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Sunday, August 17, 2014  
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Results from Last Question

Regarding the use of tap water for rinsing gas permeable contact lenses, which statement do you agree with most?

 Always acceptable

 Only acceptable prior to disinfection

 Never acceptable

Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO
Now is a good time of year to send reminders to your patients that it is important to have children come in for their “back to school” eye examination. This is often over-looked by parents, but a critical element of academic success of their children. And, while they are in your office—don’t forget to educate your non-contact lens wearers about the many, many benefits of contact lenses (if appropriate)—psychosocial, cosmetic, sporting, and otherwise. Best of luck to those entering a new school year, no matter what grade you are in.

New Anterior Toric Optics
for Blanchard Scleral Lenses
Blanchard has a new proprietary anterior toric design, manufactured with Sector Prism Technology, for msd and Onefit scleral lenses. This new option will enable practitioners to address the issue of uncorrected residual refractive cylinder for those patients wearing Blanchard scleral lenses.

Sector Prism Technology works by confining prism ballast within an area of lenticulation outside of the optical zone while maintaining a uniform edge thickness for the entire circumference of the lens. According to the company, the absence of prism within the optical zone insures there is no visual disturbance and the uniform edge thickness provides exceptional comfort. Scribe marks at 3 and 9 o'clock are easily evaluated for proper axis orientation.

In keeping with the company’s “simple is best” approach to fitting, applying toric optics to msd and Onefit designs is boiled down to a 3-step process:
1. Select the appropriate sagittal depth (msd), or base curve (Onefit)
2. Evaluate central and limbal clearance in addition to edge lift as appropriate
3. Assess lens power

Fitters then over-refract in 1-diopter steps and refine in 0.25-diopter steps. If visual acuity is not acceptable, refine with a sphero-cylindrical over-refraction. Residual cylinder equal to/greater than 0.75 diopters should be incorporated into an anterior toric design. When ordering fitters provide the over-refraction to the lab.

To learn more about anterior optics for msd and Onefit contact your Blanchard Sales Representative by calling 800-367-4009.
Accu Lens Contact Lens Expands to South America and Europe
Denver-based Accu Lens has entered into a licensing agreement with B&L UK (Hastings) for manufacture of the Maxim Scleral Lens. This is the second license agreement that now has Maxim being manufactured and distributed throughout Europe and South America.

Maxim is a semi-scleral lens design available in multiple diameters with lens trial sets of 24 and 12 lens groups. The lens has an extremely simplified trial fitting system for ease of fit and ultimate patient success.

Practitioners across North America, Europe and South America may now order the Maxim design from anyone of the following laboratories: Accu Lens – Denver, Colorado, B&L(UK) Hastings – England, and Mediphacos – Brazil.

For more information on Accu Lens or the Maxim lens visit
Rigel Dry Eye Drug Misses Endpoints in Phase 2
Rigel Pharmaceuticals Inc. announced that R348, its ophthalmic JAK/SYK inhibitor, did not meet the primary or secondary endpoints in a recently completed Phase 2 clinical study in patients with dry eye disease. The endpoints were measured by changes in corneal fluorescein staining, conjunctival staining, tear production and dry eye symptom scores from baseline over 12 weeks of treatment versus placebo. No significant adverse events were reported in the trial. Rigel has decided not to initiate any new studies of R348 for this indication, but is continuing its Phase 2 study of dry eye in patients with graft versus host disease (GvHD).
Register Now for 10th Annual OMS – CE in December in Orlando

Learn from the best. Experience the motivation. Move your practice forward. Plan now to attend the Optometric Management Symposium on Contemporary Eye Care, December 5-7, 2014 at Disney's Yacht & Beach Club Resort in Lake Buena Vista, FL.

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.

OMS offers a comprehensive program, flexible schedule, ABO, COPE and Florida Board approved credits included 12 CEE's (TQ credits)! The education is also sponsored by a school of optometry meeting the requirements of several states. Rejuvenate yourself and expand your education while visiting exhibitors to learn about their products and services during our refreshment breaks.

For agenda, more information and to register visit

LensFerry Patient Contact Lens Ordering Service in Beta Release
CooperVision, Inc., through its subsidiary WebSystem3 LLC, unveiled its LensFerry service. Now in its U.S. beta release, LensFerry allows wearers to quickly and conveniently order replacement contact lenses from any manufacturer via their mobile device, tablet or computer for fast shipment to their homes. Not only does the prescribing practice receive the sales revenue as if the lenses had been ordered in-office, but it also enhances its relationship with the wearer, since all LensFerry communications are customized with the practice’s name and/or logo.

The service, which will be part of WebSystem3’s EyeCare Prime suite later this year, includes contact lenses from all manufacturers at ECPs’ specified prices. Online ordering and fulfillment is easy for subscribing practices and their wearers:

1. In conjunction with an in-office visit and the selecting and prescribing of contacts by the ECP, a practice enrolls a wearer in just a few steps and verifies the prescription.
2. The wearer selects from buying options, using available insurance benefits and qualifying for any applicable manufacturers’ rebates.
3. The contact lenses are shipped directly to the wearer’s home or business through LensFerry’s partnership with ABB Optical.
4. The ECP can send the wearer custom-branded email and/or text reorder reminders via LensFerry.

LensFerry was developed with hands-on input from a group of U.S. optometrists representing a range of practice sizes and locations. The service’s beta launch period is anticipated to take place over the next 90 days, accounting for testing and final design. LensFerry is then expected to roll out to other U.S. practices, with the potential for select international availability in 2015.

