Hopefully many of you have been busy with pediatric eye examinations over the last month as kids prepare to go back to school. As we all know, undetected ophthalmic conditions can be associated with significant learning and/or behavioral issues in kids, which is unfortunate as often these issues can be addressed by the eyecare practitioner. Also, as you examine these children—don't forget about the benefits of fitting them in contact lenses, if appropriate.

The 2010 Census of Optometric Practice, conducted by the American Optometric Association (AOA) Research and Information Center, collected information about private and corporate practice, and other employment situations in which ODs practiced Results from the Census will be released in three reports: 1) Income from Optometry; 2) Employment of Paraoptometrics; and 3) Practicing Optometrists and their Patients.

The first report details an analysis of net income and annual gross billings of owner ODs in private or corporate practice as a primary occupation in 2009. Net income for employed ODs is also reported where the number of responses was large enough to allow for reliable statistical analysis.

Key findings showed that the average net income from the primary practice of optometry was $130,856 in 2009. ODs who own all or a portion of their practice reported an average net income of $142,414 while ODs employed by others reported average earnings of $98,393. ODs who own or share ownership in their practice earned $35,000 more in private practice than in corporate practice while employee ODs earned $30,000 more in corporate practice than in private practice.

Click here to download the Executive Summary of "Income from Optometry". The complete 2010 Census of Optometric Practice is available for purchase by AOA members and nonmembers; costs and ordering information are at http://www.aoa.org/x18447.xml.

The 2011 Survey of Optometric Practice is currently underway and information obtained will be used in conjunction with the census data to report trends within the profession beginning in late 2011.

VSP Vision Care (VSP) launched its national Eye Pledge campaign to provide more than $19 million in free eye exams and glasses to at-risk kids through Boys & Girls Clubs of America.

The Eye Pledge campaign is designed to support and promote the importance of healthy vision. People nationwide are encouraged to give back by taking the Eye Pledge at www.SeeMuchMore.com and selecting either their local Boys & Girls Club or choosing to donate to a Club with the greatest need. For every Eye Pledge taken, a gift certificate, valid for a comprehensive eye exam and, if needed, a pair of glasses, will be donated by VSP.

For more information about the VSP Eye Pledge campaign and to take the pledge, visit www.SeeMuchMore.com.

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.
--ADVERTISING

Menicon America, Inc. today announced the introduction of a novel GP lens care system in the United States. The system brings together well-known and trusted products with several enhancements, a new look, and an e-commerce selling strategy.

This GP lens care system consists of Menicon Unique pH, Menicon Progent, and Menicon Rewetting Drops. Menicon has acquired the Unique pH brand name and worldwide manufacturing license from Alcon Laboratories Inc. Previously available in the United States for in-office use only, Menicon PROGENT is now FDA cleared for biweekly cleaning by patients at home. Menicon Rewetting Drops have been rebranded and are now available in a 10mL bottle.

In conjunction with the launch of the Menicon Lens Care System, the company has created the Menicon WebStore, hosted by eyecare practitioners for their patients.

For more information, visit www.meniconamerica.com

Bausch + Lomb (B+L) recently announced two additions to its Boston Lab Channel division.

Pat Murphy, is now the technical services manager for the Boston Lab Channel in Toronto, Canada. As a mechanical engineer, he will assist the authorized Boston Lab partners throughout the world. He comes from B+L Waterford, Ireland, where he was employed as a senior mechanical project engineer. He also provided technical support to B+L plants worldwide, as part of the B+L Global Engineering group.

As Global Marketing Manager, Boston Lab Channel in Wilmington, Mass., Claire Venezia will lead global marketing efforts for Boston materials within the Global Lab Channel. She has more than two decades of experience in the medical industry at companies such as Alcon, B+L, CooperVision, FirstVisionMediaGroup, Varilux Corp/Essilor of America, Vistakon and VISX.

Paragon Vision Sciences has appointed Dr. Goretty Alonso-Amigo as new assistant director of materials development. Company officials say she will play a key role in the research and development of new and innovative polymer options for all applications, including Paragon CRT.

She began her career in the contact lens industry nearly two decades ago where she served as manager of Analytical Chemistry at Pilkington Barnes-Hind. She worked for ACLARA Bioscienes as a research and development manager, followed by leading the U.S. Operations of JENOPTIK Mikrotechnik. Since that time, Dr. Alonso-Amigo founded her consulting company, Arlanzon Technologies, and taught polymer chemistry, general chemistry and analytical chemistry at San Jose State University.

CooperVision, Inc. recently announced executive leadership changes, effective Nov. 1.

Dennis Murphy, current president, Americas, is being promoted to Executive Vice President for Global Sales and Marketing. Andrew Sedgwick, current president EMEA, is being promoted to President, The Americas, including Latin America. Juan Carlos Aragon, president Asia Pacific & Latin America, is being promoted to President, EMEA, and will continue to be responsible for Australia and New Zealand. Fernando Torre, executive vice president, Global Operations, will add Global Distribution & Packaging to his responsibilities.

