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Sunday, May 22, 2011  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

I was recently reminded while implementing the new format for Contact Lenses Today that while challenging, change can indeed be a good thing. To carry this thought further, sometimes when implementing change in your office, with your staff, or even friends and family, it can be met with resistance. However, countless individual and organizational stories again and again demonstrate that the benefits of a new approach are usually worth it. Like our experience with change (or re-change) in our newsletter format, open-mindedness and weathering the storm of resistance generally pays off--good things will follow.

Surveys Indicate CL Wearers Non-Compliant in Virtually All Active Steps of Wear

Findings from two independent, sponsor-masked online surveys, along with a review of the many activities involved with good compliance with soft contact lens (CL) wear, suggest a number of missteps that occur before, during, and after CL wear that could lead to clinical complications. Findings are being published in Contact Lens & Anterior Eye.

The first survey, to a random sample of 645 frequent replacement CL wearers, included questions related to lens replacement frequency. The second survey, to a random sample of 787 wearers, included questions relating to lens disinfection, hygiene and replacement of the lens storage case. Respondents represented wearers of hydrogel and silicone hydrogel lenses available in the U.S. prescribed for two-week or monthly replacement.

Highlights of results include:

  • Nearly half of survey respondents admitted to not having washed their hands with soap prior to lens insertion in the morning (44%) and removal in the evening (49%).
  • Few patients rub their lenses with disinfecting solution (27% in morning, 25% in evening).
  • There is generally low compliance with practitioner recommendation on lens replacement frequency.
  • Although 75% reported that they emptied disinfecting solution from the lens case in the morning, only 46% reported that they filled the lens case with fresh solution instead.
  • Average frequency for cleaning the lens case was 2-3 times per week. Most patients reported methods that involved exposure to tap water.
  • The median interval for replacement of the lens storage case was 4-6 months; however, 48% replace the storage case annually or less often.

The studies were sponsored by Vistakon, Division of Johnson & Johnson Vision Care, Inc.

Duette Hybrid Contact Lens Video Now Available

SynergEyes, Inc. announced the addition of a new patient-focused astigmatism video to the Eyemaginations practitioner video libraries, 3-D Eye Office and LUMA. The video features Duette, SynergEyes' second generation silicone hydrogel hybrid contact lens.

The video explains astigmatism and discusses the benefits of the Duette hybrid contact lens compared to other modalities. Practices that utilize the Eyemagination 3-D Eye Office software can find the new video in their media library under the Vendor Media section or by searching for "SynergEyes" on their media library homepage. LUMA users will be able to access the video the same way in their media library after the next software update occurs in June 2011.

Duette is currently available in sphere powers of +6.00D to -15.00D and is offered in five base curves and three skirt curves. Eye care professionals interested in prescribing Duette should visit www.fitsynergeyes.com.

Merck Completes Acquisition of Inspire

Merck completed its $430 million acquisition of Inspire Pharmaceuticals, Inc., a specialty pharmaceutical company focused on developing and commercializing ophthalmic products, on May 16, 2011. Inspire's products include Azasite, Elestat and Restasis, which is sold by Allergan Inc.

C-Vue Disposable Brands Now Available through VisionWeb

Unilens Vision Inc. announced that it has joined the VisionWeb network of suppliers. VisionWeb provides technology services to the optical industry.

VisionWeb members will now be able to order C-Vue disposable contact lenses along with thousands of other ophthalmic products from one convenient, online location at www.visionweb.com. VisionWeb can view C-Vue brand lens options, choose shipping methods, and track order status. Members can also choose to have their lenses shipped directly to their practice location, or to have them drop-shipped from the Unilens distribution center and sent to a patient address.

Ordering on VisionWeb is free for eye care providers. For more information, or for help with VisionWeb ordering, please contact VisionWeb Customer Service at (800) 874-6601 or email customerservice@visionweb.com.

Contamac Opens Training Facility: Centre of Excellence

Contamac Ltd. opened its new state-of-the-art Centre of Excellence facility which offers practitioner training and continuing education, customized product research and development, medical device contract testing and analysis, and a comprehensive staff of scientists and chemists for the development and application of specialty polymers for both IOL and contact lenses. The facility is located at the company headquarters in Essex, England.

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Pyogenic Granuloma
Gregory W. DeNaeyer, OD, FAAO

A 13-year-old boy reported complaining of an irritation of his left lower lid that had been slowly worsening since his initial symptoms four weeks prior. Systemically he was healthy except for mild asthma, for which he did not take medication. He did not wear glasses or contact lenses and denied any history of trauma. The patient's visual acuity was 20/20 OS. The picture shows a lesion of his left lower cul-de-sac that was discovered upon examination. The lesion was excised, and the biopsy report suggested a pyogenic granuloma.

For more on this patient, see http://www.clspectrum.com/article.aspx?article=&loc=archive\2010\february\cls0210_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.

Ronald K. Watanabe, OD, FAAO

Any Allergy Sufferers Out There?

