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Sunday, June 26, 2011  
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Last week's question:
Where would you like to see more technological advances?

 1. Contact lens materials
  68%


 2. Contact lens care solutions
   32%



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

One of the continual themes I have heard over the years is that multifocal contact lenses often don't work. My clinical experience has been quite the opposite. I find it most helpful to initially follow the fitting guides provided by the manufacturers. I have heard that manufacturers will sometimes incorporate hundreds, if not thousands, of their own patient fits into the development of these fitting guides. As noted in our 2010 Annual Report (http://www.clspectrum.com/article.aspx?article...), multifocal contact lens fits seem to have surpassed monovision fits these last couple of years. Let's hope that with continued new introductions into the field, multifocal contact lens prescribing will continue to grow.



Conforma Announces New VFL3 Progressive Multifocal Options

Conforma Contact Lenses' VFL3 Multifocal has been a successful option for specialty GP lens fitters for many years. In 2007 Conforma added HD-OPTICS, the first stage in the development of their front surface technology that minimizes aberrations and maximizes optical quality resulting in improved visual acuity, according to the company. Now, HD-AP, which targets the demand for higher add powers, is the latest front surface development from Conforma.

VFL3 with HD OPTICS, or HD-AP for advanced presbyopes, will extend the add power range to better accommodate those patients with higher add demands. This aspheric front surface provides a junctionless progression of increasing add power from the optical center to the intermediate and peripheral areas of the optical zone. Conforma states that this progressive power change results in 360 degrees of functional distance, intermediate and near vision, providing distortion-free transition from a distant street sign to an intermediate dash board or small print near task.

Conforma recommends Boston XO material and their plasma cleaning for the lens. For ECPs who have not fit the VFL3 HD Options, a free warranty coupon is available on-line at www.conforma.com. Consultants are available to assist with questions and fitting issues at 800-426-1700.


A New Look for Yourlens.com, ABB Concise's Patient Reorder Website

In an effort to help to bring more patients to their accounts' yourlens.com powered web stores, ABB Concise has changed the yourlens.com website to be filled with patient eyecare information and a new Doctor Locator search engine.

ABB Concise's yourlens.com contact lens reorder website provides ECPs a response to the industry's online competition. According to the company, ECPs that utilize yourlens.com can remain competitive by lowering their transaction costs and make it easier for their patients to obtain lenses. ABB Concise's yourlens.com service provides its accounts with an Internet reorder functionality that is easy to graft onto existing practice web sites in a transparent manner. The service can also be used as a stand-alone Internet reorder site.

The company submitted all yourlens.com websites to local search engines to maximize the page rank potential of ABB Concise accounts' websites and make it easy for patients in the accounts' zip code to find them via PC, GPS or mobile Internet device. Other free web store enhancements include: Patient Enrollment, Find a Doctor Feature, Exam Recall Reminders, Patient Activity Reports, and Patient AutoShip. Many new free upgrades are also available to existing web stores.

For additional information, visit www.abbconcise.com.

Global Specialty Lens Symposium Call for Papers, Posters and Photos

Plan now to attend the Global Specialty Lens Symposium to be held January 26 - 29, 2012 at the Paris 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.

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

Those interested in submitting can visit the redesigned website at www.GSLSymposium.com for more information. Web submissions only. Deadline for submissions is August 31, 2011.
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Metro Optics Implements "It Fits or It's Free" Soft Lens Policy

Effective immediately, all Metro Optics soft lens designs and all materials - including custom lenses - will have unlimited free exchanges for 90 days with no cancellation charges. This new policy frees the practitioner from cancellation fees and exchange fees, allowing the practitioner to focus on the patient fit without financial risk.

To create a totally custom silicone hydrogel option for the patient, Definitive silicone hydrogel material is included in this policy. Metro Optics soft lens designs, available in virtually unlimited parameters, include: Spheres (clear, handling tint and eye enhancing tints of blue, green and aqua), Torics, Multifocals, Multifocal Torics and a FDA Cleared Post Refractive Surgery Lens.

