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Sunday, August 7, 2011  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

Being associated with ocular surface and contact lens research is one of the most fulfilling aspects of my career. I am also very aware that this work bears a great responsibility as well, particularly when combined with my role as an editor of this journal. It's important that we stay aware of clinical research issues that meet the needs of those "in the trenches" — the sort of issues that come up every day in clinical practice. If you don't mind, please drop me a note at cltoday@wolterskluwer.com with your thoughts on the most relevant issues you are facing today that could be addressed by a new clinical research study. Thank you for your input.

SynergEyes Duette Multifocal Hybrid Contact Lens Available Soon

SynergEyes, Inc. announced that the company will begin releasing its second generation multifocal hybrid contact lens, Duette Multifocal, in August. The Duette Multifocal is the first silicone hydrogel hybrid contact lens specifically designed for patients with presbyopia.

According to the company, the Duette Multifocal lens features a revolutionary simultaneous vision design that provides true binocular vision at all distances. The lens also incorporates MultiPro2 Technology, which utilizes a near center aspheric Add Zone in combination with a distance asphere to provide progressive visual correction.

The Duette Multifocal lens features a high modulus GP center with a Dk of 130 and a low modulus silicone hydrogel skirt with a Dk of 84. Hybrid technology provides excellent centration and stability to deliver full binocular vision that is not affected by lens movement, making it an ideal contact lens for any presbyopic patient, as reported by the company. In addition, the lens utilizes an optimized lacrimal layer to decrease aberrations and enhance optical performance while also correcting corneal astigmatism.

Eye care professionals interested in prescribing Duette Multifocal should visit www.synergeyes.com to complete an interest form.

Walsh Joins Alden Optical

Alden Optical Inc, manufacturer of custom made-to-order soft and gas permeable contact lenses, announced that Maggie Walsh, FCLSA, has joined the company as a Senior Product Specialist. Walsh will assume a lead role on technical and fitting support for the company's emerging specialty lens portfolio, and will be initially responsible for developing a comprehensive technical support package for NovaKone, the company's new product for patients with keratoconus. The company recently received FDA clearance for NovaKone and is planning an October, 2011 launch.

Walsh, a trained optician, has over 25 years' experience in specialty lens fitting including most recently 6 years in a consultative role for Synergeyes and more than 20 years in private practice in central New York. She served 10 years on the New York State Board of Ophthalmic Dispensing, received NCLE Advanced Accreditation and is currently Chair of the CLSA Fellowship Committee.

Still Time to Submit Papers, Posters and Photos for GSLS 2012

August 31, 2011 is the deadline for submission of papers and posters for the Global Specialty Lens Symposium (GSLS), to be held January 26 - 29, 2012 at the Paris Hotel and Casino in Las Vegas. 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.

New this year is the photo contest. Contestants may submit up to two (2) photographic images in the following anterior segment categories: Contact Lens, Lids, and Cornea/Conjunctiva. Contestants may also submit images obtained utilizing equipment such as OCT, topographers, etc.

Visit www.GSLSymposium.com for more information. Web submissions only.

2011 GP Clinical Excellence Awards Winners Announced

Every year one 4th year student from each of the optometric colleges and universities in North America is selected to receive the GP Clinical Excellence Award. These awards are sponsored by the GP Lens Institute (GPLI) and member companies of the Contact Lens Manufacturers Association (CLMA). The award is bestowed upon the student that showed interest and enthusiasm in the fitting of GP contact lenses in their clinical environments, and honorees are selected by the faculty at each college or university. Each award winner receives an engraved plaque and a GP lens diagnostic set manufactured by a CLMA member laboratory for their professional use.

Recipients for 2011 are: Paul Pambrun, OD, New England College of Optometry; Stephanie A. Lang, OD, Pennsylvania College of Optometry; Jessica Fulmer, OD, SUNY; Anthony Perry, OD, Southern College of Optometry; Beth Lin, OD, The Ohio State University College of Optometry; Elizabeth Shelus, OD, Illinois College of Optometry; Christine M. Hayes, OD, UMSL College of Optometry; Tyler Smith, OD, University of Houston College of Optometry; Eric Robert Kawulok, OD, Pacific College of Optometry; Jorge Meléndez Hernández, OD, Inter-American University College of Optometry; Sarah Brehm, OD, NOVA Southeastern College of Optometry; Kyle N. Tate, OD, Oklahoma State College of Optometry-Tahlequah; Stephanie L. Woo, OD, Southern California College of Optometry; Britta Hansen, OD, University of California-Berkeley College of Optometry; Laura Frances Rayne, OD, UAB College of Optometry; Mathieu Deshaies, OD, University of Montreal and Kristen Fink, OD, University of Waterloo.

Take the Challenge and Help Change a Life

Optometry Giving Sight invites optometrists and the optical community in the U.S. and Canada to take part in the fifth annual World Sight Day Challenge to raise funds for people who are needlessly blind or vision impaired due to uncorrected refractive error.

Optometrists are invited to take the Challenge by donating their eye exam fees on World Sight Day (October 13), or any other day in October, or they can join their colleagues across the profession by making a personal or practice donation at www.givingsight.org. Practices are also encouraged to involve their staff and patients by having an office celebration throughout the month.

Eighty-five percent of donations to Optometry Giving Sight from eye care professionals, optical staff, employees and patients go directly to support projects that provide vision care, local training, and infrastructure support for people in underserved communities.

To learn more about the World Sight Day Challenge please visit www.givingsight.org or call 1-888-OGS-GIVE in the U.S. or 1-800-585-8265 ext. 4 in Canada.

