CONTACT LENSES TODAY

July 22, 2007

Contact Lenses Today® is edited by Carla Mack and the staff of Contact Lens Spectrum. This week CLToday® reaches more than 12,000 readers in 74 countries.


1-800 Offers New Billing Option
Contact lens retailer, 1-800-CONTACTS now offers patients a Bill Me Later option, through 14 Commerce. Bill Me Later is a secure way for patients to pay for purchases without providing credit card information. It also offers a flexible financing option, through which customers make no payments for 90 days.

Alcon Appoints CFO, Makes Offer for Wavelight AG & Announces Study Results
Alcon Inc. announced the appointment of Richard Croarkin to the position of senior vice president and chief financial officer, effective August 1. Mr. Croarkin comes to Alcon from Nestle, where he served as executive vice president finance and chief financial officer of Nestle Waters North America.
     The company also announced its plans to acquire Wavelight AG through a friendly takeover and that the parties have entered into a business combination agreement. Wavelight’s Executive Committee supports the transaction and will recommend acceptance for the offer to its shareholders. The parties intend for Max Reindl to continue as Wavelight’s Chairman of the Executive Committee. He will also be a member of an operating committee with Alcon management in the development of the integration plans.
     The three-month interim results of Alcon’s clinical study of anecortave administered as an anterior juxtascleral depot in the sub-Tenon’s space to reduce IOP in patients with open-angle glaucoma were presented at the World Glaucoma Congress in Singapore. In the proof-of-concept study, researchers randomly assigned 85 open-angle glaucoma patients to one of four arms: 3mg, 15mg or 30mg of anecortave acetate or control. All patients had experienced glaucomatous visual field changes and had off-therapy IOPs between 24- and 36mm Hg. IOPs were assessed after two weeks, six weeks and three months.
     On a combined basis, 38% of patients in the active arms were classified as treatment successes at three months, compared with 24% of controls. In the highest dose (30mg) 50% of patients were defined a treatment successes at three month. The mean IOP reduction in the active arms of the study at three months was 7.2mm Hg, versus 1.4mm Hg in controls. The mean IOP decline in the active arms was maintained at the three-month mark, while IOPs in the control group essentially returned to baseline. Mean IOP at month three declined 2% for the control arm, versus 15% for the 3mg arm, 16% for the 15mg arm and 19% for the 30mg arm. The most frequently reported adverse events included eye pain, foreign body sensation and blurred vision. The study will continue with full clinical assessments through the six-month period, with safety follow-up through the conclusion of the study.

FDA Approves AMO’s CustomVue Monovision Procedure
The U.S. Food and Drug Administration (FDA) has approved AMO’s Advanced CustomVue Monovision procedure, a wavefront-guided laser vision correction procedure for the visual correction of presbyopia, with or without astigmatism. AMO says the procedure is individualized for the unique corrections of presbyopic patients with low to moderate myopia, resulting in reduced dependency on reading glasses and contact lenses.
     The FDA based its approval on clinical data from a multi-center clinical trial involving 160 patients for up to two years. According to those results, 100% of patients achieved 20/40 or better vision at both distance and near, binocular correction of 20/40 or better and binocular uncorrected distance vision of 20/40 or better six months after treatment. In addition, over 96% decreased their use of corrective lenses. At the 12 month mark, more than 88% of patients achieved 20/20 or better uncorrected intermediate vision and 100% achieved 20/32 or better uncorrected intermediate vision. Finally, when asked if they would undergo the procedure again, more than 98% of patients said yes.

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Global Keratoconus Congress 2008
Contact Lens Spectrum and the LWW Health Care Conference Group will host the second Global Keratoconus Congress (GKC), January 25-27, 2008, at Bally’s Hotel and Casino in Las Vegas, NV. As with the 2007 meeting, the 2008 congress will include information for vision care professionals in all disciplines, with both surgical and non-surgical treatment options. GKC 2008 will also feature 15 new speakers providing hands-on workshops, strategies for irregular astigmatism and expert insights into fitting after surgery and corneal trauma. More than 500 participants attended the 2007 meeting, which was accredited for continuing education under COPE, NCLE and JCAHPO and offered 17.5 credit hours. Those interested in attending the 2008 Global Keratoconus Congress can visit www.GKCongress.com for more information or to register for this unique meeting. Companies interested in exhibiting should contact Heather Seasholtz at 215-643-8073.
     Additionally, the Educational Program Committee of the Global Keratoconus Congress invites the submission of abstracts for the Free Papers and Scientific Posters Competition to be held January 25-27, 2008 in Las Vegas. Papers and Posters related to keratoconus, corneal topography, post penetrating keratoplasty or related irregular corneal surface, gas permeable lens and lens care topics are welcome. Please visit http://www.GKCongress.com for information.

