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Sunday, June 14, 2015  
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What percent of your contact lens wearing patients are “poor blinkers”—however you define that to be?

> 80%

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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

I know we all go through our days with so many normal activities and challenges that sometimes distract us from thinking about some other really important activities. For example, it is hard to think much about the blink reflex when you’re constantly challenged by shrinking margins in your practice. I would encourage you to set aside a few minutes of each day, perhaps the same time each day, to think about something really important (but that you often overlook) in your daily care of your patients. Take again the blink reflex and how important it is the spread of the tear film over the ocular or contact lens surface. Our patients should blink well over 10,000 times per day (while awake), but yet how many have reduced blink rates or incomplete blinking. As you take a moment to ponder on that thought, make sure you keep up on your own blinks.

Efron Named Companion of the Order of Australia

Professor Nathan Efron has been made a Companion in the General Division of the Order of Australia in the 2015 Queen’s Birthday Australian honors list. Companion of the Order of Australia is awarded for eminent achievement and merit of the highest degree in service to Australia or to humanity at large. This is a significant accolade because Companion of the Order is the highest level of the award aside from Knights and Dames.

Professor Efron is the first optometrist to have been accorded this honor. The citation issued by the Office of the Governor General states that Professor Efron has received this award “For eminent service to medicine in the field of clinical optometry, particularly to vision correction and corneal physiology, as an academic, researcher and author, to the treatment of juvenile diabetes, and through executive roles with national and international professional organisations.”

Professor Efron completed his BScOptom and PhD at the University of Melbourne in 1981. Following two years of post-doctoral studies at the University of California, Berkeley and the University of New South Wales, he returned to Melbourne, becoming a senior lecturer responsible for contact lens education. In 1990 became the foundation Chair of Clinical Optometry at the University of Manchester, England, and established a contact lens research and consultancy unit known as Eurolens Research.

Professor Efron returned to Australia in 2006 and joined the School of Optometry and Vision Science, and the Institute of Health and Biomedical Innovation at the Queensland University of Technology. At QUT he established the Anterior Eye Laboratory where, as well as continuing his contact lens research, he has been exploring a range of novel ophthalmic markers of diabetic neuropathy.

Alcon to Offer Air Optix Colors in Two-Count Package

Alcon will launch a two-count package of Air Optix Colors contact lenses, available in the U.S. from June 15 to September 30, 2015, or while supplies last. Packages of two lenses will be available in all nine colors and the full range of available lens powers, including plano.

Patients who have expressed interest in enhancing their eye color may want to try more than one color with different makeup and clothing to see which ones best suit them. The two-packs offer a way to introduce patients to color contact lenses, because they allow patients to try one or more colors in a real-world environment before purchasing a longer term supply.

Patients who purchase a two-count package from eye care professionals and internet retailers between June 15 and September 30, 2015, are eligible to receive a $10 rebate gift card.

Air Optix Colors contact lenses are the first monthly replacement, daily wear color lenses available in the U.S. on a silicone hydrogel platform. The available colors include Brilliant Blue, Gemstone Green, Sterling Gray, Honey, Pure Hazel, Blue, Green, Gray and Brown. The lenses are available with an 8.6 mm base curve and a 14.2 mm diameter. The contact lens power ranges from +6.00D to -6.00D in 0.25D steps (including plano) and -6.50D to -8.00D in 0.50D steps.

InSite Vision to Merge with QLT

InSite Vision Inc. announced that it has reached a definitive agreement with QLT Inc. under which QLT will acquire InSite in an all-stock transaction that will create an ophthalmic specialty pharmaceutical company with a diversified portfolio of products, full R&D capabilities and innovative platform technologies.

The newly formed company will be incorporated in Canada and led by a combined InSite Vision and QLT leadership team. With operations in Alameda, California and Vancouver, British Columbia, and headquarters in Vancouver, the new company will retain the name of QLT.

InSite Vision plans to promptly file a New Drug Application (NDA) later this week with the U.S. Food and Drug Administration (FDA) for marketing approval of its drug candidate BromSite to reduce post-operative inflammation and prevent pain following cataract surgery. The merged companies expect to file a second NDA for InSite Vision’s DexaSite for the treatment of blepharitis in 2016.

Other products in the combined new company’s pipeline include: AzaSite Plus, antibiotic/steroid combination for bacteria-related blepharitis which is Phase 3 ready, and ISV-101, an NSAID for Dry eye disease due to inflammation which is Phase 1/2 ready.

The transaction is expected to close in the third quarter of 2015.

OCuSOFT Launches New and Improved Website

OCuSOFT Inc. launched its newly redesigned website at The new website showcases not only the company’s central focus on eye care, but also its continued expansion into other markets with a wide selection of products ranging from eyelid cleansers and artificial tears to cosmetics and office supplies to meet the needs of health care professionals and patients alike.

Along with a fresh look, the new website is mobile friendly, has a more user-friendly interface, improved navigation functions, simple search options, access to order history and a secure online shopping cart for quick and easy purchasing 24 hours a day, 7 days a week. The new website provides a quick purchase list for added convenience to all repeat customers and allows for easy registration and access to the OCuSOFT Rewards program where shoppers earn points for every dollar spent. It also hosts useful resources including product instructions, videos, patient testimonials, current news and professional journal articles.

