As noted in this week's CLToday Quick Poll results, respondents are most bullish about the idea of a combination product that includes a contact lens incorporating some sort of anti-dry eye agent. I have to admit, I am not that surprised by this result. I think the results perhaps reflect the frequency at which we experience dry eye, in both our lens wearers and non-lens wearers, and our clinical need for more treatment options. Our July issue of Contact Lens Spectrum is our annual dry eye issue, and we will indeed focus on the treatment pipeline for dry eye disease amongst other relevant topics associated with ocular surface disease.

The Association of Optometric Contact Lens Educators (AOCLE) presented their 2011 awards at their annual workshop held June 2-5, 2011.

Dr. Joel Silbert, Pennsylvania College of Optometry at Salus University, is the recipient of the Lester Janoff Cornea and Contact Lens Memorial Award. This award is presented annually to the AOCLE member who has demonstrated excellence in the area of contact lens-related publications, contact lens education, and research.

Dr. Michael Harris, University of California, Berkeley School of Optometry, was awarded the AOCLE Lifetime Achievement Award to honor an optometric educator who has demonstrated exemplary commitment and dedication to the AOCLE organization over numerous years.

Other awards included the George Mertz New Educators Travel Award presented to Dr. Kathryn Richdale, The Ohio State University, College of Optometry, and the Faculty Development Travel Grant presented to Dr. Luigina Sorbara, University of Waterloo, School of Optometry.

After more than a year of trials and field testing, the Diversicon Division of Diversified Ophthalmics announces the availability of PureSite Revision Plus, a GP multifocal lens which, according to the company, provides clarity at distance, intermediate, and near and is designed to satisfy patients' most optimistic expectations.

The PureSite Revision Plus is manufactured exclusively in Boston ES material. The lens is offered in base curves from 7.00 to 8.40mm in 0.10mm steps and in distance powers from +20.00 to -20.00. Suggested diameter is 9.6. Available add powers are +1.00 to +3.00.

The company reports that of the first 200 cases, more than 50% needed no exchanges and another 33% needed only one exchange. A failure rate of only 16.5% was experienced among these 200 initial cases.

For ECPs who have not fit the Revision Plus, a free warranty is included for the first two patients. Diversified consultants are available to assist with questions and fitting issues at 800-626-2281.

Plan now to attend the Global Specialty Lens Symposium to be held January 26 - 29, 2012 at the Paris Hotel and Casino in Las Vegas, Nevada. This meeting will include insightful presentations by international experts in the field, hands-on demonstrations of cutting-edge products and valuable continuing education credits.

The Program Committee of the GSLS invites the submission of Papers and Posters. Papers and abstracts related to presbyopia, keratoconus, corneal topography, post penetrating keratoplasty or related irregular corneal surface, myopia control, orthokeratology and lens care topics are welcome.

New this year is the photo contest. Contestants may submit up to two (2) photographic images in the following anterior segment categories: Contact Lens, Lids, and Cornea/Conjunctiva. Contestants also will be able to submit images obtained utilizing such equipment as OCT, topographers, etc.

Those interested in submitting can visit the redesigned website at www.GSLSymposium.com for more information. Web submissions only. Deadline for submissions is August 31, 2011.
--ADVERTISING

The nipple-type cone, which is often very steep and normally affects only the central 5mm of the cornea, poses a challenge for the fitter as existing keratoconic designs may not fit these shaped cones ideally. The Rose K2 NC from Menicon is specifically designed for all stages of the nipple cone, and features a very small aspheric back optic zone diameter which decreases as the base curve steepens. It also incorporates a very rapid peripheral flattening outside the back optic zone, and front surface aberration optics to provide outstanding vision.

The fitting process adopts the same 5-step systematic approach as with all previous Rose K2 designs.

The Rose K 2 NC will be launched first in the United Kingdom, followed soon thereafter with launches in the United States and Canada, and then across Europe and worldwide. Further specific information about the product and availability will be available soon.

Clearlab has announced the launch of Eyedia brand contact lenses in the United States. Clearlab US is based in Suwanee, Georgia. The Clearlab group is a global organization with state of the art manufacturing facilities in Singapore and Korea.

Eyedia soft contact lenses feature Aquagrip technology that enables the lenses to retain 99 percent of their moisture throughout a full day of wear for greater comfort and less contact lens-related dry eye, according to the company. Eyedia contact lenses also feature aspheric optics for sharper vision.

The Eyedia brand includes daily disposable contacts, monthly lenses, and monthly contact lenses for astigmatism. In addition, Eyedia lenses are available with the company's Clearcolor technology. This line of color contact lenses includes enhancers, vibrant, mystic, and circle lenses, as well as special effects contact lenses.

For more information about Eyedia brand contact lenses, visit clearlabusa.com.

The Gas Permeable Lens Institute (GPLI), in association with the Contact Lens Manufacturers Association, announces their schedule of live webinars through December 2011.

During these 90 minute educational programs contact lens fitters can communicate with industry experts and ask questions of the presenter. The sessions are held on the third Tuesday of every month 9PM Eastern Time. All eye care professionals are invited to participate in these free programs.

The topics and presenters scheduled are:
June 21 — Problem Solving in Corneal Reshaping, Dr. Mike Lipson
July 19 — GP Lens Practice Management, Dr. Derek Louie
August 16 — Clinical Pearls in Aspheric Multifocal Fitting and Problem-Solving, Dr. Doug Benoit
September 20 — Corneo-Scleral and Hybrid Lens Applications, Dr. Jason Jedlicka
October 18 — GP Lens Management of the High Astigmatic Patient with Dr. Clarke Newman
November 15 — Optimizing Initial Comfort with GP Lenses, Dr. Ed Bennett
December 20 — GP Lens Case Grand Rounds, Dr. Barry Eiden

For more information on these webinars and other educational programs offered by the GPLI, visit www.gpli.info.

