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Sunday, August 4, 2013  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

Contact lens cases are regulated by the Food and Drug Administration (FDA) as medical devices, although the regulatory guidance that relates to lens cases goes back at least 15 years. As such, manufacturers are required to submit manufacturing and chemistry information on the lens case to the FDA in the regulatory submission. From time to time, I've seen some novelty cases being marketed, and while attractive or humorous, I've often wondered if they have actually been approved for use. If you have had any experiences with such lens cases, please let us know at cltoday@pentavisionmedia.com.

Achenbach Named SynergEyes Vice President of Professional Services

SynergEyes, Inc. has appointed Peg Achenbach, OD, FAAO, Vice President of Professional Services.

Dr. Achenbach will be responsible for representing SynergEyes to the ECP community, developing programs to capture the voices of various key opinion leaders and increasing the company's presence and support within the profession.

Prior to joining SynergEyes, Achenbach was Chief Medical and Academic Strategist at Contamac, Ltd. She also served as Senior Director of Professional and Medical Affairs at Vistakon and as Manager of Worldwide Clinical Research at Bausch + Lomb. Dr. Achenbach also spent 16 years in private practice in various group practices across the United States and in solo practice in New Jersey. She is a graduate of Pacific University College of Optometry.

Blanchard Offers Scleral Lens Education Program

Blanchard Contact Lens is expanding the geographical and seasonal availability of its Beyond The Limbus program, a rounded education seminar for those practitioners who fit or wish to fit scleral lenses. The program encompasses the Onefit P+A series and Onefit Cone series mini scleral design in addition to the msd mini scleral lens.

According to the company, the program's success is attributed to the field of skilled and experienced OD/Instructors presenting, combined with interactive patient fits and patient feedback, small groups, and hands on instruction.

Blanchard is currently hosting one-day seminars at the BCL Professional Development Center in Manchester, NH and has announced a schedule of one-day satellite seminars in Las Vegas, NV. Manchester events which still have space available will be held on October 5, 2013 and November 9, 2013. The event schedule for Las Vegas includes: October 12, 13, 2013; October 19, 20, 2013; January 18, 19, 2014; February 22, 23, 2014 and March 1, 2, 2014.

Those wishing to attend a Beyond The Limbus seminar should contact their Blanchard Sales Representative or National Sales Director Lee Buffalo at leembuffalo@aol.com to discuss availability. Space is limited and sessions fill up quickly.

GSLS Papers and Posters Submissions Due by August 31
Plan now to attend the Global Specialty Lens Symposium to be held January 23 – 26, 2014 at the Rio All Suites 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 www.GSLSymposium.com for more information. Web submissions only. Deadline for submissions is August 31, 2013.
BCLA Call for Workshops and Clinical Spotlights

The British Contact Lens Association (BCLA) is seeking submissions for workshops and clinical spotlights to be presented at its 2014 Clinical Conference and Exhibition, June 6-9 at the ICC Birmingham, UK. Submissions for both are due by Friday, September 20, 2013.

Clinical workshops, nowadays approved for up to three contact lens CET points, allow delegates to gain new practical skills in small groups under expert guidance. For 2014, the BCLA is looking to increase their availability and presenters will be rewarded the more times their workshop is filled and repeated. Presenters of accepted workshops will be required to submit additional CET information and full abstracts shortly after being notified of an acceptance, and should anticipate running their workshop twice.

Any workshop topic related to contact lenses and/or the anterior eye will be considered, and presenters will receive a £100 discount towards the cost of attending the conference for each workshop session presented, including repeats.

Groups or individuals are welcome to submit proposals for a two-hour clinical spotlight session on any topic relating to contact lenses and/or the anterior eye. Proposals should comprise one-and-a-half hours of CET presentations, followed by a 30-minute Q&A period. Successful applicants will receive a £100 discount for each speaker, which can be used towards their 2014 delegate fee.

Sessions relating to the following will be of particular interest:

  • RGP above core competence (suitable for newly qualified practitioners)
  • Presbyopia in practice
  • Co-management in refractive surgery, Lasik and CLE
  • Integrating the optometrist and contact lens optician roles
For further information on conference submissions, visit the BCLA website at www.bcla.org.uk. If you have any questions, contact BCLA Conference Programme Coordinator, Nick Rumney, by emailing conf-co@bcla.org.uk.

This week we are publishing more comments received in response to the July 21 Editor's Commentary which discussed 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.

In the 38 years I have been in the field of contact lens fitting, there has not been one manufacturer of contact lenses who could provide the one product that does fit all different shapes and sizes. The whole statistical approach is inadequate, to be polite.

When supplying contact lenses to the public, to provide an optimized fit, we sometimes have to find the eye to match the contact lens. The best chance for the right fit is that we must design the polynomial that the manufacturer can use to lathe the inside of the contact lens.

Clothing, socks, bras, shoes, etc. have many, many more sizes to match the demand per race, age and gender all over the globe. I have tried to bring the subject to the attention of the decision makers in contact lens manufacturing but have not seen any improvements so far in the range of product shapes and sizes.

The company that is willing to expand its pallet has a good chance to win over many more ECPs and through them the undecideds in the huge pool of customers.

Onno Rueck
Optician, Optometrist, Contact Lens Specialist
The Netherlands

It has been one of my greatest frustrations with contact lens manufacturers that they discontinue steeper fitting contact lenses and less oxygen permeable materials leaving us to accept their contention that the new materials and one base curve fits all. I am usually told I am the only one having these problems; probably because of the turnover of account reps that visit our office, the representatives do not have any history with the earlier designs. I would love to see the return of some of the discontinued, non-SiHy lenses with two or more base curves.