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This photo shows the cornea of a 19-year-old female who initially presented with binocular ocular pain and photophobia that was more severe in the right eye. Her accompanying signs included bilateral pre-auricular adenopathy, follicular hypertrophy, multiple corneal infiltrates, and conjunctival injection. All of these presentations were more pronounced in the right eye. We diagnosed viral keratoconjunctivitis and instructed the patient to discontinue contact lens wear, initiate a treatment regimen of tapering topical steroid therapy, and return in one week for evaluation.

The patient did not keep her subsequent appointment, but three weeks later she again presented with similar symptoms. Visual acuity was reduced to 20/30 in the right eye and her clinical presentation was as it appears in this photo.

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

Multifocals for Irregular Corneas

GP manufacturing technology can create some amazing lens designs these days, including reverse geometry, quadrant specific, and scleral designs. Usually, special designs are used when dealing with irregular corneas. Improving visual acuity is the main priority when working with patients with irregular corneas, and when the patient attains good vision, everyone is satisfied.

When working with irregular cornea patients with presbyopia, multifocal contact lenses may be the last thing on the fitter's mind. It is difficult enough to successfully fit the cornea with a GP lens without having to worry about multifocal optics. However, most GP laboratories today are able to manufacture specialty designs that incorporate multifocal optics. For example, Blanchard Contact Lens can pair their Refractive Surgery Specific (RSS) back surface with their Reclaim HD front surface, and other labs can put an aspheric multifocal front surface on various specialty back surface designs. Art Optical offers the SO₂Clear Progressive, a multifocal corneo-scleral design, and other scleral multifocals will probably be available in the future. For any of these designs, lens centration and proper movement are critical for success. Though this type of design may not be needed very often, it is good to know that today's technology makes it possible.

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

Central Toxic Keratopathy

Signs resembling a post-refractive surgery condition, central toxic keratopathy (CTK), have been reported in soft contact lens wearers. CTK after refractive surgery is a syndrome characterized by central corneal opacification, thinning, and a hyperopic shift.

A similar syndrome has been reported in at least two cases of contact lens induced keratitis. Hsu et al recently reported a 45-year-old white male who presented with three weeks of photophobia and foreign body sensation after extended contact lens wear with central stromal opacities, thinning, and hyperopic shifts in both eyes. Moshirfar et al in 2009 reported a 23-year-old female who developed acute, central, stromal haze subsequent to soft contact lens overwear with corrugated stromal "mud cracks" as seen in stage IV diffuse lamellar keratitis, relative corneal thinning and flattening, and a hyperopic shift of approximately 6 diopters.

Clinicians should be aware of this rare syndrome described in contact lens wearers and post-refractive surgery cases, suggesting a similar mechanism of action.

Hsu M, Tu E, Bouchard C.Confocal Microscopy of Contact Lens Keratitis Presenting as Central Toxic Keratopathy. Eye & Contact Lens. 2011 Jul 29. [Epub ahead of print]

Moshirfar M, Kurz C, Ghajarnia M.Contact lens-induced keratitis resembling central toxic keratopathy syndrome. Cornea. 2009 Oct;28(9):1077-80.

The goal of the study was to report on the influence of rigid gas permeable contact lens (CL) wear on the results of ultraviolet A/riboflavin cross-linking (CXL) for stabilization of progressive keratoconus. Researchers conducted a prospective non-comparative study of 15 eyes without CL and 12 eyes fitted with CL from 1 to 10 weeks post-CXL. None of the patients had been wearing CL before CXL. The effect of the CXL treatment was measured by the change from the baseline of best spectacle corrected visual acuity (BSCVA), refractive sphere and cylinder, maximal keratometry value (K max), simulated keratometry steep, flat, astigmatism, refractive power (RP) steep, flat and astigmatism, I-S value on EyeSys (EyeSys Vision Inc, Houston, Texas) and K max on Pentacam (Oculus Optikgerate, Wetzlar, Germany). The results of these measurements are reported pre-CXL and at six-month intervals up to 18 months post-CXL.

Researchers found that in the eyes without CL, none of the study parameters showed a significant change from baseline. Only in the group of eyes fitted with CL post-CXL, several parameters showed a significant improvement: I-S value and K max on EyeSys (all time points), RP steep and simulated astigmatism (6 and 12 months) and RP flat (12 months). Researchers concluded CL can be a confounding factor in interpreting the results of CXL: lens wear itself leads to improved topographic parameters.

Koppen C, Gobin L, Mathysen D, Wouters K, Tassignon MJ. Influence of contact lens wear on the results of ultraviolet A/riboflavin cross-linking for progressive keratoconus. Br J Ophthalmol 2011

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