Robert Breece, OD, 59, a pioneer in specialty contact lens design, died August 10 in Front Royal, VA. Dr. Breece was President of and lens design consultant for MedLens Innovations, where he used his experience as a practitioner, biomedical engineer, contact lens designer and manufacturer to provide alternative GP and soft contact lens designs for difficult cases. Dr. Breece consulted in all phases of the contact lens industry, and developed unique contact lens designs for keratoconus, post refractive surgery, orthokeratology and other medical conditions.
     "Rob Breece was one of the most innovative and creative contact lens designers of this generation," said Ed Bennett, OD, Director, Student Services, University of Missouri-St. Louis College of Optometry and Executive Director, GP Lens Institute. "His sudden passing leaves a huge void; his legacy will be the many successful specialty GP and soft lens designs that he developed that are in common use today as well as the many clinicians that he encouraged and mentored to fit these designs."
     A graduate of the Southern California College of Optometry in 1978, Dr. Breece also received a degree in Biomedical Engineering from the University of Virginia in 1979. That year he established a practice, which became one of the largest contact lens specialty practices in Washington, D.C., where he developed new lens designs to solve contact lens problems. In 1983 Breece founded Applied Optical Corporation, a producer of soft and GP specialty contact lenses and from 1990-1999, he was President of BioMed Devices Corporation, a company consulting in all phases of the contact lens industry.
     Dr. Breece wrote study protocols and supervised several clinical investigations of new contact lenses, including a GP contact lens for overnight orthokeratology, and he holds a U.S. patent on a manufacturing method for soft toric lenses. He lectured extensively and authored numerous articles on specialty contact lenses. 
     Dr. Breece was recently honored by the American Optometric Association Contact Lens and Cornea Section with their 2009 Achievement Award. He also received the 2008 Creative Design & Process Award from the Contact Lens Manufacturers Association.
     The family has requested that, in lieu of flowers, donations can be made to The National Keratoconus Foundation, Attn: Robert Olin Breece.

Jeffrey P. Gilbard, MD, a pioneer in the treatment of dry eye disease, died August 12 from complications related to a bicycle accident. He was 55 years old.
     Dr. Gilbard is best known for his pioneering research that led to treatments for dry eye disease and he is also considered to be one of the first ophthalmologists and researchers to understand the correlation between nutrition and the health and wellness of the eye.
     Dr. Gilbard founded Advanced Vision Research (AVR) in 1995 to market and distribute TheraTears. His holistic approach to eye care included the use of nutritional supplements to improve the ocular surface and to treat and prevent retinal disease. This research resulted in additional products including TheraTears Nutrition, Macutrition and NutriDox.
     Dr. Gilbard received his medical degree in 1979 from the College of Physicians and Surgeons at Columbia University. He interned in Internal Medicine at Stanford University Medical Center and served his Ophthalmology residency at Harvard Medical School in the Massachusetts Eye and Ear Infirmary. He remained at Harvard as a Heed Fellow in Cornea. He was a clinical assistant professor of Ophthalmology at Harvard Medical School and director of the Dry Eye and Ocular Surface Disease Clinic at the New England Eye Center in Boston.
     In 1978 Dr. Gilbard received project grant funding from the National Eye Institute, and to this day he remains the youngest scientist in history to have received such funding. His research program goal was to develop an eye drop for dry eyes that really worked.
     "Jeff Gilbard was an innovative, gifted ophthalmologist and researcher, who made several important contributions to our profession," said Dr. Edward Holland, Director of Cornea Service at the Cincinnati Eye Institute. "He was the first person to understand the importance of tear film osmolarity and his development of hypotonic artificial tears containing bicarbonate and potassium is a landmark event in the treatment of dry eye disease. Dr. Gilbard's legacy will be the scientific papers he authored, the revolutionary products he developed to help patients with ocular surface and retinal disease, and most notably the people whose lives he'll continue to improve."

