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Sunday, August 19, 2012  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

Colored contact lenses are particularly popular with some patients for cosmetic reasons, but can also be quite helpful when used for therapeutic reasons. Unfortunately, there is often a perception by the public that these colored contact lenses are "decorative" and are no different than buying a toothbrush. It doesn't help that every so often, these types of lenses find their way into convenience stores and gas stations. Certainly the internet has not helped with the control of medical devices and pharmaceuticals. Although we can't completely stop this perception, it's important that we do our part in educating our patients and the public as much as possible.

Coastal Contacts Appoints Collins President

Coastal Contacts Inc. announced that Gary Collins has been appointed President.

Most recently, Collins was Senior Vice President of Belkorp Industries, a private company with diverse holdings in a variety of industries. Prior to Belkorp, he was the President and CEO of Harmony Airways and he also served as the Minister of Finance for the Province of British Columbia from 2001 to 2004. In addition Mr. Collins serves as a Director on the public company boards of Lantic and Rogers Sugar, Chorus Aviation Inc. and Liquor Stores North America Inc.

Coastal's founder, Roger Hardy will continue in his role as CEO and Chairman of the Board.

Founded in 2000, Coastal designs, produces and distributes eyeglasses and contact lenses, sunglasses, and vision care accessories on the Internet. Coastal serves customers in more than 150 countries through the Coastal Contacts family of websites including: Coastal.com, ClearlyContacts.ca, Lensway.com, Lensway.co.uk, Lensway.se, Lensway.com.br, ClearlyContacts.com.au, ClearlyContacts.co.nz, Contactsan.com, and Coastallens.com.

Salus University Names Caldwell Dean of Students

James M. Caldwell, OD, EdM, FAAO, has been appointed dean of Student Affairs at Salus University. He will succeed Robert E. Horne, who is retiring after 36 years at the institution.

A 1989 graduate of Pennsylvania College of Optometry (PCO), Dr. Caldwell completed an optometric residency at the PCO clinical facility, The Eye Institute. He began his career at PCO as an admissions officer; since then he held a variety of positions including director of Student Recruitment, director of Admissions and most recently, associate vice president of Academic Affairs. He also holds the rank of assistant professor.

A Fellow of the American Academy of Optometry, Dr. Caldwell is also a member of the following professional organizations: American Association of Collegiate Registrars and Admissions Officers, American Optometric Association, Delaware Valley Association of Collegiate Registrars and Officers of Admission, Middle States Association of Collegiate Registrars and Officers of Admission, National Association of Advisors for the Health Professions, Northeast Association of Advisors for the Health Professions, and Pennsylvania Optometric Association.

Still time! August 31 Is Deadline for GSLS Paper and Poster Submissions

Plan now to attend the Global Specialty Lens Symposium to be held January 24 — 27, 2013 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.

Those interested in submitting can visit our redesigned website at www.GSLSymposium.com for more information. Web submissions only. Deadline for submissions is August 31, 2012.

Morgan Named Interim Dean of the Michigan College of Optometry

Ferris State University announced the appointment of Bruce Morgan, OD, FAAO, as interim dean of the Michigan College of Optometry effective August 24.

Most recently, Dr. Morgan has served as a professor in the MCO. He is chief of the Cornea and Contact Lens Service, and director of Residencies and Externships. Dr. Morgan will replace the current dean, Dr. Michael Cron, who announced his retirement last fall.

Dr. Morgan has 25 years of experience as an optometrist and educator. He is a member of numerous professional organizations, including president of the Association of Contact Lens Educators, fellow of the American Academic of Optometry, member of the Cornea and Contact Lens Section of the American Optometric Association, and advisory board member for the Gas Permeable Lens Institute. Additionally, his relationships with representatives in the contact lens industry around the country have greatly benefited Ferris' clinical research and residency programs.

Dr. Morgan's research interests include gas-permeable contact lenses, keratoconus and corneal reshaping, and he specializes in the design and fitting of orthokeratology lenses. He also has been involved in numerous accreditation processes for both college and residency programs, including serving as a member of the Accreditation Council on Optometric Education.

RevitalVision Names Moro Vice President and General Manager

RevitalVision, a leader in Neural Adaptive Visual Improvement Therapy, has named Glenn Moro as Vice President and General Manager, with responsibility for amblyopia therapy.

Glenn comes to RevitalVision after a long and distinguished career at Alcon, where most recently he served as Global Director of Marketing for the Opti-Free contact lens care business. His experience and expertise will factor heavily in expansion of the company's FDA approved amblyopia therapy into the optometric market. According to the company, this is another step forward as they continue to employ strategies that meet current medical needs and expand product usage through eyecare providers.

Delayed Hypersensitivity to Lens Care Solutions
By Gregory W. DeNaeyer, OD, FAAO

Figure 1 shows the right eye of a 56-year-old man who had allergic contact dermatitis, allergic conjunctivitis and keratitis. The patient had been wearing a scleral contact lens on his right eye to improve his visual function after he had developed irregular astigmatism of his corneal graft. He used a multipurpose disinfecting solution to clean and disinfect his lens, and he filled it with preserved saline solution before application. He used preserved artificial tears as needed. He had been wearing the scleral lens for 1 year without incident. During the previous 2 weeks, however, he had been experiencing irritation and redness of the right eye.

