CONTACT LENSES TODAY
May 14, 2006
Contact Lenses Today® is edited by Dr. Joseph T. Barr and the staff of Contact Lens Spectrum. This week CLToday® reaches more
than 12,000 readers in 74 countries.
Update on Keratitis Infections
The Centers for Disease Control (CDC) announced on Friday that it has confirmed 122 cases of
Fusarium keratitis, with another 15 possible
cases and 60 cases still under investigation in 33 states the U.S. Due to a lag in reporting, the CDC only has complete data for 98 cases. Of reported
cases, 75 include insufficient evidence to classify them as cases of Fusarium or other non-Fusarium diagnoses.
The CDC released updated numbers on solution use and
pertinent exposures on Tuesday, May 9th. Of the 98 cases on which CDC has complete data, five did not wear contact lenses, 93 are contact lens wearers, 59 reported using
Bausch & Lomb’s (B&L) ReNu with MoistureLoc, 19 reported using ReNu Multiplus, nine reported using an unspecified ReNu brand, three used Advanced Medical Optics’ (AMO)
solutions and four used solutions from Alcon. Some cases reported using more than one type of solution.
In related news, B&L China removed locally made ReNu with
MoistureLoc products from the market on May 11th in he interests of consumer health. The action has the support of the Chinese regulatory agency. A spokesperson for B&L
says there have been no unusual trends in Fusarium keratitis in China.
NIH Study Finds 14 Million Visually Impaired
As part of the National Health and Nutrition Examining Survey, an ongoing survey conducted by the CDC’s National Center for Health
Statistics, the National Eye Institute (NEI) of the National Institutes of Health (NIH) recently designed and supported a study that attempted to estimate the number
of people over the age of 12 in the U.S. with impaired distance vision due to uncorrected refractive error. Researchers interviewed more than 15,000 people from 1999 to
2002. They interviewed participants in their homes and invited them to undergo a comprehensive exam in a Mobile Examination Center (MEC). More than 14,000 presented to
an MEC and more than 13,000 completed visual acuity tests.
The study found that while 94% of Americans have good vision, the remaining 6%, 14 million, are visually
impaired. Of those, more than 11 million have uncorrected visual impairment. Teenagers, diabetics, Hispanics and the economically disadvantaged were found to have higher
rates of visual impairment and may benefit most from correction.
The study authors say the survey confirms that uncorrected visual acuity is a major public health
problem. They recommend practitioners talk to patients about the importance of eye health; periodic eye exams, expanded vision screening opportunities and efforts to
increase public awareness. The study was published in the May 10th issue of the
Journal of the American Medical Association.
CooperVision Restructures
Contact lens manufacturer CooperVision announced organizational changes to its clinical research and professional affairs division in an
effort to provide better service to the professional community, enhance clinical research and product development efforts and support educational development in
optometry schools.
• Dr. Nikki Irvani, formerly the director of clinical research and professional/academic affairs, was promoted to vice president of the same
division.
• Harvard Sylvan, O.D. has joined the company as director of professional development. He previously served as a contact lens specialist with Opticare
Eye Health and Vision Center and vice president of professional services for Biocompatibles Eyecare.
• Mark Andre, F.C.L.S.A., will consult on CooperVision’s
academic programs. Mr. Andre has also been on staff at Casey Eye Institute in Portland and serves as an associate professor at Pacific University.
Feeling Less Is Worth More
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PureVision™, and approximately 15 times less friction than Night & Day™. With an average of 11,000 blinks per day, patients will benefit
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Night & Day™ is a registered trademark
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Global Keratoconus Congress 2007
Mark your calendars for the first-ever Global Keratoconus Congress to be held January 26-28, 2007 in Las Vegas. The Global Keratoconus
Congress is an assembly of experts in the field of patient care, teaching and research. They will share the latest information on this chronic sight-threatening
condition that affects one in 2,000 people. Attendees will learn about the latest approaches to contact lens fitting, surgical techniques, clinical research and
appropriate third-party reimbursement for medically necessary contact lens care. Manufacturers and laboratories that support the care of these patients will assist
in demonstrating the usefulness of their latest products and treatments. More information will be coming soon.
