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In thinking about contact lenses that act as drug delivery vehicles, which of the following areas do you think would have the most clinical appeal?

Dry Eye

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

The Center of Disease Controls estimated healthcare costs in the U.S. are over $3 trillion and over half of these healthcare costs are associated with hospital care and clinical and physician services. In contrast to this, the current budget for the United States National Institutes of Health is $30 billion—a fraction of the total healthcare costs. I think it is important to consider the idea of staying ahead of disease states in our patients, and to do this, we need more basic and clinical research. This is certainly true in the eyecare arena. Knowledge about disease etiology is the first step toward both treatment and prevention.

Canadian Association of Optometrists Announces Inaugural Vision Champion Award

The inaugural 2015 Vision Champion Award has been awarded to Pat Davidson, MP, Member of the Canadian House of Commons. The Vision Champion Award is the only award presented to the general public (non-optometric community) by the Canadian Association of Optometrists (CAO). It honors individuals or organizations for distinguished service to the eye care and vision health of all Canadians.

Davidson’s Private Members Bill, Bill C-313, An Act to Amend the Food and Drugs Act (non-corrective contact lenses), will bring non-corrective (also known as cosmetic) contact lenses under a Class II medical device categorization in line with the same regulations for prescription contact lenses. Bringing federal oversight to the contact lenses industry will ensure that producers, importers and retailers throughout Canada possess the necessary licensing associated with a Class II medical device and greatly enhance consumer protections concerning the cosmetic lenses industry. Bill C-313 was unanimously endorsed by all MPs in the House, passed easily in the Senate, and received Royal Ascent in December 2012.

AOA Announces Optometric Registry EHR Vendors

The American Optometric Association (AOA) announced three EHR vendors that will integrate with the profession’s new optometric registry, AOA MORE (Measures and Outcomes Registry for Eyecare), by Prometheus Research. The initial EHR vendors include: Compulink Eyecare Advantage/HER, MaximEyes by First Insight, and RevolutionEHR by Health Innovation Technologies. Optometric practices use a variety of EHR systems and AOA MORE will add more EHR vendors in the near future.

AOA MORE is a private, secure database that will integrate data from a doctor’s EHR to provide a systematic way of collecting real-time patient data and reporting data as needed. The data from AOA MORE will promote clinical improvement through self-benchmarking, outcomes and population analytics, and will support increased access and scope of care.

The registry is an AOA member benefit, but will be available to nonmembers for a fee. AOA MORE continues trial testing in select practices nationwide and will launch at Optometry's Meeting 2015. Click here for an optometric registry FAQ.

Registration and Housing Open for Academy 2015 New Orleans

The American Academy of Optometry announced that registration and housing are open for Academy 2015 New Orleans, taking place on October 7-10, 2015 at the New Orleans Ernest N. Morial Convention Center.

Over 250 hours of lectures and workshops have been selected, offering attendees up to 35 hours of CE. Highlights include:

  • This year’s Plenary Session, “Today’s Research, Tomorrow’s Practice: Recognizing and Treating Ocular Melanomas,” will feature Drs. Carol and Jerry Shields from the Ocular Oncology Service at the Wills Eye Hospital. The session will highlight how to differentiate between suspicious and non-suspicious pigmented and amelanotic lesions as well as new treatment and management options including clinical trials using chemotherapeutic agents.
  • The American Academy of Optometry and American Academy of Ophthalmology Joint Symposium, “Amblyopia and Beyond: Evidence-Based Pediatric Eye Care,” will focus on evidence-based pediatric eye care. The first-ever joint educational program is scheduled to take place at the meeting in New Orleans, with the identical program to be repeated at the American Academy of Ophthalmology annual meeting in Las Vegas in November.

The Academy 2015 New Orleans Program Preview provides an overview of the exciting events and CE that will be offered. This year’s exhibit hall will be world class with more than 200 booths displaying the latest products and technology. Register online,, by August 3, 2015 to receive the early bird registration discount.

