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Sunday, May 6, 2012  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

The Association for Research in Vision and Ophthalmology's (ARVO) annual meeting is upon us this week (May 6-10, 2012) in Fort Lauderdale, Florida.

It is one of largest conferences, if not the largest conference, pertaining to eyes and vision in the world. While not without some controversy, ARVO's meeting will be leaving its current home location of Fort Lauderdale for future venues—next year it will be held in Seattle, WA. For those of you attending this year, take a moment to reflect on all of the clinical and scientific insights you've gained from this meeting over the years while looking forward to new venues ahead.

PEN Announces Internet Webinar Series on the Path to PIO 2012

Primary Eyecare Network (PEN), the practice development division of ABB CONCISE, announced a new webinar series, "The Road to Optometric Internet Marketing," as a lead-up to their annual conference, PIO 2012 (Preserving Independent Optometry) in August. Webinar registration is open to both PEN members and non-members.

The monthly webinar series will bring a wide array of speakers from both inside and outside the industry. These speakers will address the questions related to internet marketing confronting optometric practices today. EyeCarePro, a Canadian-based company exclusively serving optometric practices and optometry industry throughout North America, is the educational underwriter of the webinar series. (www.eyecarepro.net)

There is no cost to attend the webinars. In addition, all participants will be provided vouchers for a variety of products. The concept is to give away $1 million in product vouchers by the end of the series. Through partnerships with the voucher sponsors, the company hopes to bring everyone together to educate and facilitate every practice's entrance into internet marketing.

To register for the entire series or specific sessions, visit www.PrimaryEye.net/education. Preregistration is required. You do not need to be a PEN member to participate in either the webinar series or the PIO conference scheduled for August 10-11 in Monterey, CA. To learn more about PIO or to register, visit www.PrimaryEye.net/PIO.

Philanthropist of the Year; Practice of the Year Announced by Optometry Giving Sight
Optometry Giving Sight has named Dr. Mario Gutierrez from San Antonio, Texas as its Vision Source Philanthropist of the Year, and Cole, Krohn and Jensen from Fresno, California as its Vision Source Practice of the Year. The announcement was made at the Vision Source North American Meeting in Orlando.

The criteria for both awards includes recognizing an individual and practice that demonstrate a tremendous passion for the elimination of refractive error blindness and low vision through their own personal giving; practice fundraising and advocacy among their peers.
Dr. Gutierrez is a Chairman's Club member, active Ambassador and is currently initiating a hands-on service delivery program in the San Antonio area.

Cole, Krohn and Jensen has achieved great success in introducing the Seeing Eye to Eye (SETE) Program into their own practice, and encouraging their colleagues to do likewise. The SETE 'buy one-give one' program generates a large donation each quarter as the practice donates $5 for every frame sold.

Dr. Vic Connors won the Outstanding Achievement Award in 2011.
ONS Issues Statement Declaring Need for Eye Health Education

The Ocular Nutrition Society (ONS) has issued a statement regarding the urgent need to educate Americans about the role of nutrition in supporting eye health. The statement is the consensus of a multidisciplinary roundtable of experts recently convened by the ONS to explore the role of nutrition in eye health. Experts from the fields of ophthalmology, optometry, diet and nutrition, and primary care reviewed current data regarding nutrients that support the health of the aging eye and the results of a recent survey that examined U.S. baby boomer attitudes and awareness regarding eye health.

The impetus for action included findings from a recent nationwide consumer survey conducted by the ONS, which identified a lack of public awareness regarding the relationship between nutrition and eye health (Eye on the Boomer Survey. KRC Research. 2011). The results of the survey demonstrated a lack of knowledge around this important but under-appreciated health concern. Survey findings included the following results:

  • Baby boomers value their vision more than any other sense, but most are not taking necessary steps to protect their eyes
  • There is low awareness of specific nutrients that are important for eye health
  • Most respondents were not aware that smoking increases the risk of blindness
Bausch + Lomb provided support for the expert roundtable and the consumer survey.

For the complete text of the statement, more information about the ONS and the survey findings visit www.ocularnutritionsociety.org.

Cornea Abrasion Secondary to Fingernail Injury
By William Townsend, OD, FAAO

This 53-year-old female presented to our office with a complaint of severe left eye pain that began the previous evening as she was removing her multifocal soft contact lenses. She thought that she had injured her eye with her fingernail. The patient was new to lens wear and had done very well in learning application and removal during her in-office training a few days earlier. She was not wearing her contact lenses at the time of her emergency visit.