Patients wearing contact lenses for astigmatism feel the lens sometimes rotates on the eye, resulting in blurry vision. The Accelerated Stabilization Design (ASD) of ACUVUE® OASYS™ Brand Contact Lenses for ASTIGMATISM provides greater stability by harnessing the pressure of the blink. ASD has four zones of stability to help maintain the position of the lens, resulting in more consistent visual acuity during repetitive eye movements and throughout everyday activities. So with ACUVUE® OASYS™ Brand for ASTIGMATISM, you provide your astigmatic patients with stable, crisp vision throughout their day.
For more information, click here.

ACUVUE® Brand Contact Lenses are indicated for vision correction. As with any contact lens, eye problems, including corneal ulcers, can develop. Some wearers may experience mild irritation, itching or discomfort. Lenses should not be prescribed if patients have any eye infection, or experience eye discomfort, excessive tearing, vision changes, redness or other eye problems. Consult the package insert for complete information. Complete information is also available from VISTAKON®, Division of Johnson & Johnson Vision Care, Inc., by calling 1-800-843-2020 or by visiting jnjvisioncare.com.
     ACUVUE®, ACUVUE® OASYS™, and VISTAKON® are trademarks of Johnson & Johnson Vision Care, Inc.
© Johnson & Johnson Vision Care, Inc. 2009.

--ADVERTISING

Alcon, Inc. announced the launch of a contact lens cleaning and disinfecting product for patients who wear gas permeable contact lenses. Opti-Free GP Multi-Purpose Solution is now available exclusively at Wal-Mart. This product joins the Opti-Free family of multi-purpose solutions.
     "This is a great addition to the Opti-Free product line," said Jim Murphy, Vice President and General Manager of Consumer Products. "There was such an overwhelming response when Unique-pH Multi-Purpose Solution was discontinued that we are launching the formulation with a new, more recognizable package and name - Opti-Free GP."
     Opti-Free GP uses the same advanced HP-Guar system found in Systane lubricant eye drops. It works by automatically adjusting product viscosity in the eye for all day lens wear comfort, according to the company. The product includes Tetronic 1304 which enhances lens surface wettability to improve comfort throughout the day. It also contains Polyquad, a PHMB-free preservative system.
     "For patients wearing gas permeable lenses, it is crucial to have an effective multipurpose solution since they often use the same lenses for well over a year," said Dr. Lamar Zigler. "In addition, since comfort can be an initial challenge for some patients, solution choice is a critical element to ensure initial patient comfort and lasting success. Opti-Free GP provides a cushion of comfort that makes a noticeable difference to my patients." 

ABB Concise and Paragon Vision Sciences (Paragon) announce the continuation of their Practice Partnership Education Series. The August program, No-nonsense Management of the Presbyope, will be presented by Patrick Caroline, FAAO of Pacific University. The presentation will review "what's new" in contact lenses for the presbyope in 2009 and the presenter's techniques for selecting the "right lens for the right patient."
     On Thursday, August 27, 2009, there will be two presentations at times convenient to different time zones: Session 1 will be at 6-7:30pm EDT (registration link https://www2.gotomeeting.com/register/426090595) and Session 2 will be at 6-7:30pm PDT (registration link https://www2.gotomeeting.com/register/359260882).  

The Educational Program Committee of the Global Specialty Lens Symposium invites the submission of abstracts for the Free Paper Section to be held January 28-31, 2010 in Las Vegas, Nevada, USA. Papers related to presbyopia, keratoconus, corneal topography, post penetrating keratoplasty or related irregular corneal surface, myopia control, ortho-k and lens care topics are welcome.
     Those interested in submitting free papers or posters to the Global Specialty Lens Symposium can visit www.GSLSymposium.com for more information. Web submissions only. Deadline for submissions is Monday, August 31, 2009.
--ADVERTISING