I suspected the patient had developed hypersensitivity to one of his lens care solutions, which was triggering his allergic symptoms. I instructed him to immediately stop using his current multipurpose disinfecting solution, saline and artificial tears. I prescribed a hydrogen peroxide care system for cleaning and disinfection and instructed the patient to fill his lens with non-preserved saline before application. I also advised him to use only non-preserved artificial tears. At his next follow-up visit, the patient reported his symptoms had completely resolved within 1 week of switching lens care solutions.

For more on this patient, see http://www.clspectrum.com/articleviewer.aspx?articleID=106538.

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.
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Ronald K. Watanabe, OD, FAAO

What GP design did you order?

When fitting a spherical GP lens, it is important to know the design you are ordering. A GP manufacturing lab can make a lens if you specify the base curve, power, and overall diameter. But the peripheral system is then at the discretion of the lab. Though labs make lenses with very similar designs, they are not all the same.

A brief, informal survey of a few GP labs found that though the labs can make a multitude of GP designs, there are two main "default" designs in use. The first is a more traditional tricurve design with spherical peripheral curves of varying curve radii and widths. The second is one with a spherical optic zone and an aspheric periphery specified by an axial edge lift value. The optic zone diameter for both designs is 1.4 to 1.5 mm smaller than the overall diameter. These two designs, though similar, can have different fitting characteristics. This can be critical when refitting an existing GP lens wearer who is new to your office. It is best to ask your lab what design they use as their "standard" design, or better yet, specify the peripheral design on all of your GP lenses.

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Guest Columnist: Scott E. Schachter, OD; Loretta B. Szczotka-Flynn, OD, PhD, MS, FAAO

Treatment of Demodex Blepharitis

As a follow up to my recent column about the frequency of Demodex infestation in blepharitis patients, I have had several inquiries about the best treatment strategies for Demodex associated blepharitis. I have asked my colleague Dr. Scott Schacter of Pismo Beach, California to share his current treatment plan and the science behind it. He routinely diagnoses and treats this condition.

"We have patients come in for three consecutive weeks for in-office treatment. On week 4 we evaluate for Demodex, and treat again as needed. The procedure is as follows: Apply one drop tetravisc. We apply a 50:50 mix of tea tree oil and macadamia nut oil with a cotton swab. We apply at the base of the lashes laterally along the lid margin several times. The patient then closes their eyes for 10 minutes. We then repeat the procedure and rinse thoroughly after another 10 minutes.

"This treatment is based upon work reports by Tseng's group.1 Gao et al2 showed that Demodex is resistant to a wide range of antiseptic solutions. They assessed 10% povidone-iodine, 75% alcohol, 50% baby shampoo, and 4% pilocarpine. They found the survival time was significantly shortened to within 5 minutes in 100% alcohol, 100% tee tree oil (TTO), 100% caraway oil, or 100% dill weed oil and lid scrubs with 50% TTO, but not with 50% baby shampoo, can further stimulate Demodex to move out to the skin. The Demodex count dropped to zero in seven of nine patients receiving TTO scrub in 4 weeks without recurrence.

"We have not found any home treatments to be effective at this time. Some advocate ointment to slow the movement of the mites at bedtime. A commercial home tea tree oil treatment is due to hit the market in the coming months."

1. Liu J, Sheha H, Tseng SC. Pathogenic role of Demodex mites in blepharitis. Curr Opin Allergy Clin Immunol. 2010 Oct; 10(5):505-510
2. Gao YY, Di Pascuale MA, Li W, Baradaran-Rafii A, Elizondo A, Kuo CL, Raju VK, Tseng SC. In vitro and in vivo killing of ocular Demodex by tea tree oil. Br J Ophthalmol. 2005 Nov;89(11):1468-73.

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Effect of Punctal Occlusion on Tear Menisci in Symptomatic Contact Lens Wearers

The purpose of this study was to investigate by ultrahigh resolution optical coherence tomography the effect of punctal occlusion on tear menisci in symptomatic and asymptomatic contact lens wearers.

Symptomatic subjects with self-reported dry eyes (n = 20) and asymptomatic subjects (n = 20) were recruited. For each subject, one eye was randomly chosen for both upper and lower punctal occlusion with collagen plugs. Ultrahigh resolution optical coherence tomography imaged both upper and lower tear menisci before punctal occlusion, and 1, 4, 7, and 10 days afterward. Comfort scoring, noninvasive tear break-up time, tear break-up time, and Schirmer test with anesthesia were also performed.

Tear meniscus variables in the symptomatic group were lower than those in the asymptomatic group (P < 0.05) at all time points except for day 4. In the symptomatic group, the tear menisci were increased up to day 4 after punctal occlusion (P < 0.05). The increase was present only on day 1 in the asymptomatic group. Improvement of comfort scores and noninvasive tear break-up time occurred in both groups after occlusion (P < 0.05). The comfort scores were linearly correlated with the tear volumes after punctal occlusion, with higher correlation coefficients in the symptomatic group.

The researchers concluded that punctal occlusion transiently increased tear menisci in symptomatic and asymptomatic lens wearers, with a longer duration in the symptomatic group. For both symptomatic and asymptomatic lens wearers, the increased meniscus volume was associated with improved ocular comfort.

Li M, Wang J, Shen M, Cui L, Tao A, Chen Z, Ge L, Lu F. Effect of Punctal Occlusion on Tear Menisci in Symptomatic Contact Lens Wearers. Cornea. 2012 Sep;31(9):1014-22.
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