Soft Contact Lens After Year of Continuous Wear
Lindsay Sicks, OD, FAAO, Chicago, IL

A 43 year-old male new patient presented with symptoms of itching and glare with his habitual high minus soft contact lenses. The lens brand and material are unknown and the lens age was at least one year old. He reported continuous wear of the lens aside from removal once a week to clean with an unknown disinfecting solution. The lens was heavily deposited and had poor wettability. The patient was diagnosed with bilateral GPC, contact lens-induced neovascularization, and progressive myopia. He was subsequently refit into spherical GP contact lenses. The photo submitted is of his habitual soft contact lens deposits and non-wetting.

We thank Dr. Sicks 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 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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S. Barry Eiden, OD, FAAO

When is contact lens intolerance actually contact lens intolerance?

According to the National Keratoconus Foundation about 15 to 20% of patients with keratoconus will eventually require corneal transplant surgery. One of the key criteria for performing penetrating keratoplasty for patients with keratoconus or other forms of corneal ectasia is “contact lens intolerance”. But what actually is contact lens intolerance and when can we say that a patient is truly contact lens intolerant?

An observational retrospective study was recently published that evaluated the quality of life (QOL) of patients with keratoconus or who were post penetrating keratoplasty and who failed to adapt to corneal GP lens wear. The patients were refit with scleral lenses. QOL was assessed before and after scleral lens adaptation with the French version of the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ 25).

Forty-seven patients (83 eyes) were fit with scleral lenses on one or both eyes: 56 eyes had keratoconus and 27 eyes were post-keratoplasty. The average duration of wearing scleral lenses was 18±10months and the average wearing time was 14±3hours per day. Visual acuity in the better eye improved from 0.68±0.46 to 0.15±0.17 logMAR at the 6th month after scleral lens adaptation (P<0.0001). The average scores on the NEI-VFQ 25 questionnaire of patients fit with scleral lenses for at least 6 months were significantly higher than those without scleral lenses, with a global score of 80.2/100 with, versus 48.1/100 without, scleral lenses (P<0.0001). Statistical analysis found no significant difference in global score between patients in the keratoconus and keratoplasty groups (P>0.05). The investigators found that scleral lenses showed a significant improvement in quality of life for patients who had failed or were intolerant to conventional rigid gas permeable corneal contact lenses.

So were these patients in this investigation contact lens intolerant prior to being fit into scleral lenses? Obviously most were not contact lens intolerant after being fit into scleral lenses. We should consider a patient contact lens intolerant when all efforts have been made to successfully fit a patient into contact lenses. This would be based on access to a full gamut of lens designs including corneal GPs, soft custom lens designs, piggyback/tandem lens systems, hybrid lenses and scleral GPs. Furthermore, it would require that the patient had access to a contact lens practitioner with extensive experience and expertise in the contact lens management of irregular corneas. Only then should the patient be considered truly contact lens intolerant.

Picot C, Gauthier AS, Campolmi N, Delbosc B. Quality of life in patients wearing scleral lenses. J Fr Ophtalmol. 2015 May 19 [Epub ahead of print, article in French]

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Katherine M. Mastrota, MS, OD, FAAO

Dry Eye from a Patient’s Perspective

I admit it: I am a lurker---evening and weekend website and blog visits--- looking for information. I was once characterized as an “information parasite”. I guess it’s true.

For years, I have visited favorite sites to gather information on dry eye, how patients understand it and where they go for information about it. It is amazing the stories patients share with one another in personal blogs or on sites dedicated to dry eye or specific dry-eye related diagnoses such as MGD. Dry eye sufferers post the latest ocular surface, evidence-based data to share with others website members. With understanding and compassion, dry eye patients support one another in collaborative outlets, creating a vibrant and educated on-line community.

Clinicians will be taken aback by the frank patient discussions publically available and I urge you to read some dry eye website posts to truly understand the gravity of dry eye on the patient’s quality of life.

I am delighted share that Dry Eye Workshop II (DEWS II) has a Public Awareness Subcommittee tasked with communicating DEWS II conclusions and recommendations to the layperson. It will be great to move the DEWS II information into the public realm in a cohesive and structured manner. What a great idea…

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Spontaneous Blinking from a Tribological Viewpoint

The mechanical forces between the lid wiper and the ocular surface, and between a contact lens and the lid wiper, are reported to be related to dry eye symptoms. Furthermore, the mechanical forces between these sliding partners are assumed to be related to the ocular signs of lid-wiper epitheliopathy (LWE) and lid-parallel conjunctival folds (LIPCOF). Recent literature provides some evidence that a contact lens with a low coefficient of friction (CoF) improves wearing comfort by reducing the mechanical forces between the contact lens surface and the lid wiper.

This review discusses the mechanical forces during spontaneous blinks from a tribological perspective, at both low and high sliding velocities, in a healthy subject. It concludes that the coefficient of friction of the ocular surfaces appears to be strongly comparable to that of hydrophilic polymer brushes at low sliding velocity, and that, with increased sliding velocity, there is no wear at the sliding partners’ surfaces thanks to the presence of a fluid film between the two sliding partners. In contrast, in the case of dry eye, the failure to maintain a full fluid film lubrication regime at high blinking speeds may lead to increased shear rates, resulting in deformation and wear of the sliding pairs. These shear rates are most likely related to tear film viscosity.

Pult H, Tosatti SG, Spencer ND, Asfour JM, Ebenhoch M, Murphy PJ. Spontaneous Blinking from a Tribological Viewpoint. Ocul Surf. 2015 Apr 16. pii: S1542-0124(15)00032-4. doi: 10.1016/j.jtos.2014.12.004. [Epub ahead of print]

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