Ocular surface disease has really come to the forefront of both primary care and specialty contact lens practice. There is no doubt that a healthy ocular surface promotes successful contact lens wear, but we also know that some applications of contact lens wear too can promote a healthy ocular surface. Please look forward to our July issue of Contact Lens Spectrum, which is our annual dry eye issue. You will note it is packed with up-to-date, practical information to help you improve your management of ocular surface disease.

According to reports from Reuter’s and other news sources, U.S. authorities announced that Merck & Co Inc has agreed to pay $5.9 million to resolve claims that Inspire, formerly owned by Merck, fraudulently promoted AzaSite for uses not approved by the FDA.

According to a federal suit filed in U.S. District Court, Southern District of New York Manhattan, though AzaSite was approved by the FDA in 2007 solely for the treatment of bacterial conjunctivitis, Inspire marketed the drug for the non-approved treatment of blepharitis. The settlement resolves allegations that this marketing caused the submission of false claims for reimbursement by the Medicaid program and other federal programs. The settlement includes civil restitution for damages to various state Medicaid programs and other federal healthcare programs.

Paragon Vision Sciences was recently acquired by Valeant Pharmaceuticals. No details on the acquisition are available and both companies declined to comment.

Alden Optical announced the creation of a new program designed to assist cornea and contact lens residents to maximize their residency experience and transition easily into practice. The Contact Lens Residents Forum (CLRF), dedicated to residents, their common interests, goals and challenges, will be headed by Brooke Messer, OD, FSLS. As a former Cornea and Contact Lens Resident at the Southern California College of Optometry, Dr. Messer has a special interest in helping current and recent residents through these formative years. The CLRF will primarily utilize social media including Facebook, LinkedIn and Google+ to connect with and foster discussion among residents. For more information on this forum, including how to join, contact Dr. Messer at drbmesser@gmail.com or visit the CLRF Facebook page.

Plan now to attend the 10th Global Specialty Lens Symposium to be held January 21 - 24, 2016 at Caesars Palace 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 www.GSLSymposium.com for more information. Web submissions only. Deadline for submissions is August 31, 2015.

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Art Optical has again partnered with Laboratoire Precilens of Paris, France, to bring another specialty contact lens to their U.S. customer base. The mutual agreement gives Art Optical manufacturing and distribution rights to the Expert Progressive GP multifocal lens, a contact lens designed to perform like a progressive spectacle lens. Art Optical has been successfully selling the BiExpert Bifocal GP from Precilens since 2009.

The Expert Progressive design features slab-off GP lens technology, creating a thinner, uniform edge profile 360 degrees around the circumference of the lens, resulting in less lid awareness and improved comfort. According to the company, this lens transitions seamlessly and allows no compromise of near or distance vision while providing crisp, clear intermediate vision. Art Optical will manufacture Expert Progressive lenses exclusively in Boston (Bausch + Lomb) GP materials.

Expert Progressive lenses from Art Optical are competitively priced, backed by their FlexFit Multifocal Management Program allowing unlimited design changes and requiring no returns on refit lenses, and manufactured and shipped within 24 hours of order. Additional information can be found at the company website, www.artoptical.com, or by contacting Art Optical at 1-800-253-9364.

The Association of Schools and Colleges of Optometry’s (ASCO) Board of Directors announced the appointment of Dawn Mancuso, FASAE, CAE, as its Executive Director. Ms. Mancuso replaces Marty Wall who is retiring in July.

A seasoned leader in the non-profit association industry and the former Chief Executive Officer of the Hydrocephalus Association, Mancuso will serve as the lead executive responsible for the administration, operations and representation of ASCO with all member institutions and affiliates in optometric education. She will also continue the association’s strong collaborations with other organizations in the profession and forge partnerships with other associations of health professions education to create greater visibility for optometry in the changing healthcare landscape.

This is a photo of a tick embedded in the nasal portion of the right upper eyelid. This patient was tending to her greenhouse and noticed a few spots of blood at the sight about a week prior to presenting to my office. She didn't think much of it and assumed that the lesion was a "skin tag". Over the next few days, the "skin tag" grew rapidly and her daughter, who worked for a veterinarian, encouraged her to come and let me look at it. Her daughter thought it was a tick, and after examination, I confirmed the diagnosis. The tick was still alive and moving! I smothered it with ointment and attempted to remove it with forceps with no success. I promptly referred patient to a trusted surgeon who removed it using local anesthesia, forceps, and a scalpel.

