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Sunday, June 9, 2013  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

While there has been a tremendous amount of research through the years that has evaluated the problem of contact lens discomfort in some way. We have good estimates of the frequency of the problem and some of the factors associated with the condition. However, we do not have a good understanding of the etiology of the condition. As the problem is sensation based, it is likely that there is a nervous component. However, what stimulates the sensory nerves? Mechanical influence? Hyperosmolarity? Subclinical inflammation? There are a variety of things that must be considered, but hopefully the community is making headway in this regard.

CooperVision Introduces MyDay Daily Disposables to Europe at BCLA

CooperVision Inc. unveiled MyDay daily disposable lenses at the British Contact Lens Association (BCLA) Clinical Conference and Exhibition.

Featuring a unique chemical structure called Smart Silicone chemistry, MyDay lenses (stenfilcon A) create efficient channels for oxygen delivery to the cornea. According to the company, with less silicon needed to achieve the desired oxygen permeability levels, the efficient silicone network allows for increased hydrophilic materials. This results in improved lens surface wettability, higher water content and lower hydrogel-like modulus for a softer, more comfortable wearing experience.

The lenses are expected to be available in Europe by September 2013, with rollouts in other global markets beginning in 2014. MyDay lenses will be available in sphere powers of -10.00D to +6.00D (in 0.25D steps to -6.00D and 0.50D steps to -10.00D; and in 0.25D steps to +5.00D and 0.50D steps to +6.00D). All lenses have an 8.4mm base curve and 14.2mm diameter, with a 0.08mm center and 0.07mm edge thickness. An ultraviolet radiation blocker helps protect wearers' eyes, limiting 75 percent of UVA and 99 percent of UVB rays.

SynergEyes Expands Duette HD Parameters

SynergEyes, Inc. announced that it is expanding the available parameters for Duette HD to include a flatter base curve and higher plus powers. The new parameters include an 8.3mm base curve and plus powers up to +10.00D.

According to the company, Duette HD lenses deliver uncompromised optics, even at night, and stable vision that is not affected by lens rotation, making it ideal for astigmats or any other patient who wants the best possible vision when wearing contact lenses. The high Dk materials and advanced lens design provide excellent patient comfort; while the new alignment fitting approach produces consistent, predictable results.

For more information on Duette HD visit http://duettecontacts.com/duette-contacts-fast-start-program.

CooperVision to Divest Aime

The Cooper Companies, Inc. announced that CooperVision has reached an agreement to sell Aime, its rigid gas permeable contact lens and solutions business in Japan, to Nippon Contact Lens Inc. Financial terms of the transaction were not disclosed.

According to the company announcement, the decision to divest Aime is consistent with CooperVision's strategy to focus on its core soft contact lens business. The business was obtained in 2010 as part of a successful acquisition which included obtaining the rights to sell Biofinity in Japan.

The divestiture is subject to numerous conditions to closing and is expected to close during Cooper's fourth quarter of fiscal 2013.

ISTA Reaches Settlement with the U.S. Department of Justice
Bausch + Lomb (B+L) announced that its subsidiary, ISTA Pharmaceuticals, Inc., a corporation that it acquired in June 2012, has reached agreement with the U.S. government to resolve and conclude civil and criminal allegations against ISTA. The settlement involves conduct by ISTA that occurred between January 2006 and March 2011, before B+L's acquisition. B+L was aware of the government investigation prior to its acquisition, and has fully cooperated with the government to resolve this matter. The government has acknowledged that it has no knowledge that B+L, any current director or officer of B+L, or any current director or officer of ISTA was party to any conduct related to this case.

In connection with the settlement, ISTA has pled guilty to charges of Conspiracy to Introduce a Misbranded Drug in Interstate Commerce with Intent to Defraud and Mislead and Conspiracy to Violate the Anti-Kickback Statute. As part of the settlement, ISTA has agreed to pay approximately $34M in civil and criminal fines including interest and attorney's fees, and will be prohibited from participating in federal healthcare programs such as Medicare and Medicaid. However, Bepreve, Bromday, Istalol, Prolensa and Vitrase have been transferred to B+L, and therefore are not subject to any exclusion resulting from this settlement, and continue to be eligible for reimbursement under those programs.

Since acquiring ISTA Pharmaceuticals, B+L has integrated ISTA's portfolio of products and related operations, and will wind down the ISTA Pharmaceuticals, Inc. corporate entity by the end of the year.
Lens Deposits Resulting from Poor Lens Care
By Ane Murueta-Goyena Larrañaga, MSc. Bilbao, Spain

Image shows an accumulation of deposits on the lens due to poor lens care. The visual acuity was also impaired and wear was uncomfortable.

We thank Ms. Larrañaga for this image and welcome photo submissions from our other 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.

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Susan J. Gromacki, OD, MS, FAAO

How Are We Caring for Scleral GP Contact Lenses?