Learn more online at www.metro-optics.com or call 800-223-1858.

Murphy Appointed Chair of U.S. Optometry Giving Sight National Committee

Dr. Mary Anne Murphy of Front Range Eye Associates, P.C., in Broomfield, Colorado will lead Optometry Giving Sight's efforts in the United States to raise funds. She will replace Vic Connors, OD as the organization's Chair of the U.S. National Committee.

In March, Dr. Murphy traveled to Tanzania in Eastern Africa to train and mentor local optometrists in rural communities. The journey gave Dr. Murphy the opportunity to see how donations to Optometry Giving Sight are changing lives and giving hope to people who otherwise may not be able to see well enough to go to school or care for their families.

Optometry Giving Sight is a global fundraising initiative that specifically targets the prevention of blindness and impaired vision due to uncorrected refractive error — simply the need for an eye examination and glasses. To make a donation or to learn more about Optometry Giving Sight please visit www.givingsight.org.

National Optometry Hall of Fame Inducts Baldwin, Caplan and Lowther

The National Optometry Hall of Fame, administered by Optometry Cares, welcomed three new inductees at a ceremony held during Optometry's Meeting. The 2011 inductees are William R. Baldwin, OD, PhD; Lester Caplan, OD, MEd; and Gerald E. Lowther, OD, PhD.

Dr. Baldwin has served as Dean of the Pacific University College of Optometry, President of the New England College of Optometry and Dean of the University of Houston College of Optometry. He also served on the board of the Association of Schools and Colleges of Optometry and as its President in 1974-76, and has chaired various committees within the AAO and the AOA.

Dr. Baldwin's experiences during extended to trips to Africa led to the establishment of the River Blindness Foundation for which he served as Executive Director and later Chairman of the Board. He was also instrumental in forming an optometry school in Poland.

During the first 30 years of his career in private practice, Dr. Caplan also served as a consultant to the director of the Indian Health Service. His involvement and accomplishments in incorporating optometry into the IHS earned him the title "Father of Indian Health Service Optometry."

Dr. Caplan joined the faculty of the University of Alabama at Birmingham School of Optometry in 1979. He co-founded the Association of Clinic Directors of Schools and Colleges of Optometry. His awards include the Optometrist of the Year Award presented by the AOA, the Carel C. Koch Memorial Award, the Life Fellowship Award presented by the AAO and the Association of Contact Lens Educator's first Lifetime Achievement Award.

Dr. Lowther became a faculty member at The Ohio State University and established a clinical research program in the area of contact lens use. He has also been on the faculty at Ferris State University College of Optometry, University of Alabama Birmingham School of Optometry and Indiana University School of Optometry. He served as Associate Dean at UAB and Dean at IU. He developed a computer-controlled videodisk for contact lens education and a computer program to do contact lens calculations.

Dr. Lowther was a member of the AOA Council on Research and is a charter member and on the executive council of the International Society for Contact Lens Research. He helped start the first optometry program in Poland. Dr. Lowther was also instrumental in setting up community clinics in Bloomington, Indiana, Guanajuato, Mexico and an optometry program at the Ramkhamhaeng University in Bangkok, Thailand.

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Unplanned Surgical Bleb
By William Townsend, OD, FAAO

This lesion is an unplanned surgical bleb that occurred in a 67-year-old female several months after cataract surgery. After an uneventful post-operative period, she and her husband were traveling when the patient experienced sudden onset ocular discomfort in the operated eye. She immediately sought care at the nearest emergency room. The ophthalmologist on call diagnosed and treated the bleb. She now has a shallow asymptomatic bleb.

For more on this patient, see http://www.clspectrum.com/article.aspx?article=&aloc=archive\2009\january\cls_january_a02.html.

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.

CARE SOLUTION CORNER
Susan J. Gromacki, OD, MS, FAAO

Allergy Season
It's the end-of-spring/beginning of summer in the Northeast, the time when the allergy and insect seasons intersect. This was best illustrated last week, when my 5 year-old daughter received an insect bite to her upper eyelid, resulting in a hypersensitivity reaction that closed the lid shut. Everywhere we went, people asked, "What's wrong with her eye?" I simply replied, "Fortunately, I'm an optometrist. I've seen it before and know just how to treat it." After three days of topical steroids and oral antihistamines, the swelling resolved.