Abstract:
Acanthamoeba Keratitis in a Non-CL Wearer
Researchers at Kocaeli University in Turkey report the case of
acanthamoeba keratitis in a five-year-old without history of trauma or contact
lens wear. The patient was referred to the university clinic with an initial diagnosis of disciform herpetic keratitis. After two weeks of antibacterial and antiviral
therapy, researchers took a corneal biopsy, which revealed acanthamoeba. They then began intensive therapy with chlorhexidine diacetate 0.02%, oral ketoconazole tb and
hexamidine di-isethionate 0.1%. After one month, they discontinued chlorhexidine diacetate 0.02%, ketoconazole tb, and added topical prednisone acetate to reduce
inflammation. Researchers also lowered the dose of hexamidine di-isethionate 0.1% to four times a day for an additional four months. After five months of treatment,
they discontinued all medications and began amblyopia treatment. They conclude that doctors should consider
acanthamoeba when dealing with keratitis in children, even
in those without a history of contact lens wear or trauma.
Demirci G, Ay GM, Karabas LV, et al. Acanthamoeba keratitis in a 5-year-old boy without a history of contact lens usage. Cornea. 2006 Apr;25(3):356-8.
Editor's Commentary:
Workshops Work
One of the best ways to teach optometry students (and probably ophthalmology residents) how to prescribe specialty contact lenses (toric,
bifocal, and sorry to say, yes GP lenses) is in a workshop situation with real patients and really qualified mentors in small groups. We took part in such a workshop
this past Tuesday and Wednesday for about 60 optometry third year students that focused on fitting toric soft contact lenses. The results were awesome! The students
learned a lot and gained confidence. And just to show it can be done, four companies supported this effort (Vistakon, CooperVision, CIBAVision, and Bausch & Lomb). The
companies sent diagnostic lenses and representatives to further inform everyone who attended.
We'll be reporting on this effort in more detail in the future. Those
of you in the contact lens education field may want to think about this multi-sponsor approach. It is effective and we have the data to prove it. While it's a lot of
work, it's worth it. The future of the field may depend upon it. Thanks to all of you who made this happen, you know who you are. It is one of the proudest education
moments I've ever had.
Fitting Tip:
Lens Care Issues
Can you imagine someone leaving used toothpaste on their toothbrush, not rinsing it off, then applying fresh paste next time on top of
the old? We've seen too many infection cases recently, in which people add new soaking/disinfecting solution to old solution (topping off). This may work for your coffee
or your gas tank, but it doesn’t work for lens cleaning and disinfection.
Tell patients to dump the old. I actually rinse my lenses with the solution in the case and
then rinse the lens with fresh solution before applying it. Then, of course, rinse the case with running water, wipe it off and let it air dry. Then when you remove and
rub the lens and rinse to clean it, fill the case with fresh solution. Tell patients why: "The lens will feel better and you will be safer."
Please send us your tips
on how to communicate with patients about lens care.
The Global Orthokeratology Symposium presents "Fundamentals of Corneal Reshaping"
— a newly formatted educational experience for 2006. Held in conjunction with the Southern California College of Optometry, this 2-day
course designed for the novice or new orthokeratology practitioner will focus on patient selection, corneal topography, choosing a design — plus "live" fitting and
next-day follow-up with actual patients. Go to www.GOS2006.com for more information.
--ADVERTISING
This month at http://www.siliconehydrogels.org, consider prescribing silicone hydrogels
for pediatric patients, evaluate the effectiveness of “no rub” multipurpose solutions, and read part two of our Academy 2005 synopsis.
Report adverse contact lens reactions here: http://www.accessdata.fda.gov/scripts/medwatch/ or
call (800) FDA-1088.
Access a reporting form for complications you've seen that were a result of contact lenses dispensed without a valid
prescription at the Association of Regulatory Boards of Optometry's (ARBO's) Web
site: http://www.arbo.org/arbo.asp?dt=R&doc=Complications. Complete and send the form online or print it
out and fax it to (866) 886-6164.
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