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Friday, June 27, 2014  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO
Our publications are deluged with information about scleral contact lenses—in fact, it is amazing how much this modality has apparently grown over the last several years. That said, I think it is important to not lose sight of some other very important, time-tested lens designs that can also benefit your patients—including (but not limited to) corneal lens designs, hybrids, piggyback lenses, and custom soft lenses. With so many options out there, I would hope we could make it a rare event that a patient would need surgical treatment for their condition. Best of fitting to you.

Alcon Debuts Air Optix Colors

Alcon has launched Air Optix Colors prescription contact lenses, a new color contact lens that encapsulates Alcon’s 3-in-1 Color Technology in a silicone hydrogel lens. Available in nine colors ranging from subtle to vibrant, Air Optix Colors are the first monthly-replacement, daily-wear color lenses available in the U.S. on a silicone hydrogel platform, allowing up to six times more oxygen through the contact lens compared to the leading color contact lens.1* The color is contained within the lens material, so that the only thing touching the wearer’s eyes is the ultra-smooth permanent plasma surface of Air Optix brand contact lenses.

A recent survey conducted by Alcon and Kelton Global revealed that color is one of the major factors that allows female Millennials to enhance their appearance and express themselves. In the survey, 71% of 18-29 year old women believe that color allows them to showcase their personality2. With 3-in-1 Color Technology, Air Optix Colors contact lenses allow consumers to enhance their eye color in a way that mimics the natural subtle color blend of the iris, gently blending with the wearer’s unique, natural eye color to create an attractive and natural-looking effect, according to the company.

Alcon designed Air Optix Colors in nine different shades, ranging from subtle (Pure Hazel, Blue, Green, Gray and Brown) to vibrant (Brilliant Blue, Gemstone Green, Honey and Sterling Gray). The lenses are available in prescription and plano. There is no refit required for current Air Optix Aqua contact lens wearers.

1. Based on the ratio of lens oxygen transmissibilities; Alcon data on file, 2013.
2. Based on an online survey of 619 American women ages 18-29 and 608 American women ages 35-49; Alcon data on file, 2014.
*High oxygen transmissible lenses: Dk/t = 138 @ -3.00D.

New CooperVision App for U.S. Consumers

A new CooperVision app provides U.S. consumers with access to useful contact lens information and tools, including ways to find a nearby optometrist, to identify potentially ideal lenses to discuss with their eye care practitioner, and a customizable reminder that will sound an alert when it is time for contact lens replacement.

Features of the CooperVision app include:

  • Find a Doctor – For users who wish to locate an optometrist, this feature uses the mobile device’s location services or a zip code to find nearby eye care professionals.
  • Find a Lens – By choosing from a variety of eye conditions and lifestyle factors, app users can utilize this tool to identify the CooperVision lenses that are best for them.
  • Lens Reminder – allows users to set up reminders for the replacement of their (or their family members’) contact lenses.
  • Vision & Health – Common vision questions and more are answered within the app.
  • Products – Users can dive more deeply into each of CooperVision’s contact lens families.

The app was previously launched in the U.K. and China. Now it is available to consumers in the U.S. The CooperVision mobile application is available for iOS and Android devices, and can be downloaded by visiting the App Store, Google Play, or

J&J Adds Acuvue Oasys Six-Month Supply Pack and Plans to Discontinue Acuvue Advance Brand in U.S.

Johnson & Johnson Vision Care, Inc. announced that Acuvue Oasys Brand Contact Lenses is now available in a new six-month supply pack (12 lenses per box). The new six-month Supply Pack will replace all three-month supply packs (6 lenses per box), which will be discontinued effective July 1, 2014.

According to the company, in a study that captured actual product use patterns among Acuvue Oasys three-month and annual supply users across a four-month time period, research showed that patients with larger pack sizes tended to be more compliant in replacing their lenses bi-weekly as recommended by their doctor, had a significantly better wearing experience with respect to better comfort throughout the day, at the end of the day, and throughout the wear cycle. Additionally, patients with larger pack sizes said they were more likely to return to their doctor the next time they need an eye examination.*

Acuvue Oasys six-month supply pack will be available in all parameters that are currently available in the current three-month and Annual Supply packs:

The company also announced that effective March 31, 2015, Acuvue Advance Brand Contact Lenses, Acuvue Advance Brand for Astigmatism, and Acuvue Advance Plus Brand will be discontinued and revenue lenses will no longer be available for sale from the company. All remaining parameters of Acuvue Brand Contact Lenses, the initial product introduced in 1987, also will be discontinued on March 31, 2015.

