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Sunday, June 10, 2012  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

As we are well aware, dryness and discomfort can be major issues for some contact lens wearers. The Tear Film and Ocular Surface (TFOS) Society is in the process of launching an international workshop on this issue—the TFOS International Workshop on Contact Lens Discomfort. More information can be found here: http://www.tearfilm.org/tfoscldreport/index.htm. This is a major effort to gain worldwide consensus on these very important issues impacting our contact lens wearers. Given the success of the two prior workshops (the TFOS Dry Eye and Meibomian Gland Dysfunction Workshops), the reports associated with this new workshop are indeed highly anticipated.

WellPoint to Acquire 1-800 CONTACTS, Inc.

WellPoint, Inc. one of the nation's largest health benefits companies, announced that it has entered into an agreement to acquire 1-800 CONTACTS, Inc., the largest direct-to-consumer retailer of contact lenses in the U.S.

1-800 CONTACTS serves approximately 3.3 million customers today. Through the company consumers may purchase contact lenses via its toll-free telephone number and its www.contacts.com website. The company also offers frames and lenses through its glasses.com website.

Financial terms of the transaction were not disclosed. The acquisition is expected to close in the third quarter of 2012, and is subject to standard closing conditions and customary approvals required under the Hart-Scott-Rodino Antitrust Improvements Act. The transaction will be financed from available cash on hand and is expected to be slightly dilutive to WellPoint's earnings per share in 2012 by approximately $0.04 due to transaction and integration costs.

Keefer to Retire from J&J

Following a distinguished 23 year career with Johnson & Johnson Vision Care, and over 40 years in the eyecare industry, Phil Keefer has announced his decision to retire, effective September 1, 2012.

Keefer joined Johnson & Johnson Vision Care in 1989 as Executive Vice President Sales, Marketing, Professional Affairs and Strategic Planning, where he oversaw the initial launch of the ACUVUE Brand. In 1993, he was appointed Vice President, New Business Development, where he created and implemented global strategic plans that included the international expansion of the Vision Care franchise. He served as Managing Director/President of multiple regions, including Asia Pacific, the Americas, Latin America and Japan.

Keefer is currently President of The Vision Care Institute, where he conceived and implemented a professional education strategy that resulted in the creation of 15 Vision Care Institutes and nine satellite centers around the world. He has also served as an active member of the Johnson & Johnson Vision Care Global Management Board for his entire 23 year career.

In 2009, The American Academy of Optometry presented Keefer with the Honorary Fellowship Award for his distinguished contributions to the science and art of optometry.

Before joining Johnson & Johnson in 1989, he held positions of increasing responsibility across multiple eye care companies, including Allergan, CooperVision, Optical Radiation Corporation and Polymer Technology Corporation.

TFOS Contact Lens Discomfort Workshop Steering Committee to Meet
The Tear Film & Ocular Surface Society (TFOS) International Workshop on Contact Lens Discomfort (CLD) Steering Committee will hold its first meeting at the end of June. The Steering Committee will finalize the mission, select additional Workshop participants (about 50 experts from around the world), establish detailed objectives, and decide upon the timeline.

The TFOS CLD Workshop Steering Committee includes: Jason Nichols (USA; Chair), Mark Willcox (Australia; Vice-Chair), David Sullivan (USA; Organizer), Joseph Ciolino (USA), Jennifer Craig (New Zealand), Gary Foulks (USA), Lyndon Jones (Canada), Kelly Nichols (USA), Chris Purslow (United Kingdom), Fiona Stapleton (Australia) and Consultants, Anthony J. Bron (UK) and Carlos Belmonte (Spain).

To learn more about the TFOS International Workshop on Contact Lens Discomfort, visit http://www.tearfilm.org/tfoscldreport/index.htm.

Granular Corneal Dystrophy
By Gregory W. DeNaeyer, OD, FAAO

The first photo shows the left cornea of a 27-year-old male who reported as a new patient for contact lens fitting. He reported no ocular or visual complaints. Other than myopia, the patient stated not having any other known ocular diagnosis or pertinent family ocular history. His best-correct visual acuity was 20/20 in both eyes. Slit lamp exam of the patient's right (Figure 2) and left corneas showed small white central opacities in the anterior stoma with clear intervening space. The patient was diagnosed with granular corneal dystrophy.

For more on this patient and granular corneal dystrophy, see http://www.clspectrum.com/articleviewer.aspx?articleID=105662.

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

Research on Myopia Control

There is a lot of clinical research going on in myopia control at present. Many studies are still in early phases and not a lot of clinical trial data is available in the published literature yet, but here is a sampling of recent known and published works.

Previous studies suggest myopic defocus in the peripheral retina can influence the development and progression of myopia.

Walline has showed that soft contact lens wear in children does not cause a clinically relevant increase in axial length, corneal curvature, or myopia relative to spectacle lens wear (as some may believe that soft lenses induce a "myopic creep").1 In fact, this data is supported by studies of peripheral refraction in conventional spherical soft contact lenses vs spectacle lenses. Spherical soft lenses result in significant myopic defocus in the peripheral retina compared to respective spectacles. If the refractive status of the peripheral retina does influence myopia progression, then these results suggest that myopia progression should be slower with conventional contact lens wear than with conventional spectacle wear — or at least certainly not greater.2

Now many groups are considering dual zone or multifocus contact lenses to control the peripheral refraction and hopefully myopia progression. Liu et al3 induced central and peripheral defocus with contact lenses in chicks. Lenses that were Plano in the center and +5 in the periphery were compared to single vision controls. There was an inhibitory effect on axial eye growth with the +5 peripheral lenses which opens the possibility that appropriately designed concentric lenses may control the progression of human myopia.

