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Sunday, June 1, 2014  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO
Myopia control with contact lenses is certainly a hot topic in our field. I continue to see new and exciting research emerge as it relates to the mechanism of control, in addition to the efficacy of various designs of contact lenses. Likewise, manufacturers are active in this space, although the regulatory climate associated with an approval for a device for myopia control seems unclear. Let us know your thoughts on the topic—in your clinics are you actively working in myopia control?

Menicon America Appoints Orphanos as
Vice President
Menicon Co, Ltd. announced that Scott Orphanos has joined the company taking up the position of Vice President, Sales and Marketing at Menicon America, Inc., a wholly owned subsidiary in North America. He will be immediately responsible for launching Menicon’s Miru 1day soft contact lens.

Orphanos brings nearly 20 years of experience in the ophthalmic industry to his new role. Most recently, as a consultant, he helped establish a presence for Safilens’ contact lens business in the U.S. Before forming his consulting business, he served as Executive Director of Business Development at Bioconcept, a boutique ophthalmic product development company based in New England. He held several positions of increasing responsibility at Biocompatibles Eyecare, launching Proclear Compatibles in the U.S. and eventually was named Business Team Leader for the Eastern U.S. He began his career in the industry at Bausch + Lomb in the early1990s.

Bear Joins OPRI Management
Optical Polymer Research Inc. (OPRI) announces the addition of Jeanne Bear to its management team. Ms. Bear brings extensive experience within the global contact lens industry in sales, marketing and business development for both the GP and soft contact lens segments.

Bear’s contact lens industry background includes equity positions with Paragon Vision Sciences as Director, and then Vice President of International Sales, and prior work within Pilkington Barnes-Hind, then the parent company for Paragon, in Asia, Mexico and South America developing a distributor sales network. She joined the founding management team at SynergEyes as Director of Marketing, where she successfully developed and implemented U.S. marketing strategy for start-up efforts, along with initial global marketing and planning. Bear served as General Manager for Global Business Development for Menicon for several years, leading market expansion and sales into Asia/Pacific Rim, South/Central America, Eastern Europe and North America. In 2008, she joined Contamac LTD in global marketing, sales and business development.

Bear served as both Board Member and President of the European Federation of Contact Lens Industries (EFCLIN), where she was the first American elected to head the organization, and was on the Editorial Board for Global Contact until recently.

ASCO Launches Resident Directory and Expands Career Video Availability

The Association of Schools and Colleges of Optometry (ASCO) has launched its Optometry Resident Directory, an online resource where users can search for and read information about optometry residents. The purpose of the Directory is to provide a tool to help residents and outside entities network with one another for career opportunities.

Sponsored by Alcon, the Directory is found at:

The Allergan Foundation has awarded a competitive Focus Grant to ASCO to support the Be a Doctor of Optometry: Put Your Future in Focus video. The Allergan Foundation joins Luxottica in supporting ASCO’s initiative to promote the Doctor of Optometry profession. The video, previously viewed nearly 4,000 times, is available on ASCO’s YouTube channel and ASCO’s website.

The recruitment video highlights students, professors and Doctors of Optometry talking about what students learn and what they can expect from the profession once they graduate, as well as demonstrates the caring aspects of the profession and the more high tech aspects of optometry. The video complements the True Stories booklet and the ASCO website, hoping to increase the number, quality and diversity of applicants to the 21 schools and colleges of optometry in the 50 states and Puerto Rico.

Report on Ophthalmic Devices Panel Meeting
Ralph P. Stone, PhD

The Ophthalmic Devices Panel of the Medical Devices Advisory Committee to the Food and Drug Administration (FDA) met on May 13, 2014 to discuss approaches to revise and modernize the May 1994 Premarket Notification 510(k) Guidance Document for Daily Wear Contact Lenses and the May 1997 Premarket Notification (510(k)) Guidance Document for Contact Lens Care Products. Much has happened since the initiation of those guidance documents including the creation of a new category of contact lenses, group 5 silicone hydrogels (2007), now considered to represent at least five different technology approaches. The FDA is focused on looking at approaches that can prevent events like those leading to the 2006 and 2007 recalls of two contact lens care products associated with outbreaks of infections with the fungi Fusarium (2006) and the protozoa Acanthamoeba (2007) .

The agency discussed their understanding of the contact lens uptake of biocides and approaches to judge compatibility of care systems and lenses based on measurements of these ingredients on representative lenses from the different groups of lenses. In public comments an alternate approach, which is currently under consideration by the ANSI and ISO standards organizations, was proposed.

Separately the FDA asked the panel for advice on the use of tap water with rigid gas permeable lenses. There was agreement that tap water should only be used prior to disinfection. While some Panel members believed it would be appropriate to eliminate the use of tap water in the regimen, it was agreed that there is no good alternative today.

The panel called for industry, academia, professional groups and the FDA to work together in finding the best approaches to providing safe and efficacious products. The FDA has called for a workshop co-sponsored by the American Optometric Association, American Academy of Optometry, American Academy of Ophthalmology and Contact Lens Association of Ophthalmologists on the microbiology of contact lens care for September 12 to evaluate alternative approaches to safe and effective care .

