Bausch + Lomb (B+L) announced the launch of Biotrue multi-purpose solution across the U.S. Biotrue multi-purpose solution is bio-inspired to work like the eyes to help lenses stay clean and moist throughout the day, according to the company.
     B+L reports that Biotrue was developed following intensive study on how the eye naturally works to clean, hydrate and keep itself healthy. It has exceptional disinfection properties, and is formulated to work like the eyes with three bio-inspired innovations. Firstly, it is pH-balanced to match healthy tears, helping to maintain the eye's natural condition and enabling optimal activation of Biotrue's dual disinfectants. In clinical trials 81% of patients who tried the solution said it felt like their natural tears.
     The second innovation noted by the company is the use of hyaluronan, a natural lubricant found in the body and in the eye. This helps attract water to envelop lenses in a moisture-rich cushion and to stabilize the tear film and reduce friction. Even after 20 hours, a high level of hyaluronan has been shown to remain on both hydrogel and silicone-hydrogel lenses, helping to provide all day comfort. The third innovation is how Biotrue keeps certain beneficial tear proteins active longer. It surrounds and protects lysozyme, a protein found in tears, helping to maintain its natural antimicrobial activity and prevent denaturization. Additionally, Biotrue lifts and dissolves denatured proteins.
     "By studying the eye, we're able not only to observe natural processes that have been proven evolutionarily, but we're also able to develop health care solutions that work with the body, rather than interfering with it," said Mo Merchea, Medical Affairs Manager, North America, Vision Care at Bausch + Lomb. "Biotrue uses the science of the eye itself, and therefore the lens care solution is optimally designed to work within the eye."
     Biotrue exceeds FDA/ISO stand-alone procedure for disinfecting products and, according to information supplied by the company, it also has been tested against a broad range of bacteria and fungi, collected from clinically worn lenses, lens cases and infected eyes. It achieves consistently high log reductions against staphylococcus aureus, MRSA and fusarium solani and is also effective against acanthamoeba cysts and tryphozoites.
     Beginning in this month, Biotrue multi-purpose solution will be available at retailers across the U.S. Biotrue features a clear bottle that allows the patient to track how much solution remains and comes in a range of sizes. 

The Gas Permeable Lens Institute (GPLI), in association with the Contact Lens Manufacturers Association, announced their schedule of live online symposia for the remainder of 2010. In addition to their traditional online symposia, two programs will be presented in a webinar format.
     During these 90 minute educational programs contact lens fitters can communicate with industry experts. The sessions are held on Tuesdays at 9 PM Eastern Time. The first hour of discussion is limited to the topic of month; however, attendees may ask any GP lens-related question during the remaining 30 minutes. For most symposia, case histories are posted on www.gpli.info prior to the discussion. All eye care professionals are invited to participate in these free programs, though webinars require preregistration. 
     The next two webinars are scheduled for July 13, GP lenses and Corneal Topography presented by Dr. Eef van der Worp and September 14, Orthokeratology presented by Dr. Bruce Morgan.
     The topics and presenters for the remaining 2010 online symposia are:
June 8 - Bitoric Design and Fitting, Dr. Ron Watanabe and Dr. Renee Reeder
August 10 - Post-Surgical Fitting, Dr. Loretta Szczotka-Flynn and Dr. Tim Edrington
October 12 - Large Diameter GP and Hybrid Applications, Dr. Derek Louie and Dr. Jason Jedlicka
November 9 - GP Multifocal Applications, Dr. Rob Davis
December 14 - GPs and Young People, Dr. Cary Herzberg and Dr. John Rinehart
     For more information on these and other educational programs offered by the GPLI, visit www.gpli.info.

Beginning June 7th, Acuvue Brand Contact Lens will launch a new TV commercial specifically targeted toward driving teens into eye care practitioners' offices. The spots, featuring 1-Day Acuvue Moist Brand Contact Lenses will run on popular teen channels like ABC Family, The CW, and MTV, and will reach even more teens via teen hotspots like Facebook and YouTube.
     Beginning Monday, June 7, the commercial can also be viewed at www.1day.acuvue.com.

