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Friday, June 20, 2014  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO
As noted in the abstract this week, it is important to rethink one’s perspective on their practice approach from time-to-time. Yes, we all are creatures of habit and prefer to do what we know, but a master-level clinician is one who is always trying new approaches, refining their skill-set, and taking on new approaches to managing their patients. This is especially true in the field of contact lenses, where we have new and exciting technologies introduced what seems like every month. Also, stay tuned for more information on dry eye disease in our annual dry eye report in Contact Lens Spectrum to help you rethink your perspective in ocular surface disease.

Now Available – New Patient Education Resource on Protecting Eyes from UV
Many people are uninformed about sun protection for their eyes and unaware of the risks of not taking simple, important steps to help protect their eyes from ultraviolet (UV) exposure year-round.

To assist eye care professionals in educating parents, caregivers and others about the risks that may be associated with UV exposure to the eyes and steps they can take to minimize UV exposure, Johnson & Johnson Vision Care, Inc. has launched a free educational resource, The Sun & Your Eyes: What You Need to Know.

The Sun & Your Eyes: What You Need to Know includes important information on the unexpected sources of UV radiation exposure, as well as straightforward, practical advice for reducing the risks of UV exposure. It also offers guidance on what to look for in selecting sunglasses to help protect eyes from the sun, along with information about UV-blocking contact lenses, which can provide an important measure of additional protection for individuals who wear contact lenses.

The Sun & Your Eyes: What You Need to Know can be viewed or downloaded in the Education and Resources section of Printed copies (50 sheets per tear pad) are also available by request by writing to Make sure to include your name and mailing address with all requests.

GSLS Call for Papers and Posters
Plan now to attend the Global Specialty Lens Symposium to be held January 22 – 25, 2015 at Bally's 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.

Visit for more information. Web submissions only. Deadline for submissions is August 31, 2014.

Poor Wetting Silicone Hydrogel Lens
Biman Das, BOptom, Chennai, India

This image shows haze and globule-type deposit, as a result of poor wettability in a silicone hydrogel contact lens after two weeks of wear due to lipid deposits and incomplete blink rate. Note the density of deposits is more inferiorly.

We thank Biman Das for this image and we 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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Katherine M. Mastrota, MS, OD, FAAO
Applying Vital Dyes to Examine the Ocular Surface

The technique of applying vital dyes to examine the ocular surface (cornea, conjunctiva and lid margin) can influence the information gathered. Flooding the surface with copious amounts of dye is messy, increases the time needed to analyze the stain, and, most importantly, can overwhelm the surface masking subtle findings. In my experience, very small amount of dye yields much better diagnostic information than the drop size that is delivered from most commercial bottle tips.

Because of manufacturing limitations, clogging issues and the physical characteristics of dye solutions, droppers emit a much larger amount of dye solution per drop than needed for efficient and effective vital dye evaluation.

I have learned to apply dye solutions to the eye by first dropping a full drop of the solution onto the wooden end of cotton-swab. The bulk of the drop will fall off the wooden stick (into the trash), but a small, fairly consistent volume of dye will remain clinging to the end of the cotton-swab applicator. Usually this is the perfect amount of dye to use in testing. The dye that balances on the applicator can be instilled in the lower cul-de-sac, using a new drop for the fellow eye. This method of application also limits contamination of the tip of the dye-containing bottle.

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Susan J. Gromacki, OD, MS, FAAO

Tap Water and GP Contact Lenses

The Ophthalmic Devices Panel of the Medical Devices Advisory Committee to the U.S. Food and Drug Administration (FDA) met on May 13, 2014, to provide advice and recommendations to the Agency on FDA's regulation of contact lenses and contact lens care products.1

