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Sunday, April 21, 2013  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

We are noticing more and more frequently that clinicians are actively expressing the meibomian glands of their patients. This is being done for both diagnostic and therapeutic reasons, and we are seeing technologies develop to help in this regard. Please send your thoughts to us about expression of the meibomian glands at cltoday@pentavisionmedia.com. It is helpful to see related discussion of such an important developing topic.

Orion Vision Group, Alden Optical Join Forces for Lens

The Orion Vision Group and Alden Optical announced the launch of BioColors custom opaque tinted contact lenses. The Orion Vision group now offers a complete line of premium opaque and prosthetic tinted soft lenses with Alden Optical's custom lenses as the base lens. BioColors are based on the HP line of custom soft lenses from Alden Optical and feature full custom parameter ranges in both spherical and toric prescriptions. BioColors lenses are available in 16 opaque colors with numerous iris patterns.

BioColors is available directly from Orion Vision Group or through an Orion Vision Group Authorized Distributor. For more information, visit www.orionvisiongroup.com. For more information on Alden Optical's custom and specialty contact lens line, visit www.aldenoptical.com.

Online Allergy Advice from CooperVision

CooperVision has created an allergy survival guide for patients this season. In it are fact sheets and videos about allergies, tips on how to look your best this allergy season, and a live feed to the Allergy Index from The Weather Channel so that patients can know when pollen counts are high. The Allergy Survival Guide also includes helpful information about eye allergies and contact lenses; including daily disposable contact lenses.

To view the guide visit https://www.facebook.com/CooperVision/app_520850094637911.

FDA Approves Toric IOL for Cataract Patients

Abbott Medical Optics announced its Tecnis Toric 1-Piece intraocular lens (IOL) has received U.S. Food and Drug Administration (FDA) approval and is launching in the United States for the treatment of cataract patients with pre-existing corneal astigmatism. The company says that unlike conventional IOLs, the Tecnis Toric 1-Piece IOL can correct a patient's loss of focus due to pre-existing corneal astigmatism of one diopter or greater. In addition to providing astigmatism correction, the TECNIS Toric 1-Piece lens minimizes imprecise light focusing (spherical aberration) to provide sharper distance vision for the patient. Tecnis toric is the only lens to meet the ANSI standards for toric lens rotational stability.

Additional information about the TECNIS Toric 1-Piece IOL, including important safety information, is available at www.tecnistoriciol.com.

B+L, Leica Set Distribution Deal

Leica Microsystems and Bausch+Lomb (B+L) have partnered to distribute Leica ophthalmic surgical microscopes, and accessories in select markets across Europe, the United States, India and Latin America beginning this month.

The partnership was designed to combine Leica's ophthalmic microscopes with B+L's global commercial infrastructure. Under this agreement, B+L can now offer Leica Microsystems' ophthalmic portfolio, which ranges from routine cataract microscopes to high-end retinal systems. Among these is the Leica M822 for cataract procedures, which combines LED and halogen lighting for a stable red reflex. Per the contract, this relationship may be expanded over time.

Red-Tinted Lens
By Boris Severinsky, MOptom, Jerusalem, Israel

These images show a contact lens with a red-tinted center to improve photophobia and visual function in an achromatopsia patient.

We thank Boris Severinsky 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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Luciano Bastos
Instituto de Olhos, Porto Alegre, RS, Brazil

We received this in response to Scleral Lens Options: A Minority View, by Jan P. G. Bergmanson, OD, PhD, PhD hc, DSc, FCOptom, FAAO in our April 7, 2013 newsletter.

I totally agree with your opinion regarding the fit of scleral lens with OAD 18.0 or larger. The only exceptions are those supertight lids or really small palpebral fissures in which we try to fit semi-scleral lenses from 15.8mm to 16.5mm. The larger diameter must also prevent blanching or imprintment of the conjunctiva. We also developed a system which allows fluid or lacrimal exchange in a really fast way for a scleral lens design. We understand that this is crucial to achieve long term physiological health of the cornea and limbus.

The only aspect about your comment I would like to review is about RGP fitting. We learned from our beloved friend and mentor Joseph W. Soper how to fit a proper GP lens design without damaging the cornea and also providing excellent comfort to the patient. We also managed to improve his designs and develop new technologies that allowed us to go farther and fit specialty GP lens designs in keratoconus conditions. That was unthinkable until a few years ago and now they are part of our daily practice when fitting specialty lens designs in irregular corneas. Despite the fact that I am so enthusiastic about scleral lens fitting I must point out that a nice RGP design can be of great benefit to a lot of patients.