For more information, visit

Possible PMD
Dina Kruger, BOptom (RAU), FOA SA CAS (SA), TPA (Boston), FIACLE, Bloemfontein, Free State, South Africa

This patient’s topography classified condition as stage 3-4 Keratoconus or Pellucid Marginal Degeneration but from a slit lamp point of view it looks more like PMD to me. The patient is also HIV positive. Note the heavy iron deposition at the base.

We thank Dina Kruger for this image and we welcome photo submissions from our other readers! It is easy to submit a photo for consideration for publishing in Contact Lenses Today. Simply visit to upload your image. Please include an explanation of the photo and your full name, degree or title and city/state/country.

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Susan J. Gromacki, OD, MS, FAAO

Dry Eye Solutions

Whether the dry eye condition is independent of contact lens wear, exacerbated by it, or caused by it, some of our patients wish to remain in contact lenses and there is much we can do to help.

Of course, we need to treat the dry eye via the palliative and medical methods we know so well, but that may not be enough. We need to make sure that we are doing everything in our power to rid a patient’s contact lenses of deposits. I believe a clean lens is a comfortable and healthy lens. As such, daily disposables are an excellent choice for dry eye patients. If a patient will not consent to (or his lens parameters are not available in) this modality, then it is our responsibility to teach proper wear and care regimens. This includes a digital rubbing step every night. In addition, select a care solution that contains a novel wetting agent (i.e. a company’s newest product with the latest technology). If there is an allergic component to the patient’s dry eye, then select a non-preserved care system, such as a hydrogen peroxide-based one. Happy fitting!

Gromacki SJ. Contact Lens Deposition and Dry Eye. Contact Lens Spectrum 2012;28(7):23.
Gromacki SJ. Multifactorial Approach Solves Lens Wear Problem in Dry Eye Patient. Contact Lens Spectrum, Special Issue 2007;22:5.

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David Kading, OD, FAAO
Daily Disposable Contact Lenses

Following the introduction of the first disposable soft contact lens in the late 1980s, most all of the contact lens companies began making lenses that were disposable—a move away from conventional yearly based lenses. Then in the mid-1990s daily disposable lenses began to emerge.

Over the next decade, we saw an incredible emergence of lens material, design and manufacturing capabilities. It was truly a testament of the technology being ahead of the curve. Within that time span, our industry partners had to work tooth and nail to help educate practitioners on the technology, and practitioners worked to educate their patients on the variety of benefits afforded them by increasing the replacement frequency. The growth of the daily disposable lenses saw a slow start. Initially practitioners would reserve the lenses for “problem” patients--non-compliant, allergic, or dry eye patients. Slowly, the benefits to the patient and to the practitioner became apparent. With daily disposable lens wearers being the most compliant, patients would be getting a fresh, clean, lens every day.

Fast-forward to today; daily disposable lenses have become the fastest growing contact lens trend, particularly in the United States (where daily disposables have notoriously lagged behind the rest of the world). Manufacturers are bringing new lenses to market on a regular basis. Most recently we have observed lens technologies being introduced in the daily disposable category first, rather than in their two-week or monthly counterparts. Specifically, in the last couple of years we have several unique silicone hydrogel single use lenses, a water gradient material, and a material with a surface that reportedly mimics the normal tear film.

We elected to become a “daily disposable first” office in early 2012. I was proud that by the end of 2013 we had reached around 65% of our contact lens box sales being daily disposable. I am excited to say that this year we are over 80%. Certainly there are cases where patients’ prescriptions call for a two-week or monthly lens, but, with the introduction of several more toric and multifocal daily disposables, we have seen this number steadily decline. I would encourage you to look at your patients, and consider whether there is a daily disposable lens option for them. With today’s lenses, I think that you will find, for most patients, they may be better off replacing their lenses more frequently.

As we conclude the History Series, I thank you for tuning in. I have had a great time looking back over the last century at the advances we have made. I can only hope that the next 15 years will bring as much advancement as the last 15. I recall a day 5 years ago where I thought, what else can we come up with for contact lens materials that would be better than what we have today? I am sure our colleagues in early days of disposable lenses were thinking the same way. I am grateful for innovators and outside the box thinkers. Thank you Industry for making me look good to my patients and for helping us to promote ocular surface health and wellness in our contact lens wearers. Happy Fitting.

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Studying Functional Properties of Hydrogel and Silicone-Hydrogel Contact Lenses with PALS, MIR and Raman Spectroscopy

Determination of free volume holes of the hydrogel and silicone-hydrogel polymer contact lenses were investigated. Two types of polymer contact lenses were used as materials: the first is a hydrogel contact lens of the Proclear family (Omafilcon A), while the second is a silicone-hydrogel contact lens of the family Biofinity (Comfilcon A). Positron annihilation lifetime spectroscopy PALS was used to characterize geometrical sizes and fraction of the free volume holes in the investigated samples. There is a clear difference in the free volume sizes and their fractions between silicone-hydrogel and polymer hydrogel contact lenses which in turn are connected with oxygen permeability in these lenses. Apart from that, spectroscopic (middle infrared) MIR and Raman examinations were carried out in order to demonstrate the differences of the water content in the test contact lenses.

Filipecki J, Sitarz M, Kocela A, Kotynia K, Jelen P, Filipecka K, Gaweda M. Studying functional properties of hydrogel and silicone-hydrogel contact lenses with PALS, MIR and Raman spectroscopy. Spectrochim Acta A Mol Biomol Spectrosc. 2014 Oct 15;131:686-90. doi: 10.1016/j.saa.2014.04.144. Epub 2014 May 15.

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