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Sunday, April 22, 2012  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

This week, we'd like to note a very special anniversary for our publication, Contact Lenses Today. This week marks the 15th anniversary of this publication. The newsletter has come a long way since its beginning, and there are many people to thank for all of the years of support and service, including our editorial staff, contributors and sponsors. Lastly, we'd like to thank our readership for their support and feedback. Here's to the next 15 years!

OCuSOFT, Inc. Debuts Retaine MGD Dry Eye Therapy

OCuSOFT, Inc. announces the availability of Retaine MGD Ophthalmic Emulsion, a new therapy for individuals suffering from Dry Eye Syndrome and Meibomian Gland Dysfunction.

According to the company, Retaine MGD is the only preservative-free oil-in-water emulsion that moisturizes, lubricates and protects moderate to severe dry eyes. Utilizing Novasorb Technology — a proprietary cationic process of binding positively charged ions to the negatively charged ocular surface, Retaine MGD prolongs corneal contact time resulting in enhanced comfort. The hypotonicity of the emulsion adds moisture by lowering the salt concentration of tears while the lipid component lubricates and protects the surface of the eye.

Retaine MGD is packaged in 30 single-dose vials and will be the first product in a complete line of Retaine brand artificial tears. Special discount pricing is available to doctors dispensing from their office, however, patients may also order online directly at www.retainebrand.com.

For more information, visit www.ocusoft.com/retainemgd or call (800) 233-5469.

Contamac Receives The Queen's Award for Enterprise: International Trade 2012

Contamac announced receipt of The Queen's Award for Enterprise 2012 in the International Trade category. The award, well known as the UK's most prestigious for outstanding achievement, is given annually by Her Majesty The Queen for the highest levels of excellence.

The company, which celebrates its 25th anniversary this year, has demonstrated continuous growth in International Trade within the ophthalmic medical device industry with the development and manufacture of specialist polymers that serve the contact and intraocular lens industries.

Contamac's International Trade strategy is a complex series of relationships that include but are not limited to, overseas distributors, a wholly owned subsidiary, a multilingual sales and marketing team, medical device experts and strategic alliances. Integral to this strategy, research and development and eyecare practitioner education is delivered through the company's Centre of Excellence and the recently formed Contamac Specialty Lens Institute.

For more information on Contamac and its products, including the Definitive silicone hydrogel for custom lenses, visit www.contamac.com.

European Academy of Orthokeratology Announces 2012 Conference

The European Academy of Orthokeratology (EurOK) is a non-profit, independent organization that represents the European section of the International Academy of Orthokeratology (IAO). EurOK is a proponent of orthokeratology in Europe, promoting this science to eye specialists and providing education in the field of corneal molding for refractive errors and the latest technology for myopia control.

The EurOK inaugural meeting will be held June 9-10 in Madrid, Spain. International and European experts will provide two days of Continuing Education with simultaneous translation in Spanish and Italian. The exhibition will host the leading industry and manufacturers in the field. For more information, visit www.eurok.eu.

New Distributors for Jupiter Scleral Lenses

Visionary-Optics LLC announced two new distributors of their Jupiter Scleral lenses in the U.S. market: ABB CONCISE and Universal Contact Lenses of Florida, Inc. ABB CONCISE's experienced consultants may be contacted at their Marshfield, MA office at 1-800-225-1812 or their Alameda, CA office at 1‑800‑772‑3911. The consultant staff at Universal Contact Lenses of Florida may be reached at 1-800-874-4884.

The Jupiter Scleral design falls into two main design categories — the 15 mm diameter (mini-scleral) and the 18 mm diameter series. For use when alternative GP designs will not center or cause intolerable bearing forces on the central cornea and soft lenses cannot provide good vision. Also for the fitting of irregular corneas with conditions such as: keratoconus, trauma or post-surgical deformities. For more information on Jupiter Scleral lenses please visit www.visionary-optics.com.

Intra-Operative Hemorrhage Related to DSAEK
By William Townsend, OD, FAAO

The individual in this photo suffered an intra-operative hemorrhage while undergoing Descemet's stripping with automated endothelial keratoplasty (DSAEK). In reviewing the literature, we found no reports of this specific complication. DSAEK was introduced by Melles et al in the late 1990s and has been a useful and often successful alternative to penetrating keratoplasty (PK). It is particularly helpful in conditions that impair endothelial function such as Fuch's dystrophy. Advantages over PK include lower rejection rates, shorter recovery time, and reduced levels of induced astigmatism. Patients often report visual improvement within days or weeks.

For more on DSAEK procedures, see http://www.clspectrum.com/articleviewer.aspx?articleID=105074.

We welcome photo submissions from our 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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Ronald K. Watanabe, OD, FAAO

Protect Your Eyes from UV

Even in New England, we are starting to spend more time outdoors as the weather gets warmer. Ultraviolet exposure from the sun is something many think about in terms of sunburns and skin cancer, but not as many think about the potential for ocular damage. While we all recommend sunglasses and spectacle lenses with UV blockers for our patients, we should also think about added protection provided by UV blocking contact lenses.