In the meeting's morning session, Marc Robboy, OD, of the FDA presented, "The Impact of Using Tap Water as a Rinsing Agent in the Care of Rigid Gas Permeable Contact Lenses." He reviewed published cases of Acanthamoeba keratitis in GP contact lens wearers as well as the recommendations of the Ophthalmic Devices Panel (2008), Consensus Statement by Ophthalmic Organizations (2008), Revisions to FDA Consumer Website (2009), and FDA's Addendum to 510(k) Contact Lens Care Labeling Guidance (2010)--all which contraindicate the use of tap water with contact lenses.2-4

Still, 15 of the 18 GP cleaners reviewed by the FDA currently recommend the use of non-sterile water to rinse contact lenses and/or lens cases.3,5 In addition, some members of this year's panel agreed that using tap water with GP lenses was acceptable. One panelist remarked that the physical force of water emanating from a tap was so important that he would not recommend replacing it. Another stated that there was not yet enough data that "water is a problem." Others provided evidence and/or agreed that water should be avoided for rinsing lenses, particularly just prior to lens insertion.

What do you think? Particularly among those practitioners who have been prescribing gas permeable contact lenses on a daily basis for several years, what is your opinion on the use of tap water with GP lenses? Please participate in our readers' Poll on August 8, or contact me directly at

5. Legarreta JE, Nau AC, Dhaliwal DK. Acanthamoeba keratitis associated with tap water use during contact lens cleaning: manufacturer guidelines need to change. Eye Contact Lens. 2013 Mar;39(2):158-61.

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Rethinking Dry Eye Disease: A Perspective on Clinical Implications
Publication of the DEWS report in 2007 established the state of the science of dry eye disease (DED). Since that time, new evidence suggests that a rethinking of traditional concepts of dry eye disease is in order. Specifically, new evidence on the epidemiology of the disease, as well as strategies for diagnosis, have changed the understanding of DED, which is a heterogeneous disease associated with considerable variability in presentation. These advances, along with implications for clinical care, are summarized herein.

The most widely used signs of DED are poorly correlated with each other and with symptoms. While symptoms are thought to be characteristic of DED, recent studies have shown that less than 60% of subjects with other objective evidence of DED are symptomatic. Thus the use of symptoms alone in diagnosis will likely result in missing a significant percentage of DED patients, particularly with early/mild disease. This could have considerable impact in patients undergoing cataract or refractive surgery as patients with DED have less than optimal visual results.

The most widely used objective signs for diagnosing DED all show greater variability between eyes and in the same eye over time compared with normal subjects. This variability is thought to be a manifestation of tear film instability which results in rapid breakup of the tear film between blinks and is an identifier of patients with DED. This feature emphasizes the bilateral nature of the disease in most subjects not suffering from unilateral lid or other unilateral destabilizing surface disorders. Instability of the composition of the tears also occurs in dry eye disease and shows the same variance between eyes.

Finally, elevated tear osmolarity has been reported to be a global marker (present in both subtypes of the disease - aqueous-deficient dry eye and evaporative dry eye). Clinically, osmolarity has been shown to be the best single metric for diagnosis of DED and is directly related to increasing severity of disease. Clinical examination and other assessments differentiate which subtype of disease is present. With effective treatment, the tear osmolarity returns to normal, and its variability between eyes and with time disappears.

Other promising markers include objective measures of visual deficits, proinflammatory molecular markers and other molecular markers, specific to each disease subtype, and panels of tear proteins. As yet, however, no single protein or panel of markers has been shown to discriminate between the major forms of DED.

With the advent of new tests and technology, improved endpoints for clinical trials may be established, which in turn may allow new therapeutic agents to emerge in the foreseeable future. Accurate recognition of disease is now possible and successful management of DED appears to be within our grasp, for a majority of our patients.

Bron AJ, Tomlinson A, Foulks GN, Pepose JS, Baudouin C, Geerling G, Nichols KK, Lemp MA. Rethinking Dry Eye Disease: A Perspective on Clinical Implications. Ocul Surf. 2014 Apr;12(2S):S1-S31. doi: 10.1016/j.jtos.2014.02.002. Epub 2014 Feb 13.

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