Drug delivery through contact lenses, or combination products, has been discussed for many years. There are numerous advantages that we might think about in terms of delivery of a drug to the eye (or perhaps even the body) via a contact lens, including sustained dosing and improved compliance with medication delivery. Combination products will also likely change the way in which we care for our contact lens patients in terms of things even as simple as the follow-up schedule. I suspect we might see such a contact lens on the market sooner than you think, so it is critical for us to be thinking about the future and what it may hold for our practices and patients.

The American Optometric Foundation (AOF) and Vistakon announced recipients of the 2011 Dr. Terrance Ingraham Pediatric Optometry Residency Awards, the Dr. George W. Mertz Contact Lens Residency Awards, and the Dr. Sheldon Wechsler Contact Lens Residency Awards. These awards are intended to promote post-graduate optometric clinical education by supporting residents who demonstrate talent and commitment in the fields of children's vision and contact lenses. Recipients are selected by the AOF.

Each recipient will receive $4,000 toward their graduate education that includes a $750 travel fellowship to attend the Annual Meeting of the American Academy of Optometry in Boston, October 12 -15.

The 2010-2011 winners are:

• Dr. George W. Mertz Contact Lens Residency Awards: Christen Kenrick, OD, New England College of Optometry and Lindsay A. Sicks, OD, Northeastern State University Oklahoma College of Optometry
• Dr. Sheldon Wechsler Contact Lens Residency Awards: Michael Rebarchik, OD, Pennsylvania College of Optometry at Salus University and Steven J. Warne, OD, University of Alabama at Bloomington School of Optometry
• Dr. Terrance Ingraham Pediatric Optometry Residency Awards: Jenelle L. Mallios, OD, New England College of Optometry and Yos M. Priestley, OD, New England College of Optometry

The European Federation of the Contact Lens and IOL Industries (EFCLIN) held its annual congress in May in Barcelona, Spain. With over 250 delegates from 33 countries, the 38th congress was seen by many as the organization's most successful to date.

The academic program covered fields as diverse as fitting contact lenses to the irregular cornea to oscillating machining technology; plasma treatment of contact lenses to characterizing aspheric IOLs and from regulatory affairs to marketing.

EFCLIN also annually honors those individuals who have made exceptional contributions to the industry. This year was no different with George Muller from Netherlands-based diamond tool producer Technodiamant, receiving the EFCLIN Technical Award for innovation. For his outstanding contribution to education, Dr. Eef van der Worp received the EFCLIN award, and retiring Executive Director Wim Aalbers received the EFCLIN Laureate Award for his outstanding contribution to the organization over many years.

"Click 'n'Fit," a new program from the GP Lens Institute (GPLI), is now available on the organization's website, www.gpli.info. This program provides students and practitioners desiring to enhance their spherical GP fitting skills the opportunity to actually view the fluorescein pattern of 15 different lens designs on the same patient, allowing them to virtually experience GP lens fitting without even touching a lens.

Start with the case history and choose lenses from a virtual diagnostic fitting set. Make changes in the base curve radius and diameter and see the effect on the fluorescein pattern, all from the comfort of your computer.

Base curve radius, optical zone diameter, and overall diameter are varied to show the effect on the lens-to cornea fitting relationship. When the eye care practitioner clicks on a chosen lens, the program shows: a video of the fluorescein pattern of the lens on the eye, information about the fitting relationship, what parameter changes (if indicated) would improve the fitting relationship and why, and a simulated one week follow-up visit to provide likely patient symptoms if the fit is not optimum.

For example, if the edge clearance is insufficient or excessive, if the lens fit exhibits excessive apical bearing or clearance, or if there is decentration, this program will indicate the possible long-term complications and recommend design changes to minimize or eliminate this problem. As the ECP exits the program, it will show all 15 lenses in the trial set and their respective fluorescein patterns so that they can be compared.

TearScience, Inc., a privately-held medical device company, announced that its LipiView Ocular Surface Interferometer has received the Medical Design Excellence Award from UBM Canon. The LipiView provides eyecare practitioners with a quantifiable, in-office option for evaluating patients' tear film; the procedure generally takes less than five minutes.

The Medical Design Excellence Awards competition exclusively recognizes contributions and advances in the design of medical products cleared for marketing by the FDA. Entries are evaluated on the basis of design and engineering features.

For additional information, visit www.tearscience.com.

