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Sunday, May 13, 2012  
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Last week's question:
Do you think it takes substantially more time to fit a low astigmat in a soft toric compared to a soft spherical lens?

 1. Yes

 2. No

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

As shown in this edition of the newsletter, about 40% of practitioners find that fitting soft toric lenses in low astigmats takes "substantially" more time than fitting a soft spherical lens in this patient population. While I realized that some practitioners likely felt this way, I had no idea that there was still such a widespread of belief about soft torics. Although soft toric lens penetration has grown through the years, perhaps this issue remains a major barrier to further growth in this market segment? Manufacturers often provide statistics on successful fits with the first soft toric lens placed on the eye, but I am not aware of any literature showing that the time it takes to fit a soft toric lens is substantially longer. Further insights into this issue would certainly lead to a better understanding of this segment of the contact lens market.

Holden Honored by the University Of Houston

Professor Brien Holden, CEO of the Brien Holden Vision Institute, was presented with an Honorary Doctor of Humane Letters degree from the University of Houston, College of Optometry. The degree was presented to Professor Holden in recognition of his exceptional career in the field of optometry, his academic research and humanitarian accomplishments.

Holden's research focus has been in the area of vision correction and ocular health, in particular with contact lenses, spectacles and surgery. He has been a driving force behind the development of a number of lens products, most notably, the creation of the third generation of soft contact lenses to correct astigmatism and the co-developer of the breakthrough highly oxygen permeable silicone hydrogel lenses.

His humanitarian efforts have been integral to the creation of organizations which are to helping build sustainable eyecare systems in developing communities, including the International Centre for Eyecare Education, where he serves as CEO and Optometry Giving Sight, of which he is Executive Chair. Under Holden's direction the Brien Holden Vision Institute was a founding partner and continues to be a major contributor to these organizations.

Brien Holden has also made a strong contribution to global initiatives to address avoidable blindness and vision impairment through his involvement with the International Agency for the Prevention of Blindness and the World Health Organization's Refractive Error Working Group.

New Edition of Healthy Vision Focuses on Eye Allergies

An estimated 50 million Americans suffer from the miseries of allergies and about 50 percent of individuals with seasonal and indoor allergies also experience some degree of eye symptoms. On the new edition of Healthy Vision with Dr. Val Jones, Paul Karpecki, OD, FAAO, a top authority on eye allergies, joins Dr. Val to talk about how to identify, treat, and manage eye symptoms from seasonal and indoor allergies.

Healthy Vision with Dr. Val Jones is devoted to educating and improving the eye health of Americans. The program is supported by Acuvue Brand Contact Lenses and is hosted by Val Jones, MD, CEO of Better Health, LLC. Her new blog on eye health can be found at http://www.healthline.com/health-blogs/healthy-vision.

Free podcasts of the program can be found in the iTunes Store (for best results, search for the show by its complete title. You will find it in LifeMinute.TV Health) and on BlogTalk Radio (www.blogtalkradio.com/healthyvision).

USPTO Issues Notice of Allowance for Patent for Enhancing Efficacy of Antimicrobial Contact Lenses

Quick-Med Technologies, Inc., a life sciences company that is developing innovative technologies for the healthcare and consumer markets, announced that the U.S. Patent and Trademark Office issued a Notice of Allowance for the Company's pending patent, "System and Method for Enhancing the Efficacy of Antimicrobial Contact Lenses and Other Surfaces."

The forthcoming patent covers the method of post-treating Nimbus contact lens and other Nimbus surfaces to enhance antimicrobial efficacy and increase biofilm resistance. By introducing a citrate solution to a surface to which a Nimbus polymer has been non-leachably bound, the bactericidal performance is improved significantly. According to the company, this significantly enhanced performance is sustained even after rinsing the lenses.

This enhancement is particularly useful in achieving antimicrobial protection in delicate materials such as soft contact lenses with gel-like physical properties and a high percentage of water content and where requirements for clarity and material integrity limit the amount of antimicrobial agent that can be employed.