Indeed such studies are underway in humans. Sankaridurg4 followed 45 myopic Chinese children, aged 7 to 14 years fitted with novel contact lenses to reduce relative peripheral hyperopia (and compared them to 40 controls). After controlling for several factors, the estimated progression in spherical equivalent at 12 months was 34% less with the novel contact lenses compared to spectacle lenses (-0.57 D vs. -0.86 D). Their 12-month data support the hypothesis that reducing peripheral hyperopia can alter central refractive development and reduce the rate of progress of myopia.

1. Walline JJ, Jones LA, Sinnott L, Manny RE, Gaume A, Rah MJ, Chitkara M, Lyons S; ACHIEVE Study Group. A randomized trial of the effect of soft contact lenses on myopia progression in children. Invest Ophthalmol Vis Sci. 2008 Nov;49(11):4702-6. Epub 2008 Jun 19.
2. Backhouse S, Fox S, Ibrahim B, Phillips JR. Peripheral refraction in myopia corrected with spectacles versus contact lenses. Ophthalmic Physiol Opt. 2012 May 12. doi: 10.1111/j.1475-1313.2012.00912.x. [Epub ahead of print]
3. Liu Y, Wildsoet C. The effect of two-zone concentric bifocal spectacle lenses on refractive error development and eye growth in young chicks. Invest Ophthalmol Vis Sci. 2011 Feb 22;52(2):1078-86. Print 2011 Feb.
4. Sankaridurg P, Holden B, Smith E 3rd, Naduvilath T, Chen X, de la Jara PL, Martinez A, Kwan J, Ho A, Frick K, Ge J. Decrease in rate of myopia progression with a contact lens designed to reduce relative peripheral hyperopia: one-year results. Invest Ophthalmol Vis Sci. 2011 Dec 9;52(13):9362-7. Print 2011.

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Ronald K. Watanabe, OD, FAAO

A New 1 Day Multifocal

CooperVision has launched the new Proclear 1 Day Multifocal contact lens. This lens has a new center-near aspheric design with a single power profile. This is different from the other CooperVision multifocals which utilize the Balanced Progressive Technology design that consists of both center-distance and center-near options in multiple add powers. Also, while the concentric/aspheric Balanced Progressive Technology design is available in three different materials for monthly replacement, the new 1 Day lens is available exclusively in the omafilcon material. Omafilcon is reported to work well for patients with dryness symptoms.

The new Proclear 1 Day multifocal lens is designed to be easy to fit with its single power profile. The base curve (8.7 mm) and diameter (14.2 mm) are the same as for the spherical Proclear 1 Day lens. Power range is +6.00 to -10.00 D. Currently, it comes in 30-lens packs. Until now, the only other daily disposable multifocal was the Focus Dailies Progressive (Alcon), another center-near aspheric design. With this additional daily disposable option, even more presbyopes will be able to wear contact lenses on a full- or part-time basis.
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Visual Performance and Optical Quality with Soft Lenses in Keratoconus Patients

The objective of this study from the UK was to assess visual performance and ocular aberrations in keratoconic patients using toric soft contact lenses (SCL), rigid-gas-permeable (RGP) contact lenses and spectacle lens correction.

Twenty-two keratoconus patients (16 RGP lens wearers and six spectacle wearers) were fitted with toric SCL. Ocular aberrations were measured with and without the patient's habitual RGP lenses and with the SCL in place. In the spectacle wearers, aberrations were measured with and without the SCL. Visual performance (high- and low-contrast visual acuity) was evaluated with the patient's habitual correction and with the SCL.

In the RGP lens wearers both the habitual lenses and the toric SCL significantly reduced coma, trefoil, 3rd-order, 4th-order cylinder and higher-order root-mean-square (RMS) aberrations (p </= 0.015). In the spectacle wearers the toric SCL significantly reduced coma, 3rd-order and higher-order RMS aberrations (p </= 0.01). The patients' habitual RGP lenses gave better low-contrast acuity (p </= 0.006) compared to the toric SCL; however, no significant difference was found between lens types for high-contrast acuity (p = 0.10). In the spectacle wearers no significant differences in visual performance measurements were found between the patients' spectacles and the toric SCL (p >/= 0.06).

The researchers concluded that the results show that RGP lenses provided superior visual performances and greater reduction of 3rd-order aberrations compared to toric SCL in this group of keratoconic patients. In the spectacle-wearing group, visual performance with the toric SCL was found to be comparable to that measured with spectacles. Nevertheless, with the exception of spherical aberration, the toric SCL were successful in significantly reducing uncorrected higher-order aberrations.

Jinabhai A, Radhakrishnan H, Tromans C, O'Donnell C. Visual performance and optical quality with soft lenses in keratoconus patients. Ophthalmic Physiol Opt. 2012 Mar;32(2):100-16. doi: 10.1111/j.1475-1313.2011.00889.x. Epub 2012 Jan 24.
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