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This 22-year-old female presented complaining of asymmetric bilateral injection and irritation, with a scant discharge. Over the previous six weeks, she had seen several other healthcare providers for this condition. They had prescribed topical antibiotics, none of which really alleviated her symptoms. On examination, I noted punctate keratitis, the large follicles apparent in the photo, and mild conjunctival injection. She had bilateral, non-tender preauricular adenopathy. The patient admitted that she was currently sexually active with one partner. Based on the history and our findings, I diagnosed adult inclusion conjunctivitis and referred the patient to her primary care provider for lab testing and consultation. He confirmed our diagnosis and treated the patient and her partner with a five-day course of azithromycin.

For more on this patient, see http://www.clspectrum.com/article.aspx?article=&loc=archive\2010\may\cls0510_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.

A Fundamental Consideration
This time of year is always poignant with graduations and changing seasons--endings, new beginnings, and the long days of summer ahead. Many clinicians take time off or slow down in the summer months, and many others attend conferences to catch up on continuing education hours.

As you are reading this, you may be preparing to attend the annual American Optometric Association meeting in Salt Lake City. A quick glance at the program shows the continued interest in dry eye, meibomian gland dysfunction, ocular allergy, and contact lenses. Yet, there are few lectures where the topic of medical management of ocular surface diseases in contact lens wear is featured. Why is this?

Previous CL Today Quick Polls have indicated that medical management is generally considered after other contact lens related changes have been tried, for example switching lens materials, solutions, or modalities. There are several possible explanations for this hesitancy. Some would argue that if you need a prescription to wear contact lenses, then you should not wear contact lenses. Try telling that to a patient, when contact lenses have and will continue to be, a very viable correction for refractive error.

If contact lenses are an exacerbating factor in ocular surface diseases, a fundamental approach is to address the underlying condition, whether it be dry eye, MGD, or ocular allergy. So, continue to think about all of your options as you manage these patients.

Vive La Différence!
In my last column, I described some of the differences in contact lens care product availability between the United States and our bordering neighbor, Canada.

The two countries also differ in their prescribing trends. First of all, hydrogen peroxide care systems (primarily Clear Care, CIBA Vision) are prescribed more frequently in Canada than in the U.S., accounting for almost 25% of the lens care market there. (Sales in the U.S. registered 15.9%, the highest percentage in years.) Are American practitioners more reluctant to prescribe hydrogen peroxide? And if so, why?

Secondly, only 4.7% of solutions sold in Canada are private label or "generic," as opposed to 25.7% in the U.S. Are American doctors less convincing? Patients here less compliant? Are Canadians less likely to shop at "big box" stores? The difference in price not as great? Perhaps yes to all—but there is one noticeable difference between the two countries.

A quick poll at my lecture in Quebec last week revealed that a majority of the approximately 400 optometrists in the audience retail solutions in their practice. Those numbers are consistent with the other Canadian provinces. Many offices bundle the care system with the patient's contact lens supply. The advantages are numerous. For patients, there is improved convenience ("one-stop shopping") and automatic compliance with the prescribed solution. For practices, there is added revenue, and--most importantly-- the ability to exert more control over patient compliance: both the composition and the volume of the solution as well as regular lens case replacement. It appears to be a win-win situation, and it will be interesting to see if American practitioners adopt the practice going forward.

AC Nielsen MarketTrack data for Drug+ Grocery+ Mass Merchandiser retail sales: 13 Weeks ending January 1, 2011.
AC Nielsen MarketTrack data for Drug+ Grocery+ Mass Merchandiser retail sales: 13 Weeks ending December 25, 2010.

Researchers wanted to evaluate by in vivo laser scanning confocal microscopy (LSCM) the morphological changes of the Meibomian glands (MGs) and the status of periglandular inflammation in contact lens wearers (CLWs), and to investigate the correlations between clinical and confocal findings.

Twenty CLWs and 20 age- and gender-matched control subjects were consecutively enrolled. Each participant completed an Ocular Surface Disease Index questionnaire and underwent a full eye examination, including tear film break-up time, fluorescein and lissamine green staining, and Schirmer test. LSCM of the MGs were performed to determine the cell density of the mucocutaneous junction epithelium, acinar unit density and diameter, glandular orifice diameters, meibum secretion reflectivity, and inhomogeneous appearance of the glandular interstice and acinar wall.

All clinical parameters showed statistically significant differences between groups (P <0.01, Mann-Whitney U test) except the Schirmer test. Confocal data (Mann-Whitney U test) showed significantly decreased basal epithelium cell density ( P <0.01), lower acinar unit diameters (P <0.05), higher glandular orifice diameters (P <0.05), greater secretion reflectivity (P <0.01), and greater inhomogeneity of the periglandular interstices (P <0.05) in CLWs compared to controls. The duration of contact lens wear was correlated with the acinar unit diameters (P < 0.05, Spearman).

According to the researchers, morphological changes of the MGs shown by LSCM were interpreted as signs of MG drop-out, duct obstruction, and glandular inflammation. A comprehensive LSCM evaluation of the ocular surface in CLWs could better clarify the role of MG drop-out and eyelid margin inflammation on the pathogenesis of CL-induced dry eye.

Villani E, Ceresara G, Beretta S, Magnani F, Viola F, Ratiglia R. In Vivo Confocal Microscopy of Meibomian Glands in Contact Lens Wearers. Invest Ophthalmol Vis Sci. 2011 May 12. [Epub ahead of print].

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