Katherine M. Mastrota, MS, OD, FAAO

Tools to Identify Ocular Surface Disease

Our expanding understanding of ocular surface disease has guided the development of clinical tools to better diagnose and quantify clinical change in dry eye patients. Tear osmolarity correlates well with dry eye severity and is considered an important biomarker for dry eye disease.1 Similarly, matrix metalloproteinase 9, an inflammatory biomarker, has been shown to be elevated in the tears of patients with dry eyes.2

In a multicenter clinical trial, the sensitivity and specificity of a rapid point-of-care diagnostic test to detect elevated matrix metalloproteinase 9 levels (InflammaDry, [RPS, Sarasota, Fla.]) was evaluated.3 In this prospective, sequential, masked, multicenter clinical trial, InflammaDry was performed on 206 patients: 143 patients with clinical signs and symptoms of dry eye and 63 healthy controls. Participants were categorized as healthy controls or with dry eye using the Ocular Surface Disease Index, Schirmer tear test, tear breakup time, and keratoconjunctival staining. Compared with clinical assessment, InflammaDry was sensitive and specific in diagnosing dry eye in this trial.3 The authors conclude that ability to accurately detect elevated matrix metalloproteinase 9 levels may lead to earlier diagnosis, more appropriate treatment, and better management of ocular surface disease.

1. Suzuki M, Massingale ML, Ye F, Godbold J, Elfassy T, Vallabhajosyula M, Asbell PA. Tear osmolarity as a biomarker for dry eye disease severity. Invest Ophthalmol Vis Sci. 2010 Sep;51(9):4557-61. doi: 10.1167/iovs.09-4596. Epub 2010 Apr 14.
2. Chotikavanich S, de Paiva CS, Li de Q, Chen JJ, Bian F, Farley WJ, Pflugfelder SC. Production and activity of matrix metalloproteinase-9 on the ocular surface increase in dysfunctional tear syndrome. Invest Ophthalmol Vis Sci. 2009 Jul;50(7):3203-9
3. Sambursky R, Davitt WF 3rd, Latkany R, Tauber S, Starr C, Friedberg M, Dirks MS, McDonald M. Sensitivity and specificity of a point-of-care matrix metalloproteinase 9 immunoassay for diagnosing inflammation related to dry eye. JAMA Ophthalmol. 2013 Jan;131(1):24-8.

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Susan J. Gromacki, OD, MS, FAAO

Cleaning and Disinfecting the New UltraHealth Hybrid Contact Lens

SynergEyes recently launched its newest hybrid contact lens, UltraHealth. This lens, designed for keratoconus and irregular corneas, combines a high-Dk rigid center (Si-150) with a silicone hydrogel skirt.

After lens removal from the eye(s), SynergEyes recommends that patients rinse the lens with nonpreserved saline (e.g. Unisol); then digitally rub the lens with saline; and finally, rinse again with nonpreserved saline. The company highly recommends that the lenses are disinfected with Clear Care (Alcon). Although BioTrue (Bausch + Lomb), AQuify (Alcon), Opti-Free Express, and RepleniSH (Alcon), Renu Fresh (Bausch + Lomb), and Complete Easy Rub (Abbott Medical Optics) are also approved for this lens, SynergEyes emphasizes that it highly recommends Clear Care.

Note that a digital rubbing step is always required with these lenses, and due to its hydrophilic skirt, solutions designed for gas permeable lenses are contraindicated.

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Effect of Contact Lens Wear on the Diurnal Profile of Matrix Metalloproteinase 9 in Tears

This study set out to determine how contact lens wear affects the profile of matrix metalloproteinase 9 (MMP-9) in the tear film.

Flush tears were collected from 47 healthy neophytes before lens wear, during the first day of lens wear, and after one month adaptation. Participants were randomized to either Acuvue Oasys (Vistakon) or O2OPTIX (Alcon) with the choice of extended (EW) or daily wear (DW). Each time, tears were collected at midday, before sleep, and on waking and analyzed for concentrations of total protein, MMP-9, and its regulators TIMP-1 (tissue inhibitor of metalloproteinases 1) and NGAL (neutrophil gelatinase-associated lipocalin).

Researchers found initial extended contact lens wear resulted in significantly elevated MMP-9 levels on waking (3598.7 +/- 3229.1 ng/mL) compared with the same time point at baseline (2123.3 +/- 1762.8; p = 0.02), whereas DW remained unchanged (2373.0 +/- 2091.6 ng/mL; p = 0.61). After one month of EW, the levels on awakening were no longer different to those of baseline (2408.2 +/- 1376.1 ng/mL; p = 0.63). The MMP:TIMP ratio during EW was greater after the first night (18.6 +/- 19.9) than both no wear (13.2 +/- 13.4) and one month (10.4 +/- 7.7), but only the latter was significant (p = 0.048). The profile of NGAL did not differ from baseline (p = 0.055).

Researchers concluded that in the neophyte, the initial period of overnight lens wear seems to disturb the tear film homeostasis, as indicated by a significant increase in MMP-9 on awakening. The return to baseline by one month suggests that an adaptive process takes place. No comparable changes are seen in DW.

Markoulli M, Papas E, Cole N, Holden B. Effect of Contact Lens Wear on the Diurnal Profile of Matrix Metalloproteinase 9 in Tears. Optometry and vision science : official publication of the American Academy of Optometry 2013

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