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Sunday, April 28, 2013  
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Last question:
Which of the following do you most frequently recommend for the daily cleaning and disinfection of a scleral contact lens?

 Gas permeable lens daily cleaner and conditioning solution

 Gas permeable lens multipurpose solution
 Soft lens multipurpose solution
 Hydrogen peroxide system

Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

As many anxiously await summer months to come, it is important that we remind ourselves and our patients about the risks associated with UV exposure from the sun. While beneficial to some biological systems, excessive UV radiation can do significant damage to bodily tissues, including the eyes. Amongst other things, a critical component to patient examinations is to make sure that our patients are educated about and prepared for UV exposure. Proper protection of the eyes includes a combination of reducing exposures, using caps and visors with a wide brim, in addition to ophthalmic protection (sunglasses and/or UV blocking contact lenses). Recommendations from you can make a significant difference in the lives and behaviors of your patients.

World Council of Optometry Announces Award Winners

The World Council of Optometry (WCO) announced the recipients of its international optometry awards to recognize outstanding contributions to the development of the profession and to the community at a ceremony in Malaga, Spain. Professor Brien Holden (Australia) was named winner of the Distinguished Service Award while Dr. Jillia Bird (Antigua) picked up the International Optometrist Award.

Professor Holden, a pioneer in contact lens development and eye health, and now a global leader of efforts to eliminate avoidable blindness and vision impairment, is only the sixth to receive the Distinguished Service Award, the organization's highest honor.

In his nomination, the organization cited Holden for more than 40 years of vision and unfaltering dedication to optometry. His leadership has led to major breakthroughs in scientific knowledge and the development of devices for vision correction; as well as significant advances in the fight against avoidable blindness and vision impairment worldwide. He created a social enterprise that has generated over $1 billion in research, education and humanitarian funds to create advanced vision correction products and provide quality vision care to people in need. Holden has also provided postgraduate opportunities for close to 200 young researchers from around the globe, and been heavily involved in the development of the optometry profession in countries lacking comprehensive eyecare services.

Dr. Jillia Bird was nominated for the International Optometrist Award by the Trinidad and Tobago Optometrists' Association for her outstanding work in raising awareness of glaucoma in the Caribbean. Her family's history of preventable vision impairment has fuelled her passion for blindness prevention.

In 2007, Dr. Bird founded the Antigua and Barbuda Glaucoma Support Group, a thriving patient support and advocacy group. The group successfully lobbied Antigua's government to recognize the public health threat that glaucoma poses to its predominantly African-origin population. She has also been elected President of the World Glaucoma Association.

TheRightContact.com Launches Mobile App

TheRightContact.com, a contact lens search engine for eyecare professionals, announced the launch of their new mobile app for both iPhone and iPad users. Over 2,000 eye care professionals have already registered for the website, and now the mobile app is available for free within the Apple App Store.

Like the website version, TheRightContact mobile app allows users to easily search and compare contact lenses as well as lens care products. With this new technology, practitioners can quickly find base curve, packaging and dozens of other relevant parameters all within their mobile device. Articles, videos, glossary, fitting tools, including calculators, are available on this platform. Using push notification technology users can also be notified immediately on product releases and parameter changes.

The service remains free for both professionals and students, but registration is required. Users can login with their current website login information or register directly from within the app.

Johns Joins B+L Educational Support Team

Bausch + Lomb Custom Lab Channel Business has contracted with Lynette Johns, OD, FAAO, who will provide academic and educational support as well as a global speaking presence for the Boston and KeraSoft IC product lines.

Dr. Johns, who has in-depth expertise in scleral lenses for irregular cornea patients, will travel internationally to speak on specialty lens fitting and products, assist Authorized Boston and KeraSoft Laboratories, train ECPs, as well as provide expertise and guidance on products and educational resources.

Dr. Johns most recently worked as the senior optometrist at Boston Foundation for Sight, and was on the adjunct clinical faculty of New England College of Optometry.

UltraVision Names White Clinical Director and Stonehouse Engineering Manager

UltraVision CLPL, based in the United Kingdom, has employed Clinical Director, Lynn White MSc FCOptom and Engineering Manager, Nick Stonehouse.

Lynn White has been a consultant to UltraVision since 2007, contributing heavily to the development of KeraSoft IC, the soft lens for keratoconus and irregular corneas. She has over 30 years varied experience in optometry. She ran her own practices for over 20 years, worked in the Caribbean as an optometrist and on her return to the UK, developed her own dedicated irregular cornea contact lens practice. She was an AOP Councillor for 8 years, with a special interest in Low Vision.

Nick Stonehouse brings a wealth of experience in contact lens manufacturing, having worked at Alcon's (formerly CIBA Vision) Farnham manufacturing plant. He started there 25 years ago making GP and soft contact lenses before joining their Quality department as QA Engineer. In the short time Nick has been at UltraVision he has been implemental in helping streamline UltraVision's manufacturing processes and practices.

Severe Subconjunctival Hemorrhage
By Stephanie D. Curts, OD, Brownsburg, Indiana

This image shows severe subconjunctival hemorrhage in a 67 year old patient on blood thinners.

We thank Dr. Curts for sending this image and 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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Expressing Meibomian Glands
Cosmo Salibello, OD, FAAO, Wood Village, OR

The following commentary was received in response to last week's editorial in Contact Lenses Today on the increase of clinicians are actively expressing the meibomian glands of their patients.

Your sharing, in the latest issue of Contact Lenses Today, that you have noticed more and more clinicians routinely expressing meibomian glands for their patients brings up a few questions. Please be aware that I retired from active practice in 2011, after a 28 year career in optometry. I did maintain the highest level scope of practice allowed in my state right up to my retirement.

