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Sunday, July 8, 2012  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

One thing I am often struck by is how frequent I find that practitioners are not using advanced technology such as topography or OCT to fit challenging patients in specialty contact lenses. I understand the issues in that some practitioners believe that their offices don't "do enough" of these fits to justify the costs of the equipment. That said, there are opportunities in terms of practice growth that might justify the benefits of this advanced technology.

AOA Bestows National Awards

The American Optometric Association (AOA) presented its annual awards to five recipients at the 115th Annual AOA Congress & 42nd Annual AOSA Conference: Optometry's Meeting. The 2012 AOA Award recipients are:

  • Rear Adm. Michael Mittelman, Distinguished Service Award
  • Melvin D. Shipp, OD, DrPH, MPH, Optometrist of the Year
  • Chris Wroten, OD, Young Optometrist of the Year
  • Tony Carnevali, OD, Optometric Educator of the Year and
  • Vera Kohler, CPOA, Paraoptometric of the Year Award

Safilens Acquired by Bruno Pharmaceuticals

Since entering the U.S. market two years ago, Safigel, the official U.S. distributor for Safilens, has been growing steadily with its Safigel 1-Day daily disposable sodium hyaluronate (HA) contact lens. Now, with the purchase of Safilens (based in Staranzano, Gorizia, in northeast Italy) by Bruno Pharmaceuticals, S.P.A., further investment in Safigel is planned to provide additional resources to expand its sales and marketing efforts to reach more doctors, eyecare staff, and patients in the U.S.

Bruno Pharmaceuticals, S.P.A., is a privately-held, family-owned, Italian pharmaceutical company based in Rome. They have been in operation since 1996, and are dedicated to improving the health and well-being of people through the development, manufacture, and distribution of medical solutions with improved and innovative formulations.

For more information visit www.safigel.com or contact Customer Service toll-free at 877-723-4435.

Alden Optical Adds OOGP as Authorized Distributor

Alden Optical, Inc. has added OOGP, ophthalmic distributor and buying group, to its network of Authorized Distributors of their portfolio of custom and specialty lenses.

Practitioners with an OOGP account can begin ordering Alden products immediately. OOGP can be reached at 800-654-3829 to establish an account. For a complete list of Alden Optical's Authorized distributors go to http://www.aldenoptical.com/distributors/.

Pencil Injury
By William Townsend, OD, FAAO

The unusual pigmentation seen in this photograph resulted from an accident that occurred when the patient was a teenager. He was in class when a classmate threw a pencil across the room. It struck the patient's eye, point first, and penetrated the conjunctiva but not the underlying sclera. According to the patient, the injury was treated with a topical antibiotic. The wound healed, but residual grains of graphite remain trapped beneath the conjunctiva many years later. The patient denied any pain, discomfort or inflammation related to the graphite deposited beneath his conjunctiva.

For more on this patient, see http://www.clspectrum.com/articleviewer.aspx?articleID=106325.

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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Loretta B. Szczotka-Flynn, OD, PhD, MS, FAAO

Considering Disposability in Healthy Lens Wear

I predict that the use of daily disposables is going to take off in the near future in the U.S. (as it has already around the world). Manufacturers are quite active in this area—Bausch & Lomb announced details their new daily disposable Biotrue ONEday at the June AOA meeting and Alcon's Daily Total 1 is also being launched in various regions around the globe. Recent research by Chalmers et al1 tells us that daily disposable lenses are associated with significantly fewer infiltrative events compared to reusable soft lenses — although more studies have yet to be done to assure repeatability of this finding.

One study published in 2009 from the U.K.2 claimed daily disposable lenses actually increased risk of infectious keratitis, although there was a fair amount of wear abuse in that cohort. More recently, Chalmers found either no difference between daily disposables and reusable soft lenses in infectious keratitis or other inflammatory events3,4 or up to a 12.5-fold lower risk of CIEs for daily disposable lenses compared to reusable lenses.1

If bacterial bioburden on lens surfaces and within cases predispose patients to infectious keratitis and inflammatory events, an obvious step towards limiting these events is elimination of the lens case and lens re-use. In that regard, daily disposable lens wear is in my opinion the optimal method of lens wear to avoid such complications.

