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Monday, April 13, 2015  
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What do you perceive to be your number one barrier to increasing your multifocal fittings in your practice?

Visual performance
Lack of patient interest
Contact lens discomfort

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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO
Of course, our patients would love it if they did not need to use “comfort” drops to wear their contact lenses. But have you ever thought about what you would do to improve on the concept of a comfort drop? Perhaps you might move beyond alleviating discomfort, and even consider their use for preventative care for potential future ocular surface disease. I think we have a lot to anticipate in the future regarding this potential technology.

Web-Based Tool for Custom Soft Contact Lens Design and Ordering

To make it easier for eyecare professionals to design and order precision-fit custom soft contact lenses, SpecialEyes, LLC has enhanced its online Arc Length Calculator to include ordering functionality directly from the Web-based tool. The custom contact lens manufacturer also added a brief video demo, presenting step-by-step directions for using sagittal-depth measurements to design and order a trial pair of contact lenses.

P. Douglas Becherer, OD, FAAO, developed the SpecialEyes Arc Length Calculator based on a sagittal-depth fitting philosophy, incorporating two basic measurements to calculate a patient’s corneal arc length. These measurements include the corneal diameter – also known as horizontal visible iris diameter, or HVID – and corneal curvature, as determined by keratometry (K) readings. Practitioners simply enter the HVID, central K readings, and manifest refraction into the online calculator, then click “Calculate” to view the mathematically computed lens design.

While the software will automatically generate a customized lens design, ECPs have the option to manually adjust the lens diameter and recalculate to update the design parameters. A dropdown menu allows users to select from three lens materials, and practitioners can specify prescription details such as add power, pupil diameter, and lens type in the comments section. Upon reviewing and approving the lens design, users can immediately submit an initial trial lens order.

To access the SpecialEyes Arc Length Calculator, Over-Refraction Calculator, or lens design demo, visit

Alcon Announces Celebrity Stylists to Support Air Optix Colors

Alcon announced its new “The Color Squad” to headline the promotion of its Air Optix Colors contact lenses this year. The team includes award-winning fashion stylist, Ilaria Urbinati, renowned hair stylist, Lacy Redway, and famed make-up artist, Scott Barnes. “The Color Squad” will inspire consumers around the globe to use Air Optix Colors contact lenses as a way to complement their make-up, hair and fashion choices in a way that enhances their natural beauty.

Bringing red carpet experience with Hollywood’s most trend-setting and beautiful stars, team members will lend their expertise and provide Air Optix Colors contact lenses fans with exclusive fashion and beauty tips as well as tutorials that relate to adding color through personal style. By changing their eye color, consumers can experiment with entirely new make-up palettes and wear shades they’d never thought possible – and “The Color Squad” will show them how through a series of tips, images and videos to be released by Alcon in 2015.

AOA Announces Winners of 2015 AOA Awards

Six winners were selected by the American Optometric Association (AOA) for its annual AOA Awards, which will be presented at Optometry’s Meeting in Seattle, Washington.

  • The Optometrist of the Year Award recognizes Sen. David Heitmeier, OD, of Louisiana, for his outstanding service on behalf of the profession and the visual welfare of the public.
  • The Young Optometrist of the Year Award recognizes Tamara Petrosyan, OD, of New Jersey, who has been in practice less than 10 years and demonstrates remarkable leadership when serving the profession, patients and her community.
  • The Optometric Educator Award recognizes Tammy Than, OD, of Alabama, for outstanding service on behalf of the profession, optometric education and the visual welfare of the public.
  • The Paraoptometric of the Year Award recognizes Marilyn Beeson, CPOA, of Mississippi, for her significant contributions to the field of paraoptometry.
  • The Distinguished Service Award recognizes Lee Carr III, OD, of Oklahoma, for his unusually significant contributions to the profession of optometry.
  • The Apollo Award honors NewView Oklahoma, Inc., for distinguished service to the visual welfare of the public. The nonprofit organization is the leading employer of the blind and visually impaired in the state and the state's only private agency that provides specialized vision rehabilitation services.

Corneal Ulcer Complication for Repeat Corneal Transplant
Edward Boshnick, OD, Miami, FL

This is the third corneal transplant on the eye of a 67 year-old woman with Sjögren Syndrome. The central corneal ulcer had been there for at least one month prior to the taking of this photo. This eye has not responded to aggressive medical therapy. Preparations are being made for a fourth corneal transplant.

We thank Dr. Boshnick 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 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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S. Barry Eiden, OD, FAAO
Pharmacological Presbyopia Management – Look, No Glasses, No CLs and No Surgery!

A study was conducted to evaluate the efficacy of using a parasympathomimetic drug (carbachol) with an alpha agonist (brimonidine) to create optically beneficial miosis to reduce the effect of presbyopia.