As I reported in my October 2011 CL Spectrum column,1 the regular utilization of scleral gas permeable contact lenses is so recent that there is no established standard of care regarding these lenses' handling, cleaning and disinfection. At this year's Global Specialty Lens Symposium in Las Vegas, various presenters offered a multitude of ways in which they recommend caring for the lenses.

In the April 21, 2013, CLToday Quick Poll, we sought to obtain a better understanding of what practitioners are recommending. When asked which care system they prescribed for scleral lens care, the respondents answered:2

Gas permeable lens daily cleaner and conditioning solution: 62%
Gas permeable lens multipurpose solution: 15%
Soft lens multipurpose solution: 0%
Hydrogen peroxide system: 23%

These responses differ slightly from the 2010 van der Worp poll which found: 72% GP lens solutions; 48% peroxide; and 17% soft contact lens solutions (multiple options were allowed).3 It also reinforces the fact that most practitioners are providing their own specific recommendations on how to care for the lenses—and that there may be more than one good way to do it. Look for more universal, updated recommendations as we become more familiar with the on-eye performance and nuances of this important contact lens modality.

1. http://www.clspectrum.com/articleviewer.aspx?articleID=106171
2. http://www.cltoday.com/new/issue_042813.asp
3. http://archive.constantcontact.com/fs030/1101462388342/archive/1103899240059.html

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Katherine M. Mastrota, MS, OD, FAAO

The Impact of Dry Eye Disease on Visual Performance While Driving

In the Center for Clinical Investigation of Quinze-Vingts National Ophthalmology Hospital, Paris, France, 20 dry eye patients and 20 age- and sex-matched control subjects were enrolled in a study to assess the driving visual performance in patients with dry eye disease (DED) and to determine clinical predictors of visual impairments while driving.

Vision-related driving ability was assessed using a specific driving simulator displaying randomly located targets with a progressive increase in contrast to be identified. Other examinations included clinical examinations, serial measurements of corneal higher-order aberrations (HOAs), and vision-related quality-of-life questionnaire (Ocular Surface Disease Index [OSDI]). Data collected during the driving test (i.e., the number of targets seen, their position, and the response time) were compared between groups and analyzed according to clinical data, aberration dynamics, and quality-of-life index.

The percentage of targets missed as well as average response time were significantly increased in DED patients as compared with controls. Specifically, the visual function of DED patients was more impaired in situations such as crossroad or roundabout approaches. In DED patients, the response time was found to positively correlate with the progression index for HOAs and with the OSDI "symptoms" subscale.

The authors of this study concluded that degradation of ocular optical qualities related to DED is associated with visual impairments during driving. This study objectively has demonstrated the impact of tear film-related aberration changes on activities of daily living, such as driving, in DED.1

1. Deschamps N, Ricaud X, Rabut G, Labbé A, Baudouin C, Denoyer A. The Impact of Dry Eye Disease on Visual Performance While Driving. Am J Ophthalmol. 2013 May 22. pii: S0002-9394(13)00164-5. doi: 10.1016/j.ajo.2013.02.019. [Epub ahead of print]

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Psychological and Other Mechanisms for End-of-Day Soft Lens Symptoms

The purpose of this research was to examine psychological factors and other mechanisms for soft contact lens (CL)-related end-of-day symptoms of dryness and associated dropping out from lens wear.

A PubMed search for articles related to dryness, comfort, and discomfort in CLs was conducted. Comparisons with rigid lens adaptation have been used to construct and examine a hypothesis that high levels of initial soft lens comfort increase expectations of an absence of lens awareness that result in end-of-day symptoms being more difficult to tolerate.

Relevant reports were referenced in this review having been located using the 143 listed by PubMed. Contact lens-induced corneal hypoalgesia and the association between the influence on blink function of end-of-day general and ocular fatigue, lens front surface degradation, a dysfunctional pre-lens tear layer, and symptoms of dryness suggest that lid wiper friction has a prime role in determining the level of lens awareness.

The author concluded that, rather than dry eye symptoms, end-of-day discomfort in CL wearers might be more appropriately described as dry lens symptoms. Apart from tear function, lens condition, compliance with lens care instructions, and symptom strength, lens awareness may also be determined by psychological factors such as motivation, high expectations for comfort, and sense of subjective well-being. For example, high levels of comfort experienced on lens insertion may increase expectations of the level of comfort to be experienced at the end of the day. In addition, patient management seems to require a thorough assessment of lens comfort, which may indicate the need to review a patient's understanding of the relation between compliance and other factors, which could influence CL performance negatively. For example, increased use of digital devices, especially in air conditioning, and any associated reduced blink efficiency seem likely to be important contributors to dry lens symptoms.

McMonnies CW. Psychological and Other Mechanisms for End-of-Day Soft Lens Symptoms. Optom Vis Sci. 2013 Jun;90(6):e175-81.

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