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Sunday, April 29, 2012  
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Last week's question:
How much refractive cylinder do you believe is worth correcting in soft lens wearers in terms of providing visual benefit?

 A. 0.75DC
  66%


 B. 1.00DC
   24%


 C. 1.25DC
   10%

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

Use of the Internet continues to remind us that we are indeed a global economy. Consumers have gone from shopping in their local, family owned shops to big box retail stores to online merchants. Consumers now use the Internet to shop for items in other markets, including both pharmaceuticals or medical devices such as contact lenses. While trade of these sorts of items is often restricted from region to region, we're all aware that it certainly happens and have encountered a patient or two who has acquired contact lenses from such a source. That said, remain vigilant in educating patients about associated risks, which are more costly than the few bucks perhaps saved when all is said and done.


Meyers Awarded Outstanding Achievement in the Field of Orthokeratology

William E. Meyers, Ph.D., vice president, Science & Technology at Paragon Vision Sciences, received the award for Outstanding Achievement in the Field of Orthokeratology in a ceremony this month at the Vision by Design 2012 Conference in Scottsdale, Ariz.

This honor, awarded by the Orthokeratology Academy of America, was given to Dr. Meyer, who has devoted decades to the advancements in contact lens polymer development, manufacturing processes, designs, and contact lens corneal reshaping. Among Dr. Meyers' pertinent patents were six for Corneal Refractive Therapy. The CRT product based on these patents was FDA approved for overnight wear in June 2002.

For the past 16 years, Meyers has been employed as vice president, Science & Technology at Paragon Visioin Sciences. After earning a Ph.D. in Biochemistry from Ohio State University he began his career in the eyecare industry with Syntex Ophthalmics in 1983 as a director of Research and Development. He went on to work with Pilkington Barnes Hind for eight years and was responsible for widely known lens designs such as SoftPerm, CSI Toric, and many others. Meyers holds more than 30 issued U.S. patents, mostly in the eyecare arena.

eyecareScore Launches New Website

A new website, focalCenter.com, aims to inform users of the features, benefits and effectiveness of eyecareScore, a survey tool to measure eyecare patient feedback in an online, standardized way. Visitors will gain a comprehensive understanding of the rationale for use, relevance to their business and robustness of this tool for eyecare stakeholders.

Visitors can learn about the main features of eyecareScore with a series of screen shots and short videos to help become acquainted with the application, its functionality, and ease of use. There are calculators to determine the Return On Investment (ROI), and the margin of error a user can expect by subscribing to eyecareScore.

A free trial is offered allowing users to click for access to the dashboard reports and benchmarks. In upholding focalCenter's mission to deliver the best feedback solutions, the new website will also ultimately serve as a basis for learning insights on best practices for feedback management.

For more information, visit www.focalCenter.com.

Eye TV New Feature of WebMD

WebMD recently launched Eye TV for display within the Eye Health Center on webmd.com. Eye TV provides on-demand video programming that will bring to life real people successfully managing their eye health and vision.

In addition, WebMD is adding two optometrists to the WebMD Eye Health Board of Advisors: Robert Butterwick, OD, and Darren Levine, OD. WebMD utilizes the Board of Advisors to provide insights for creation of new editorial content. According to the company, board members offer guidance on interpreting new scientific research, identifying trends in treatments and providing clinical insights into patients' needs.

For more information about the Eye Health Center and Eye TV, visit http://www.webmd.com/eye-health/default.htm.

Eyecare Concerns Heard by U.S. Congress

More than 350 ophthalmologists met with members of Congress on Thursday to raise awareness about eyecare concerns and ask their support for policies that enhance disease prevention.

The American Academy of Ophthalmology's Congressional Advocacy Day is an annual event to educate Congress and urge policy support for eye care. This year, the academy has three key priorities: protecting patient access to quality eye care and preventing blindness; advancing research for new eye disease treatments; and alleviating public confusion about healthcare providers.

