and minus, in designs produced with other available materials with similar permeability, Rx and thickness profiles. The lower specific gravity represents a weight reduction of 20-30%, a fitting and comfort advantage for all lenses > -6.00 and all plus lenses.
     The oxygen permeability of Optimum 1.51 is 50, while that of Optimum HR 1.53 is 26. Optimum HR is FDA approved for a full range of indications including myopia, hyperopia, astigmatism and aphakia and may be plasma treated for enhanced wettability.
      For more information, contact your authorized Contamac laboratory or visit www.contamac.com.

Mark Andre, FAAO, was recently awarded the Contact Lens Society of America (CLSA) Joseph W. Soper Award for Excellence in Education. Established in 1995, the award recognizes outstanding contributions in the area of contact lens education.  
     Andre, an associate professor of optometry at Pacific University, has over 30 years of experience in the field of contact lenses and shares his knowledge through teaching, seminars, and continuing education events around the world. Andre has been a faculty member of Pacific University's College of Optometry for the past four years. Previously, he was the director of the Contact Lens Service at the Casey Eye Institute, located on the campus of the Oregon Health and Sciences University.
     Andre is very active in the contact lens community. He is a Fellow member of the American Academy of Optometry and the CLSA, and a contributing editor for Contact Lens Spectrum. Andre has also acted as a consultant for top contact lens manufacturers for more than 15 years, including providing insight for CooperVision's Online Learning Center.
     The Award was established to honor educators in the contact lens arena in memory of Joseph W. Soper, a pioneer contact lens technician whose many contributions to the eye care field included invention of a topographical corneal mapping device and authorship or contribution to eight texts and more than 150 scientific papers on contact lenses. It has been awarded only seven times in the past 14 years.

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Important Safety Information
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TearLab Corporation announced that its TearLab Osmolarity System has received a 2009 Medical Design Excellence Award (MDEA). The Medical Design Excellence Awards competition is organized and presented by Canon Communications LLC of Los Angeles, and is the only awards program that exclusively recognizes contributions and advances in the design of medical products. A comprehensive review of the entries was performed by an impartial, multidisciplinary panel of third-party jurors with expertise in biomedical engineering, human factors, industrial design, medicine, and diagnostics.
     "We are honored to be recognized by the MDEA judges," said Eric Donsky, CEO TearLab Corporation. "Receiving the prestigious Medical Design Excellence Award is a validation that our TearLab technology represents a breakthrough in the development of innovative, point-of-care diagnostic products. Our engineering team, led by Dr. Benjamin Sullivan and Steve Zmina, along with our dedicated partners, Minifab & Invetech, worked tirelessly to overcome the many challenges of establishing a product capable of precisely measuring a diagnostic marker in 50 nanoliters of tears within seconds, while maintaining a simple user interface for a technician to achieve repeatable results in an office setting. We thank the judges for their appreciation of the huge potential of TearLab as a non-invasive diagnostic platform." 
     For more information on TearLab Corporation visit www.tearlab.com. 

Tear film instability and tear hyperosmolarity are considered core mechanisms in the development of dry eye. The authors hypothesized that evaporation and instability produce transient shifts in tear hyperosmolarity that lead to chronic epithelial stress, inflammation, and symptoms of ocular irritation. The purpose of this study was to (1) provide indirect evidence for short term hyperosmolar conditions during tear instability and to (2) test whether the corneal epithelium responds to transient hyperosmolar stress.
     Five subjects kept one eye open as long as possible and overall discomfort and sensations associated with tear break-up were scaled. Later, the same subjects used the same scales to report discomfort sensations after instillation of NaCl and sucrose hyperosmolar drops (300mOsm/Kg to 1000mOsm/Kg). A two-alternative forced choice experiment was used to obtain osmolarity thresholds.
     In a separate experiment, primary cultured bovine corneal epithelial cells were transiently stressed with the same range of hyperosmolar culture media and pro-inflammatory Mitogen Activated Protein Kinase (MAPKs) were measured by western blot.
     Tear instability lead to an average discomfort rating of 6.13 and sensations of burning and stinging. These sensations also occurred with hyperosmolar solutions (thresholds between 450-460mOsm/Kg) that required 800-900mOsm/Kg to generate the same discomfort levels reported during tear break-up. MAPK was activated at 600mOsm/Kg of transient hyperosmolar stress.
     The authors concluded that these experiments provide a link between hyperosmolarity and tear instability, suggesting that hyperosmolar levels in the tear film may transiently spike during tear instability, resulting in corneal inflammation and triggering sensory neurons.
Liu H, Begley CG, Chen M et al. A Link between Tear Instability and Hyperosmolarity in Dry Eye. Invest Ophthalmol Vis Sci 2009.

For five years I worked in very busy optometric offices. These practices were so busy that it was hard to take the time to educate patients on GP lenses. Since opening my own practice 18 months ago, I have been pleasantly surprised at most patients' response to wearing gas permeable lenses.
     I approach the discussion by saying, "Gas permeable lenses are the best option for contact lens wear regarding vision but comfort takes some time to get used to." Once I tell the patients that the lenses can be exchanged for full credit towards soft lenses if they are not pleased, they are usually very comfortable with trying GPs whether it be spherical, toric, or multifocal. After I apply Fluess and, just before I do tonometry, I insert a GP out of my trial fitting set. I do a quick over-refraction and check the fit. I ask the patient about their comfort level and the response usually is, "It is not as bad as I thought. I can see the bottom line on the eye chart really clearly, and yes, I can try these for a couple of weeks."
     Now, I am finding that chair time is less because the optics of GPs are so crisp and the fit is a piece of cake (especially with the gas permeable consultants at the lab when needed).
Mike Mayers, OD
Powell, OH 

This week's abstract is of great interest as it provides some actual physical links to what are thought to be some key components to dry eye disease. That is tear instability (which is likely due to evaporation) leading to hyperosmolarity, symptoms, and ultimately up-regulation of the inflammatory process on the ocular surface. What is interesting to consider is that contact lens wear can lead to an even greater tear film instability and evaporation resulting in the increased dry eye symptoms during lens wear. Yet, the cornea is in a way protected from these transient spikes in osmolarity by the contact lens. It will be interesting to see how the research community continues to sort through these important fundamental issues that are so relevant to our contact lens wearing patients.
Jason J. Nichols, OD, MPH, PhD, FAAO

This month at www.siliconehydrogels.org: incorporating Acanthamoeba testing into the MPDS licensing process; prescribing silicone hydrogels for post-RK patients; variability in corneal swelling with different silicone hydrogel lenses; and part 2 of our 2008 BCLA update.