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Materials & Designs
Ronald K. Watanabe, OD, FAAO
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Presbyopic contact lens designs are better than ever. There are now many soft disposable multifocal options, including three silicone hydrogels and one daily disposable. There are also quite a few good custom soft and gas permeable multifocal options. With all these technologically advanced designs, most presbyopes, including astigmats and high ametropes, can wear multifocal lenses. So with all of these good options, has multifocal fitting increased?
In the U.S. market, the percentage of the population wearing contact lenses drops off significantly after age 40, and surveys suggest that less than 20% of presbyopes wear multifocal contact lenses (Nichols, 2010). Despite these low numbers, it appears that presbyopic contact lens fitting is on the rise. A recent study found that the average age of contact lens wearers worldwide has increased significantly during the past decade (Morgan, et al, 2010). Also, at a recent meeting I attended, the speaker presented market data for the U.S. that showed a 14% increase in multifocal contact lens fitting over the past year (GfK Market Data, 2009). These positive trends are a testament to growing demand, more experienced and educated practitioners, and better multifocal contact lens designs. As seen from our CLToday Quick Poll results last week, practitioners believe that of all options listed, new multifocals overwhelmingly would lead to the greatest growth in the contact lens portion of their practice.
References:
Nichols JJ. Contact Lenses 2009. Contact Lens Spectrum 2010 Jan.
Morgan PB, et al. Demographics of international contact lens prescribing. Contact Lens Ant Eye 2010; 33: 27-29.
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CLToday Quick Poll
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Research Review
Loretta B. Szczotka-Flynn, OD, PhD, MS, FAAO
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The recent article in Pediatrics, of which we posted the abstract in Contact Lenses Today two weeks ago, is still gaining national and local attention. This two year study assessed reasons for emergency room visits associated with medical devices in children under the age of 21. Of all the visits, about 23% were associated with contact lens wear. Contact lens related adverse events included mostly abrasions and conjunctivitis, which were generally superficial and did not require hospitalization. Nonetheless, the article points out that many of these adverse reactions could have been prevented with better adherence to lens care compliance and replacement schedules. Additionally, involvement of the parents in the lens fitting and follow-up was recommended by the authors as a critical step in preventing contact lens related complications. We should add that contact lenses should only be acquired with a valid prescription after appropriate fitting by licensed eye care practitioner.
The American Academy of Optometry Section on Cornea, Contact Lenses and Refractive Technologies has released a statement in this regard. Click here to view their message.
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EC Clears Planned Acquisition of Alcon by Novartis, Subject to Conditions – Similar Agreement in Canada
Under the European Union Merger Regulation, the European Commission (EC) has approved the proposed acquisition of Alcon by Novartis, both pharmaceutical companies from Switzerland. Novartis is seeking to buy an additional 52 percent of Alcon from current owner Nestle, to add to the 25 percent interest Novartis already owns.
The decision is conditional upon Novartis' commitments to divest several products in the ophthalmological pharmaceutical and consumer vision care areas in the European Economic Area (EEA) or in specific Member States.
In its investigation, the EC found that competition concerns arose in a number of ophthalmological pharmaceutical markets and consumer vision care markets across the EEA because of the high combined market shares for certain products, the fact that Novartis' and Alcon's products are close competitors and because of the presence of barriers to entry. The markets in question are: ophthalmological anti-infective, anti-inflammatory/anti-infective combinations, anti-allergics, decongestants, antiseptics, mydriatics and cycloplegics, diagnostic agents, non steroidal anti-inflammatories, injectable miotics, anti-glaucoma products, artificial tears, and multipurpose solutions for contact lenses.
To address the Commission's concerns, Novartis offered to divest a number of businesses across the EEA in the product areas concerned. In view of these commitments, and following a market test, the Commission concluded that the transaction would no longer raise competition concerns.
The Competition Bureau in Canada also announced that it had reached a similar agreement with Novartis. The Bureau concluded that the proposed transaction was likely to result in a substantial lessening of competition in Canada for the supply of certain ophthalmic products; namely, multi-purpose solution contact lens cleaners/disinfectants; injectable miotics; and ocular conjunctivitis drugs. Over the course of its review, the Bureau worked closely with both the Federal Trade Commission and the Competition Directorate of the EC.
Under the terms of the consent agreement, assets and associated licenses related to the sale in Canada of the following products must be divested to a third party purchaser: Solocare Aqua MPS including the MicroBlock anti-bacterial lens case, Miochol-E; and Zaditor.