During the advocacy day, academy members asked for renewed federal investment in research and innovation to advance treatment for eye disease. The academy requested $32 billion for federal fiscal year 2013 funding for the National Institutes of Health, including $730 million for the National Eye Institute.


Conjunctival Intraepithelial Neoplasia
By Gregory W. DeNaeyer, OD, FAAO

This photograph shows a conjunctival intraepithelial neoplasia (CIN) in a 67-year-old white male patient's left eye. The patient reported noticing a growth on his affected eye that started six weeks prior to his examination. His previous ocular history was unremarkable. The patient systemically had a history of leukemia that was currently in remission. His visual acuity in the left eye was 20/20. Slit lamp examination showed a 5mm x 6mm inferior fleshy growth of his conjunctiva that was vascularized. A similar lesion that measured 5mm × 3mm was located nasally to the cornea. The patient was diagnosed with a CIN of his left eye and was prescribed mitomycin C 0.02% ophthalmic solution q.i.d. for one week. Then after being off the drops for one week, he was instructed to use them again q.i.d. for one week.

For more on this patient and CID see http://www.clspectrum.com/articleviewer.aspx?articleID=105183.

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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CARE SOLUTION CORNER
Susan J. Gromacki, OD, MS, FAAO

Spring Allergies and Contact Lenses

As I write this column, we are enjoying a beautiful, sunny, warm day on the east coast. But it is still April, so the high pollen counts have dampened the spirits of many of our contact lens wearers.

Seasonal allergic conjunctivitis may be a common diagnosis in many of our practices, but it has a tremendous impact on patient quality of life. Patients complain of itching, tearing, redness, burning, photophobia, foreign body sensation, and blurred vision; we see hyperemia, chemosis, watery discharge, clear mucus and sometimes lid edema.

Patients need to understand that there may be times when they need to switch to glasses; I find that about 50% of contact lens wearers with seasonal allergies do. Here are some tips for these patients to enhance their contact lens-wearing experience.

  • Wear clean lenses; replace and care for as recommended and consider daily disposables
  • Use frequent application of artificial tears or rewetting drops to rinse out allergens
  • Understand that oral antihistamines can cause dryness, which may be contributing to your symptoms
  • Understand that topical vasoconstrictors may cause rebound hyperemia
  • Use a topical antihistamine/mast cell stabilizer twice per day: 10 minutes before lens insertion and immediately after lens removal
  • Be patient; the spring allergy season will soon come to an end!
For more on seasonal allergies and contact lens wear, see these articles from Contact Lens Spectrum:
http://www.clspectrum.com/articleviewer.aspx?articleid=103966
http://www.clspectrum.com/articleviewer.aspx?articleid=103350
http://www.clspectrum.com/articleviewer.aspx?articleID=106746

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VIEWS FROM ABROAD
Guest Columnist: Montani Giancarlo Dip. Optom. FIACLE, FBCLA; Lecce, Italy

The Italian Contact Lens Market

In Italy, the soft contact lens (SCL) market is the most important part of the contact lens business. The replacement modality most widely used is the daily one (50%), followed by the monthly modality (39%).1 Regarding SCL materials prescribed, silicone hydrogels (61%) are in the first position, followed by mid-water hydrogels (39%). The lens fitting activities are primarily done in the optical stores where SCLs are predominant. GP lenses are fitted in few specialized centers—some outside optical stores—where spherical, toric and mostly specialty GP lenses with specific designs suited for the irregular corneas are fitted.

One of the most interesting topics for Italian eyecare practitioners is the contact lens fitting of presbyopic patients, even though many patients continue to use single vision contact lenses to correct refractive errors, and spectacles to correct presbyopia. Another interesting topic for Italian practitioners is orthokeratology, also for the possible effects in slowing the progression of myopia, even if the percentage of fitting lenses in children or teens is still very low. In Italy also there is always a lot of attention to the new products that increase the comfort of contact lenses, particularly focused on lenses and solutions with technologies suited to reduce dry eye symptoms.

