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Sunday, July 28, 2013  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

It seems like most public restrooms (also called "toilets" in other parts of the world) have some display of an important and perhaps overlooked practice that says "Please Wash Your Hands." This is true in even the finest and most elegant establishments. Stop and think about it for a minute. A practice that should be inherently taught from parent to child needs to be displayed as such and I don't disagree. The reason why I stopped to think about it is because I believe we often don't provide such messages to our patients, who may not have been taught hygienic contact lens practices from an early age. We all need to be steadfast in promoting healthy behaviors for successful contact lens wear.

CooperVision Appoints Sedgwick Executive Vice President

CooperVision, Inc. announced that it has recently appointed Andrew Sedgwick to the new role of executive vice president of Commercial Strategy and Business Development.

In this role, Sedgwick will be responsible for CooperVision's long range strategic plan, product life cycle management, business development and professional services. He has considerable experience as an executive working in a variety of different positions within the company. Most recently, Mr. Sedgwick served as the president of the Americas for CooperVision.

ABB Optical Group Enhances Their Patient Retention Program

ABB Optical Group has added two new annual supply sales aids to help their customers add value to their practice by driving more annual supply sales of soft contact lenses. These improved personalized communication tools help practices retain their patients by illustrating the value of purchasing an annual supply through their trusted eyecare professional.

The new Annual Supply Product Sheets are for individual soft contact lens product that can be updated with a practice's annual supply pricing. Practices will have the ability to print individual sheets for the products that they fit most often. Utilizing these sheets with manufacturer rebates, new fit/refit rebates and insurance benefits will help illustrate the cost savings with an annual supply.

The new Annual Supply Patient Savings Tool is fully customizable and can illustrate four, six, or nine products on a single sided sales aid. Double sided versions are also available to have price comparisons on more products. Once developed for a practice, it can easily be updated with pricing or rebate adjustments as needed.

Accounts can order their customizable annual supply tools directly from their ABB Optical Group sales representative. The sales representatives have been fully trained to show a practitioners' office staff how to go about presenting annual supplies of contact lenses, and can also work with the office to develop a plan for increasing annual supply business by utilizing all of the tools that the ABB Optical Group Patient Retention Program provides.

Registration Now Open for 25 CEs - December in Orlando
Plan now to attend the Optometric Management Symposium on Contemporary Eye Care, December 6-8, 2013 at Disney's Contemporary Resort in Lake Buena Vista, Florida. This popular annual symposium provides the perfect balance of timely, disease management courses and practice-building courses with plentiful networking and leisure time to enjoy all that Disney resorts and theme parks have to offer.

The educational program is presented by the Pennsylvania College of Optometry, Salus University. For agenda, more information and to register visit www.OMConference.com.
AAO Announces 2013 Award Recipients

Each year the American Academy of Optometry (AAO) recognizes distinguished individuals who have made countless contributions to advancing the profession of optometry. The Academy is pleased to announce the 2013 award recipients:

  • Gordon E. Legge, PhD, Charles F. Prentice Medal and Lecture Award
  • David B. Elliott, PhD, MCOptom, FAAO, Glenn A. Fry Award and Lecture (American Optometric Foundation Award)
  • Pete Kollbaum, OD, PhD, FAAO, Irvin M. and Beatrice Borish Award
  • George Woo, OD, PhD, FAAO, AAO-Essilor Award for Outstanding International Contributions to Optometry
  • Sandra Block, OD, MEd, FAAO, Carel C. Koch Memorial Award
  • Krystal L. Schulle, OD, Julius F. Neumueller Award in Optics (American Optometric Foundation Award)
  • Murray Fingeret, OD, FAAO, Vincent Ellerbrock Clinician Educator Award
  • Louis J. Catania, OD, FAAO, Eminent Service Award
  • Anthony P. Cullen, OD, PhD, FAAO and Michael G. Harris, OD, JD, FAAO, Life Fellow Award
  • Padmaja Sankaridurg, BOptom, MIP, PhD; Leslie Donovan, BOptom; Saulius Varnas, PhD; Arthur Ho, PhD, FAAO; Xiang Chen, MS; Aldo Martinez, PhD, FAAO; Scott Fisher, BScPsych; Zhi Lin, MSc; Earl L. Smith, III, OD, PhD, FAAO; Jian Ge, MD; and Brien A. Holden, PhD, DSc, FAAO, Garland W. Clay Award
  • Barbara Junghans, BOptom, PhD, FAAO, Michael G. Harris Award for Excellence in Optometric Education (American Optometric Foundation Award)
Awards of the Section on Cornea, Contact Lenses & Refractive Technologies
  • Lyndon W. Jones, PhD, FCOptom, FAAO, Max Schapero Memorial Lecture Award
  • Pat Caroline, FAAO, Mark P. Andre, FAAO, and Craig Norman, Founders' Award
Award winners will be recognized at the Academy 2013 Seattle Awards Ceremony on Friday, October 25, 8:00-10:00 AM, in Room 4E of the Washington State Convention Center, and at 5:00 PM, in Room 4C 3-4 after the Section on Cornea, Contact Lenses & Refractive Technologies Symposium.

