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Sunday, June 24, 2012  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

As you have seen in the News, WellPoint, which is a major health insurer, has entered into an agreement to purchase 1-800-CONTACTS. I think this raises some interesting and nebulous issues. In this sort of scenario, could the health insurer require patients to use their medical services? Would patients be penalized for not filling contact lens prescriptions through 1-800-CONTACTS? Although I am not an attorney, this seems to me to be an interesting legal and/or ethical dilemma, which has the impact to perhaps restrict commerce, ultimately hurting those in other practice settings. We'll do our best to keep you posted as we learn more.

New Report from PBA Shows Sharp Increase in Eye Disease Prevalence

According to the 2012 update of the "Vision Problems in the U.S." report, a study recently released by Prevent Blindness America (PBA) and the National Eye Institute, the number of those ages 40 and older with vision impairment and blindness has increased 23% since the year 2000. The study, conducted by researchers from Johns Hopkins University, provides prevalence rates and estimates cases of age-related eye conditions.

In addition, a preliminary update to the 2007 Prevent Blindness America "Economic Impact of Vision Problems" report shows a $1 billion increase in costs of excess medical care expenditures, informal care and health-related quality of life related to visual impairment and blindness.

Statistics from the 2012 Vision Problems in the U.S. report on the four most common eye diseases highlight alarming increases since 2000, including:

  • 2,069,403 people age 50 and older have late AMD, a 25% increase
  • 24,409,978 million people age 40 and older have cataracts, a 19% increase
  • 2,719,379 million people age 40 and older have open-angle glaucoma, a 22% increase
  • 7,685,237 million people ages 40 and older have diabetic retinopathy, an 89% increase

Diabetes is the leading cause of new cases of blindness in adults 20-74 years of age. According to the Centers for Disease Control, diabetes affects 25.8 million people in the United States.

All data from the Vision Problems in the U.S. report can be obtained through a new searchable database housed on the PBA website at www.preventblindness.org/visionproblems. This unique tool enables users to research a wide range of information including eye disease and condition numbers broken down by state, age, sex, and race, and provides comparisons across disease conditions.

AOCLE Educators Hold Annual Workshop and Recognize Colleagues

The Association of Optometric Contact Lens Educators (AOCLE) held their annual workshop at Indiana University School of Optometry from June 7-10, 2012. Over 50 contact lens educators and 20 industry representatives gathered at the workshop with theme of "Current Controversies in Cornea and Contact Lenses".

During the meeting, the George Mertz Award was presented to three new contact lens educators: Dr. Amy Dinardo-Michigan College of Optometry, Dr. Christina Newman-Southern College of Optometry, and Dr. Nikki Rai-University of Waterloo. The Lester E. Janoff Memorial Award, presented to an optometric educator of the AOCLE who has demonstrated excellence in the area of contact lens related publications, contact lens education and research and an active role in the AOCLE, was presented to Dr. Janice Jurkus of Illinois College of Optometry.

Vision Source Announces Organizational Changes

Vision Source announces the promotion of Tracy Moody to President and Chief Growth Officer effective July 1, 2012. Also, effective June 18, 2012, Doug Rice joined the management team as its Chief Financial Officer.

Moody, with 22 years of industry experience, joined Vision Source in 2000 as the VP of Growth and Development and became the Senior VP of Growth and Development before taking the role of COO for the past five years.

Before joining the company, Rice spent the last five years as the Treasurer/VP-Finance for an international security software company, McAfee, Inc., and prior to that he spent seven years as Senior Vice President and Controller for a large healthcare cost containment company, Concentra, Inc.

New BCLA Council Members Announced

The British Contact Lens Association (BCLA) welcomed four new members onto the Council.

At the Association's 2012 annual general meeting, Maxine Green, Iain May, Sheetal Patel and Dr. Siobhan Wren were appointed as directors of the BCLA. Katherine Reed, who had already served a three-year term as a lay member director, was voted on for a further three years.