1. Morgan Philip B. et al. International Contact Lens Prescribing in 2011. Contact Lens Spectrum, Volume: 27, Issue: January 2012, page(s): 26-32

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OCULAR SURFACE UPDATE
Guest Columnist: Anita Ticak OD, MS; Kelly K. Nichols, OD, MPH, PhD, FAAO

The Summer Cool-Down

If I told you to Google "worst dry eye cities," would you be surprised that five of the top 20 cities are in Texas? And, four of which make the top five?1

Houston is not in this list, but Dallas is fifth. When I first moved to Houston from Ohio I was amazed at how much dry eye I was seeing in the clinic. Yes it is hot, but also very humid—"humid subtropical" technically. So what's happening?

As I began to work with these patients, I began to realize part of what may be happening — we create our own arid environment. If it is under 60° everyone cranks up the heat. If it's over 70° everyone cranks up the air conditioning. It is rarely between 60-70° in Houston. By taking a thorough history I discovered patients are either running heat or air constantly, the fan is above their beds at night, and when they get in their car the air conditioning is full blast pointed at their face. The result is that every time we have a major season shift we become flooded with new dry eye patients.

The good news is that simple environmental adjustments can be made by the patient, such as repositioning fans, purchasing humidifiers, using more viscous or frequent lubrication, and trying moisture chamber goggles during the day and/or night for relief. Anecdotally, I have helped many of my patients find relief with moisture chamber goggles. Currently there is a study actively enrolling at the Singapore National Eye Centre to study the effectiveness of moisture chamber goggles after 2 weeks of outdoor wear (http://clinicaltrials.gov/ct2/show/NCT01388426). A previous study in India2 on intensive care unit patients showed the benefit of these devices in the reduction of corneal staining and corneal epithelial breakdown in sedated or semi-conscious patients.

The lesson here is clear—the outdoor environment does not necessarily mimic the ambient environment, and the non-obvious environmental history of the dry eye patient can result in simple solutions. As we get ready to "warm up" across the U.S., remember that the indoor "cool down" can be part of the dry eye problem.

1. http://thedryeyereview.com/2010/06/the-20-worst-dry-eye-cities-in-the-us/
2. Sivasankar, S et al. Eye Care in ICU. Indian J Crit Care Med 10(1): January-March 2006

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Morphology of Contact Lens-induced Conjunctival Epithelial Flaps: A Pilot Study

This study utilized impression cytology to investigate the cellular composition and health of conjunctival epithelial flaps (CEF).

Nine subjects were enrolled in the study—three- non-lens wearers, three contact lens wearers without CEF, and three contact lens wearers with CEFs wearing 8.4/13.8 lotrafilcon A lenses. Impression cytology samples were collected from the flap or similar locations, if CEF was absent, using rectangular 5mmx2mm Millipore HAWP02500 membrane filters. The filters were gently pressed onto the conjunctiva, subsequently fixed in 95% alcohol, stained with hematoxylin-eosin and evaluated under an Olympus IX70 microscope. Measurements of the longest cell and nucleus dimensions were measured on 40 cells from each filter by utilizing NIH Image 1.63.

Researchers found the CEF consisted of multilayers of epithelial and goblet cells and were devoid of inflammatory cells, basement membrane material and stromal tissue. The cytoplasmic and nuclear dimensions were similar within the groups and the cytoplasm-to-nucleus ratio was not different between the flap group and the non-lens wearing group. They concluded the CEF appeared to be formed by healthy epithelial and goblet cells that have been dislocated from their normal location along the conjunctival surface by the lens edge. No inflammatory cells were present in this contact lens induced condition, which is reported to be associated most commonly with the silicone hydrogel material.

Bergmanson JP, Tukler J, Leach NE, et al. Morphology of contact lens-induced conjunctival epithelial flaps: A pilot study. Contact lens & anterior eye : the journal of the British Contact Lens Association 2012.

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