Think children are not responsible enough to take good care of their contact lenses? Then it may be time for you to rethink kids and contact lenses. Because, according to the CLIP¹ and ACHIEVE² studies, younger patients are not only capable of caring for their lenses but also enjoy significant improvements in their self-perception and quality of life. This means that you, as an eye care professional, have an opportunity to make a significant impact on the lives of your young patients simply by offering to fit them with contact lenses. 
     Making that impact is a lot easier with ACUVUE® Brand Contact Lenses. ACUVUE® Brand lenses offer exceptional comfort, vision, UV protection, and overall eye health. And ACUVUE® also offers a variety of options to fit the active lifestyles of young patients. Among others in the ACUVUE® family, there are 1·DAY ACUVUE® MOIST® Brand Contact Lenses with convenient daily disposable modality, ACUVUE® OASYS® Brand Contact Lenses with HYDRACLEAR® Plus* technology for smoothness and optimal comfort, and ACUVUE® OASYS® Brand Contact Lenses for ASTIGMATISM for children with astigmatism. In addition, ACUVUE® is the only contact lens brand that offers UV protection across its entire line of products.
     Make kids and contacts part of your practice. Fit them with ACUVUE® Brand Contact Lenses and see them — and your practice — reach full potential.

ACUVUE® Brand Contact Lenses are indicated for vision correction. As with any contact lens, eye problems, including corneal ulcers, can develop. Some wearers may experience mild irritation, itching or discomfort. Lenses should not be prescribed if patients have any eye infection, or experience eye discomfort, excessive tearing, vision changes, redness or other eye problems. Consult the package insert for complete information. Complete information is also available from VISTAKON®, Division of Johnson & Johnson Vision Care, Inc., by calling 1-800-843-2020 or by visiting jnjvisioncare.com
     The level of maturity of each young patient and the degree of parental oversight and support should be taken into account in assessing whether the child can follow your recommended wear and care instructions and is a good candidate for contact lens wear.
     WARNING: UV-absorbing contact lenses are NOT substitutes for protective UV-absorbing eyewear such as UV-absorbing goggles or sunglasses because they do not completely cover the eye and surrounding area. You should continue to use UV-absorbing eyewear as directed. NOTE: Long term exposure to UV radiation is one of the risk factors associated with cataracts. Exposure is based on a number of factors such as environmental conditions (altitude, geography and cloud cover) and personal factors (extent and nature of outdoor activities). UV-blocking contact lenses help provide protection against harmful UV radiation. However, clinical studies have not been done to demonstrate that wearing UV-blocking contact lenses reduces the risk of developing cataracts or other eye disorders. Consult your eye care practitioner for more information.
REFERENCES:
1. Jones LA, Walline JJ, Gaume A, et al. Purchase of contact lenses and contact-lenses-related symptoms following the Contact Lenses in Pediatrics (CLIP) study. Cont Lens Anterior Eye. 2009;32(40):157-163.
2. Walline JJ, Jones LA, Chitkara M, Coffey B, et al; Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) Study; Optom Vis Sci. 2006; 83(1):37-45.
     *HYDRACLEAR® PLUS is our brand name for the next generation of our proprietary technology that allows us to use a higher volume of a moisture-rich wetting agent in a state of the art formulation. This creates more wettable, ultra smooth contact lens, especially for challenging environments that make the eyes feel dry.
     ACUVUE®, ACUVUE® MOIST®, ACUVUE® OASYS®, and HYDRACLEAR® are registered trademarks of Johnson & Johnson Vision Care, Inc.
© Johnson & Johnson Vision Care, Inc. 2010.
--ADVERTISING