In last week’s Contact Lenses Today Editorial, we asked for your thoughts on how often you use the “Pepsi challenge” when fitting patients in contact lenses. We received several emails on the topic. Here are some of them.

I use the “Pepsi challenge” as often as I can. When I am not professionally sure which contact lens may work better for a specific patient, but I have determined that there may be two that will work, what better way to decide than to have the patient actually wear both lenses and then return with their input.
Craig Liebig, OD
Clarksburg, WV

While there is much to say for the “Pepsi challenge” in order to select the lens with the best initial comfort, it will not tell you anything about the desired fit of the lenses. Only in cases of equally well fitting lenses, the “Pepsi challenge” would support which lens to choose. Remember it is not only comfort that counts. It's about health, comfort (including visual comfort), and safety, as we know.
Ruud van 't Pad Bosch, OD
The Netherlands

Despite all the wonderful technology and in depth research, the individual wearer’s reaction to a lens is what determines success. We see information that tells us 8 out of 10 prefer brand X and that 8 out of 10 prefer brand Y, but we have no clinical test that tells us which lens the wearer in the chair prefers.

We can tell the patient that, considering your wearing habits, tear film status, refraction, etc., we would recommend this type of contact lens. And, in our experience, there are two brands that are likely to be successful. It’s then up to the wearer to tell us which lens they prefer once they have experienced the lens on eye, handling, end-of-day comfort, etc.

This approach also tells the wearer that all contact lenses are not the same and there are alternatives out there that may be better for them and their friends.

Finally, I think putting the wearer in control aids compliance as it gives them ownership of the process and builds trust between the eyecare practitioner and wearer.
Andrew J Elder Smith
Harrogate, United Kingdom

This has been debated for years. I believe we would see a distinct difference in prescribing of GP lenses compared to traditional soft lenses if more consideration was given to the “Pepsi challenge” process. I know you were not likely thinking of comparing GPs to soft lenses, so let me explain.

I believe when the conditions are right for GP lenses, i.e. the ideal upper lid positioned to allow for an under the lid attached fit, the superior visual acuity delivered by a GP lens will many times outweigh the very initial reduced awareness of a soft lens with less than optimal VA. This is especially true in comparing a standard low cost spherical GP lens to a higher cost soft toric modality.

Try it…Pepsi or Coke? GPs or Soft Torics?
Keith Parker, President
Advanced Vision Technologies
Lakewood, CO

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S. Barry Eiden, OD, FAAO

Prismatic Effect in Soft Toric Lenses – It Can Be an Issue

Soft toric contact lenses utilize various methods to achieve rotational stability. Two of the most commonly used toric lens stabilization methods are prism-ballasting and peri-ballasting, both of which might result in vertically induced prism within the optic zone of the lens. A study was conducted to evaluate the prismatic effect found in a number of popular soft toric lens designs.

The researchers computed vertical prism using published refractive index and vertical thickness changes within the central optic zone. Thickness maps were measured using scanning transmission microscopy. Designs tested were reusable, silicone hydrogel and hydrogel toric soft lenses (SofLens Toric, PureVision 2 for Astigmatism, PureVision Toric, Biofinity Toric, Avaira Toric, Clariti Toric, Air Optix for Astigmatism and Acuvue Oasys for Astigmatism). Eight parameter combinations for each lens (-6.00DS to +3.00DS, -1.25DC, 90° and 180° axes) were evaluated. The results of the analysis found that all toric lens designs evaluated had vertical prism in the optic zone except one which had virtually none (0.01Δ). Mean prism ranged from 0.52Δ to 1.15Δ, with three designs having prism that varied with sphere power. Vertical prism in Acuvue Oasys for Astigmatism was significantly lower than all other TSCLs tested.

The authors concluded that toric soft contact lens designs utilizing prism-ballasting and peri-ballasting for stabilization have clinically significant vertical prism in the central optic zone. In monocular astigmats fit with a toric lens in one eye and a sphere in the other eye or those wearing a mix of toric designs between the two eyes, vertical prism imbalance could create or exacerbate disturbances in binocular vision function. They stated that practitioners should be aware of this potential effect when selecting which toric lens designs to prescribe, particularly for monocular astigmats with pre-existing binocular vision anomalies, and when managing complaints of asthenopia in monocular astigmats.