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Salzmann's Nodular Degeneration
By Gregory W. DeNaeyer, OD

This corneal GP patient presented with bilateral Salzmann's nodular degeneration. The lesions consist of dense collagenous tissue in the anterior stroma and are the result of chronic keratitis. They appear gray or grayish-blue and are not vascularized, although the underling stroma may be.

For more on this patient, see http://www.clspectrum.com/article.aspx?article=&loc=archive\2009\june\cls_june_a02.html.

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.

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

Corneal Graft Survival in Keratoconus

As clinicians we frequently contemplate when it is the best time to send our keratoconus patients for keratoplasty. For example, I often wonder whether a particular patient will heal well, be compliant with their medications and follow-up, and whether any underlying systemic conditions, such as atopy, put them at more risk for graft rejection.

One paper in 2009 found a trend towards increased graft rejection in atopic keratoconus patients. Yildiz et al found the incidence of graft rejection (rejection episodes per 100 person-years) to be 7.3, 15.8, and 13.4, for non-atopic, mildly atopic and severely atopic patients, respectively. However, these differences were not statistically significant, possibly due to their small sample size (75 patients).

A recent paper by Thomas et al at the University of Texas Southwestern Medical Center at Dallas adds more data to this question. They compared the prevalence of endothelial rejection episodes and the probability of graft survival after initial and repeat penetrating keratoplasties in 122 patients with keratoconus with and without atopy. In the study group, 66 (39.2%) patients had a history of atopy. There were no significant differences in the prevalence of endothelial rejection episodes after the first (P = 0.716), second (P > 0.999), and third or further grafts (P > 0.999). Graft survival between the atopic and non-atopic groups did not differ significantly in the first (P = 0.881), second (P = 0.752), or third or further graft (P = 0.157). They concluded that among patients with keratoconus receiving PK, there is no statistically significant difference in the prevalence of endothelial graft rejection episodes or probability of graft survival between patients with and without a clinical history of atopy. Of course their sample size may also have not been large enough to find a difference, but it lends more evidence based information. A good meta-analysis combining all the relevant studies would be a great way to increase the samples for greater power on this subject.

Yildiz EH, Erdurmus M, Hammersmith KM, Rapuano CJ, Laibson PR, Cohen EJ. Comparative study of graft rejection in keratoconus patients with and without self-reported atopy. Cornea. 2009 Sep;28(8):846-50.

Thomas JK, Guel DA, Thomas TS, Cavanagh HD. The Role of Atopy in Corneal Graft Survival in Keratoconus. Cornea 2011 Jul 26. [Epub ahead of print]

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Ronald K. Watanabe, OD, FAAO

Should we let patients swim in their lenses?

Though summer is almost over, many of our patients will still be on vacation, enjoying all sorts of outdoor activities, including water sports. It is widely recommended that patients should remove their contact lenses before swimming or other water activities due to the seeming increased risk of complications, such as Acanthamoeba keratitis. But we know that many of our patients will continue to wear their lenses in the water.

So, education is important. I tell my patients that it is best not to wear lenses while swimming, but if they do, they should remove them as soon as they can and clean and disinfect them properly. They should NEVER sleep in them after swimming in them. I also recommend daily disposable lenses, even if it's only for water activities, so that contaminated lenses are not reused. I also instruct them to wear swim goggles. For those who are in the water a lot, such as competitive swimmers, I present corneal reshaping as an option. One final consideration is ultraviolet blocking for extra protection from the sun while at the beach. Many soft and GP lens materials can block UV and should be selected for outdoor activities. These simple recommendations can make a big difference for your patients.

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Contact Lens Characteristics and Contrast Sensitivity of Patients with Keratoconus

The aim of this study was to describe the contact lens characteristics and contrast sensitivity of patients with keratoconus managed conservatively with contacts lenses at a tertiary eye center in Singapore.

This was a prospective cross-sectional study of 116 patients with clinically evident or suspected keratoconus (on videokeratography) recruited over 11 months. Demographic and medical details, visual acuity (VA) and refraction, corneal topography and contact lens characteristics were documented. Contrast sensitivity with contact lenses was performed with the Vision Contrast Test System 6500 under standardized conditions.

Overall, 67% of the study patients were wearing contact lenses. Of the 129 eligible eyes analyzed, there were 108 eyes with keratoconus and 21 eyes with keratoconus suspect, and 94% were fitted with rigid gas permeable (RGP) lenses. Proprietary keratoconus design lenses were fitted in 74.9% of keratoconus eyes and 30.0% of suspect eyes. With contact lens wear, 83.3% of keratoconus eyes and 100% of suspect eyes achieved 0.3 vision. Mean contrast sensitivity curves of eyes with keratoconus and keratoconus suspect were found to be within normal, although contrast sensitivity in the keratoconus group was consistently lower.

Most of the patients were managed conservatively with contact lenses, and keratoconus design RGP lenses were the most common type fitted. The researchers concluded that good VA can be achieved, but patients with keratoconus may still experience a reduction in contrast sensitivity.

Wei RH, Khor WB, Lim L, Tan DT. Contact Lens Characteristics and Contrast Sensitivity of Patients With Keratoconus. Eye Contact Lens. 2011 Jul 22. [Epub ahead of print]

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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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For more information on Contact Lenses Today including archives of previous issues, please visit our website at www.cltoday.com. For the latest articles on contact lenses, important clinical information and helpful tools related to the contact lens practice visit the Contact Lens Spectrum website at www.clspectrum.com.

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