The researchers performed a double-masked, randomized, placebo-controlled clinical trial. Forty-eight naturally emmetropic and presbyopic subjects aged between 43 and 56 years with an uncorrected distance visual acuity of at least 20/20 in both eyes without additional ocular pathology were eligible for inclusion in the study. Subjects were divided into two groups. The treatment group (n=30 eyes) received single dose of 2.25% carbachol plus 0.2% brimonidine eye drops. The control group (n=18 eyes) received placebo drops. Drops were given to all subjects in a masked fashion, in their non-dominant eye. The minimum post-treatment follow-up was 3 months. The subjects’ pupil size and both near and distance visual acuities were evaluated before and after treatment at 1, 2, 4, 8, and 10 hours, by a masked examiner at the same room illumination.

Results of the study found statistically significant improvement in near visual acuity in all subjects who received carbachol plus brimonidine drops (P<0.0001). There was no evidence of tolerance to the drops or tachyphylaxis during the study period. When polled after the study, all treatment subjects liked and would use this therapy if it was available. None of the control subjects stated that they would use the placebo.

Our approach to vision correction and management is expanding beyond the traditional use of spectacles and contact lenses. Surgical alternatives are becoming safer and more effective and now we continue to explore the role of pharmacological management in vision correction. This study looked at the role that could be played by pharmacologically induced miosis in managing presbyopia in emmetropic patients. The use of a combination formulation of carbachol and brimonidine seemed to be well tolerated and highly effective when used unilaterally in the non-dominant eye. Further research will enable us to incorporate pharmacological vision correction into our armamentarium.

1. Abdelkader A. Improved Presbyopic Vision With Miotics. Eye Contact Lens. 2015 Mar 24. [Epub ahead of print]

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Katherine M. Mastrota, MS, OD, FAAO

Hazards of Eyeliner

A topic near and dear to me is lid hygiene, especially in patients who use eye cosmetics. Especially troublesome to me is the application of eye makeup along the lid margin, referred to as “the water line” by lay populations and makeup aficionados.

Although the results are intuitive, a recent study illustrates the effect of cosmetics applied in this manner on the tear fillm.1

Here the researchers aimed to quantify the migration of a conventional eye cosmetic pencil when applied to periocular skin in two different locations: behind the lash line and along the periocular skin (lid margin).

Pencil eyeliner (with glitter) was applied to the subject's upper and lower eyelid by the examiner. Slitlamp video recording of glitter particles suspended within the tear film was conducted for 30 seconds on 10 occasions up to 2 hours post-eyeliner application. The number of glitter particles suspended in the tear film was analyzed. The migration of the glitter particles occurred more readily in the lid margin application, with maximum contamination of the tear film achieved 5 to 10 minutes post-application. The migration of eyeliner following application behind the lash line was comparatively slower and reduced compared with margin application. Thus, pencil eyeliner migrates most readily and maximally contaminates the tear film when applied posterior to the lash line. This has implications for contact lens wearers and patients with dry eye syndrome or sensitive eyes. Are you surprised?

1. Ng A, Evans K, North RV, Purslow C. Migration of Cosmetic Products into the Tear Film. Eye Contact Lens. 2015 Mar 3. [Epub ahead of print]

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Evaluation of Contact Lens Multipurpose Solutions on Bacterial Biofilm Development

No sooner are contact lenses (CLs) inserted into the eyes than lipids, proteins, and glycoproteins rapidly accumulate on their surface, thus favoring the adhesion of commensal bacteria and biofilm formation. Infections may be caused by the proliferation of indigenous flora or other opportunistic pathogens. The researchers’ purpose was to evaluate the activity and the capacity of different CL solutions to interfere with the mechanisms of biofilm formation and stability and use of a system to study dynamically biofilm development.

They evaluated the anti-biofilm activity of three different multipurpose solutions (MPSs): Regard, Biotrue, and Opti-Free PureMoist on four bacterial species (Serratia marcescens, Pseudomonas aeruginosa, Staphylococcus epidermidis, and Staphylococcus aureus). Static biofilm assay was first performed to analyze the effect of MPSs. Dynamic assays were performed with the BioFlux system to analyze the effect of the OxyChlorite solution Regard on the biofilm formation.

Their studies show that MPSs are able to completely inhibit biofilm formation of Staphylococcus species and of S. marcescens after only 4 hours of incubation. Moreover, a reduction of biofilm formation by Pseudomonas was noted. Best results on P. aeruginosa were obtained with Regard. Regard was also used for dynamic assay, revealing its ability to disaggregate the mature biofilm. Regard completely inhibited biofilm formation by S. epidermidis and slowed down biofilm development by P. aeruginosa.

The researchers concluded that their findings indicate that the CL solutions tested were all able to reduce biofilm formation. Furthermore, the BioFlux system was proven to be useful for the evaluation of the effectiveness of CL solutions against microbial biofilm formation.

Artini M, Cellini A, Scoarughi GL, Papa R, Tilotta M, Palma S, Selan L. Evaluation of Contact Lens Multipurpose Solutions on Bacterial Biofilm Development. Eye Contact Lens. 2015 Mar 30. [Epub ahead of print]

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