Diagnostic lenses for Acuvue Advance Brand and Acuvue Advance Brand for Astigmatism had previously been discontinued, and diagnostic lenses for Acuvue Advance Plus will be discontinued effective August 1, 2014.

To ease the transition, Johnson & Johnson Vision Care is offering a Fitting Fee Reimbursement of up to $100 toward patients’ fitting fees when Acuvue Advance Brand Family or Acuvue Brand wearers are prescribed an annual supply of any product in the Acuvue Oasys Brand Family, 1-Day Acuvue Moist Brand Family, or 1-Day Acuvue TruEye Brand Contact Lenses.

*2011/2012 study that captured actual use patterns among Acuvue Oasys Brand 3-month and Acuvue Oasys annual supply users across a 4-month time period to understand if having a larger box (annual supply pack) in their pantry (compared to the smaller traditional 3-month supply) would have an impact on lens consumption.

B+L Launches Soothe XP Eye Drops with Restoryl

Bausch + Lomb announced the availability of Soothe Xtra Protection (XP) eye drops with Restoryl, a unique emulsion system featuring a proprietary blend of mineral oils and interfacial molecules. The eye drops target the main source of dry eye symptoms by replenishing the lipid layer of the tear film.

By restoring lipid layer thickness, Soothe XP with Restoryl addresses a key component in the onset of dry eye symptoms. A compromised lipid layer of the tear film, which results in tear evaporation, is the deficiency most commonly associated with dry eye symptoms. 1-4 The product on shelf is now preserved with polyquaternium-1 (PQ1) and has a borate buffer system - both are widely used in in ophthalmic formulations.

The company announcement said that they are pleased to bring back the product to eye care professionals and consumers. Soothe XP is now available at Walmart and will be available in Target in July. Additional retailers, such as Walgreens, Rite Aid and CVS, will follow in the coming months.

Scleral Lens Over INTACS
Melissa Barnett, OD, FAAO, Sacramento, CA

This photograph is of a patient fit with a scleral lens over INTACS for Keratoconus. The patient is able to wear the lens successfully all day long. 20/20-2 vision was obtained.

We thank Dr. Barnett 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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David Kading, OD, FAAO
Scleral Lens History

In 1508 Da Vinci conceptualized the idea of changing light patterns. Over a century later Descartes described the neutralization of refractive light with a glass tube. Two centuries later we had our first glass scleral contact lens. In the late 1880s, three men independently invented the first contact lenses. They were Adolph Gaston Eugen Fick, a Swiss ophthalmologist, a French ophthalmologist Eugene Kalt who made his lenses from the bottom of glass test tubes, and August Muller, a German medical student who wanted to correct his own high myopia.

Since then scleral lenses have made some dramatic improvements having shifted out of glass material into PMMA plastic in the 1930s. PMMA, which was known for its superb optical properties was introduced in the U.S. by Rohm and Haas Co. and rapidly became the material of choice for "hard" contact lenses. Then RGP (Rigid Gas Permeable) materials were introduced in the1970s. Additionally, the lathing capabilities for scleral lenses have improved dramatically. I recall my grandfather telling me about the early days of fitting a football athlete with "the first contact lenses (scleral lenses)" and then the patient losing the lens on the football field. This was a small town and in a day and age where everyone swarmed onto the field to help the young man find the lens (which they somehow did).

Today, we have amazing capabilities with our scleral lens technology, and education is abundant. Scleral lens fitting workshops are popping up all over the world. Nearly every lab in the country either does in lab training, in-office training, or community training on how to fit their scleral lenses. So if you are like Da Vinci and are just now conceptualizing the idea, fast forward a couple centuries and make the idea a reality. Bring scleral lenses into your office. It will change the way you see patients, change the way that your patients see, and improve patients’ quality of life. Happy Fitting.

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S. Barry Eiden, OD, FAAO

Daily Disposable Contact Lenses… The Healthiest Option Perhaps, But Not Immune to Contamination and Infection

A study was conducted in order to identify the identity and quantity of contaminating organisms on daily disposable contact lenses (DD), which as with other contact lenses, potentially could be associated with microbial keratitis.1 Ten subjects wore DD lenses, and 10 subjects wore planned replacement (PR) lenses. Lenses were analyzed for microbial contamination. Colony-forming units (CFU) were recorded. The DD lenses evaluated in this study were found to be contaminated with coagulase-negative staphylococcus (CNS), ranging from 1 to 653 CFU. PR lenses showed more diversity in the types of contaminating micro-organisms and consisted of CNS, Gram-negative bacteria (Pseudomonas), a yeast (Candida) and a mold (Aspergillus), ranging from 1 to 230 CFU. CNS was the only type of micro-organism found on DD contact lenses and therefore should be considered as the most likely cause of microbial keratitis when found in DD lens wear.

