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Sunday, April 13, 2014  
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Results from Last Question

What percent of your contact lens wearers also have seasonal allergies (i.e., hay fever)?





 > 20%

Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO
It often surprises me just how infrequently contact lens practitioners think about the contact lens care solution. In lectures and educational forums, I always try to stress just how important our understanding of these products is to the ultimate success of the contact lens wearer. In fact, recalls of two prior care solutions in the last 10 years also suggest we remain vigilant in our understanding of care solution performance, as these two recalls also point to the fact that regulatory agencies don’t always get it right either.

Novartis Appoints George as Division Head, Alcon as Buehler Retires
Novartis announced the appointment of Jeff George as Division Head of Alcon, effective May 1, 2014. Mr. George succeeds Kevin Buehler who is retiring from the company after a distinguished 30-year career at Alcon. As part of the planned transition, Mr. Buehler will provide management and strategic support on the Alcon business. The company thanks Mr. Buehler for his significant contributions to Novartis and Alcon and wishes him the best for the future.

As Division Head of Alcon, Jeff George will continue to serve as a member of the Executive Committee of Novartis (ECN), reporting to Joseph Jimenez, CEO of Novartis. Since joining Novartis in January 2007, Mr. George has held leadership positions of increasing importance in the Vaccines and Diagnostics Division and the Pharmaceuticals Division, becoming Division Head of Sandoz in December 2008. At Sandoz, Mr. George built a best-in-class leadership team and created a winning, high-performance culture. He grew Sandoz sales from $7.5 billion in 2009 to $9.2 billion in 2013, while becoming the global leader in biosimilars with an industry-leading pipeline. He holds an MBA from Harvard University, an MA from Johns Hopkins, and a BA from Carleton College.

Novabay Introduces i-Lid Cleanser
NovaBay Pharmaceuticals, Inc., a clinical-stage biopharmaceutical company developing topical non--antibiotic antimicrobial products, is introducing a new eyecare product, i-Lid Cleanser. The Advanced i-Lid Cleanser can help patients with irritation of their eyelids by cleaning their lids and lashes, removing debris and microorganisms. It has been cleared by the FDA through its 510(k) process.

Surveys of eye doctors1 show that more than one-third of the people who see an ophthalmologist or optometrist have a condition in which the eyelid is inflamed. Typically, doctors treat the condition by recommending careful cleaning of the lid lash margin with warm compress and mild soap. However, in many cases, this condition can become chronic, and antibiotics and topical steroids may be necessary. Successful treatment usually also requires cleaning the lids and lashes effectively of debris and micro-organisms, which contribute to the chronic inflammation and irritation.

NovaBay’s Advanced i-Lid Cleanser offers a new option. According to the company, the key innovation behind the i-Lid Cleanser is the stabilized form of pure hypochlorous acid solution (with no bleach impurities, which are often present in Dakin and Dakin-like solutions). In in vitro laboratory models, hypochlorous acid has shown to be fast-acting against bacteria, biofilm and toxins. Hypochlorous acid made by the body’s cells breaks down quickly, but NovaBay was able to create a formulation in which hypochlorous acid is both stable and free from impurities.

iLid Cleanser contains 0.01% pure hypochlorous acid in saline (with no bleach impurities, which are often present in Dakin and Dakin-like solutions). Bleach impurities impede the growth of fibroblasts. Hypochlorous acid is a preservative in solution in NovaBay’s iLid Cleanser.

NovaBay’s i-Lid Cleanser is intended for use under the supervision of ophthalmologists, optometrists and other healthcare providers and is available through a prescription. For more information on NovaBay, please visit www.novabay.com.

1. http://mededicus.com/downloads/Blepharitis-Update-on-Research-and-Management.pdf

IDOC Announces Comprehensive Online Education Program
IDOC announces a new comprehensive, online education program for optometrists and their staff available at special pricing exclusively for IDOC members. This collection of online optometric education materials, which includes a thorough resource library as well as podcast lessons, was developed by Scot Morris, OD, FAAO, operating partner of Morris Education and Consulting Associates. Dr. Morris is an international speaker and author known for his expertise in the areas of practice management, technology and ocular surface disease.

The resource library covers all of the topics essential for independent practitioners and the management of their businesses, including vision and insurance plans, medical model, marketing, human resources, practice management, legal issues, scripting office procedures and more. Extensive guides provide in-depth information on optometric finances, frame buying and sales, and there are nearly 100 downloadable, customizable resources such as workflow worksheets, daily checklists and guides to ocular conditions such as dry eye. The library outlines the steps for hiring new employees, from sample job descriptions to the steps to take during the interview process and what the employee should do on a first day. The podcasts, concise and most just five minutes long or less, often reference other materials available in the resource library to help practitioners and staff improve and grow their businesses.

All of the resources are available 24/7 on the member portal of www.idoc.net and accessible from desktops, laptops, smartphones and tablets. If you are interested in learning more about this online education opportunity for IDOC members please contact IDOC at info@idoc.net or call 203-853-3333.

Keratoconus with a Pinguecula
Edward Boshnick, OD, Miami, Florida

This is an eye with an advanced case of keratoconus along with a pinguecula on the nasal conjunctiva. The eye was fit with a 16.0 mm scleral lens with a notched out and polished edge to avoid touching the pinguecula. Patient has been able to wear this lens for over 12 hours every day.

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 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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S. Barry Eiden, OD, FAAO

Advanced Technologies in Corneal and Anterior Segment Shape Analysis for Contact Lens Design…
Will we even remember fluorescein and the Burton lamp?

