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Friday, July 11, 2014  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO
This is the time of year that our editorial team at Contact Lens Spectrum begins planning its 2015 editorial calendar. As always, we solicit editorial ideas from both our team of contributing editors and editorial staff in addition to our readership. Please let us know if you have ideas for articles and content for next year. We look forward to hearing from you in this regard. Email us at

B+L Receives FDA Clearance for Biotrue ONEday
for Presbyopia
Bausch + Lomb announced that the U.S. Food and Drug Administration (FDA) has issued marketing clearance for Biotrue ONEday for Presbyopia (nesofilcon A) soft (hydrophilic) contact lens, the first daily disposable multifocal contact lens from the Biotrue ONEday family of products. Featuring a next generation 3-Zone Progressive design, also used in PureVision2 for Presbyopia, along with bio-inspired HyperGel material, the new lens provides comfortable vision throughout the day, and exceptional vision across near, intermediate and distance, according to the company.

The bio-inspired HyperGel material is designed to work like the eye by meeting the oxygen level the open eye needs for healthy, white eyes, while matching the cornea’s water content for all-day comfort and mimicking the lipid layer by using a surfactant-enriched lens surface to retain moisture and shape throughout the day. In September, Biotrue ONEday was recognized by R&D Magazine as one of the 100 most technologically significant products introduced into the marketplace over the past year.

New App Helps ECPs Educate Patients About UV Protection for Eyes
To help eyecare professionals educate patients about the causes and effects of UV exposure and steps they can take to help protect their eyes from harmful UV rays, The Vision Care Institute, LLC (TVCI), part of the Johnson & Johnson Family of Companies, has launched a new educational resource The Vision Care Institute UV Protection App.

Practitioners and office staff can use this helpful resource during patient evaluations and follow-up communications to demonstrate:

  • Who needs protection
  • The cumulative effects of UV rays on the eyes
  • The impact of environmental exposure to the eyes throughout the day
  • Steps to take to help protect eyes from harmful UV radiation

The Vision Care Institute UV Protection App is free and was designed specifically for use with the iPad. It can be downloaded via the Apple App Store. It is not intended as, and does not constitute medical or optometric advice. It is only available in the U.S. App Store at this time.

GSLS Papers and Posters Submissions Due August 31
Plan now to attend the Global Specialty Lens Symposium to be held January 22 – 25, 2015 at Bally's 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.

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 for more information. Web submissions only. Deadline for submissions is August 31, 2014.

B+L Recall of Muro 128 5% Eye Ointment
Some recent news stories reported on an ongoing recall of close to 850,000 tubes of Bausch + Lomb’s Muro 128 5% Ointment (Sodium Chloride Hypertonicity Ophthalmic Ointment, 5%) related to crystallization with crystal precipitate formation and an increase in the number of complaints associated with a gritty, sand-like feeling in the eye. The OTC product is intended for temporary nighttime relief for individuals suffering from corneal edema.

The Wall Street Journal reports1 that B+L voluntarily initiated the recall earlier this year. The same article states that B+L said affected products may have been exposed to freezing temperatures after leaving company-owned facilities and that freezing temperatures can cause the crystal formations in the salt-based product. Boxes containing the tubes carry a "do not freeze" label.

In a recall notice sent to retailers and distributors on May 30, 2014,2 the company stated it was recalling the product in the interest of public safety due to the increase in the number of complaints related to crystal precipitate formation.

The FDA classified this as a Class II recall:3 a situation in which use of or exposure to a violative product may cause temporary or medically reversible adverse health consequences or where the probability of serious adverse health consequences is remote. Further details on lot numbers can be found in the Enforcement Report posted on the FDA website.3

1. Accessed July 10, 2014.
2. Accessed July 10, 2014.
3. Accessed July 10, 2014.

Coyle Re-Elected ASCO President, New Board Members Welcomed
Pacific University College of Optometry dean Jennifer Coyle, OD, MS has been elected for a second term as president of the Association of Schools and Colleges of Optometry (ASCO). Dr. Coyle continues to lead the association comprised of 21 schools and colleges of optometry in the 50 states and Puerto Rico.