Microbial keratitis has been reported in numbers of prior studies,2,3 while other studies have identified associated risk factors in contact lens associated microbial keratitis including factors such as contamination of lens cases, smoking, higher socio-economic class, internet purchase of contact lenses and of course overnight wear.4,5 Microbial keratitis in DD lens wear however was reported to be significantly less likely to be associated with vision loss.2 In addition, an international survey of DD lens wearers found that rates of DD lens wear re-use varied from 4 to 18% of wearers with an average of 9% and a rate of 28% of respondents reporting wearing of DD lenses at least one night of continuous wear over the past month.6

Understanding the risk factors associated with contact lens MK and the fact that DD lens wear is not “immune” to this complication can allow ECPs to properly educate their patients in order to minimize their risk.

1. Hall B, McCanna D, Jones L. Identification of coagulase-negative staphylococci in daily disposable contact lens wearers. Lett Appl Microbiol. 2014 May 8. doi: 10.1111/lam.12277.
2. Dart JK, Radford CF, Minassian D, Verma S, Stapleton F. Risk factors for microbial keratitis with contemporary contact lenses: a case-control study. Ophthalmology. 2008 Oct;115(10):1647-54.
3. Stapleton F, Keay L, Edwards K, Naduvilath T, Dart JK, Brian G, Holden BA. The incidence of contact lens-related microbial keratitis in Australia. Ophthalmology. 2008 Oct;115(10):1655-62.
4. Stapleton F, Edwards K, Keay L, Naduvilath T, Dart JK, Brian G, Holden B. Risk factors for moderate and severe microbial keratitis in daily wear contact lens users. Ophthalmology. 2012 Aug;119(8):1516-21.
5. Jiang Y, Jacobs M, Bajaksouzian S, Foster AN, Debanne SM, Bielefeld R, Garvey M, Raghupathy S, Kern J, Szczotka-Flynn LB. Risk factors for microbial bio-burden during daily wear of silicone hydrogel contact lenses. Eye Contact Lens. 2014 May;40(3):148-56.
6. Dumbleton KA, Richter D, Woods CA, Aakre BM, Plowright A, Morgan PB, Jones LW. A multi-country assessment of compliance with daily disposable contact lens wear. Cont Lens Anterior Eye. 2013 Dec;36(6):304-12.

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OCT Combined with Videokeratography to Differentiate Mild Keratoconus Subtypes

The purpose of this study was to develop parameters using a combination of optical coherence tomography (OCT) and videokeratography to detect early keratoconus.

Videokeratography, wavefront analysis, and measured OCT indices were performed on 180 normal eyes, 46 eyes with moderatekeratoconus, 54 eyes with early keratoconus, 7 eyes with forme fruste keratoconus, and 16 eyes with keratoconus "suspect" to determine the most sensitive parameters for separating these groups.

A combination of videokeratography and OCT indices (inferior-superior [I-S] value and minimum pachymetry) was statistically the most significant in separating the keratoconus groups from normal eyes (P < .001). Using a newly derived index, the minimum pachymetry divided by the I-S value (pachymetry/asymmetry [PA]/I-S index) with a cut-off of 100, 100% of early and forme fruste keratoconus could be identified as being abnormal with 7 normals misclassified (misclassification rate 2.7%). By adding keratoconus "suspect" to the analysis and an I-S value of 1.2 as a cut-off point, 5 "suspects" were classified as normal and 11 normals as abnormal (misclassification rate 7.8%). The PA/I-S index, with a cut-off point of 100, reduced this misclassification rate to 4.4%.

The researchers concluded that these results suggest that OCT combined with videokeratography may be more useful for differentiating mild forms of keratoconus than videokeratography alone.

Rabinowitz YS, Li X, Canedo AL, Ambrósio R Jr,Bykhovskaya Y. Optical coherence tomography combined with videokeratography to differentiate mild keratoconus subtypes. J Refract Surg. 2014 Feb;30(2):80-7. doi: 10.3928/1081597X-20140120-02.

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