As I sit here sniffling and sneezing, I can't help but feel for all those miserable contact lens wearers with seasonal allergies out there. Talk about a comfort problem! A multi-faceted approach is often very effective in quelling allergy symptoms and allowing us to continue to wear lenses during this rough time. Simple strategies include use of unpreserved artificial tears to flush the tear film, cool compresses to reduce ocular inflammation, and use of ocular and systemic allergy medications to reduce the allergic response.

In terms of contact lenses, refitting to daily disposables (even on a temporary basis) helps by reducing accumulation of debris on the lens surface. Even GP lens wearers can use daily disposables for a short time. Switching to a peroxide based care system could minimize solution-related ocular irritation, and one could even take the extra step to rinse their lens off with unpreserved saline solution prior to insertion. Enzymatic cleaning at home or deeper cleaning in office with Progent or an alcohol-based laboratory cleaner can also reduce surface build-up and lessen symptoms. By addressing this problem from all angles, you can maintain comfortable and happy contact lens patients.

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Loretta B. Szczotka-Flynn, OD, PhD, MS, FAAO

Pediatric Aphakia and Contact Lenses

I was dispensing a Silsoft lens for pediatric aphakia secondary to surgical extraction of a congenital cataract on a 4 week old baby this week. Seeing the frustration on the parents' faces I wanted to know whether there was evidence to support their struggle.

Chen et al published an article last year chronicling 15 infants fit with contact lenses for pediatric aphakia between 1982 and 2009. About half of their patients developed what they defined as excellent visual acuity (defined as 20/50 or better), and another four patients (26.67%) developed moderate Snellen visual acuities (20/125 to 20/60). They concluded approximately 50% of unilateral nontraumatic pediatric aphakic patients aged older than 5 years can achieve excellent Snellen visual acuity in the aphakic eye. They conclude that early cataract extraction, good to moderate patching compliance, and aggressive early contact lens management can lead to moderate to excellent Snellen visual results in several unilateral pediatric aphakic patients. Good news for our families and reason to persevere!

Chen YC, Hu AC, Rosenbaum A, Spooner S, Weissman BA. Eye Contact Lens. Long-term results of early contact lens use in pediatric unilateral aphakia. 2010 Jan;36(1):19-25.

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Accommodative Functions with Multifocal Contact Lenses: A Pilot Study

The purpose of this study was to evaluate accommodative response and facility in presbyopic patients fitted with several types of simultaneous-image multifocal contact lenses (CLs).

Six presbyopic patients, unadapted wearers of simultaneous-image bifocals, were fitted with the Focus Progressives and the low- and high-addition PureVision simultaneous vision multifocal CLs. Each individual wore each of the three types of lenses in successive random order. Accommodative response, accommodative facility, visual acuity, and contrast sensitivity at distance and near were evaluated in all cases. A control group of eight non-presbyopic patients was also studied.

The mean age was 28.6 +/- 2.72 and 51.2 +/- 5.81 years in the non-presbyopes and presbyopic patients, respectively. For the presbyopic group, statistically significant differences were not found for distance visual acuity between the baseline situations and with the three different CLs types. For the near visual acuity, there were no statistically significant differences between baseline situation (without add) compared with patients wearing the Focus Progressives and with PureVision Low Add. With the PureVision High Add, the near visual acuity was slightly better than baseline situation (p = 0.03). Non-presbyopic subjects showed relatively linear 1:1 stimulus response functions for all situations. Presbyopic subjects showed an increasing lag of accommodation with amplitude as they approach to the maximum amplitude for all situations. Distance and near accommodative facility rate for the presbyopic patients was zero for all conditions.

The researchers concluded that the results of this study suggest that simultaneous-image multifocal CLs studied do not alter accommodative functions. The high add of the PureVision CL enhances near vision for advanced presbyopes compared with the other models studied.

Montes-Mico R, Madrid-Costa D, Radhakrishnan H, Charman WN, Ferrer-Blasco T. Accommodative Functions with Multifocal Contact Lenses: A Pilot Study. Optom Vis Sci. 2011 May 5. [Epub ahead of print]

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This month at www.siliconehydrogels.org:
Ethnic differences in ocular physiology, tear mixing and contact lens-related adverse events, risk factors for inflammatory and mechanical events, and our synopsis of the 2010 meeting of the American Academy of Optometry.

Important Links:
To report adverse contact lens reactions visit: http://www.accessdata.fda.gov/scripts/medwatch/ or call (800) FDA-1088.
To report possible grievances related to the Fairness to Contact Lens Consumers Act or associated Contact Lens Rule visit: https://www.ftccomplaintassistant.gov/.

CLToday Services:
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For more information on Contact Lenses Today including archives of previous issues, please visit our website at www.cltoday.com. For the latest articles on contact lenses, important clinical information and helpful tools related to the contact lens practice visit the Contact Lens Spectrum website at www.clspectrum.com.

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