The composition of the 2012-13 BCLA Council is: Dr. Catharine Chisholm, President; Shelly Bansal, Immediate Past President; Andy Yorke, President Elect; Susan Bowers, Optometric Representative; Maxine Green, Technical Representative; Iain May, Contact Lens Optician Representative; Katherine Reed, Lay Member; Keith Tempany, Contact Lens Optician Representative; Sheetal Patel, Optometric Representative; Brian Tompkins, Optometric Representative; Michael Wilkinson, Technical Representative; Dr. Ursula Vogt, Medical Representative and Dr. Siobhan Wren, Medical Representative.

For more information about the BCLA, events, membership and resources, visit www.bcla.org.uk.

Epithelial Iris Cyst
By Gregory W. DeNaeyer, OD, FAAO

The photograph shows a primary epithelial iris cyst of a 44-year-old white male patient's right eye. This iris cyst was diagnosed in childhood and has remained unchanged. Uncorrected visual acuity is 20/20 OD and OS. Intraocular pressure measured 12mm Hg OD and OS. All other anterior slit lamp and posterior pole/peripheral retina finding were unremarkable OD and OS.

For more on this patient, see http://www.clspectrum.com/articleviewer.aspx?articleID=106026.

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.
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Cary M. Herzberg OD, FIAO

First EurOK Education Meeting a Great Success

Madrid OK, the first educational meeting of the European Academy of Orthokeratology (EurOK), was held June 9-10 at the Universidad Europa de Madrid. The meeting was attended by close to two hundred enthusiastic ortho-K practitioners from all over Europe and the world and included dual translation in Spanish and Italian.

The topics at this conference were wide ranging and included clinical orthokeratology, myopia control with ortho-k, biomechanical effects of ortho-k, adverse effects in ortho-k and how to reduce them, and worldwide ortho-k today. The speakers were the leading presenters from around the world and included Pat Caroline, John Mountford, Antonio Calossi, Jacinto Santodomingo, Jaume Paune Fabre, Trusit Dave, Sami El Hage, Cesar Villa-Collar and Jose M. Gonzalez-Meijome. This program was put together by Jose M. Gonzalez-Meijome, Antonio Calossi and the Scientific Committee of EurOK.

Mirko Chinellato, Giuseppe Toffoli, Andrea Polverini, Mauro Frisani, Nataliya Kashchenko and Olga Ryabenko were introduced as the first class of Fellowship of the International Academy of Orthokeratology (FIAO) candidates to take the fellowship exam in Europe, while Marino Formenti and Jaume Paune Fabre successfully completed their international fellowship begun in Scottsdale earlier this year.

EurOK, which began in July of last year, has grown to 170 members and will be hosting the International Academy of Orthokeratology (IAO) meeting in Europe next year. The meeting dates and location will be announced soon.

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Ronald K. Watanabe, OD, FAAO

Augmented Reality

Imagine a contact lens that creates a virtual display the size of a 240" television viewed at 10'. Innovega, (Hansville, Washington), is developing the iOptik contact lens for this purpose. The iOptik lens allows the wearer to view the environment while simultaneously viewing a transparent micro-display in the spectacle plane of a normal pair of eyewear. The contact lens incorporates filters and lenslets that restrict the light from the display to pass through a small area in the center of the lens while allowing ambient light to pass through the rest of the lens. This allows the wearer to see everything in their normal field of view while also seeing anything that is presented on the micro-display.

According to Dr. Jerry Legerton, one of the inventors of this AR system, the initial uses for iOptik will be in defense, low vision, and surgical / medical visualization. Ultimately, it can deliver multiple applications for the general population, including wearable computing, mobile gaming and social networking. Though a final product is more than a year away, when available, this daily wear lens will require licensed professionals for fitting. This is a cool and exciting innovation to look forward to.
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Loretta B. Szczotka-Flynn, OD, PhD, MS, FAAO

Culture Negative Microbial Contamination

Microbial contamination of contact lens surfaces is an established association with microbial keratitis and corneal inflammatory events. There are always those puzzling situations when, either clinically or in research, microbiological cultures reveal no growth, yet our instinct tells us bacteria (or other organisms) are involved.

