No doubt you've noticed a redesigned version of Contact Lenses Today this week. Last year, we expanded our content and format, which was received with great enthusiasm. However, we learned from you that the three column format proved difficult to read on many electronic devices. With significant research and field testing, we've gone back to a one column format, and have included a Table of Contents and a new column highlighting a clinical image or case.

As always, we appreciate the feedback we receive from our readership and continue to strive to make improvements to our editorial materials whenever possible. Thank you for your continued support.

Akorn, Inc., a niche generic pharmaceutical company, entered into an agreement to acquire Advanced Vision Research, Inc. (AVR), which develops and markets TheraTears and MacuTrition brands, for $26 million in cash. AVR was founded in 1995 by the late Jeffery P. Gilbard, MD with its lead products developed in the clinics and laboratories of Harvard University's Schepens Eye Research Institute.

Akorn also plans to launch a new Consumer Health Division to enter the $1.2 billion OTC eyecare market, pending the acquisition of AVR. The company plans to further expand by licensing new products and developing private labeled eyecare products for major retailers.

The company named Bruce Kutinsky, PharmD, as President of the Consumer Health Division. Kutinsky joined Akorn as its Senior Vice President of Corporate Strategy in 2010. Previously, he served as the Vice President of Strategic Solutions at Walgreens.

Eyecare professionals can support Optometry Giving Sight this May with two opportunities from AllAboutVision.com. For every "Like" of its Facebook page, AllAboutVision.com will donate $1 to Optometry Giving Sight. In addition, each time AllAboutVision.com's free Eye Health News Feed is added to an eyecare practice's Facebook page, AllAboutVision.com will donate $10.

Just five "Likes" can provide an eye exam and a pair of eyeglasses to someone in a developing country through Optometry Giving Sight funded programs, which provide eye care services to people with little or no access to eye care.

By "Liking" AllAboutVision.com on Facebook, eyecare professionals can be the first to hear about eye care news and new articles that are published on the site. And, practices can boost their own Facebook efforts by adding the company's free Eye Health News Feed to their practice Facebook page. The feed automatically posts patient-friendly news, keeping the page fresh and interesting, and encouraging return visits.

For more information or to use the Eye Health News Feed, visit www.allaboutvision.com/ecp/. To "Like" AllAboutVision.com on Facebook, go to www.facebook.com/allaboutvision.

GP Specialists unveiled their new website, www.gpspecialists.com. The new site presents a comprehensive overview of their product offering, including the Global-OK Vision (GOV) series of Ortho-K lenses and Biocurve custom soft lenses. They have also incorporated online GP ordering capability.

In addition, GP Specialists has joined the social media wave and now has a presence on Facebook, Twitter & YouTube. Visit www.gpspecialists.com to learn more.

Ocusoft, Inc. announced the availability of their prescription-only Ocudox Convenience Kit for immediate dispensing at most retail pharmacies including, but not limited to: Walgreens, CVS, Wal-Mart, Rite Aid and Duane Reade.

The Ocudox Convenience Kit contains Ocudox (Doxycycline Hyclate 50 mg, 60 Capsules, USP), Ocusoft Lid Scrub Plus Extra Strength Pre-Moistened Pads (30 Ct.) and Tears Again Advanced Liposome Spray (15 mL).

In the event that Ocudox is not available at your local pharmacy, please inform the pharmacist that they may order directly from their wholesale distributor by using the following codes: McKesson - 1645191, Cardinal - 4424172, AmerisourceBergen - 108264 or Dakota Drugs - 982561. For assistance, please call customer service at 800-233-5469.

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This photograph shows acute corneal hydrops on the right eye of a 42-year-old male patient who has severe keratoconus. The patient had been successfully wearing scleral contact lenses, but he had suddenly noticed a dramatic decrease in the vision of his right eye. Slit lamp exam showed marked central corneal edema with mild bullous changes. There was no sign of infection or inflammation. IOP measured 10mmHg. The patient had been wearing his contact lens and was not experiencing discomfort. His best-corrected visual acuity was 20/60 with his scleral lens.

For more on this patient, see http://www.clspectrum.com/article.aspx?article=105442.

We would love to receive photo submissions from our readers! It is easy to submit a photo for consideration for publishing in Contact Lenses Today, simply email your JPG or PDF photo to cltoday@wolterskluwer.com. Please include an explanation of the photo and your full name, degree or title and city/state/country.