PBA Announces Launch Date of 2012 Most Beautiful Eyes Contest

Prevent Blindness America (PBA) is announcing the dates to the 2012 "Most Beautiful Eyes" contest. The contest allows children across the United States the chance to win a $10,000 educational scholarship. The goal of the contest is to get parents thinking about the importance of their children's healthy vision.

From June 25 through July 31, 2012, parents of children up to 17 are encouraged to enter their child in the Contest by submitting a photo to the PBA Facebook page at www.facebook.com/preventblindness. Once again, renowned broadcaster Larry King will serve on the celebrity panel of judges as well as "Fox NFL Sunday" Host Curt Menefee.

During August, the public will be encouraged to place online votes for their choice of the child with the most beautiful eyes. Each state will have one winner, who will advance to the second round of voting. The national winner and two family members will enjoy a weekend in Chicago to attend the PBA Annual Awards Banquet where the scholarship will be officially awarded.

For more information, please visit preventblindness.org.

Contact Lens Fitting After Penetrating Keratoplasty
By Lindsay A. Sicks, OD, Glendale, AZ

This 28 year-old male exhibits extensive corneal neovascularization and ghost vessels in his central cornea. He rejected his first penetrating keratoplasty after sustaining ocular trauma within a week of the initial surgery. After his second transplant, BCVA with a silicone hydrogel SCL is 20/80. He has a history of corneal GP fits and discontinued wear due to discomfort. He was fit with a diagnostic scleral GP showing possible BCVA of 20/30

We thank Dr. Sicks for her image and welcome photo submissions from our other 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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Kelly K. Nichols, OD, MPH, PhD, FAAO

Learning to Listen

What a long way we have come. I am looking at a book called "An Atlas of Diseases of the Eye" by Perfins and Hansell, published in 1957. The pictorial book documents common conditions of the eye, and nowhere to be found is there even a description of dry eye disease. Hordeola (stye), chalazion, blepharitis, and rosacea keratitis are discussed, yet what is missing from each description is the mention of ANY patient-based symptom. The forward in the text, by Sir Duke-Elder, claims that "a pictorial presentation is more meaningful than a host of words," and that "an atlas supplemented by text is the best substitute for a patient himself." And while the reference was to learning and to a lesser degree patient care, I like to think the practice of medicine has evolved to include the patient as an active partner in the patient care process, with the clinician as an avid listener.

Stop to hear your patients—there have been at least two recent studies linking depression and dry eye disease,1-2 so as clinicians we should remember patient-reported depression, and medications for depression can be a red flag for undiagnosed dry eye. In addition, dry eye has been shown time and time again to impact quality of life, which could exacerbate or trigger depression. In this case, a picture is not worth a thousand words—a conversation with your patient is.

1. Galor A, Feuer W, Lee DJ, Florez H, Faler AL, Zann KL, Perez VL. Depression, Post-traumatic Stress Disorder, and Dry Eye Syndrome: A Study Utilizing the National United States Veterans Affairs Administrative Database. Am J Ophthalmol. 2012 Apr 26. ePub ahead of print.
2. Kim KW, Han SB, Han ER, Woo SJ, Lee JJ, Yoon JC, Hyon JY. Association between depression and dry eye disease in an elderly population. Invest Ophthalmol Vis Sci. 2011 Oct 10;52(11):7954-8. Print 2011.
3. Friedman NJ. Impact of dry eye disease and treatment on quality of life. Curr Opin Ophthalmol. 2010 Jul; 21(4):310-6.

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Dennis M. Bunz, Cheektowaga, NY

In response to the April 29, 2012 Editor's Commentary, we received the following reader's comment.

Re: Internet Sale of Contact Lenses

Unfortunately, we in the optical community, meaning the three "O's", have let the contact lens manufacturers run "roughshod" over our practices and turn our practices into showrooms and education/training centers for their lenses, while they become bed fellows with the large internet providers which provide nothing other than unreasonable prices.

The manufacturers still have the audacity to send in their sales force to attempt to promote their product and have us believe that we are still important to them.