As for our contact lens-wearing patients with ocular allergies, it is always important for us to view the appearance of their contact lenses. Deposited lenses may contain or attract allergens. In addition, many topical ophthalmic anti-allergy medications are not approved for use while wearing contact lenses. As a result, our patients may need to discontinue their contact lenses until the problem is resolved. As for questions as to why they are wearing their glasses? Well, they can simply answer, "My eye doctor is treating my condition. He/she has seen it before and knows just how to treat it."

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OCULAR SURFACE UPDATE
Kelly K. Nichols, OD, MPH, PhD, FAAO

Cost vs. Benefit
Recently I read that upwards of $500 million have been spent in failed dry eye drug development, with no new approved therapeutics in sight. Why is this the case? There are several plausible reasons:
1. The tested compounds do not work at the identified biological site in humans.
2. The tested compounds do work, but the impact of the effect on the multifactorial condition of dry eye is subclinical or insufficient to significantly change signs and symptoms of the disease.
3. The "right" outcome measure(s) have not been identified or validated for use in clinical trials. Let's face it—the Schirmer test was first described in 1903—it is hardly a "new" outcome.
4. Study design is critical to dry eye trial success and several key components can seriously confound results including patient identification and selection, concurrent therapies during a trial (e.g. Restasis and artificial tears), and the omnipresent and dramatic placebo effect demonstrated in previous trials.

Fortunately, even though this daunting and likely incomplete list could make companies run for the hills (or to another "easier" disease state), there are numerous molecules under investigation. The payback, if successful, is that attractive. You do not have to look further than the annual sales of Restasis for validation, along with the hypothesized 20 million and growing dry eye sufferers in the U.S. market. This is one instance where the race for approval will ultimately benefit the patient, in an attempt to mutually address unmet need.

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Fitting an MSD (Mini Scleral Design) Rigid Contact Lens in Advanced Keratoconus with INTACS

Keratoconus is a bilateral degenerative disease characterized by a non-inflammatory, progressive central corneal ectasia (typically asymmetric) and decreased vision. In its early stages it may be managed with spectacles and soft contact lenses but more commonly it is managed with rigid contact lenses. In advanced stages, when contact lenses can no longer be fit, have become intolerable, or corneal damage is severe, a penetrating keratoplasty is commonly performed. Alternative surgical techniques, such as the use of intra-stromal corneal ring segments (INTACS) have been developed to try and improve the fit of rigid contact lenses in keratoconic patients and avoid penetrating keratoplasties.

This case report follows through the fitting of rigid contact lenses in an advanced keratoconic cornea after an INTACS procedure and discusses clinical findings, treatment options, and the use of mini-scleral and scleral lens designs as they relate to the challenges encountered in managing such a patient. Mini-scleral and scleral lenses are relatively easy to fit, and can be of benefit to many patients, including advanced keratoconic patients, post-INTAC patients and post-penetrating keratoplasty patients.

Dalton K, Sorbara L. Fitting an MSD (Mini Scleral Design) rigid contact lens in advanced keratoconus with INTACS. Cont Lens Anterior Eye. 2011 Jun 9. [Epub ahead of print]

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This month at www.siliconehydrogels.org:
Ethnic differences in ocular physiology, tear mixing and contact lens-related adverse events, risk factors for inflammatory and mechanical events, and our synopsis of the 2010 meeting of the American Academy of Optometry.




Important Links:
To report adverse contact lens reactions visit: http://www.accessdata.fda.gov/scripts/medwatch/ or call (800) FDA-1088.
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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For more information on Contact Lenses Today including archives of previous issues, please visit our website at www.cltoday.com. For the latest articles on contact lenses, important clinical information and helpful tools related to the contact lens practice visit the Contact Lens Spectrum website at www.clspectrum.com.

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