Robert A. Foote, OD
Traverse City, MI

When hydrogel lenses were first invented, the hope was that one-size-would-fit-all. While a standard base curve for a given diameter may work for the majority of patients, experience has taught that there are exceptions. I recently had to fit a new patient with a pair of British soft contact lenses, after going through at least five pairs of popular international brands and models. In that particular case the non-British products rode low and were too loose. However, there are cases when lateral centration and/or coverage are unacceptable. In some countries the law allows patients to purchase soft contact lenses (labeled "federal law prohibits dispensing without a prescription) without a fitting, which typifies the unfortunate prevailing public attitude.

The bottom line – there is still an art to fitting soft contact lenses, and those patients who "self-fit" themselves are bound to show up in our offices with symptoms of poor vision, unsatisfactory comfort, and health complications.

Gary Roth, OD
Jerusalem, Israel

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Susan J. Gromacki, OD, MS, FAAO

Understanding the Psychology of Non-Adherence

We practitioners are all well-aware of the consequences of poor contact lens care.1-3 However, the literature has yet to provide us clear guidelines on which factors lead to patient non-adherence and how we can improve it. A recent article looks at this issue from the perspective of a clinical psychologist.4

First, Dr. Christina Duncan and her graduate students, Margo Szabo and Paul Enlow, prefer the term "non-adherence" to "non-compliance". According to the authors, the former places more emphasis on the contribution of the provider, while the latter is primarily a patient characteristic.

Next, since "indirect methods," such as interviews, are most frequently used in both research and patient care, non-adherence to contact lens care regimens is likely underestimated. Patients may answer in a certain way due to bias from outside factors such as social desirability or their tendency to want to please their health care provider by reporting adherence.

The factors in non-adherence, as written by the authors, include insufficient knowledge of the lens care regimen; and the interaction of the perceived severity of illness, health benefits, and motivation.

In my next column, I will discuss the authors' ideas on how to improve patient adherence.

1. http://www.cltoday.com/issues/CLToday_041512.htm
2. Campbell D, Mann A, Hunt O, Santos LJ. The significance of hand wash compliance on the transfer of dermal lipids in contact lens wear. Cont Lens Ant Eye. 2012 Apr;35(2):71-6; quiz 96-7. Epub 2011 Dec 16.
3. McMonnies CW. Hand hygiene prior to contact lens handling is problematical. Cont Lens Ant Eye. 2012 Apr;35(2):65-70. Epub 2011 Dec 24.
4. Szabo MM, Enlow PT and Duncan CL. Understanding the psychology of non-adherence. Rev Corn CL. 2013 June:14-17.

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Katherine M. Mastrota, MS, OD, FAAO

Osmolarity and Glaucoma

From the Singapore Eye Research Institute comes a study of the effect of chronic anti-glaucoma medications and post-trabeculectomy on tear film osmolarity. In this single-center, prospective case-controlled study, 130 eyes of 130 patients were included: 49 controls, 50 glaucoma patients on chronic preserved anti-glaucoma medications for 6 months or more and 31 post-trabeculectomy patients not on medications for 6 months or greater. Tear film osmolarity (TFO), tear break-up time, Schirmer's test 1 and dry eye symptoms were evaluated. Data from both groups of glaucoma patients were compared with age and sex-matched controls.

Compared with normal controls, chronically medicated glaucoma patients and post-trabeculectomy patients were more likely to have a raised TFO. Both groups of glaucoma patients were also more likely to experience dry eye symptoms, There was no significant difference in TFO and symptoms between both groups of glaucoma patients, and in TBUT and Schirmer's test across all three groups.

The authors conclude that patients on chronic topical anti-glaucoma medication and post-trabeculectomy patients were more likely to have raised TFO and dry eye symptoms, suggesting significant ocular surface disease. They advise that glaucoma practitioners should be aware that dry eye symptoms and raised TFO may occur in the absence of TBUT and Schirmer's test abnormality in glaucoma patients.1

1. Lee SY, Wong TT, Chua J, Boo C, Soh YF, Tong L. Effect of chronic anti-glaucoma medications and trabeculectomy on tear osmolarity. Eye (Lond). 2013 Jul 12. [Epub ahead of print]
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Hard Contact Lens Wear and the Risk of Acquired Blepharoptosis: A Case-Control Study

Since there are increasing numbers of patients with blepharoptosis who have a history of wearing contact lenses, these researchers attempted to estimate the risk of developing ptosis from wearing hard contact lenses.

In an age-matched case-control study that was performed in a hospital in Japan, they compared the rate of hard contact lens users in ptosis cases with that in a control group and then estimated the odds ratio.

The history of wearing hard contact lenses was significantly higher in patients (90.2%) versus controls (31.6%). Hard contact lens wearers had a 20 times increased risk of ptosis (odds ratio: 19.9; 95% confidence interval: 6.32-62.9) compared with the non-wearing subjects.

The author concluded that this study indicated that there was a significant association between hard contact lenses and blepharoptosis. Because of both the prevalence of use and the aging of the population, contact lens-induced blepharoptosis is no longer just a problem for young and middle-aged people with myopia but also for the elderly population.

Kitazawa T. Hard contact lens wear and the risk of acquired blepharoptosis: a case-control study. Eplasty. 2013 Jun 19;13:e30.

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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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