To review a PDF of the slides in the FDA presentation at this meeting and other related documents, visit

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David Kading, OD, FAAO

We Are All the Same

In the past two months, I have had the pleasure of lecturing across Asia, the Netherlands, Australia and New Zealand to over 1000 practitioners. Our international colleagues have the same issues with patients when trying to upgrade lens materials and designs that we do here in the United States. Time and again international colleagues tell me that their patients just don’t want to pay or cannot afford new technology. Wherever I am, in the U.S. or somewhere international, I have been pleased to see that there are groups of practitioners who lead by example with why they are doing eyecare to ultimately put patients’ health and visual welfare first. These are the practitioners who have shifted their case history to begin asking questions that lead to what the patient likes least about their contact lenses. Thus a problem emerges for which the practitioner can now begin to look for a solution in our growing arsenal of modern lens materials and designs. Loyalty and trust emerge.

So, regardless of where you live, there are others like you who are pushing the envelope on comfort, vision, and success with upgraded technologies. I invite you to join us. It is what is best for the patient, practice, and our industry. Here’s to new materials, new designs, and progressive practitioners everywhere and happy fitting.

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S. Barry Eiden, OD, FAAO

Intra-Corneal Ring Segments for Keratoconus – A Contact Lens Challenge or a Benefit?

A retrospective study of patients who were fit with contact lenses following intra-corneal ring segment implantation for keratoconus was conducted in order to evaluate contact lens visual acuity and comfort responses.1 The criterion for contact lens fitting was based on unsatisfactory visual acuity with spectacle correction as determined by the patients. All patients in the study were intolerant to contact lens wear prior to intra-corneal ring segment implantation. Visual acuity analysis was done by conversion of Snellen to logMAR scales. The comfort was evaluated according subjective questioning of good, medium or poor comfort.

Outcomes from this small sample size study (N=19) discovered that only two subjects (10.5%) reported poor comfort with contact lenses. The remaining 17 subjects (89.5%) reported either good or medium comfort with contact lenses. Of the subjects fit in contact lenses in the study, four were fit in rigid gas-permeable contact lenses, one piggyback approach, three toric soft contact lenses, two soft lenses specially designed for keratoconus and seven disposable soft lenses. The average visual acuity improved from 0.77 ± 0.37 to 0.19 ± 0.13 logMAR units after contact lenses fitting. The researchers concluded that contact lens application following intra-corneal ring segment implantation for keratoconus provides good comfort, improved visual acuity and therefore may postpone the need for penetrating keratoplasty

Admittedly this was a small sample size study with questionable design, however it does suggest that success with contact lens wear following intra-corneal ring segment implantation for keratoconus with the utilization of numerous designs of contact lenses is possible. Many reports of contact lens fitting following intra-corneal ring segment implantation emphasize the challenges faced by the practitioner due to the uniquely shaped anterior surface corneal topography. Although this may be an issue in many cases, when this technology is appropriately implanted according to suggested surgical nomograms and utilized at the appropriate point along the continuum of the disease, contact lens fitting should actually be easier and more successful. The goals for intra-corneal ring segment implantation for keratoconus should include: flattening of the corneal apex, movement of the corneal apex more centrally, some reduction of corneal surface irregularity, and generally to make the cornea more receptive to contact lenses potentially with less complex designs. In addition, intra-corneal ring segments may provide improved stability to the keratoconic cornea and control over the progressive nature of the disease. 2

Continued research and development is necessary to clarify when intra-corneal ring segment implantation would be most appropriate for keratoconus and to further improve the outcomes of standardized surgical nomograms.

1. Moreira LB, Bardal RA, Crisigiovanni LR. Contact lenses fitting after intra-corneal ring segments implantation in keratoconus. Arq Bras Oftalmol. 2013 Jul-Aug;76 (4):215-7.
2. Kymionis GD, Siganos CS, Tsiklis NS, et al. Long-term follow-up of Intacs in keratoconus. Am J Ophthalmol. 2007 Feb;143(2):236-244.

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Parents' Knowledge and Perspective of Optical Methods for Myopia Control in Children

The purpose of this study was to solicit parents' knowledge on myopia control strategies available; to investigate their attitudes toward the use of orthokeratology (ortho-k), daily wear soft lenses, and spectacles for myopia control, assuming all three optical strategies were equally effective for myopia control; and to collect their opinion on the age at which children can commence contact lens wear for vision correction.

Telephone interviews were conducted with parents who responded to the advertisement for two myopia control studies, one on ortho-k and one on soft lenses.

Most of the 196 respondents (ortho-k group, 56%; soft lens group, 44%) were mothers, aged 36 to 45 years. Ortho-k was the most commonly known myopia control strategy (86%). Parents in the ortho-k group selected ortho-k (49%) and spectacles (45%) (p < 0.001) as their preferred myopia control strategy, whereas parents in the soft lens group had no preference (p = 0.57). Decision was affected by prior knowledge of myopia control strategy. Major considerations were convenience and safety among parents selecting contact lenses and spectacles, respectively, as their preferred options. Overall, because of the lack of confidence in safety in contact lens wear, most parents (75%) were of the opinion that contact lenses for vision correction were only for children older than 14 years (53%) and not indicated for children younger than 8 years.

The authors concluded that parents in Hong Kong were open to the use of contact lenses for myopia control in young children and they appeared to regard myopia control contact lenses as "treatment" and not as visual aids. They were more conservative in the use of contact lenses for vision correction in children. Parents' decision in selecting a myopia control strategy, assuming all three strategies to be equally effective, was affected by an individual's concerns of safety and additional benefits as well as influenced by positive evidence on myopia control effects.

Cheung SW1, Lam C, Cho P. Parents' Knowledge and Perspective of Optical Methods for Myopia Control in Children. Optom Vis Sci. 2014 May 7. [Epub ahead of print]

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