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Sunday, June 16, 2013  
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Last question:
Which of the following innovations in contact lens technologies would be the most desirable in clinical practice?

 Customized, wavefront guided correction

 Drug delivery
 Health status monitoring
 Video display

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

Staff are the lifeblood of the successful practice, and anyone in practice knows just how critical staff are to a practice's long-term success. However, one of the things practitioners will most frequently say when asked about dislikes in leading a practice is managing staff. I certainly agree that managing people is one of the more difficult tasks associated with any management position I have had. The ideal staff member is pleasant and kind, consensus building amongst other team members, productive and efficient in their responsibilities, and can not only identify problems, but will take the even more important step of offering a solution to the problem. When you find this sort of staff member, make sure to treat him or her as a real gem.

AllAboutVision.com Introduces Free Videos for Practitioner Websites

More than ever, people are turning to the web to research prospective health care providers. Eyecare professionals can help their websites look polished and educational to potential and current patients with AllAboutVision.com's new eye health videos. These embeddable videos provide website visitors with an entertaining and educational resource – at absolutely no cost.

Expected to serve 21 million visitors this year, AllAboutVision.com is linked to by thousands of eyecare practitioners who wish to direct their patients to reliable, up-to-date information. With these new eye health videos, practitioners can further enhance their own practice websites.

The four videos available to ECPs cover the basics of astigmatism, cataract surgery, blurry vision and preventing eye injuries. Signing up to use them is simple. Interested practitioners should visit AllAboutVision.com's Eye Care Professional portal and fill out a video request form.

In addition to the newly available eye health videos, AllAboutVision.com also offers practitioners free Directory listings and a free Eye Health News Feed for Facebook pages. For details or to register, practitioners should visit www.allaboutvision.com/ecp/.

GSLS Call for Papers and Posters

Plan now to attend the Global Specialty Lens Symposium to be held January 23 – 26, 2014 at the Rio All Suites 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.

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

Those interested in submitting can visit the website at www.GSLSymposium.com for more information. Web submissions only. Deadline for submissions is August 31, 2013.

Former Chief Scientific Officer of Alcon Joins GrayBug

GrayBug, LLC, a company developing innovative drug delivery systems and its own drugs to more effectively treat eye disease, announced that Gerald D. Cagle PhD, former Senior Vice President and Chief Scientific Officer at Alcon Laboratories, has joined GrayBug as a senior advisor and head of business development.

Dr. Cagle's pharmaceutical executive, managerial, technical and business experience spans over 35 years. Dr. Cagle served in key leadership roles for Alcon Laboratories Inc., including positions as a laboratory scientist, followed by service in clinical research, regulatory affairs, and product development. During the last 13 years at Alcon, he held the position of Senior Vice President and Chief Scientific Officer. While at Alcon, Dr. Cagle either directed or was a contributing author of numerous new drug applications (NDAs) and premarket approvals (PMAs), from which more than 100 new Alcon products were achieved.

GrayBug is a platform drug delivery company that is developing proprietary controlled release technologies for ophthalmic pharmaceutical indications. The company's lead product is a polymer-drug biomolecular conjugate for the treatment of neovascular diseases, including age-related macular degeneration (AMD). GrayBug also has a proprietary platform technology that allows sustained drug delivery into various compartments of the eye while minimizing inflammation common with current controlled release technologies applied to the eye. For more information, please visit www.graybug.com.

Google Glass-Like Features on a Contact Lens?

Ongoing research on development of nanomaterials technology may be bringing us closer to contact lenses that can provide displays similar to those creating so much excitement and interest in Google Glass.

A recent study conducted at the Ulsan National Institute of Science and Technology (UNIST) in the Republic of Korea, demonstrated the use of hybrid electrodes to fabricate oxide semiconductor transistors and single-pixel displays integrated on wearable soft contact lenses by in vivo tests on rabbit eyes. According to reports in MIT Technology Review, the team of researchers "mounted a light-emitting diode on an off-the-shelf soft contact lens, using a material the researchers developed: a transparent, highly conductive, and stretchy mix of graphene and silver nanowires." Over five hours, the electronics remained functional and the rabbits appeared to be fine.

For more on this research and these developments see http://www.technologyreview.com/news/515666/contact-lens-computer-like-google-glass-without-the-glasses/ and http://pubs.acs.org/doi/abs/10.1021/nl401070p.

Epitheliopathy of Corneal Transplant
By Boris Severinsky, MOptom, Jerusalem, Israel

This image illustrates ischemic epitheliopathy of a corneal transplant due to hypoxia induced by a scleral lens with poor fluid-ventilation.