So, I wonder:

1) Do the clinicians you mention number more ODs or more MDs?
2) How are the results of the gland expression being utilized; i.e., does a pasty effluent cause the doctor to change what would otherwise be done to treat or prescribe based solely on reported symptoms?
3) Is there a specific treatment pharmaceutical or procedure which would change the quality of the expressed material and restore more normal function to the gland?
4) Does a finding of pasty effluent cause the doctor to change the amount or content of patient education, conducted due to dry eye complaints or contact lens discomfort, which would not have been shared based on symptoms or the condition of the lenses alone?
5) In today's mode of practice for eye care, does either the patient or the clinician gain any benefit from the addition of another routine test? If so, can the procedure enhance practice revenue and/or patient outcome? If not, why bother?

I'm not suggesting that eye care adopt a "get 'em in, get 'em out" philosophy of patient care, although increasing patient volume does seem to be a financial reality in today's health care environment. I am proposing that a reasoned approach to adding procedures for patient care be taken with more of a wellness, rather than curative, emphasis. In essence, current health care policy does seem to be headed toward "prevent it", rather than "fix it" and maybe that is not such a bad thing.

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Ronald K. Watanabe, OD, FAAO

More One Days!

Last month, I wrote about daily disposables (DDCL) made by smaller labs that I was not as familiar with. Since then, two of the larger manufacturers have introduced DDCLs that are new to the United States. Vistakon has brought their higher Dk TruEye brand to the U.S. For a few years, we have had the narafilcon B version of 1-Day Acuvue TruEye. This version has a Dk of 65, water content of 48%, and is available in a base curve of 8.5 mm in 30 or 90-packs. Until now, it had been the highest Dk DDCL in the U.S. The narafilcon A version has been available in other parts of the world and is reportedly being worn by over 1 million patients. It has a higher Dk at 100, and is available in base curves 8.5 and 9.0 mm in 90-packs only.

Soon to be released is Alcon's Dailies Total 1. Already available in parts of Europe, it features "water gradient" technology that reportedly allows the lens to maintain different water contents in the center and surface of the lens. It boasts a Dk/t of 156 (at -3.00 D), highest of any DDCL thus far. More on the performance of these "big box" DDCL options in future columns.

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Loretta B. Szczotka-Flynn, OD, PhD, MS, FAAO

Experts Summarize Current Knowledge of Contact Lens Induced Pseudomonas Keratitis

Experts in Pseudomonas aeruginosa (P. aeruginosa) infection have recently written a summary of their evidence-based hypotheses of how P. aeruginosa bypasses the ocular defense mechanisms during contact lens wear to cause (rare) infection. The basis of this research is to understand how the healthy cornea resists infection. During contact lens wear, the ocular surface may be bombarded with microorganisms with which it either peacefully coexists, clears, or infection and/or inflammation ensue. "Null-infection" in vivo models, cultured human corneal epithelial cells, contact lens-wearing animal models, and bacterial genetics are used to help elucidate mechanisms by which P. aeruginosa survives at the ocular surface, adheres, and traverses multilayered corneal epithelia. It has been shown that multiple defenses on the ocular surface must be overcome to cause infection; this involves P. aeruginosa adaptation, expression of the type III secretion system, proteases, and P. aeruginosa biofilm formation on contact lenses.

The authors conclude that P. aeruginosa keratitis occurs by bacterial adaptation to ocular surface defenses combined with changes to the biochemistry of the corneal surface caused by trapping bacteria and tear fluid against the cornea under the contact lens. Their knowledge base and ongoing research is key in determining next steps in prevention of what can be a visually devastating disease.

Evans DJ, Fleiszig SM.Why Does the Healthy Cornea Resist Pseudomonas aeruginosa Infection? Am J Ophthalmol. 2013 Apr 17. [Epub ahead of print]

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Applicability of Contact Angle Techniques Used in the Analysis of Contact Lenses, Part 1: Comparative Methodologies

Contact angle, as a representative measure of surface wettability, is often employed to interpret contact lens surface properties. The literature is often contradictory and can lead to confusion. This literature review is part of a series regarding the analysis of hydrogel contact lenses using contact angle techniques. Here the authors present an overview of contact angle terminology, methodology, and analysis. Having discussed this background material, subsequent parts of the series will discuss the analysis of contact lens contact angles and evaluate differences in published laboratory results.

The concepts of contact angle, wettability and wetting are presented as an introduction. Contact angle hysteresis is outlined and highlights the advantages in using dynamic analytical techniques over static methods. The surface free energy of a material illustrates how contact angle analysis is capable of providing supplementary surface characterization. Although single values are able to distinguish individual material differences, surface free energy and dynamic methods provide an improved understanding of material behavior. The frequently used sessile drop, captive bubble, and Wilhelmy plate techniques are discussed. Their use as both dynamic and static methods, along with the advantages and disadvantages of each technique, is explained.

The authors conclude that no single contact angle technique fully characterizes the wettability of a material surface, and the application of complimenting methods allows increased characterization. At present, there is not an ISO standard method designed for soft materials. It is important that each contact angle technique has a standard protocol, as small protocol differences between laboratories often contribute to a variety of published data that are not easily comparable.

Campbell D, Carnell SM, Eden RJ. Applicability of Contact Angle Techniques Used in the Analysis of Contact Lenses, Part 1: Comparative Methodologies. Eye Contact Lens. 2013 Apr 11. [Epub ahead of print]

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To report possible grievances related to the Fairness to Contact Lens Consumers Act or associated Contact Lens Rule visit: https://www.ftccomplaintassistant.gov/.

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