As noted in Contact Lenses Today and a case series in a recent issue of Contact Lens Spectrum, we've covered the issue of corneal infiltrative events (CIEs) and practitioners' perceptions of the rates and risks for this complication. As discussed, some doctors feel that specific multipurpose care solutions and/or silicone hydrogel combinations may be related to these events, but it is emphasized that we need more clinical research around these issues.

This week's highlighted abstract in Contact Lenses Today addresses the issue from a research-based approach, using a retrospective chart review. As noted, both use of a multipurpose care solution (compared to hydrogen peroxide) and silicone hydrogels (compared to traditional hydrogels) were associated with increased odds of experiencing a CIE (as were a few other factors). The article does not, however, address specifics regarding these multipurpose care solutions or silicone hydrogels. If you or your institution has a subscription to Investigative Ophthalmology & Visual Science, you can check out the full "IOVS Paper in Press" here: http://www.iovs.org/content/early/2011/04/25/iovs.10-7018.full.pdf+html

The Management & Business Academy (MBA), sponsored by CIBA Vision and Essilor and endorsed by the American Optometric Association, has updated two comprehensive management reports detailing best practices in contact lens and spectacle lens management.

The reports discuss critical management topics for each device category, providing current optometric practice performance benchmarks, projections of revenue gains from process improvements and concrete management techniques to increase revenue and patient satisfaction. Each report also includes extensive quantitative analyses drawn from MBA practice performance surveys among private practice ODs and from proprietary research from the sponsor companies.

The 28-page report "Best Practices of Contact Lens Management" includes sections on upgrading the product mix, retail pricing and gross profit margin maximization, transaction cost reduction, managing in-office inventory, patient recall and annual supply sales strategies, and increasing the contact lens wearer base.

The "Best Practices of Spectacle Lens Management" report is also available.

The reports can be downloaded from www.mba-ce.com.

Vision By Design 2011, the annual conference of the Orthokeratology Academy of America (OAA) was held April 28-May 1 in Orlando. Attended by 240 doctors, educators and researchers, the meeting featured over 25 hours of continuing education. Topics included myopia control (including soft lens technology), corneal reshaping studies, safety of corneal reshaping, social media, progressive/hyperopic Ortho-K lens designs, new corneal reshaping technologies, post Lasik/keratoconus Ortho-K designs, scleral/corneal lens designs for corneal rehabilitation and Ortho-K in China.

The Academy bestowed honors to icons in the field of corneal reshaping. John Mountford received a Research Fellowship (FOAA) for his work in developing the innovative BE retainer design, and Jerry Legerton received the Outstanding Achievement in Orthokeratology Award for his contributions to the field of corneal reshaping including the CRT lens design with its novel Return Zone Depth (RZD) and Landing Zone Angle (LZA).

President Cary Herzberg announced the inception of the International Academy of Orthokeratology to support, promote and advance corneal reshaping worldwide through quality education and research presentations at meetings held around the world. The first meetings are planned for Europe (Fall 2011), China (March 2012) and Phoenix (April 2012). To learn more visit www.orthokacademy.com.

Acculens announced the release of extended parameters in its Maxim Scleral lens. According to the company, with addition of the new 17.5mm lens, eyecare practitioners will now be able to manage severe keratoconus, excessively steep bulging transplants and pellucid patients more efficiently.

The Maxim Scleral lens is indicated for the management of corneal distortion and dry eyes. It is available in custom parameters manufactured in Boston XO2. Twenty-lens trial sets are available free of charge. For more information contact Acculens at 1-800-525-2470 or visit www.acculens.com.

Contamac Ltd. Launched its new company website, www.contamac.com, to improve access to published articles and product information, facilitate navigation of the site, update corporate branding and provide the company with feedback and useful data for additional enhancements.

Using state-of-the-art Search Engine Optimization, Analytics and including integration of Content Management Systems, Contamac has developed a unique approach to market its materials for contact lenses and intraocular lens implants to manufacturing laboratories, ophthalmic practitioners, students, researchers and patients.

Menicon America Inc. announced the appointment of Kurtis Brown as Marketing Director for Menicon America and Lagado Corporation. Brown reports to David Moreira, Menicon America's Vice President of Marketing.

With over 25 years of experience in the contact lens industry, Brown brings a wealth of knowledge to his new position. Most recently, he was Global GP Marketing Manager for Bausch + Lomb, where he coordinated worldwide marketing efforts in support of B+L's gas permeable materials and lens care business.

In addition to expanding the specialty custom lens market, Brown will also be responsible for raising awareness of Menicon and Lagado products in the professional community.

Dr. Vic Connors resigned as Chairman and CEO of Optometry Giving Sight, USA. Dr. Connors will continue to serve the organization as a Director of the Global Board. Clive Miller, Global CEO, will also be Acting Country Manager for the USA until a replacement is found.

Miller said the organization remains deeply indebted to Dr. Connors for the incredible contribution that he has made since it was launched in the USA in 2005 and for the leadership and inspiration that he provided to the staff and also to his peers and colleagues who have donated so generously as a result of his advocacy and fundraising efforts.

The British Contact Lens Association (BCLA) is now offering a new Online Membership category. Ideal for overseas members and open to all contact lens practitioners at every stage of their career as well as those involved in education, industry and manufacturing, BCLA Online Membership is a cost-effective way to gain professional and clinical support in the field of contact lenses and/or the anterior eye.