Bausch + Lomb (B+L) has acquired the assets and U.S. rights for Zirgan (ganciclovir ophthalmic gel 0.15%) from Sirion Therapeutics, Inc. In 2007, Sirion Therapeutics acquired a license for the Zirgan product technology and trademark from Laboratoires Théa, headquartered in France, for the U.S. market.
     Zirgan was approved by the U.S. Food and Drug Administration (FDA) in 2009 as a topical anti-viral for the treatment of acute herpetic keratitis (corneal ulcers). The FDA has designated Zirgan as an orphan drug, conveying special status for rare diseases or conditions that affect fewer than 200,000 patients in the U.S.
     According to the company, ganciclovir gel has been the standard-of-care therapy in Europe for more than a decade, developed and sold worldwide under the Virgan trademark by Laboratoires Théa. Unlike older anti-viral pharmaceuticals which affect both healthy and infected cells, B+L states that Zirgan selectively targets the replication of HSV DNA. It has a low corneal toxicity profile to provide patients with comfort and relief.
     Zirgan is available by prescription through U.S. pharmacies.

The purpose of this study was to investigate the influence of soft contact lenses on regional variations in corneal thickness and shape while taking account of natural diurnal variations in these corneal parameters.
     Twelve young, healthy subjects wore four different types of soft contact lenses on four different days. The lenses were of two different materials (silicone hydrogel or hydrogel), designs (spherical or toric), and powers (3.00 or -7.00 diopter). Corneal thickness and topography measurements were taken before and after eight hours of lens wear and on two days without lens wear, using the Pentacam HR system.
     The hydrogel toric contact lens caused the greatest level of corneal thickening in the central (20.3 +/- 10.0 mum) and peripheral cornea (24.1 +/- 9.1 mum) (p < 0.001) with an obvious regional swelling of the cornea beneath the stabilizing zones. The anterior corneal surface generally showed slight flattening. All contact lenses resulted in central posterior corneal steepening, and this was weakly correlated with central corneal swelling (p = 0.03) and peripheral corneal swelling (p = 0.01).
     The researchers concluded that there was an obvious regional corneal swelling apparent after wear of the hydrogel soft toric lenses because of the location of the thicker stabilization zones of the toric lenses. However, with the exception of the hydrogel toric lens, the magnitude of corneal swelling induced by the contact lenses over the eight hours of wear was less than the natural diurnal thinning of the cornea over this same period.
Tyagi G, Collins M, Read S, Davis B. Regional Changes in Corneal Thickness and Shape with Soft Contact Lenses. Optom Vis Sci 2010.

As noted in the most recent editions of Contact Lenses Today, we've had some good discussion about factors associated with daily disposable prescribing both in North America and globally. Another important point that relates to this discussion is prescribing trends in other market segments - more specifically, prescribing trends in replacement schedules for frequent/planned replacement lenses. I have heard from a many of the readership about this topic as well. Look for more information in our June 2010 edition of Contact Lens Spectrum (Point-Counterpoint column, http://www.clspectrum.com/article.aspx?article=104336) on this specific topic.
Jason J. Nichols, OD, MPH, PhD, FAAO

I have been fitting over 90% daily disposables for the past 8 to 10 years. My patients are compliant and I see virtually no corneal problems, as I did in the past with planned replacement lenses. Daily disposables are actually less expensive than planned replacement lenses when you factor in the total cost of contact lenses and solutions (when solutions are used correctly). I believe the reason we do not fit more daily disposables is because doctors believe that they are more expensive.
John Chatelain, OD
Houston, TX

In the U.S., practitioners tend to view patients as "spectacle wearers" or "contact lens wearers." It is my impression that daily disposable lenses are in high use in Nordic countries because patients often wear both glasses and contact lenses, whichever best meets their visual needs for the task at hand. It is also my understanding that in Asian countries, doctors frequently recommend daily disposables and few patients question it.
     Here in the U.S. we would serve our patients better by:
1. Seeing patients as active people with a variety of visual needs, some of which are better met by glasses, some by contact lenses.
2. Confidently recommending daily disposable lenses (instead of simply offering them as an option).
3. Presenting the cost of daily disposable lenses on a per day basis. When educated, many patients will find the safety, comfort and convenience well worth the cost!
Thomas G. Quinn, OD, MS, FAAO
Athens, OH