ASCO Holds the 5th Summer Institute for Faculty Development Program

The Association of Schools and Colleges of Optometry (ASCO) held its 5th Summer Institute for Faculty Development Program (SIFD) July 14-17, 2013 in St. Louis, Missouri.

This year's program was comprised of 47 colleagues, from 20 schools and colleges of optometry and two affiliate schools, who have been full time faculty members for 16 years or less. The SIFD was kick-started by Dr. Charles Haine, EMRlogic Systems, who gave an empowering keynote address. The following three days, participants attended educational workshops in the areas of teaching and learning, scholarship, and academic culture. Each attendee developed long-term career plans with specific goals, objectives and action strategies and was mentored in this process by the program faculty. Participants also networked with their peers, as well as with sponsors to learn of their latest products and services available to the industry.

The SIFD builds on ASCO's major initiative, addressing its strategic priority of "Faculty Promotion and Development." SIFD attendees return to their institutions excited and rejuvenated to implement real solutions and new ideas to use immediately.

ASCO wishes to thank Alcon, Essilor, Luxottica, Vistakon, the National Board of Examiners in Optometry, and Allergan for their contributions to the program.

For more information regarding ASCO and its programs, please visit www.opted.org.

The subject of last week's Editor's Commentary was the importance of the fit of a standard soft contact lens in terms of the ultimate the success of a contact lens wearing patient relative to the fact that most mass produced soft lenses are designed so as to fit the vast majority of the population. We received several comments from our readers on this. In the next couple of issues we will share some of the comments that we received.

Though this "data on file" exists and prelaunch studies help refine fitting nomograms there is more to the story practitioners should consider. Manufacturers attempt to maximize efficiency by using this information to help to establish how production resources should be allocated, which "SKUs" should be stocked and which parameters improve practitioner success. This inevitably results in a small, finite number of patients who fall through the cracks. Multiple studies on contact lens drop-out rates would seem to indicate retention of every patient matters. But to borrow an old adage, "it is a poor carpenter who blames his tools."

Add to this the continued commoditization of contact lenses as a consumer product, the vertical integration of third party providers to include contact lens distribution channels, 1-800 suppliers, "big box" stores and the looming specter of DIY (do it yourself) kiosk dispensing and it behooves practitioners to think about the services they deliver more than ever before. There is nothing wrong with being an average provider (most of us are), but if you want to distinguish yourself to your patients and within the community you serve, more is required. It behooves today's practitioner to spend time learning the nuances and differences between products as well as the evidence-based reasons to select one product over another when addressing a specific patient's needs. It is all too easy to become complacent and fall into the mental trap of believing anyone can fit a soft lens (a refrain I have heard from some very respectable folks within academia). This is perhaps a downside to the evolution in polymers and manufacturing technology. But we need only think about SICS and the relatively unchanged rates of microbial keratitis as an argument against this fuzzy thinking.

I would respectfully suggest we as contact lens practitioners should constantly be pushing ourselves to acquire knowledge, skills, and include specialty lens fits into our practices. In doing so, we serve the needs of our patients, enhance their lifestyles, contribute to product development, secure our future as a profession and demonstrate a level of professionalism which cannot be commoditized. This argument is not unique to the contact lens domain and assumes increasing importance as the profession reviews the outcomes of the joint AOA/ASCO task force study on manpower.

Daniel G. Fuller, OD
Chief, Cornea Contact Lens Service
The Eye Center, Southern College of Optometry

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Ronald K. Watanabe, OD, FAAO

Water and Contact Lenses – a Bad Combination?

It's summer and really hot up here in New England. When it's hot, people gravitate towards water: pools, lakes, rivers, oceans, or even the backyard sprinklers. It's a time when we should educate our patients even more than usual about the potential dangers of wearing their contact lenses when playing in the water. In particular, Acanthamoeba keratitis (AK) is especially worrisome, even though it is rare. The CDC reported that about 85% of AK cases occurred in contact lens wearers1 and that poor contact lens hygiene was the greatest risk factor for infection. A recent review concluded that soft lens wear has a positive association with AK with an odds ratio of 10.21 across several studies.2

Acanthamoeba attachment to soft lenses is material dependent, with the highest accumulation on first generation silicone hydrogels. However, Acanthamoeba attachment on HEMA and second-generation SiHy lenses was also enhanced if the lenses were worn or if they also had bacterial biofilms attached.3

The bottom line is that soft lens wear during water activities increases the risk of microbial keratitis, just as showering, using tap water, and topping off do. Educating patients to use daily disposables or to properly clean and disinfect their lenses after water activities is important, especially at this time of year. Enjoy the water!