Her presenting acuities with spectacles were OD 20/20 and OS 20/30. The examination of right eye was unremarkable, but the left eye showed marked injection and epiphoria. The left lid was edematous, and upon elevation of the lid we noted the lesion in the superior aspect of the cornea. Careful evaluation with fluorescein showed loose epithelium that extended well beyond the margins of the abrasion.

For more on this patient and her treatment see http://www.clspectrum.com/articleviewer.aspx?articleID=105785.

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

Complications in Patients with Limbal Stem Cell Deficiency

A few weeks ago, I wrote about a unique application of scleral lenses in possibly promoting healing in limbal stem cell deficiency (LSCD). Before we all get too excited and start fitting scleral lenses on these patients, its prudent to point out that complications can and do develop in these patients that can be frequent and severe.

Sandali and colleagues in France have published a case series of 35 patients with severe LSCD. When infectious keratitis occurred it was mainly caused by Gram positive bacteria (94%). Only seven infections (37%) healed under fortified adapted antibiotics. In eight cases (42%) amniotic membrane transplantation was required and in four cases (21%) keratoplasty was performed. As expected, worse disease, in terms of number of quadrants of corneal vascularization and persistent epithelial defects, were associated with increased risk of infectious keratitis. Additionally, factors in conjunction with LSCD including soft contact lens extended wear and use of corticosteroid or cyclosporin eye drops were associated with increased risk.

Therefore, contact lens fitters should be judicious when treating patients with severe LSCD with continued contact lens care as complications arising can be more severe than the disease process itself.

Sandali O, Gaujoux T, Goldschmidt P, Ghoubay-Benallaoua D, Laroche L, Borderie VM. Infectious Keratitis in Severe Limbal Stem Cell Deficiency: Characteristics and Risk Factors. Ocul Immunol Inflamm. 2012 Apr 26. [Epub ahead of print]
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Ronald K. Watanabe, OD, FAAO

GP Adherence: Design or Material?

Occasionally, one of my GP patients will come in with complaints of increasing lens discomfort, blurry vision, spectacle blur, and difficulty removing their lenses. Over time, GP lenses can begin to adhere to the cornea, causing these symptoms. This is fairly easy to diagnose because the patient's lens will be stuck to the cornea. But sometimes it can be tough to figure out the main cause of this problem. Is it the lens design or the material or both? Is it dry eye? While most of these patients do have an underlying dry eye issue, the design and/or material can also contribute to adherence.

Lenses that decenter across the limbus are more likely to adhere. If this is the case, steepen the fit to improve centration, even though this may sound counter-intuitive. Lenses that dry quickly or develop deposits can also add to this problem. Use a material with a low wetting angle, and educate the patient on proper lens care. A daily cleaner and enzymatic cleaner can help greatly. If that is not enough, consider a stronger cleaner such as Progent (Menicon) on a bi-weekly basis to keep the lenses as clean as possible. By addressing both design and material issues, GP adherence can be solved.

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Estimating the Annual Economic Burden of Illness Caused by CL Associated CIEs in the U.S.

The aim of this study was to estimate the annual cost of illness caused by contact lens-associated corneal infiltrative events (CL-CIEs) among soft CL wearers in the United States.

This study was conducted in the United States. The study population was comprised of daily wear contact lens users in the United States, which number approximately 35 million. A comprehensive review of the medical literature for data on the annual incidence of CL-CIEs was conducted. Cost estimates were drawn from the literature and published tariffs. The perspective of the study was a U.S. healthcare perspective and because of the short duration of most CL-CIEs, no discounting was performed. The main outcome measure involved the total annual number of persons with CL-CIEs and associated direct and indirect costs.

In the United States in 2010, it was calculated that a total of 32,031 non-severe and 17,248 severe CL-CIEs occurred, respectively. The cost per non-severe and severe CL-CIEs was estimated to be $1,002.90 and $1,496.00, respectively. Overall, the total estimated direct and indirect cost of non-severe CL-CIEs and severe CL-CIEs in the United States in 2010 was estimated to be $58 million.

This study estimated the economic burden of illness imposed by CL-CIEs on both the healthcare system and individual patients in the United States. The authors noted that strategies designed to minimize the occurrence and impact of CL-CIEs, such as using improved lens care regimens and lens case management, the use of daily disposable lenses, and more efficacious ocular antibiotics may be beneficial in reducing this economic burden.

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 May;38(3):164-70.
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