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This photograph shows the left eye of a 78 year-old female patient who has central crystalline dystrophy. Her eye underwent two previous phototherapeutic keratoplasty (PTK) treatments in 1990 and 2005, and her current best corrected visual acuity is 20/40. The patient's right eye had significantly worse dystrophy; however, her best corrected visually acuity improved to 20/30 after a penetrating keratoplasty in 2005.

For more on this patient, see http://www.clspectrum.com/article.aspx?article=&loc=archive\2010\april\cls0410_a02.html.

We welcome photo submissions from our 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.

Vernal Keratoconjunctivitis and Limbal Stem Cell Deficiency

My eyes really itched this week as pollen counts were very high in Ohio after days of rain followed by 85 degree weather. Fortunately allergy drops alleviated my symptoms. A new article reveals our patients with vernal keratoconjunctivitis (VKC) have potential for more than just the traditional complications. Limbal stem cell deficiency (LSCD) seems to be one of the complications of long-standing VKC, contributing to severe visual impairment in young individuals.

Sangwan et al in this month's Cornea journal reviewed data relating to 49 eyes of 27 patients with VKC and features of LSCD in 2000-2005 at the LV Prasad Eye Institute. During this period, 2225 patients with VKC were seen at the institute where 49 eyes (1.2%) showed features of LSCD. Twenty-two cases had bilateral disease, and five had unilateral affection. The visual acuity at presentation ranged from hand motions to 20/20. Total LSCD was seen in 33 eyes (67.3%), and partial LSCD was seen in 16 (33%). Pannus resection with amniotic membrane graft was required in five eyes. Live-related allolimbal transplantation was done in six eyes. To my knowledge this is the first paper to demonstrate this association. The authors speculate that chronic nature and prolonged duration of the disease may be responsible for this secondary ocular surface affection, leading to the clinical manifestation of LSCD.

Sangwan VS, Jain V, Vemuganti GK, Murthy SI. Vernal keratoconjunctivitis with limbal stem cell deficiency. Cornea 2011 May; 30(5):491-6.

HD Contacts: Like HDTV?

Some contact lens products now promote the idea of providing "High Definition" optics. Presumably, HD contact lenses would provide clearer vision for wearers. But what does HD really mean for contact lenses? In most cases, HD refers to the control of optical aberrations, primarily spherical aberration (SA). By their nature, contact lenses with spherical optic zones generate SA, especially for higher powers. Even with the appropriate lens power, vision can be degraded by high levels of SA. By designing aspheric optic zones, manufacturers can minimize SA to minimize lens induced blur.

Some manufacturers take this a step further by designing lenses with negative SA to correct the inherent SA that most people have. This should improve visual quality over conventional designs, but if a patient does not have the expected amount of SA, vision may be worse. Another "HD" application is to minimize spherical aberration for both soft and GP multifocal designs to try to improve visual clarity in these simultaneous vision designs. Whether these HD designs work for your patients depends on the optics of your patient's eyes, but they are good options to go to when conventional designs don't seem to satisfy your patients' visual needs.

This paper reviews the reported effects of contact lens wear on the goblet cells of the human conjunctiva.

A literature search was undertaken to identify reports on the conjunctival health after contact lens wear, principally as assessed using the conjunctival impression cytology (CIC) technique in which cells are examined ex vivo, after fixation and staining. Details of technique, data on duration of contact lens wear and then CIC outcome in terms of goblet cell density (GCD) were extracted.

Of 24 reports identified, 22 examined the bulbar conjunctiva and two examined the tarsal conjunctiva. A decrease in GCD was considered, directly or indirectly, to be a consequence of contact lens wear in 18 of the studies, but there was no obvious overall relationship between duration of lens wear and the GCD changes. Conversely, four reports indicated an increase in GCD or goblet cell-related mucins. Two reports concluded that there was no change in goblet cells or their mucin, a result however that is consistent with a recent conclusion that no statistically significant change in GCD was detectable in contact lens wearers assessed by in vivo imaging of the human conjunctiva by confocal microscopy.

The author concluded that the majority of published studies have concluded that contact lens wear results in a decrease in goblet cells in the conjunctiva. While there are reports that draw a very different conclusion, it should be noted that there has been limited consistency in technique or the method of reporting the results across the various studies.

Doughty MJ. Contact lens wear and the goblet cells of the human conjunctiva-A review. Cont Lens Anterior Eye. 2011 May 19. [Epub ahead of print]

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