A quick search found over 40 soft lens brands and 20 GP materials that are available with UV blocking properties. These lens materials contain compounds such as benzotriazole and Uvinul D-49 that block most light below 380 nm. This translates into roughly 70-90% blockage of UV-A light, and up to 99% blockage of UV-B light in some cases. Of course, a UV-blocking contact lens does not take the place of a good pair of sunglasses, and other factors may be more important in lens material and design selection. But this type of lens can be of benefit to those who don't wear sunglasses or who spend a lot of time outdoors.
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Guest Columnist: Bo Lauenborg, Optometrist, Denmark

Strengths of Contact Lens Practice in Denmark

Denmark is fairly representative of Scandinavia when you consider a few notable exceptions, particularly the relatively higher level of online sales in Sweden and Norway, and generally higher prices in Denmark. In Denmark, eyecare practitioners are good at retaining patients, both when it comes to market loss and internal competition. However, the market is becoming more competitive, with less loyal customers. The Danes have a high purchase power parity, and consumers are fashion and lifestyle conscious, which affects attitudes to health and expectations for eyecare.

Primarily, we retain contact lens wearers by packaging services and products together in a monthly standard fee. As often as possible, we manage financial transactions through subscriptions and direct bank transfer. In the Danish Contact Lens Institute the two-tiered priority — professional retention and medical care — directs our administrative efforts: We proactively work to reduce dropout, and to heighten our medical involvement. In some cases those purposes go hand in hand. DCLI is differentiated in the market in two such areas: multifocal contact lenses and treatment of Dry Eye Syndrome (DES). Both initiatives retain patients by offering superior products according to the principle of "upgrading whenever possible", and by profiling our clinic on our competencies as eyecare professionals. This establishes trust, the key to loyalty.

Another factor in creating loyalty is a very active PR profile. We also employ a range of electronic systems to improve customer satisfaction, such as detailed patient files in the CRM system and an online booking calendar system.
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Loretta B. Szczotka-Flynn, OD, PhD, MS, FAAO

Economic Burden of Common Contact Lens and Ocular Surface Conditions

From a cornea/contact lens clinician-scientist's perspective, obtaining federal funding for what we do is very difficult. We commonly hear that the ocular surface conditions including contact lens complications we study do not have enough morbidity or public health impact to warrant federal funding, or that the contact lens industry should absorb these costs.

I am sure many of you would agree that the corneal diseases we treat such as keratoconus and contact lens complications negatively impact our patient's lives and quality of life, often in a severe manner. Moreover, the economic impact to society can be significant.

A study of bacterial conjunctivitis estimated its U.S. prevalence in 2005 to be 4 million yielding estimated total direct and indirect costs at $589 million.1 For keratoconus, a patient's expected lifetime costs over myopia is more than $25,000.2 A recent study on contact lens induced infiltrates found the 2010 U.S. prevalence to be 32,031 for non-severe and 17,248 for severe keratitis with costs estimated to be over $1,000 and almost $1,500 per episode, for non-severe and severe keratitis, respectively. Overall, the total estimated direct and indirect cost of all contact lens induced infiltrates in the U.S. in 2010 was estimated to be $58 million.3

Although contact lens induced complications can be minimized with better compliance, newer products, and non-overnight schedules, the economic burden to patients and society can be significant and should be brought to the attention of federal research sponsors.

1. Smith AF, Waycaster C. Estimate of the direct and indirect annual cost of bacterial conjunctivitis in the United States. BMC Ophthalmol. 2009 Nov 25;9:13.
2. Rebenitsch RL, Kymes SM, Walline JJ, Gordon MO. The lifetime economic burden of keratoconus: a decision analysis using a markov model. Am J Ophthalmol. 2011 May;151(5):768-773.e2.
3. Smith AF, Orsborn G. Estimating the Annual Economic Burden of Illness Caused by Contact Lens-Associated Corneal Infiltrative Events in the United States. Eye Contact Lens. 2012 Apr 10.

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Effectiveness of Artificial Tears in the Management of Evaporative Dry Eye

These researchers from the UK wanted to compare the efficacies of sodium hyaluronate, hydroxypropyl methylcellulose (HPMC), and a new oil-in-water emulsion (Emustil unidose; SIFI) in the management of lipid-deficient dry eye.

Seventy-five subjects with dry eye were randomly divided into 3 groups. Each was allocated sodium hyaluronate, HPMC, or emulsion eye drops to be used four times daily for 90 days. Parameters were measured at baseline, 30 days, and 90 days. A compliance visit was performed at days 7 and 60.

Significant reduction (P < 0.05) in evaporation and improvement in symptoms in all groups were found. No statistically significant increase in tear turnover rate (TTR) was found with any solution. A significant difference in tear stability and noninvasive tear break-up time (NITBUT) was found in the emulsion and sodium hyaluronate groups but not in the HPMC group (P > 0.05). There was a significant decrease in osmolarity and corneal staining in the emulsion group (P < 0.001) but not in the sodium hyaluronate or HPMC group (P > 0.05).

The researchers concluded that a significant reduction in evaporation and improvement in symptoms in all therapy groups were found from baseline to 90 days. However, no significant effect was seen on TTR for any group. The emulsion drops were shown to perform best, improving tear stability, and decreasing osmolarity and corneal staining. These results are consistent with improvements in the lipid layer of the tear film as a result of prolonged use of emulsion drops.

McCann LC, Tomlinson A, Pearce EI, Papa V. Effectiveness of artificial tears in the management of evaporative dry eye. Cornea 2012;31:1-5.
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