A recent paper was published describing an advanced mathematical model based off of topographic data which was able to construct a three dimensional model of the cornea. The researchers utilized data from the Oculus Pentacam corneal tomography system based on outcomes from a subject who had undergone refractive surgery. They applied what is termed as a “biconic fitting algorithm”. Results provided accuracy to the sub-micron level (0.08 microns for symmetric surfaces and 0.125 microns for asymmetric surfaces). The authors concluded that this methodology could be a platform for advanced IOL calculations and enhanced contact lens fitting.1

Already today we are seeing a transition towards non-traditional methods of contact lens fitting that more accurately assesses corneal and anterior segment surface shape to provide more accurate contact lens to ocular surface fitting relationships. Most corneal topography systems are able to “virtually” fit a contact lens based upon topographic data and applied fitting nomograms. They also can create simulated fluorescein patterns that can be modified by changing various lens parameters in the software program.2 Anterior segment optical coherence tomography is also being used to both assess contact lens fitting relationships on the eye and to actually design certain types of scleral prosthetic vision correction devices.3,4 Most recently EyePrint Prosthetics (www.eyeprintpro.com) announced the development of a novel method of 3-D printing of the ocular surface based on a simple impression technique and sophisticated surface analysis, digitization and computer model simulation that produces the EyePrint Pro prosthetic scleral cover shell that precisely matches the contour of the individual eye in order to optimize comfort, vision and physiological response. Our practice has worked with EyePrint Prosthetics in the evaluation and development of their system and has so far fit three complex cases in EyePrint Pro. The process is simple to perform and the technology is nothing short of amazing. It represents an example of where the future of contact lens fitting is going.

Technology is moving ahead at “warp speed” to allow practitioners to provide our patients with the most advanced and successful contact lens systems available. Early adapters are already taking advantage of these technologies. I believe the majority of contact lens practitioners will follow in the not too distant future.

1. Janunts E, Kannengiesser M, Langenbucher A. Parametric fitting of corneal height data to biconic surface. Z Med Phys. 2014 March [Epub ahead of print]
2. Eiden SB, DeNaeyer G, Brafman S, Harthan J, Davis R. Using advanced technologies for contact lens fitting. Contact Lens Spectrum, vol. 27, pp. 24 – 29, August 2012.
3. G. Gemoules, A novel method of fitting scleral lenses using high resolution optical coherence tomography. Eye Contact Lens. 2008 Mar;34(2):80-3.
4. Le H, Tang M, Ridges R, Huang D,Jacobs DS. Pilot study for OCT guided design and fit of a prosthetic device for treatment of corneal disease. J Ophthalmol. 2012;2012:812034.

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David Kading, OD, FAAO
This is the fourth in a series of articles highlighting designs and innovative technology from our industry partners including some of the specialty contact lens laboratories.

Something Else from Colorado

Last time we talked about “Something Good from Colorado” and many of you were surprised to hear what I wrote about. Well, in case you need more proof about the great things coming out of Colorado, here is another.

Advanced Vision Technologies (AVT) is a lab out of Golden Colorado. They have lenses ranging from standard GP lenses and scleral lenses to custom soft lenses for keratoconus to presbyopia.

Several things stand out about this custom lens lab. First is their Adjustable Tangent Carrier, large Optic Zone/Limbal Clearance Scleral Design. This fitting system incorporates three base curves, three tangent carrier angles, and a range of sagittal depths all within a diagnostic kit. Second is their approach to pediatrics. They have a lens system called the PediaSite for patients born with congenital cataracts. Additionally they have a design that has a center distance lens add, that although not FDA approved for myopia control, is used off label by many practitioners for this (I spoke of a similar concept and a study using a similar design in the March issue of Contact Lens Spectrum ( http://www.clspectrum.com/articleviewer.aspx?articleID=109927). Oh, and it works for presbyopia too, both in its soft lens configuration as well as its scleral design.

The lab has access to unique materials (soft and GP) and unique designs of which I do not have enough room here to mention.

So, if you’re interested in novel concepts from Colorado, AVT is one of them.

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Effect of Multipurpose Solutions Against Acinetobacter Carrying QAC Genes

Acinetobacter has low virulence but causes infections in subjects with reduced immunity. It has been reported in ocular infections including those of patients using contact lenses. Treatment is difficult because Acinetobacter is frequently multidrug resistant. Antibiotic-resistant strains frequently also harbor genes for antiseptic resistance (quaternary ammonium compound [QAC]) genes. Because Acinetobacter is part of the normal flora, it may contaminate contact lens and accessories. This study aims to investigate carriage rates of QAC genes in household and clinical isolates of Acinetobacter and to determine the effectiveness of two multipurpose solutions (MPSs) for soft lenses against organisms carrying QAC genes.

DNA was extracted from 11 bathroom isolates and 15 clinical isolates and amplified by polymerase chain reaction to determine the presence of qacEΔ1. Gene-positive and gene-negative control strains were used to challenge the two MPSs, and minimum inhibitory concentrations (MICs) of these organisms to benzalkonium chloride and chlorhexidine gluconate were determined.

More than 90% of isolates carried qacEΔ1. The MICs of clinical isolates were higher than those of isolates of bathrooms. Both MPSs were able to produce a 3-log reduction in the numbers of all isolates.

The researchers concluded that, although most isolates carried qacEΔ1 and elevated MICs to benzalkonium chloride and chlorhexidine gluconate were observed, all were susceptible to both MPSs tested. However, if there were to be poor compliance with care procedures, it is probable that such organisms could survive in the presence of diluted or expired solutions.

Boost MV, Chan J, Shi GS, Cho P. Effect of multipurpose solutions against Acinetobacter carrying QAC genes. Optom Vis Sci. 2014 Mar;91(3):272-7.

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