A recent paper highlights that "culture negative" lenses may indeed be contaminated. Powers and coworkers from the University of Arizona, present an approach to monitor microbial contamination on surfaces and in fluids by intrinsic fluorescence of microbes and distinguish their metabolic states (viable cells, nonviable cells, and endospores). They state this approach is sensitive (10 cells), requires no added reagents or sample contact, and measurements can be made in near real time.

The authors measured intrinsic fluorescence of soft contact lenses (samples and controls) before and after incubation with Pseudomonas aeruginosa. After contamination with P. aeruginosa, the contact lenses were disinfected with one of two MPS products or saline. They found that all lenses that were cultured following cleaning yielded no colonies. However, over 100,000 cells/mL of the bacteria on the treated lenses remained viable when analyzed by intrinsic fluorescence methodology.

Therefore, significant amounts of bacteria can remain on contact lenses after disinfection, which are viable but non-culturable and are likely to go undetected when using standard culture methods. Clinically, positive cultures should be used to help you differentiate the offending organism. However, negative cultures should not sway the clinician from treating with anti-microbial therapy and often our instinct should lead the way.

Powers LS, Snyder RW, Wardell LJ. Rapid Microbial Quantification of Disinfected Contact Lens Surfaces. Curr Eye Res. 2012 Jun 6. [Epub ahead of print]
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Peripheral Refraction in Myopia Corrected with Spectacles Versus Contact Lenses

Previous studies suggest that the refractive status of the peripheral retina can influence the development and progression of myopia. The aim of these researchers in New Zealand was to compare peripheral refractions in the same cohort of human eyes corrected with spectacle lenses vs. soft contact lenses.

Ten young adults with moderate to high myopia (-5.00 D to -8.00 D) were investigated. Open-field autorefraction was used to measure on- and off-axis refractions with the eyes in primary gaze, when uncorrected, and when corrected with spectacles and contact lenses. Measures were made every 5 degrees out to 30 degrees horizontally in nasal and temporal retina and analyzed as power vectors (M, J(0) , and J(45) ). Partial coherence interferometry measures of eye size were also made on-axis and off-axis at 10 masculine and 20 masculine in nasal and temporal retina.

Subjects (mean age 24; range 19-29 years) had an average on-axis mean-sphere refraction of -6.33 +/- 0.31 D (mean +/- 1 S.E.) and an average axial eye length of 25.99 +/- 0.20 mm. The average relative peripheral refraction (RPR) for all subjects across all eccentricities was hyperopic when uncorrected (+0.90 +/- 0.14 D) and also when corrected with spectacles (+1.01 +/- 0.13 D) but changed to a myopic RPR when corrected with contact lenses (-1.84 +/- 0.61 D). There was a highly significant effect of correction on peripheral refraction (p < 0.0001). Peripheral J(0) astigmatism also became significantly more negative (less with-the-rule) on correction with contact lenses (p = 0.015), whereas J(45) astigmatism remained unchanged. On- and off- axis eye length measures indicated a relatively prolate eye shape.

The researchers concluded that correcting the on-axis refractive error in moderate to high myopia with conventional spherical spectacle lenses results in hyperopic defocus in the peripheral retina. Correcting the same eyes with conventional spherical soft contact lenses results in significant myopic defocus in the peripheral retina. These results corroborate the general findings of earlier studies and the predictions of optical modeling by others. If the refractive status of the peripheral retina does influence myopia progression, then these results suggest that myopia progression should be slower with conventional contact lens wear than with conventional spectacle wear. However, previous studies comparing myopia progression with conventional spectacles and conventional contact lenses have reported no such difference.

Backhouse S, Fox S, Ibrahim B, Phillips JR. Peripheral refraction in myopia corrected with spectacles versus contact lenses. Ophthalmic Physiol Opt. 2012 Jul;32(4):294-303. doi: 10.1111/j.1475-1313.2012.00912.x.
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