Contact lenses will soon be used for much more than vision correction. In 2005, contact lenses were theorized to be used for non-invasive monitoring of physiological glucose through the determination and monitoring of tear glucose, which is well known to track blood glucose with an approximate 30 minute lag time.¹ Such contact lenses could be worn by diabetics who could colorimetrically see changes in their contact lens color or other fluorescence-based properties, giving an indication of tear and blood glucose levels.

Recently, a similar application for non-invasive monitoring of tear fluids with a contact lens biosensor appears to be a reality.² A team from Japan fabricated and tested such a soft lens biosensor. The biosensor has an enzyme immobilized electrode on the surface of a contact lens. The SCL-biosensor showed excellent relationship between the output current and glucose concentration. The authors claim the SCL-biosensor well worked both in the static state and the dynamic state and that it is useful for advanced biomonitoring on the eye.

Are silicone hydrogels more comfortable than traditional hydrogels? Many think so, and some clinical research supports this assertion by showing that refitting patients into silicone hydrogels improves comfort and increases wearing time. However, there are many factors to consider, including surface hydration, lubricity, and design and fitting characteristics, as I have mentioned in previous columns. Although not well understood, the higher Dk/t of silicone hydrogels may also help end-of-day comfort due to reduced oxygen stress throughout the day. Alternatively, some argue that the reduced oxygen transmissibility of traditional hydrogels may be more comfortable as they "numb" the cornea.

A recent study conducted in the U.K. reported on dryness symptoms in soft lens wearers.¹ They found that about 30% of wearers had significant dry eye symptoms, which is consistent with previous reports by other researchers. But they also found that factors like lens material, care system, and gender were not correlated to dry eye status. Interestingly, the most common lens types worn were 2-4 week replacement silicone hydrogels and daily disposables. Perhaps the lack of difference is because each has its advantages that contribute to comfort. Overall, it is best to consider each individual patient's ocular status to determine the best lens type.

1. Young G, et al. Characterizing contact lens-related dryness symptoms in a cross-section of UK soft lens wearers. Contact Lens Ant Eye. 2011; 34(2): 64-70.

The environment preferred by Acanthamoeba trophozoites and the mechanism by which the amebae enters the cornea are not yet fully understood. A better understanding of the pathogenesis of this disease may help with prevention and treatment. The purpose of this study was to define the preferred environments for Acanthamoeba survival and proliferation in vitro by examining the effect of tonicity, nutrient concentration, and free chlorine content on Acanthamoeba.

Human corneal isolates of Acanthamoeba castellanii and Acanthamoeba polyphaga trophozoites were cultured at 22 degrees C (room temperature) in PYG (peptone-yeast extract-glucose) medium. The effect of tonicity on amebae was determined by incubating trophozoites in sodium chloride solutions in concentrations ranging from 0% to 10% for 19 days. Two different sets of media were prepared-one with and the other without added nutrients. The tonicity varied from 50 to 3438mOsm/L while the pH was maintained at 6.7-6.8. Aliquots were recovered to determine the number and morphologic type of the amebae.

To test the effect of chlorine, Acanthamoeba trophozoites were incubated for 7 days in buffered solutions with free chlorine concentrations varying from 0 to 5mg/L free chlorine at 22 degrees C. The pH was maintained at 7.2 and the tonicity varied from 88 to 92mOsm/L. Trophozoites were enumerated by hemocytometer.

Low tonicity solutions (<300mOsm/L) favored the trophozoite stage, but elevating tonicity encouraged encystment. Only 3.3-3.9% of the trophozoites remained in 10% NaCl, while 46-58% of the trophozoites were present in distilled water. Increasing osmolality yielded a smaller number of Acanthamoeba with a greater proportion of cysts. Nutrients improved the replication rate at lower concentrations, increased the number of trophozoites and reduced the percentage of cysts. Chlorine completely inhibited both species of Acanthamoeba at free chlorine levels of 5mg/L, while lesser concentrations were less inhibitory.

The researchers concluded that Acanthamoeba prefer hypotonic environments. Nutrients merely slowed the conversion of trophozoites to cysts at higher tonicity levels. Chlorine concentrations less than 5mg/L, ocular irritation level, did not effectively convert trophozoites into cysts. They also concluded that contact lens patients should avoid hypotonic ocular exposures, especially tap water and stagnant media such as lake water, and water from poorly maintained swimming pools and hot-tubs.

Bergmanson JP, Wang E, Gire AI, Osato MS. In vitro effects of medium tonicity, nutrient concentration, and free chlorine content on Acanthamoeba. Cont Lens Anterior Eye. 2011 Apr 20. [Epub ahead of print]

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