We thank Dr. Fry 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 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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Fungal Case Contamination Among Asymptomatic Contact Lens Wearers

A recent paper out of Greece by Mela, Anastasious, Gartaganis, and Christofidou¹ studied fungal case contamination in the absence of infection and came up with some interesting conclusions. First, 6.9% of the case wells (10.2% of the cases) of compliant monthly disposable soft contact lenses tested positive for a fungus (there were seven species, including three filamentous fungi and four yeasts). In addition, 22.7% of hydrogen peroxide storage cases showed fungal growth, as compared with 7.4% of the MPS cases. (No lens was allowed to remain in the solution more than 7 days.) This is an interesting finding as a prior report on this topic showed that none of the confirmed cases had used a hydrogen peroxide care system.² They authors concluded, “Although much progress has been made toward making CL use safer, the need for enhancement of CL disinfectant solutions and improvement in CL hygiene undoubtedly remains.”

1. Mela EK, Anastasious ED, Gartaganis SP, and Christofidou M. Fungal isolation from disinfectant solutions of contact lens storage cases among asymptomatic users. Eye Contact Lens. 2015 Mar 41(2):87-90.
2. Chang DC, Grant GB, O’Donnell K, et al. Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution. JAMA. 2006 Aug 23;296(8):953-963.

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Choices for the Whole Family

What could be better than having the whole family share, right? I recently had a 14 year-old patient who had been overwearing and sleeping in his contact lenses. When I asked him why, his father jumped into the conversation stating that his teenage son was lazy. We all chuckled and agreed how much easier and convenient it is to not have to do anything in the morning but roll out of bed and hit the road. I then began our practice’s common discussion around single-use lenses and their health benefits. The father then said, “If you don’t take care of your eyes, you won’t be able to wear lenses when you get old like me. My eyes hurt when I try to wear lenses. And you’re lucky your prescription allows you to wear lenses; your mom has the ‘stigma’ and they don't make lenses for her.” My head was spinning as I was trying to decide which issue needed to be addressed first.

As I have said before, we are single-use contact lens ambassadors in our office. We talked with the teenager about contact lens abuse and the importance of a clean, fresh lens that is replaced daily, and how it can provide him, in our experience, with the best case scenario for long term comfortable contact lens wear. I next addressed the father and shared with him that we could do a full assessment on him and consider a dry eye work up. I shared how daily disposable contact lenses can provide the opportunity to try wearing contact lenses even on a part time basis and that they are very economical. I added how many patients find that newer technology in contact lens materials allow them to wear contact lenses more long-term if they desire. I mentioned, delicately, that the lenses also come in multifocal powers for when he needs both distance and near correction. Lastly, I shared with the father that his wife likely has ‘astigmatism’, and single-use lenses are available with astigmatic powers as well. Regardless of who in the family needs vision correction, we have amazing options with single-use lenses that allow us to consider contact lenses for nearly every member of the family.

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These researchers reviewed the published literature assessing the efficacy and safety of lacrimal drainage system plug insertion for dry eye in adults.

Literature searches of the PubMed and Cochrane Library databases were last conducted on March 9, 2015, without date restrictions and were limited to English language abstracts. The searches retrieved 309 unique citations. The primary authors reviewed the titles and abstracts. Inclusion criteria specified reports that provided original data on plugs for the treatment of dry eyes in at least 25 patients. Fifty-three studies of potential relevance were assigned to full-text review. The 27 studies that met the inclusion criteria underwent data abstraction by the panels. Abstracted data included study characteristics, patient characteristics, plug type, insertion technique, treatment response, and safety information. All studies were observational and rated by a methodologist as level II or III evidence.

The plugs included punctal, intracanalicular, and dissolving types. Fifteen studies reported metrics of improvement in dry eye symptoms, ocular-surface status, artificial tear use, contact lens comfort, and tear break-up time. Twenty-five studies included safety data. Plug placement resulted in ≥50% improvement of symptoms, improvement in ocular-surface health, reduction in artificial tear use, and improved contact lens comfort in patients with dry eye. Serious complications from plugs were infrequent. Plug loss was the most commonly reported problem with punctal plugs, occurring on average in 40% of patients. Overall, among all plug types, approximately 9% of patients experienced epiphora and 10% required removal because of irritation from the plugs. Canaliculitis was the most commonly reported problem for intracanalicular plugs and occurred in approximately 8% of patients. Other complications were reported in less than 4% of patients on average and included tearing, discomfort, pyogenic granuloma, and dacryocystitis.

The researchers concluded that, on the basis of level II and III evidence in these studies, plugs improve the signs and symptoms of moderate dry eye that are not improved with topical lubrication, and they are well tolerated. There are no level I studies that describe the efficacy or safety of lacrimal drainage system plugs.

Marcet MM, Shtein RM, Bradley EA, Deng SX, Meyer DR, Bilyk JR, Yen MT, Lee WB, Mawn LA. Safety and Efficacy of Lacrimal Drainage System Plugs for Dry Eye Syndrome: A Report by the American Academy of Ophthalmology. Ophthalmology. 2015 May 30. pii: S0161-6420(15)00417-0. doi: 10.1016/j.ophtha.2015.04.034. [Epub ahead of print]

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