A new report from the National Commission on Vision and Health, "Building a Comprehensive Child Vision Care System," found that children are being screened at low rates and those who are screened do not often receive the necessary follow-up and treatment they may require. Children without health insurance and those living in poverty are at the greatest risk. Although the majority of states do require some type of vision screening prior to children entering public schools, they often fail to use the best screening tests and to assure important follow-up for those who fail the screening. Only three states, Kentucky, Illinois and Missouri, require comprehensive eye exams for children entering school. Currently fifteen states do not require any form of screenings or exams, resulting in a public health emergency for millions of children, according to the Commission.
     "This report finds that vision screenings are not the most effective way to determine vision problems," said Deborah Klein Walker, EdD, principal author of the report and Past-President of the American Public Health Association. "Screenings missed finding vision conditions in one-third of children with a vision problem and most of the children who are screened and fail the screening don't receive the follow-up care they need. This, despite the fact that many of the vision problems affecting children can be managed or even eliminated if they receive proper care right away."
     Studies indicate that one in four children have an undetected vision problem. Additionally, a quarter of school-age children suffer from vision problems that could have been addressed or eliminated if appropriate eye assessment programs and follow-up care had been in place when they started school.
     Given the data surrounding this public health emergency, the Commission recommends agencies at the federal, state and local levels collaborate with academia, business, providers and the public to create a comprehensive child vision care system to ensure all children are assessed for potential eye and vision problems before entering school and throughout the school years. In addition to universal access to vision care, the Commission recommends a point of accountability within local public health agencies, a national education campaign, and ongoing data collection to monitor the use and efficacy of child vision exams.
     For more information visit www.visionandhealth.org.

The purpose of this study was to evaluate the effects of a customized manipulation of spherical aberration (SA) on the high and low contrast visual acuities and contrast sensitivity of young adult myopes.
     A placebo-controlled double masked trial of customized spherical aberration controlling soft contact lenses was undertaken in myopes aged 15-23. Participants wore customized soft contact lenses with either (i) zero spherical aberration or (ii) negative spherical aberration that resulted in a net SA (eye plus lens) of -0.1 micron. High and low contrast log MAR visual acuities and Pelli Robson contrast sensitivity were assessed in 196 eyes of 98 subjects after a period of 12 months wearing the lenses.
     Both high and low contrast acuities were significantly better in the group wearing the contact lenses with negative spherical aberration (high contrast log MAR, p = 0.043; low contrast log MAR, p = 0.043) which was not due to differences in residual astigmatism or pupil size between the two groups. Pelli Robson contrast sensitivity was not significantly different in the two groups.
     The authors concluded that manipulation of spherical aberration, taking account of the participants' baseline level of aberration, can cause statistically significant improvements in high and low contrast distance visual acuity although these improvements are too small in magnitude to be of clinical significance.
Rae SM, Allen PM, Radhakrishnan H et al. Increasing negative spherical aberration with soft contact lenses improves high and low contrast visual acuity in young adults. Ophthalmic Physiol Opt 2009. 

Following up on my editorial last week, I received numerous comments from readers about important research questions that need clarification. Interestingly, however, there was no over-arching theme in the comments I received. Below is a summary of some of the more frequent responses:
· Better understanding of the relative frequencies of evaporative vs. aqueous deficient dry eye.
· Inflammation and biomarkers in the tear film associated with contact lens wear, including the impact of care solutions.
· Improved understandings of why oxygen seems to play a smaller role in microbial keratitis than what has been traditionally thought.
· Better (unbiased) critical studies about new contact lens technologies and their potential impact on comfort.
· Better studies about the apparent increase in giant papillary conjunctivitis associated with silicone hydrogels.
Jason J. Nichols, OD, MPH, PhD, FAAO 

This month at www.siliconehydrogels.org: adverse events with daily wear of silicone hydrogels, SEALs with extended wear, controlling case contamination, contact lens complications, and part two of our AAO 2008 synopsis.