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Sunday, July 22, 2012  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

It's important to consider the impact of technology on the growth of a market, or segments of it. Sometimes it's obvious—think of the way that Apple, for example, has developed technologies that changed the way the world thinks of a cell phone. Other times, it may not be so obvious. For example, have silicone hydrogel materials changed the contact lens market? Have these materials grown number of lens wearers? Or, have these materials made contact lens wear safer? I am sure many of our readers have thoughts on this, and we would love to hear from you on this topic. Please send us your thoughts at cltoday@wolterskluwer.com.

Optometric Workforce Study Survey Launched

The American Optometric Association (AOA) and the Association of Schools and Colleges of Optometry (ASCO) announced they have distributed via mail a survey to more than 4,000 optometrists across the nation to capture optometric workforce trends. Respondents will have a choice to mail the survey or to complete it online.

Once the surveys are completed, The Lewin Group will create a comprehensive model of supply and demand for eye and vision care in the United States. Government entities, health care organizations, as well the profession, will be able to use this information in establishing public and private sector health care policy over the coming decades, according to the AOA/ASCO Joint Workforce Study Project Team.

A first-of-its-kind comprehensive database of all practicing eye care providers in the United States will also be developed in conjunction with the study.

A multidisciplinary team, consisting of an economist, a public health researcher, a statistician, a software developer and several policy analysts has been assembled to work on the project. The Lewin Group has also been consulting with the AOA/ASCO Joint Workforce Study Project Team and a panel of 10 experts with professional backgrounds both in and outside of optometry.

The study is to be completed by the end of 2012 and the database of practicing U.S. eye care providers is to be completed about the same time.

The study is underwritten by generous grants from Alcon, Essilor, Hoya, Luxottica, TLC Vision, Transitions, and Vistakon. Additional information on the study will be posted on the AOA Web site (www.aoa.org).

Heart of America Announces Meeting Dates

The 52nd Annual Heart of America Contact Lens Society Contact Lens and Primary Care Congress will be held February 15-17, 2013 at the Sheraton Kansas City Hotel and Crown Center in Kansas City, Missouri. After over 50 years in existence, the Congress has proven to be a premier optometric meeting in the Midwest. The convenient Midwest location allows attendees access to valuable continuing education, while the exhibit hall provides an opportunity to browse the latest ophthalmic products and technology.

Contact Dr. Steve Smith for registration information at registration@thehoacls.org or visit the organization's website: www.hoacls.org.

Phase 3 Clinical Trial Initiated to Evaluate Rebamipide Ophthalmic Suspension in Patients with Dry Eye

Acucela Inc., a clinical stage biotechnology company focused on developing new treatments for blinding eye diseases, and Otsuka Pharmaceutical Co., Ltd., announced the initiation of a Phase 3 clinical trial to evaluate rebamipide ophthalmic suspension in patients with dry eye syndrome.

Rebamipide ophthalmic suspension is a novel compound discovered by Otsuka Pharmaceutical and reportedly has a new mechanism of action to increase the level of mucin in the tear film covering the conjunctiva and cornea. In January 2012, the drug was launched for the treatment of dry eye syndrome in Japan as Mucosta ophthalmic suspension UD2%.

This Phase 3 clinical study will be a multi-center, randomized, placebo-controlled, double-masked, parallel-group study. Approximately 560 subjects are planned to be enrolled equally into the two treatment groups and the study is expected to be completed by the end of 2013.

Global Market for Artificial Tears to Exceed $2 Billion by 2018

Global Industry Analysts, Inc., publisher of off-the-shelf market research, released a global report on artificial tears markets, "Artificial Tears: A Global Strategic Business Report." Propelled by growth drivers such as aging population, prevalence of auto-immune diseases, pollution and low pricing, the market for artificial tears is projected to cross U.S. $2.0 billion by 2018.

The United States represents a major market for dry eye solutions, commanding a sizeable share of the global artificial tears market, as stated by the report. In terms of market potential, the Asian market is primed to grow at a compound average growth rate of about 14% through 2018. Sales of OTC ophthalmic products are witnessing an aggressive increase in the developing Asian market, with its huge population base, rising income levels and under-penetrated market potential, positioning the region as an attractive manufacturing hub.

J&J Vision Care to Sponsor Free Vision Evaluations at NUL Conference

Johnson & Johnson Vision Care, Inc. will sponsor programs for free vision evaluations and patient education to attendees of the National Urban League (NUL) conference in New Orleans, July 25-28. The conference is a national forum that helps create solutions to the challenges confronting African Americans and urban communities.

Vision problems can disproportionately affect certain ethnic groups. However, according to a 2006 survey1 of 676 African Americans, almost all (92%) surveyed agreed that maintaining proper vision is an important priority for them, but less than half (47%) said they had an eye exam within the past year, while a quarter (24%) had not had an eye exam in more than two years. Nearly one-third (30%) said their child has never seen an eyecare professional.

The on-site evaluations will be lead by local optometrists. Following the evaluation, a doctor will review the results with each individual and provide educational materials. Those who may have additional medical or optometry needs uncovered in the evaluations, will have the opportunity for further assistance by Daughters of Charity Health Centers, a New Orleans organization.

1. Americans' Attitudes and Perceptions About Vision Care, conducted in 2006 by Harris Interactive on behalf of The Vision Care Institute, Division of Johnson & Johnson Vision Care, Inc.