Additional elected officers to the Board of Directors are: President-Elect Dr. Richard Phillips, President, Southern College of Optometry; Immediate Past-President Dr. David Heath, President, State University of New York, State College of Optometry; Secretary-Treasurer Dr. Joseph A. Bonanno, Dean, Indiana University, School of Optometry; and At-Large Member Dr. Elizabeth Hoppe, Founding Dean, Western University of Health Sciences.

ASCO also welcomed new Directors to the Board. They are: Dr. John Flanagan, Dean, University of California at Berkeley, School of Optometry; Dr. Lori Grover, Dean, Salus University - Pennsylvania College of Optometry; Dr. Kelly Nichols, Dean, University of Alabama at Birmingham; Dr. Timothy Wingert, Dean, University of The Incarnate Word Rosenberg School of Optometry; and Dr. Joseph Zinkovich, Acting Associate Dean, MCPHS University, School of Optometry.

Minnesota Optometrist Receives Dr. W. David Sullins, Jr. InfantSEE Award
Dr. Mary Gregory is this year’s recipient of the Dr. W. David Sullins, Jr. InfantSEE Award. The award is presented to a practitioner who goes above and beyond for the InfantSEE program, which, thanks to volunteer American Optometric Association (AOA) optometrists, provides no-cost comprehensive eye and vision assessments for infants within the first year of life. InfantSEE is a public health program managed by Optometry Cares - The AOA Foundation.

Dr. Gregory is a driving force behind the Minnesota Optometric Association’s (MOA) strong participation in InfantSEE, ranking it in the top five states for the program. Of Minnesota’s 641 InfantSEE assessments in 2013, Dr. Gregory provided 82 of those exams. She chairs the MOA’s Children’s Vision Committee, has designed several InfantSEE recruitment programs for the MOA and has made her voice heard in legislative efforts for quality early childhood eye care. She also recruits doctors to participate and put together a kit for her colleagues to use to promote early childhood eye care.

To help families and educators understand the importance of children’s eye care, Dr. Gregory works tirelessly to promote the InfantSEE program to the community. She serves as a media spokesperson for the program and volunteers her time speaking to parents and teachers at local schools about children’s eye care.

Attempted Re-epithelialization in Acanthamoeba Keratitis Patient
Ian G. Sim, B.Optom (UNSW), Perth, Australia

This case involves a young male orthokeratology patient who, having rinsed his lenses in tap water as per the GP lens cleaner instruction sheet, missed proper disinfection. Some apparent epithelial compromise led to Acanthamoeba keratitis. This image, taken approximately two years post initial diagnosis, shows inferior arcuate tissue after two amniotic membranes were used in an attempt to re-epithelialize. Image shows poor epithelial coverage generally, descemetocele and gross neovascularization. Eye was eviscerated a few weeks later.

Although AK is a rare disease, it can be devastating, as in this case.

We thank Ian Sim 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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S. Barry Eiden, OD, FAAO

Assessing the Influence of Contact Lens Wear in the Digital World… It’s a Different View

A review of research articles was conducted to synthesize the knowledge about ocular and visual alterations related with computer use in contact lens wearers.1 An International review of scientific papers (2003-2013) was conducted using Scoping Review method, in Medline through PubMed and in Scopus. All of them revealed that symptoms when using computer are more prevalent in contact lens wearers, with values of symptoms presentation prevalence ranging from 95.0% to 16.9% in wearers and from 57.5% to 9.9% in non-wearers, and with wearers four times more likely to develop dry eye [OR: 4.07 (95% CI: 3.52 to 4.71)]. The researchers concluded that computer workers suffer more ocular and visual disturbances if they also are contact lens users, however the number of studies pertaining this topic in the literature were quite few in number (The initial search provided 114 references, after applying inclusion/exclusion criteria only six studies were included in this review). As such, they stated that further research regarding contact lens type and their conditions of use, both in symptoms and tear quality and ocular surface are needed.

The world that we live in is changing at an exponential rate. It was only seven years ago that the first iPhone was released and now a significant percentage of our patients spend extended time using digital hand held devices. When we add that to the majority of our patients who utilize computers each and every day, we quickly realize that their visual demands are quite different from traditional near centered reading and writing tasks of a few decades ago. The influence of these digital devices has also impacted contact lens performance in numerous ways including both visual performance and contact lens wearing comfort resulting in symptoms of dryness, blurred vision, eye strain, and delayed focus.2 A major contributor to these contact lens related performance deficits is a significant decrease in the blink rate found while utilizing digital devices. Average blink rates can be reduced by as much as 2/3 while utilizing these devices. It is imperative that technologies are developed that can address contact lens performance and ocular surface challenges while utilizing digital devices. Industry is well aware of this problem and has already taken steps to directly address it; however we still have a way to go!