Topcon Launches New Website
Topcon Medical Systems has launched a new, interactive website, www.topconmedical.com, that offers customers new features and easier use. Additions include an internal search engine and a user-friendly visual interface for improved site navigation. All products are displayed as picture thumbnails, allowing users to click on each product. Topcon has also added video testimonials and digital brochures, trade articles and instruction manuals. An updated dealer locator includes a new zip code mapping feature and product literature can now be downloaded or printed directly from each product page.

Test for Horner Syndrome Causes Severe Lethargy in Infants
A study published in the June issue of the Journal of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) suggests use of apraclonidine to diagnose Horner Syndrome in infants can cause severe lethargy lasting up to 10 hours, requiring hospitalization and oxygen administration. The authors describe five cases of extreme drowsiness or unresponsiveness in infants under six months of age after administration of 1% apraclonidine eye drops. While no deaths or permanent injuries occurred, the authors recommend against using apraclonidine in infants. If apraclonidine must be used in children under six months of age, they say the patient should be monitored for at least two hours after instillation of the drops, with administration to a pediatric ward prompted by lethargy, bradycardia or a reduced respiratory rate. No problems were reported with use of this medication in older children or adults.

Abstract: Visual Impairment Linked to Increased Mortality Risk
A study published in this month’s Archives of Ophthalmology shows patients age 49 and older with cataract and those between the ages of 49 and 74 with AMD appear to have higher mortality rates over an 11-year period, versus those without visual impairments. Researchers at the University of Sydney, Australia assessed 3,654 individuals age 49 or older who were part of the Blue Mountain Eye Study, who enrolled between 1992 and 1994. After an average 11-year follow-up in December 2003, 1,051 participants (29%) died. Rates of death were higher among those with any visual impairment versus those without (54% vs. 34%), among those with AMD and those without (46% vs. 34%) and among those with cataract and those without (39% vs. 30%).
     After adjusting for factors that predict mortality, they found that neither AMD nor visual impairment was significantly associated with all-cause mortality in all ages. Among those younger than age 75, however, AMD predicted a higher all-cause mortality. Cataracts were also associated with a higher risk of death from any cause among patients of all ages. Investigators note that it’s not clear whether there is a direct or indirect link between visual impairment and death or if another factor not measured in this study affected the results.
Cugati S, Cumming RG, Smith W, Burlutsky G, Mitchell P, Wang JJ. Visual Impairment, Age-Related Macular Degeneration, Cataract, and Long-term Mortality: The Blue Mountain Eye Study. Arch Ophthalmol. 2007 Jul;125(7):917-24.


Editor's Commentary: Change is Good
First, I want to extend best wishes to Dr. Joe Barr in his new endeavor. I've had an amazing opportunity to work with and learn from Joe each day for the last eleven years at Ohio State and as clinical columns editor for Contact Lens Spectrum for the past two years. I've seen some strange expressions and perplexed reactions about his career move in the last month. Personally, I feel Dr. Barr's change in career from academia to industry will bring exciting results in the contact lens field.
     I cannot express enough gratitude for his guidance during this transition. As with Contact Lens Spectrum, the name of the editor may have changed, but both of these publications remain true to their missions. CLToday will continue to provide you complete, accurate, up-to-date news and clinically relevant information on the contact lens field. Please, send your thoughts, feedback and fitting tips to tips@cltoday.com. We always want to hear what our readers have to say.
Carla Mack, O.D., F.A.A.O.


Fitting Tip: PiggyBack for Keratoconus
I have been fitting keratoconic lenses for about 30 years. Since I started piggyback fitting four years ago, I have noted both an increase in comfort and a decrease in scarring in all my patients. I think it’s essential to protect the cornea from the GP lens.
     I’ve found that a silicone hydrogel lens with a low-plus power to be the best soft lens to use in these cases. Sometimes you can just slip one of these under a good keratoconus GP fit without changing the GP fit. Other times, you’ll need to refit the GP over the soft lens to achieve the best acuity for the patient. The patients always report increased comfort with no dust/debris getting under the GP and irritating the bare cornea as before.
C. Lee Mellinger, O.D.,
via e-mail.


This month at http://www.siliconehydrogels.org enter the topical discussion into the classification of silicone hydrogel lenses into specific categories. Follow the work of Dr Phil Morgan et al who have independently examined the oxygen permeability of current silicone hydrogel lenses using a new and repeatable technique, and read into the use of custom designed silicone hydrogel lenses.

Report adverse contact lens reactions here: http://www.accessdata.fda.gov/scripts/medwatch/ or call (800) FDA-1088.

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Visit Contact Lens Spectrum ( http://www.clspectrum.com ) for interactive clinical posters and issue archives. Visit Contact Lenses Today for our Best Fitting Tips.
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