1. Brown AC. Shedding new light on a potentially blinding eye infection. http://www.medscape.com/viewarticle/769679_print (Accessed 9/6/12).
2. Pacella E, LaTorre G, DeGiusti M, et al. Results of case-control studies support the association between contact lens use and Acanthamoeba keratitis. Clin Ophthalmol. 2013; 7: 991-994.
3. Beattie TK, Tomlinson A, McFadyen AK. Attachment of Acanthamoeba to first- and second-generation silicone hydrogel contact lenses. Ophthalmol. 2006; 113(1): 117-125.

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

Anti-VEGF Agents for Corneal Neovascularization

Vascular endothelial growth factors (VEGFs) regulate blood and lymphatic vessel development. Anti-VEGF agents have proven extremely valuable in the treatment of retinal conditions such as neovascular age-related macular degeneration and diabetic retinopathy. Recent studies in animal models and humans suggest that VEGF inhibition may be an effective therapeutic modality for corneal neovascularization as well.

Animal models are able to demonstrate that topical or sub-conjunctival administration of ranibizumab (Lucentis) or bevacizumab (Avastin) seem to be promising and effective medications in the treatment of corneal neovascularization. Topical and subconjunctival ranibizumab treatment was assessed in an experimental corneal neovascularization model in rats. The percentage of the corneal neovascularization area and number of vessels in all treatment groups were found to be significantly lower than the control group.1 Similarly others have evaluated and compared the inhibitory effects of topical and subconjunctival bevacizumab on corneal neovascularization in a rat model where histologically, each treatment group had fewer vessels than the control group.2

In humans, off label use of topical ranibizumab and bevacizumab in the treatment of corneal neovascularization has also been studied. Koenig et al showed that off-label topical bevacizumab therapy against corneal neovascularization was generally well-tolerated for up to 12 months. Bevacizumab eye drops inhibited corneal neovascularization, and lead to a reduction of the vessel diameter.3 Stevenson et al have also shown that both ranibizumab and bevacizumab demonstrated clinical utility in the control of corneal neovascularization.4

The findings clearly indicate that ranibizumab and bevacizumab are promising and effective future treatments for corneal neovascularization when appropriate precautions are observed. More on this topic in an upcoming Research Review in Contact Lens Spectrum.

1. Türkcü FM, Cinar Y, Türkcü G, Sahin A, Cingü AK, Yüksel H, Sahin M, Yildirim A, Caça I. Topical and subconjunctival ranibizumab (Lucentis) for corneal neovascularization in experimental rat model. Cutan Ocul Toxicol. 2013 Jul 17. [Epub ahead of print]
2. Öner V, Küçükerdönmez C, Akova YA, Çolak A, Karalezli A. Topical and subconjunctival bevacizumab for corneal neovascularization in an experimental rat model. Ophthalmic Res. 2012;48(3):118-23.
3. Koenig Y, Bock F, Horn F, Kruse F, Straub K, Cursiefen C. Short- and long-term safety profile and efficacy of topical bevacizumab (Avastin) eye drops against corneal neovascularization. Graefes Arch Clin Exp Ophthalmol. 2009 Oct;247(10):1375-82.
4. Stevenson W, Cheng SF, Dastjerdi MH, Ferrari G, Dana R. Corneal neovascularization and the utility of topical VEGF inhibition: ranibizumab (Lucentis) vs. bevacizumab (Avastin). Ocul Surf. 2012 Apr;10(2):67-83.

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Eye-Blink Behaviors in 71 Species of Primates

The present study was performed to investigate the associations between eye-blink behaviors and various other factors in primates. We video-recorded 141 individuals across 71 primate species and analyzed the blink rate, blink duration, and "isolated" blink ratio (i.e., blinks without eye or head movement) in relation to activity rhythms, habitat types, group size, and body size factors.

The results showed close relationships between three types of eye-blink measures and body size factors. All of these measures increased as a function of body weight. In addition, diurnal primates showed more blinks than nocturnal species even after controlling for body size factors. The most important findings were the relationships between eye-blink behaviors and social factors, e.g., group size. Among diurnal primates, only the blink rate was significantly correlated even after controlling for body size factors. The blink rate increased as the group size increased. Enlargement of the neocortex is strongly correlated with group size in primate species and considered strong evidence for the social brain hypothesis.

The researchers conclude that their results suggest that spontaneous eye-blinks have acquired a role in social communication, similar to grooming, to adapt to complex social living during primate evolution.

Tada H, Omori Y, Hirokawa K, Ohira H, Tomonaga M. Eye-Blink Behaviors in 71 Species of Primates. PLoS ONE. 2013 May 31;8(5):e66018. doi: 10.1371/journal.pone.0066018. Print 2013.

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Important Links:
To report adverse contact lens reactions visit: http://www.accessdata.fda.gov/scripts/medwatch/ or call (800) FDA-1088.
To report possible grievances related to the Fairness to Contact Lens Consumers Act or associated Contact Lens Rule visit: https://www.ftccomplaintassistant.gov/.

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