1. Chalmers RL, Keay L, McNally J, Kern J. Multicenter Case-Control Study of the Role of Lens Materials and Care Products on the Development of Corneal Infiltrates. Optom Vis Sci. 2012. 89(3): p. 316-25.
2. Radford CF, Minassian D, Dart JK, Stapleton F, Verma S. Risk Factors for Nonulcerative Contact Lens Complications in an Ophthalmic Accident and Emergency Department: A Case-Control Study. Ophthalmology. 2009. 116(3): p. 385-92.
3. Chalmers RL, W.H., Mitchell GL, Lam DY, Kinoshita BT, Jansen ME, Richdale KL, Sorbara L, McMahon TT. Age and Other Risk Factors for Corneal Infiltrative and Inflammatory Events in Young Soft Contact Lens Wearers from the Contact Lens Assessment in Youth (Clay) Study. Invest Ophthalmol Vis Sci. 2011. 52(9): p. 6690-6.
4. Chalmers RL, Keay L, Long B, Bergenske P, Giles T, Bullimore MA. Risk Factors for Contact Lens Complications in Us Clinical Practices. Optom Vis Sci. 2010. 87(10): p. 725-35.

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Ronald K. Watanabe, OD, FAAO

Biotrue: A New Material

Bausch + Lomb has received FDA approval for their new Biotrue ONEday daily disposable contact lens, introduced in Europe last month and available in the U.S. later this year. Continuing with their "bioinspiration" philosophy for product development, B+L developed a new material called HyperGel (nesofilcon A). According to B+L, the new polymer does not contain silicone and has a water content of 78%, the same as that of the cornea. Despite this high water content, the lens undergoes very little dehydration and is able to maintain its shape even in a dehydrated state. It is able to do so via novel polymer chemistry that allows the surface to mimic the lipid layer of the tear film, making the lens surface very wettable.

The Dk/t of the lens is 42 at -3.00 D. The lens is available in a base curve of 8.6 mm, diameter of 14.2 mm, and powers from +6.50 D to -9.00 D. The modulus is 0.49 mPa, and the material contains a UV blocker. In addition, the lens design incorporates aspheric HD optics that provide crisp, clear vision. This new material is significantly different from other currently available hydrogel polymers and may help more people comfortably wear contact lenses.
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Tear Film Inflammatory Mediators During Continuous Wear of Contact Lenses and Corneal Refractive Therapy

The researchers' goal was to study changes in tear film inflammatory mediators following continuous wear of silicone-hydrogel lenses and corneal refractive therapy with reverse geometry contact lenses.

This was a prospective, case-control study. Twenty-eight subjects had worn silicone-hydrogel lenses on a 30-night continuous wear basis. Thirty-two subjects had worn corneal refractive therapy lenses on an overnight basis. Thirty-two matched control subjects were also recruited. Tear samples were obtained 12 months after initial fitting and assayed using ELISA for cytokines (interleukin (IL)-6 and IL-8), matrix metalloproteinase 9 (MMP-9) and epidermal growth factor (EGF).

EGF was significantly increased 12 months after both interventions. IL-6, IL-8 and MMP-9 were significantly increased only after corneal refractive therapy. The inflammatory response for the corneal refractive therapy patients was found to be associated with the degree of myopia corrected and the presence of corneal staining. Moreover, an increased level of MMP-9 and EGF was found to be associated with the presence of corneal-pigmented arc in the corneal refractive therapy group.

The authors concluded that this research showed long-term increased tear levels of inflammatory markers in subjects wearing corneal refractive therapy lenses when compared with continuous wear of silicone-hydrogel lenses or no lens wear.

Gonzalez-Perez J, Villa-Collar C, Sobrino Moreiras T, et al. Tear film inflammatory mediators during continuous wear of contact lenses and corneal refractive therapy. Br J Ophthalmol. 2012 Jun 13. [Epub ahead of print]
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