I bring up daily disposables frequently, but in American society patients have been driven to think that contact lenses are a commodity by the emphasis on low prices from internet and discount stores. In my opinion, too many doctors think they are doing the patient a favor by telling them that two-week lenses can be worn for four to six weeks to save money.
     I recently had a patient say that contact lenses are too expensive, so he only changes his two-week lenses every few months, when a lens starts to bother him. He has two scars from previous infections and 1mm 360 neovascularization in both eyes. I asked him if he only changes the oil in his truck when it starts making noise. He said that he changes it every 3000 miles as he doesn't want to damage the engine. When I said that a truck engine can be replaced but no amount of money can replace eyes destroyed from contact lens abuse, he had no response. Yet, he still insisted that he would not change his wearing schedule because of the expense. So, I refused to fit him as I know he will continue the abuse of his eyes and ultimately have a major complication. Sadly, too many eyecare practitioners will still fit a patient that will blatantly abuse their lenses. Unfortunately, we created a monster in this country that we may not be able to stop. In fact, the U.S. might soon be like British Columbia where recently no prescription is even required for contact lenses!
Craig L. McManis, OD
Lafayette, IN

I continue to hear from our colleagues that they would fit more patients in a daily disposable lens, but cost is the main barrier that keeps them from making the recommendation. Supporting this attitude are the results of the 2009 Gallup Study of the Consumer Contact Lens Market: cost is a major influence on the buying habits of current contact lens wearers as well as prospective wearers.  
     For parents of preteens and teens, the potential for hassle-free, healthy lens wear may tip the scales in favor of daily disposables. In the ACHIEVE study, when the cost was not a factor in choosing the lens for their child, 93.3% of parents chose daily disposable lenses over two-week replacement lenses. When the costs were explained at the conclusion of the study, 62.5% said they would still choose the single-use lenses even if they had to pay for them. The ACHIEVE researchers suggest this is an indication that daily disposable contact lenses may be underutilized in typical practices and practitioners' assumptions that this modality is too expensive for their patients may not be accurate.
     Recent surveys conducted by the Rochester Research Group and Fairfield Research, Inc. also suggest that many parents know their kids don't like or always wear their eyeglasses and would rather wear contact lenses. They also know that contact lenses will likely boost their children's self-esteem and ease some of the disadvantages of eyeglasses in sports and other activities. Additionally, 66% of the Fairfield Research survey respondents report that whatever their eye care practitioner recommends is the right choice for their child's vision correction. 
     Contact lens wear in preteens and early teens presents an opportunity for eye care professionals to improve the lives of their young patients. Many of the major concerns associated with contact lens wear in first time wearers can be alleviated with the use of daily disposable lenses. Practitioners might find it beneficial to present the opportunity and benefits of daily disposables to parents to help them make their decision about contact lens wear for their kids.
Michael Pier, OD
Director, Professional Relations
Bausch + Lomb Vision Care North America

And among the comments we received were some from those areas of the world that do fit significantly more daily disposable lenses, like the one below.

In my experience, there are many types of patients in Hong Kong who prefer daily disposable lenses. 
     Many occasional wearers use daily disposables for sports, weekends, special occasions. For these, price and convenience of daily disposables are an advantage. Some of my clients calculated that for two days or less contact lens wear per week, daily disposables are more cost effective than two-week lenses (including solution cost and using the lenses only for two weeks).
     Many parents, most of whom are also contact lens wearers, ask for daily disposables for their children since they know lens care and handling is far easier.
     Also, people in Hong Kong are very busy and don't want to spend time on contact lens care. They don't mind paying a bit more to save time. 
     However, our recommendation is the most important reason people choose daily disposable lenses, since daily disposables reduce many contact lens problems. Most of the people here do not produce good tears and with planned replacement lenses we see other issues (e.g. CLPC problems, oily tears, heavy deposits). So comfort and ocular health are improved when using daily disposable lenses.  
     For me, it is most important to explain clearly why daily disposables are better than the client's habitual contact lens and why daily disposables can solve previous problems/discomfort. After that, our clients don't have problems paying a bit more to improve their ocular health and extend their contact lens wear life.
Patrick Ting, PhD
Hong Kong

This month at www.siliconehydrogels.org: a review of the potential uses, efficacy, safety and clinical performance of antimicrobial contact lens technology.