We thank Boris Severinsky for sending this image and 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

Population Differences in Spherical Aberrations and Corneal Asphericity

Recently, two independent publications have been released assessing population differences in spherical aberrations and corneal asphericity. Amanda Kingston and Ian Cox from Bausch + Lomb used the Zywave II Wavefront Aberrometer to measure the lower and higher order aberrations of each eye to determine the relationship between total spherical aberration, ametropia, age, corneal curvature, and image quality. They found no correlation between spherical aberration and degree of ametropia, however, there was a weak correlation between spherical aberration and age; spherical aberration became more positive with increasing age. Additionally, there was a correlation between spherical aberration and steepness of corneal curvature; spherical aberration became more positive with increasing power of the anterior corneal surface.1

A related study by Dan Fuller and my colleague Danielle Alperin looked at corneal asphericity between African-American and white populations. Using corneal asphericity (Q value) data obtained from Pentacam HR, they compared data from African-American and white subjects stratified by ethnicity, age, and spherical equivalent (SE) refractive error. Interestingly, they found that the eyes of African-Americans were significantly more prolate than those of whites but their appeared to be minimal influence by age, gender, or SE.2

Knowing population based variations in corneal asphericity and ultimately spherical aberration can be helpful when selecting contact lenses that control for population averaged spherical aberration. Studies looking at applications of such lenses within these population subgroups may be interesting; would such lenses be more useful in whites, those with increased age or increasing corneal curvature? Hopefully these studies will advance further research in this area.

1. Kingston AC, Cox IG. Population spherical aberration: associations with ametropia, age, corneal curvature, and image quality. Clin Ophthalmol. 2013;7:933-8.
2. Fuller DG, Alperin D. Variations in Corneal Asphericity (Q Value) Between African-Americans and Whites. Optom Vis Sci. 2013 May 24. [Epub ahead of print]

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Ronald K. Watanabe, OD, FAAO

A Revolutionary "Material"

Alcon is launching Dailies Total1 one-day contact lenses in North America this summer; the lens has been launched in other parts of the world already. You may have heard about this lens and are wondering if it is truly revolutionary. After trying a pair myself, I think it has the potential to live up to the expectation. How is the lens different? The answer lies in the "Water Gradient" technology that scientists have been working on for over 10 years. Unlike other lenses that have a homogeneous polymer composition, this new lens is made up of two different phases. The core is a 33% water content silicone hydrogel material with a Dk of 140. Imbedded into the surface of the SiHy core are extremely hydrophilic polymer chains that can attain 80-100% water content. These polymer chains emerge in single strands from the core with less and less crosslinking towards the surface, analogous to the microvilli on the corneal surface. The result is a 6 micron ultrasoft, hydrophilic surface gel that can maintain surface hydration throughout the day. If this lens can consistently maintain this level of surface hydration, it may be as revolutionary as SiHys were in the early 2000s.

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Human Corneal Anatomy Redefined: A Novel Pre-Descemet's Layer (Dua's Layer)

The purpose of this study was to define and characterize a novel pre-Descemet's layer in the human cornea. In this clinical and experimental study, the researchers included 31 human donor sclerocorneal discs, including 6 controls (mean age, 77.7 years).

Air was injected into the stroma of donor whole globes (n = 4) and sclerocorneal discs (n = 21) as in the clinical deep anterior lamellar keratoplasty procedure with the big bubble (BB) technique. The following experiments were performed: (1) creation of BB followed by peeling of the Descemet's membrane (DM); (2) peeling off of the DM followed by creation of the BB, and (3) creation of the BB and continued inflation until the bubble popped to measure the popping pressure. Tissue obtained from these experiments was subjected to histologic examination. The main outcome measure was the demonstration of a novel pre-Descemet's layer (Dua's layer) in the human cornea.

Three types of BB were obtained. Type-1, is a well-circumscribed, central dome-shaped elevation up to 8.5 mm in diameter (n = 14). Type-2, is a thin-walled, large BB of maximum 10.5 mm diameter, which always started at the periphery, enlarging centrally to form a large BB (n = 5), and a mixed type (n = 3). With type-1 BB, unlike type-2 BB, it was possible to peel off DM completely without deflating the BB, indicating the presence of an additional layer of tissue. A type-1 BB could be created after first peeling off the DM (n = 5), confirming that DM was not essential to create a type-1 BB. The popping pressure was 1.45 bar and 0.6 bar for type-1 BB and type-2 BB, respectively. Histology confirmed that the cleavage occurred beyond the last row of keratocytes. This layer was acellular, measured 10.15±3.6 microns composed of 5 to 8 lamellae of predominantly type-1 collagen bundles arranged in transverse, longitudinal, and oblique directions.

The researchers concluded that there exists a novel, well-defined, acellular, strong layer in the pre-Descemet's cornea. This separates along the last row of keratocytes in most cases performed with the BB technique. Its recognition will have considerable impact on posterior corneal surgery and the understanding of corneal biomechanics and posterior corneal pathology such as acute hydrops, Descematocele and pre-Descemet's dystrophies.

Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

Dua HS, Faraj LA, Said DG, Gray T, Lowe J. Human Corneal Anatomy Redefined: A Novel Pre-Descemet's Layer (Dua's Layer). Ophthalmology. 2013 May 25. [Epub ahead of print]

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To report possible grievances related to the Fairness to Contact Lens Consumers Act or associated Contact Lens Rule visit: https://www.ftccomplaintassistant.gov/.

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