Our goal in contact lens management is to provide excellent visual clarity, all day comfort and optimal eye health response. However, we can’t forget that the vast majority of our patients are binocular in their function. Being sensitive to the potential for our patients having binocular dysfunction (either naturally occurring or iatrogenic) is both important and unfortunately frequently overlooked. Let’s keep our “two eyes” on this issue from now on when managing patients in soft toric contact lenses!

Sulley A, Hawke R, Lorenz KO, Toubouti Y, Olivares G. Resultant vertical prism in toric soft contact lenses. Cont Lens Anterior Eye. 2015 Mar 27 [Epub ahead of print]

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Katherine M. Mastrota, MS, OD, FAAO

The Lid Margin

Anyone who knows my professional interests can tell you I love the lid margin. I, along with a few other lid margin crusaders, have spent hours examining, staining, poking, warming, squeezing, cleaning, buffing and admiring the lid margin.

The lid margin, in my opinion, is just amazing. Along this narrow strip of anatomy, skin and mucus membrane meet, glands abound, and, when in perfect balance with the ocular surface, clear and comfortable vision exists.

Thus it is no surprise to me that there is current research interest in the sensitivity of the lid margin. As eyecare practitioners, we are accustomed to assessing corneal sensitivity and can discuss with facility the neural feedback loops for tear production. Should testing lid margin sensitivity become routine, especially in patients with dry eye/ ocular surface disease? What would we learn from the data collected on lid margin testing? How would that information impact our clinical decisions and practice patterns? What direction could that knowledge provide for drug development in lid margin/meibomian gland disease? Questions, questions. More to follow in the weeks ahead…

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Efficacy of a Contact Lens Sensor for Monitoring 24-H Intraocular Pressure Related Patterns

The purpose of this research was to study performance of a contact lens sensor (CLS) for 24-hour monitoring of IOP-related short-term patterns and compare with IOP obtained by pneumatonometry.

In this prospective clinical trial, 31 healthy volunteers and 2 glaucoma patients were housed for 24 hours in a sleep laboratory. One randomly selected eye was fitted with a CLS (Triggerfish, Sensimed, Switzerland), which measures changes in ocular circumference. In the contralateral eye, IOP measurements were taken using a pneumatonometer every 2 hours with subjects in the habitual body positions. Heart rate (HR) was measured 3 times during the night for periods of 6 minutes separated by 2 hours. Performance of CLS was defined in two ways: 1) recording the known pattern of IOP increase going from awake (sitting position) to sleep (recumbent), defined as the wake/sleep (W/S) slope and 2) accuracy of the ocular pulse frequency (OPF) concurrent to that of the HR interval. Strength of association between overall CLS and pneumatonometer curves was assessed using coefficients of determination (R2).

The W/S slope was statistically significantly positive in both eyes of each subject (CLS, 57.0 ± 40.5 mVeq/h, p<0.001 and 1.6 ± 0.9 mmHg/h, p<0.05 in the contralateral eye). In all, 87 CLS plots concurrent to the HR interval were evaluated. Graders agreed on evaluability for OPF in 83.9% of CLS plots. Accuracy of the CLS to detect the OPF was 86.5%. Coefficient of correlation between CLS and pneumatonometer for the mean 24-h curve was R2 = 0.914.

The researchers concluded that CLS measurements compare well to the pneumatonometer and may be of practical use for detection of sleep-induced IOP changes. The CLS also is able to detect ocular pulsations with good accuracy in a majority of eyes.

Mansouri K, Weinreb RN, Liu JH. Efficacy of a contact lens Sensor for Monitoring 24-H Intraocular Pressure Related Patterns. PLoS One. 2015 May 5;10(5):e0125530. doi: 10.1371/journal.pone.0125530.

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