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B+L Promotion Offers Free Admission to Some of America's Most Visually Inspiring Attractions
To celebrate the launch of its newest lens care product, Biotrue multi-purpose solution, Bausch + Lomb (B+L) has teamed up with journalist and world traveler Lisa Ling to challenge Americans to find visual inspiration in their surroundings. In an effort to make some of the nation's most beautiful, compelling sites more accessible to consumers, the company offered free admission on Friday, August 13, to visitors at the Aquarium of the Bay in San Francisco with an unobstructed view of the Golden Gate Bridge, the Space Needle in Seattle and the John Hancock Observatory in Chicago, as well as free ferry tickets to view the Statue of Liberty in New York City.
Additionally, B+L is launching the "Inspiration in Your Eyes" contest, inviting consumers to share a story about the U.S. location most visually inspiring to them. The grand prize winner will receive an all-expense-paid trip for two to one of the top 10 most visually inspiring places in the U.S. Consumers can visit www.facebook.com/biotrue to enter.
Allen Appointed Vice President of Manufacturing at Lagado
Menicon Co. Ltd. announced the appointment of Mark Allen as Vice President of Manufacturing for Lagado Corporation, a wholly-owned subsidiary of Menicon America Inc. Allen will report to Jonathan Jacobson, President of Menicon America. He will oversee manufacturing operations of Lagado Corporation in Denver and work closely with Bill Hoffman, research scientist for Lagado, in bringing new contact lens materials to market for custom lens manufacturers.
Allen joins Menicon with over 25 years' experience in the GMP (Good Manufacturing Practice) manufacturing sector, including over 11 years in the contact lens and ophthalmic viscoelastics industry. During his career in medical products, Allen has held key leadership roles in manufacturing, quality assurance, regulatory affairs and research and development. For the last three years, Allen has held the position of Vice President of Quality Assurance and Regulatory Affairs at Bonfils Blood Center, a renowned leader in blood collection, manufacturing, testing and research located in Denver, Colorado.
This month at www.siliconehydrogels.org: fitting silicone hydrogels for patients with sub-optimal endothelial cell function, tear exchange rate with silicone hydrogel lenses, and our synopsis of silicone hydrogels at the 2009 AAO meeting.
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Editor's Commentary
Jason J. Nichols, OD, MPH, PhD, FAAO
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The editorial staff of Contact Lens Spectrum and Contact Lenses Today hopes to seamlessly integrate content in an interactive way to provide you the most current information regarding the contact lens portion of your practice. One new way we are doing this is via the CL Today Quick Polls, which can provide you with interesting clinical information, while at the same time can indirectly help guide the editorial staff in planning editorial content. In this regard, please check out the just released August issue of
Contact Lens Spectrum at www.clspectrum.com. As you can see, the issue is loaded with clinically useful information on topics such as the current views on microbial keratitis, an update on daily disposables, and fitting mini scleral lenses in filamentary keratitis. As always, thank you for your continued support and please let us know your thoughts and feedback.
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Treatment of Primary Sjogren Syndrome: A Systematic Review
A variety of topical and systemic drugs are available to treat primary Sjogren syndrome, although no evidence-based therapeutic guidelines are currently available. This paper summarizes evidence on primary Sjogren syndrome drug therapy from randomized controlled trials.
The authors searched MEDLINE and EMBASE for articles on drug therapy for primary Sjogren syndrome published between January 1, 1986, and April 30, 2010. Controlled trials of topical and systemic drugs including adult patients with primary Sjogren syndrome were selected as the primary information source.
The search strategy yielded 37 trials. A placebo-controlled trial found significant improvement in the Schirmer and corneal staining scores, blurred vision, and artificial tear use in patients treated with topical ocular 0.05% cyclosporine. Three placebo-controlled trials found that pilocarpine was associated with improvements in dry mouth (61%-70% vs. 24%-31% in the placebo group) and dry eye (42%-53% vs. 26%). Two placebo-controlled trials found that cevimeline was associated with improvement in dry mouth (66%-76% vs. 35%-37% in the placebo group) and dry eye (39%-72% vs. 24%-30%). Small trials (<20 patients) found no significant improvement in sicca outcomes for oral prednisone or hydroxychloroquine and limited benefits for immunosuppressive agents (azathioprine and cyclosporine). A large trial found limited benefits for oral interferon alfa-2a. Two placebo-controlled trials of infliximab and etanercept did not achieve the primary outcome (a composite visual analog scale measuring joint pain, fatigue, and dryness); neither did two small trials (<30 patients) testing rituximab, although significant results were observed in some secondary outcomes and improvement compared with baseline.
The authors concluded that, in primary Sjogren syndrome, evidence from controlled trials suggests benefits for pilocarpine and cevimeline for sicca features and topical cyclosporine for moderate or severe dry eye. Anti-tumor necrosis factor agents have not shown clinical efficacy, and larger controlled trials are needed to establish the efficacy of rituximab.
Ramos-Casals M, Tzioufas AG, Stone JH, Siso A, Bosch X. Treatment of primary Sjogren syndrome: a systematic review. JAMA 2010;304:452-460.
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