Online Membership costs £60 for 12 months of unlimited access. Among the online benefits and resources included are: online access to Contact Lens & Anterior Eye; BCLA e-newsletters; discounts on various publications; factsheets, contact lens standards, grading scales, calculators and simulators; online libraries and virtual lectures, including conference presentations and Pioneers Lecture.

To join or learn more, visit the Membership section at www.bcla.org.uk.

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This 15-year-old male patient presented with a history of a "red spot" that appeared on the limbus of his right eye 18 months earlier. He noted that it became more injected at times. It had remained fairly consistent in size until several months ago when it began to grow. The patient could not remember any specific trauma to the right eye. His uncorrected presenting acuities were 20/20 OU.

For more on this patient, see http://www.clspectrum.com/article.aspx?article=&loc=archive\2010\january\cls_1_10_a02.html.

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.

Change: A Good Thing
After attending ARVO and talking with industry and colleagues, I have decided the phrase "the times are changing in dry eye" definitely is accurate. Mergers and acquisitions of existing companies and new start-up pharmaceutical companies entering the field most certainly will change the future plans for new and existing marketing and research efforts in dry eye disease.

Some would say all of this instability (no pun intended) will be negative. For example, with mergers there are fewer companies, thus a smaller quantity of dollars to go around. The flip side of the coin is that there will be movement—people changing employment, new ideas generated through restructuring, a death of the "that is the way we have always done it" sort of mentality. This is an excellent opportunity that start-up companies always seem to capitalize on—cross training of people, more ideas, and nose-to-the grindstone hard work. At ARVO, I overheard representatives from venture capital companies come to the solid conclusion that the field of dry eye and subsequently getting approval of a dry eye therapeutic is very "hard," which is likely true. Yet, even with this perceived barrier, there are more new companies with big ideas in the dry eye space than ever before. Get set to be amazed—change is afoot, and the opportunity has not been brighter.

Take a Different Look
A spirited column summarizing the contact lens-related keratitis outbreaks and its aftermath was recently composed by William Benjamin, OD, PhD, and printed in Optometry. Beginning with his chosen section headings, Dr. Benjamin's take on the situation is an interesting read for anyone with interest in contact lens (CL) care.

Threat of the 'Unstandard'. An "unstandard" is prepared without "adequate knowledge, consensus, or a logical basis to do so." The author notes that the "pressure" to change CL care system regulatory standards after the outbreaks "began to subside."
Enter the fungus, Fusarium. The standards organizations modified the standards: "the organisms must now be killed or inactivated when growing in an organic substance that makes them hardier."
Enter the protozoan, Acanthamoeba. Since there was no proven test procedure for assessing the kill of Acanthamoeba by CL regimens, another "unstandard" was avoided.
Let's rub it out! The author states that, "'No Rub' wasn't eliminated from the CL standards. The issue became one of labeling."
The issue of encystment. The standards groups are generating a test to identify care regimens that induce high levels of Acanthamoeba encystment. If no link between encystment and keratitis is found, this can be abandoned.
Familiarity can breed contempt. As practitioners and patients have become more familiar with contact lenses, they have treated them more as commodities. The author writes, "We must all go back to the fundamentals and become more fastidious if we really intend to lessen the frequency and severity of infectious problems associated with contact lens wear."

Benjamin WJ. Perils of the "Unstandard" and the habitual hygiene of hydrogels. Optometry. 2010; 81(8):377-380.

Researchers wanted to describe age and other risk factors for corneal infiltrative and inflammatory events (CIEs) in young soft contact lens (SCL) wearers and to model the age-related risk. A multi-center, retrospective chart review of 3,549 SCL wearers (8 to 33 years at first observed visit, +8.00 to -12.00D, over-sampling <18 years) captured CIEs from January 2006 to September 2009. Chart review noted age, gender, SCL and lens care products, and SCL wearing history. Event diagnoses were adjudicated to consensus by reviewers masked to wearer identity, age, and SCL parameters. Significant univariate risk factors for CIEs were subsequently tested in multivariate generalized estimating equations.

Charts from 14,327 visits observing 4,642 years yielded 187 CIEs in 159 wearers. Age was a significant non-linear risk factor peaking between 15 and 25 years (p<0.008). Less than one year of SCL use was protective versus longer years of wear (p<0.0003). Use of multi-purpose care products (2.86X), silicone hydrogels (1.85X) and extended wear (2.37X) were significantly associated with CIEs in the multivariate model (p<0.0001 each).

The researchers concluded that patient age, years of lens wear, use of multi-purpose care products, silicone hydrogels and extended wear were all significantly associated with CIEs with SCL wear. Use of SCLs in young patients aged 8 to 15 years was associated with lower risk of infiltrative events compared to teens and young adults. In terms of safety outcomes, SCLs appear to be an acceptable method to deliver optics designed to manage myopia progression in children and young teens in the future.

Chalmers RL, Wagner H, Mitchell GL, et al. Age and Other Risk Factors for Corneal Infiltrative and Inflammatory Events in Young Soft Contact Lens Wearers from the Contact Lens Assessment in Youth (CLAY) Study. Invest Ophthalmol Vis Sci. 2011 Apr 28. [Epub ahead of print]

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