Reticular Sub-Epithelial Haze Post PRK
By Gregory W. DeNaeyer, OD

A 45-year-old female patient presented for refractive surgery evaluation. She previously wore GP lenses and manifest refraction resulted in -5.75 -0.75 × 105 20/30 and -5.25 -0.75 × 154 20/30 in the right and left eyes respectively. She had been diagnosed with epithelial basement membrane dystrophy (EBMD) and had a history of multiple recurrent corneal erosions. Topographies showed mild orthogonal with-the-rule astigmatism, and pachymetry readings were 508 OD and 501 OS. PRK treatment was recommended rather than LASIK because of her EBMD and relatively thin corneas.

She underwent PRK in both eyes on separate surgery dates one week apart. Unfortunately, she slowly developed sub-epithelial haze (see image) and regression of her myopia in both eyes despite aggressive treatment with topical steroids. An attempt to scrape the sub-epithelial scarring and application of mitomycin in her left eye three years post-operatively failed to reduce the haze. Eight years after PRK her refraction is OD -4.75 DS 20/25 and OS -6.25 DS. The patient was successfully refitted into GP contact lenses and is satisfied with the vision they provide.

For more on this patient and sub-epithelial haze, see http://www.clspectrum.com/articleviewer.aspx?articleID=102352.

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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Ronald K. Watanabe, OD, FAAO

Protein Deposition and Lens Materials

Protein deposition can be a significant problem for contact lens wearers. It can cause symptoms of discomfort, dryness and blur, as well as induce physiological changes to the eye. A recent review1 on contact lens protein deposition discusses the current state of hydrogels as well as future possibilities for better materials.

We all know that traditional hydrogel materials with higher water contents and ionic surfaces tend to deposit more readily with proteins. We also know that silicone hydrogel (SiHy) materials overall deposit less with proteins than their traditional hydrogel counterparts. These are good properties to know when trying to manage a patient who is having a protein related problem.

Looking to the future, new ideas for more protein resistant contact lenses include various materials surface coated with phosphorylcholine or polyethylene oxide, and polymers cross-linked with hyaluronic acid. Other compounds combined with current polymers or used as surface treatments also showed promise for lower amounts of protein accumulation.

By continuing to develop novel lens materials and designs, the contact lens industry aims to develop more comfortable and biocompatible options for our patients to hopefully increase lens performance while decreasing complications and drop-outs.

1. Luensmann D, Jones L. Protein deposition on contact lenses: The past, the present, and the future. Cont Lens Anterior Eye. 2012 Apr;35(2):53-64.

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

Care Solutions' Efficacy Against Fusarium Biofilms

The elimination of fungal keratitis associated with contact lens wear is still on the minds of eyecare practitioners and manufacturers alike. To that end, independent research groups are still studying fungal strains from the Fusarium epidemic and methods to eradicate their ability to cause keratitis. A recently published paper in Optometry and Vision Science investigated two common strains of fungal biofilms and efficacy of common care solutions against them.

Unfortunately, both strains formed dense biofilms on all the lens types tested (lotrafilcon A, balafilcon A, and etafilcon A) and lens type or wear did not alter quantity or activity of biofilm formation. Fortunately, both hydrogen peroxide care systems tested were efficacious against biofilms of both Fusarium solani and Fusarium oxysporum strains. Only one MPS care product was efficacious against both strains.

Manufacturers should strive to seek MPS care products that meet the efficacy of hydrogen peroxide care systems. This study did not assess any of the dual preserved products that are on the market today. If they met such standards they would be good substitutions for peroxide care systems in this regard and ongoing work in this area is needed.

Retuerto MA, Szczotka-Flynn L, Ho D, Mukherjee P, Ghannoum MA. Efficacy of care solutions against contact lens-associated Fusarium biofilms. Optom Vis Sci. 2012 Apr;89(4):382-91.

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Comparison of Tear Osmolarity and Ocular Comfort Between Daily Disposable Contact Lenses

The aim of this study was to evaluate tear osmolarity and ocular comfort with two different types of hydrogel daily disposable lenses.

The right eyes of 15 first-time contact lens users were included in this prospective study. All eyes wore hilafilcon B hydrogel contact lenses for 8 hours (group 1). After 1 week without contact lenses, all eyes wore narafilcon A silicone hydrogel contact lenses for 8 hours (group 2). Tear osmolarity measurement was performed before and after 4 and 8 hours of each contact lens wear. Ocular comfort was assessed after 4 and 8 hours of each contact lens wear.

In group 1, the mean baseline, 4- and 8-hour tear osmolarity values were 293 +/- 10.57, 303.00 +/- 10.5 mOsm/L (p = 0.023), and 295.0 +/- 1.4 mOsm/L (p > 0.05), respectively. In group 2, the mean baseline, 4- and 8-hour tear osmolarity values were 294 +/- 13.65, 300.9 +/- 11.3 mOsm/L (p = 0.007), and 298.80 +/- 7.2 mOsm/L (p > 0.05), respectively. In group 1, the mean comfort score was 7.20 +/- 0.45 and 8.60 +/- 0.45 at 4 and 8 hours, respectively (p = 0.038). In group 2, the mean comfort score significantly decreased from 9.80 +/- 0.45 to 7.80 +/- 0.84 at 4 hours (p = 0.039). Both hydrogel and silicone hydrogel daily disposable contact lenses elevated tear osmolarity during 8 hours of contact lens wear. The increase in tear osmolarity with both contact lenses was below the cut-off value for dry eye and was not associated with ocular comfort.

Sarac O, Gurdal C, Bostanci-Ceran B, Can I. Comparison of tear osmolarity and ocular comfort between daily disposable contact lenses: hilafilcon B hydrogel versus narafilcon A silicone hydrogel. Int Ophthalmol. 2012 Jun;32(3):229-33.

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