It is the optical community's fault that this happened simply because the three "O's" were never together as a whole, to create a stronger voice in our profession.

Now that the internet is here to stay, and people are in the cyber buying mode, it is our job to reinforce to our patients (for the short time we have them) not only the benefits of professional care, but the consequences of those purchases, as it potentially eliminates jobs and money returning back into our practices and our communities.

Let these be lessons for the future as the three O's cannot stand apart on such issues.

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Susan J. Gromacki, OD, MS, FAAO

Efficacy of Care Solutions Against Contact Lens-Associated Fusarium Biofilms

The contact lens-related Fusarium keratitis outbreak of 2005-6 is thankfully behind us. All of the current contact lens care products have demonstrated good efficacy against Fusarium planktonic (free-floating) cells in the United States Food and Drug Administration's regulatory testing. One recently-published study has taken the testing one step further—against the fungus's biofilms.

Biofilms are closely packed multicellular formations of organisms. A planktonic cell undergoes a phenotypic change when switching to a biofilm form, rendering it more resistant to contact lens solutions.

The study found that on all three lens types utilized, the biofilms of F. solani were consistently susceptible to both hydrogen peroxide care products but only two out of the five multipurpose solutions; and the biofilms of F. oxysporum were consistently susceptible to both hydrogen peroxide care systems but only one of five MPSs. These results may help explain why we continue to see fungal keratitis among contact lens wearers, even after the removal of a care system from the market. And although there is no epidemiological evidence at the moment on the incidence of true lens-associated biofilms recovered from patients with fungal keratitis, there have been for bacterial keratitis. Given the serious nature of fungal keratitis, any attempt to better understand the disease process and how to eradicate the pathogens is a much-needed contribution to the literature.

Retuerto MA, Szczotka-Flynn L, Ho D et al. Efficacy of care solutions against contact lens-associated Fusarium biofilms. Opt Vis Sci 2012;89(4):382-391.

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Microvascular Abnormalities in the Bulbar Conjunctiva of Contact Lens Users

Soft contact lenses are commonly used to improve vision acuity or in cosmetic enhancement. The authors hypothesized that contact lens use can cause inadvertent damage to either the conjunctival microcirculation via direct vaso-occlusion when the lens physically interacts with or damages the underlying vessels, or to the bulbar conjunctiva itself when the lens rests unevenly on the surface of the bulbar conjunctiva.

Computer-assisted intravital microscopy was utilized to document (via video recording) and objectively quantify (via image analysis) real-time microvascular abnormalities resulting from changes and vessel remodeling in the conjunctival microcirculation in long-term (>2 yrs) contact lens users (n = 102), with non-users serving as control subjects (n = 29). A severity index (SI) - computed as the arithmetic sum of the abnormalities found in the conjunctival microcirculation in each contact lens user - was established for objective comparison with control subjects and critical interpretation.

Contact lens user SI was significantly higher than control SI (user = 6.21 +/- 1.26; control = 2.31 +/- 1.49; p < 0.05), indicative of severe vasculopathy arising from contact lens use. The users also had significantly wider conjunctival vessel diameter (user = 71.25 +/- 12.09 mum; control = 52.20 +/- 5.10 mum; p < 0.05). Additional abnormalities, including damaged vessels, hemosiderin deposits (from damaged vessels or injury to the surface of the bulbar conjunctiva), vessel sludging, intermittent blood flow, and vessel tortuosity were commonly found in or adjacent to locations where the contact lens physically rested on the underlying conjunctival vessels.

According to the authors, these results strongly suggest that microvascular abnormalities and remodeling changes occurred as a result of the inadvertent physical interaction of the lenses with either the underlying conjunctival vessels or the surface of the bulbar conjunctiva in contact lens users.

Cheung AT, Hu BS, Wong SA, Chow J, Chan MS, To WJ, et al. Microvascular abnormalities in the bulbar conjunctiva of contact lens users. Clin Hemorheol Microcirc. 2012 Jan 3.

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