1. Tauste Francés A, Ronda-Pérez E, Seguí Crespo Mdel M. Ocular and visual alterations in computer workers contact lens wearers: scoping review. Rev Esp Salud Publica. 2014 Apr;88(2):203-15. [Article in Spanish]
2. American Optometric Association. Computer Vision Syndrome Symptoms. Accessed October 15, 2012.

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Katherine M. Mastrota, MS, OD, FAAO
Etiology of Discomfort in Patients with Conjunctivochalasis

The most frequent subjective symptoms of patients with conjunctivochalasis are irritation and lacrimation.1 In all likelihood the mechanism for these symptoms is multifold: a recent interesting study may shed light on the etiology of discomfort in patients with conjunctivochalasis. The aim of this study was to map the sensitivity of the marginal and other conjunctival regions and to investigate changes in the sensitivity of these regions when determined in the morning and evening.2 Mechanical sensitivity was measured at 8 locations on the ocular surface and adnexa (cornea, marginal, bulbar, and tarsal conjunctiva) using a Cochet-Bonnet esthesiometer. The cornea was found to be the most sensitive region. The marginal conjunctiva showed greater sensitivity than did the bulbar and tarsal conjunctiva. The temporal marginal conjunctiva was more sensitive than the central marginal conjunctiva. There was no significant difference in the sensitivity determined in the morning and the evening for any of the locations investigated. Certainly this information proves useful in understanding the complex clinical signs and symptoms in dry eye and ocular surface disease.

1. Yokoi N, Komuro A, Nishii M, Inagaki K, Tanioka H, Kawasaki S, Kinoshita S. Clinical impact of conjunctivochalasis on the ocular surface. Cornea. 2005 Nov;24(8 Suppl):S24-S31.
2. Navascues-Cornago M, Maldonado-Codina C, Morgan PB. Mechanical Sensitivity of the Human Conjunctiva. Cornea. 2014 Jun 9. [Epub ahead of print]

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Developments in the Correction of Presbyopia I: Spectacle and Contact Lenses
This article outlines the refractive problems associated with presbyopia and reviews the basis and relative merits of currently-available methods for their correction, with detailed consideration of spectacle and contact lens approaches.

In the developed world, most of the present population will spend roughly half their lives as presbyopes. The well-known presbyopic changes with age in amplitude of accommodation and required near addition are briefly reviewed, together with the less widely acknowledged slow drifts that occur in distance refraction. The desirability of restoring to presbyopes clear vision for objects at any distance, ideally corresponding to vergences within the range of at least 0 to -5 D, in any viewing direction, is stressed. A general outline is given of possible corrective methods. Methods which satisfy the needs of a 50 year-old may not be suitable for the 80 year-old. Corrections may involve both fixed- and variable-focus lens systems, and surgical methods which modify the optics of the cornea, replace the crystalline lens with different fixed optics, or attempt to at least partially restore active accommodation. Some more recent methods of spectacle and contact lens correction are described in more detail. Particular attention is given to recent commercially-developed spectacles in which the corrective power can be varied actively by either mechanical (liquid-filled deformable lenses or Alvarez lenses) or electrical (liquid crystal lenses) means to allow objects at different distances to be seen clearly. Contact lens corrections show less progress and are still preferred only by a minority of older patients, most of whom are early presbyopes.

In summary, the rising proportion of presbyopes in the population, covering an age span of around 40 years, represents both a problem for those concerned with giving their patients the best vision possible at both far and near viewing distances and a commercial opportunity. Traditional single-vision distance and near, bifocal, and progressive spectacle lens solutions, together with contact lens modalities for presbyopic correction, are being challenged by a variety of new approaches. It remains to be seen whether the latter will receive wide acceptance in practice.

Charman WN. Developments in the correction of presbyopia I: spectacle and contact lenses. Ophthalmic Physiol Opt. 2014 Jan;34(1):8-29. Epub 2013 Nov 10.

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