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Sunday, August 22, 2010  
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Ocular Surface Update
Kelly K. Nichols, OD, MPH, PhD, FAAO

I am somewhat contact lens intolerant, and over the years I have tried pretty much every lens, and every care solution. I would say I am most tolerant with my recent lens/ care solution combination, yet I still never have a day in which I am not "aware" of my lenses, especially in the evening. Therefore, for the past two weeks I have tried a daily disposable lens. This is not my first daily trial, and I am evaluating it from both a doctor and patient perspective.

Most of the clinical research literature regarding daily disposable contacts involves lens-to-lens comparisons, generally in normal, non-dry eye subjects, and is somewhat sparse (< 10 published peer-reviewed papers in the last two years). However, a Google search of daily disposable contact lenses and dry eye results in numerous "hits" with many testimonials recommending daily disposable contact lenses for dry eye. Clearly, there is a lack of recent clinical research evidence, yet, it is a common suggestion.

How often do practitioners fit mildly intolerant patients into daily disposable lenses? Considerations include cost, convenience, comfort, and most importantly yet hardest to assess, promotion of ocular surface health. Hopefully we'll have more evidence in the future to support this clinical decision.

CLToday Quick Poll
Last week's question:
What is the most important aspect of contact lens care relative to optimizing the wearing experience for patients?

 Compliance with contact lens replacement schedules
   29%

 Compliance with contact lens case replacement
   0%

 Compliance with the overall care regimen
   62%

 Compliance with an individual step in the care regimen (rinsing, rubbing)
   9%

Care Solution Corner
Susan J. Gromacki, OD, MS, FAAO

We all have patients in our practices, those with mild-to-moderate dry eye who wish to remain in their contact lenses and will not take "no" for an answer! With a multifaceted approach, it is possible to keep many of them happily wearing their lenses. Too many of us change the lens material or replacement interval (both appropriate solutions, since some materials do wet better and/or deposit less than others) and prescribe rewetting drops during contact lens wear, only to give up a few months later.

Here's an additional strategy: have your patients instill a rewetting or artificial tear drop just prior to inserting their contact lenses in the morning. Then instruct them to apply another drop to moisten the lens just prior to removing it in the evening. Always use discretion as to which drop you recommend, as not all formulations are compatible with contact lenses. And there's more; I will continue the discussion on dry eye and contact lenses in my future Contact Lenses Today columns.

NEWS
Voluntary Recall of Select Lots of 1•Day Acuvue TruEye in Japan, Asia and Europe

Johnson & Johnson Vision Care, Inc. is voluntarily recalling select lots of 1•Day Acuvue TruEye Brand Contact Lenses (narafilcon A) manufactured in Ireland and distributed in Japan, as well as several countries within Asia and Europe. No other markets, including the United States (which markets a different version of 1•Day Acuvue TruEye made with narafilcon B) are affected.

Johnson & Johnson Vision Care is initiating this voluntary recall because it received a limited number of customer complaints in Japan associated with these affected lots. Some of the reported complaints described an unusual stinging or pain upon insertion. Most events involved one eye of the patient. According to the company, long term health consequences arising from this situation would be unlikely.

Upon investigation, the company determined there was an isolated issue in one portion of the lens rinsing process on a particular manufacturing line in a select number of lots. Neither other lots of this product nor any other Acuvue product have been associated with this manufacturing issue.

The company has suspended shipment of the affected lots still in its control and, following a comprehensive quality assessment, has implemented corrective actions to ensure that products meet the company's carefully controlled standards.

ABB CONCISE Inks Distribution Agreement with PolyVue

ABB CONCISE has begun distributing PolyVue's High Definition Multifocal Progressive and High Definition Aspheric soft contact lenses.

PolyVue HD lenses feature patented spherical aberration control optics for enhanced visual acuity at all distances, improved depth of field and reduced refractive astigmatism. The Comfort Perfected lens edge design and Hypathin cast-mold manufacturing make PolyVue lenses exceptionally comfortable to wear, according to the company.

PolyVue High Definition Progressive lenses incorporate additional patented optics providing comfortable simultaneous correction for near, intermediate and distance vision while simulating natural stereo accommodation equally in both eyes. The company states that this is possible because the lens eliminates the spherical aberration associated with most contact lens designs. Because of this, most PolyVue Progressive fits are binocular rather than the modified monovision. PolyVue High Definition Aspherics, which mask more cylinder than traditional aspheric designs, can be fit for single vision and emerging presbyopes with up to a +1.00D add.

For additional information, visit www.abbconcise.com.

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On-Demand Webinars on Keratoconus Management from the GPLI

The GP Lens Institute (GPLI) has expanded its online educational resources by adding a series of on-demand webinars on fitting and managing patients with keratoconus. This program is presented by Christine Sindt, OD, FAAO, Associate Professor of Clinical Ophthalmology and Director of Contact Lens Service at the University of Iowa. The series includes four modules on the etiology, progression and diagnosis of keratoconus; use of corneal topography; lens design and fitting; and problem-solving. The first two modules are currently available at www.gpli.info/gp-lecture. The final two modules will be added in the near future and there are plans for other on-demand lectures on various aspects of specialty GP lens fitting.

In addition to the on-demand programs, the GPLI is hosting its next live webinar event, Orthokeratology presented by Bruce Morgan, OD, FAAO, Professor and Chief of Cornea and Contact Lens Services at the Michigan College of Optometry at Ferris State University, on September 14 at 9PM Eastern time.  All eye care professionals are invited to participate in this free program, though preregistration is required.

For more information these webinars and other educational programs offered by the GPLI, visit www.gpli.info

Global Specialty Lens Symposium ... August 31 Deadline for Paper and Poster Submission

The Global Specialty Lens Symposium will be held January 27-30, 2011 at the Paris Hotel and Casino in Las Vegas, Nevada, USA. 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 Educational Program Committee of the GSLS invites the submission of abstracts. 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.

Those interested in submitting can visit www.GSLSymposium.com for more information. Web submissions only. Deadline for submissions is August 31, 2010.
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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.
Editor's Commentary
Jason J. Nichols, OD, MPH, PhD, FAAO
There is tremendous interest in the medical community to find biomarkers for various disease states. Simply put, a biomarker is a biological substance that is indicative of a future or present biological state, and potentially its severity. Diagnostic biomarkers hold great promise in potentially allowing for the early detection of disease. Without question, many clinician-scientists are seeking for biomarkers to ocular surface conditions, and someday, this concept may also find its way into the contact lens field. How might this be? To start, it might be of great interest if we knew of a biomarker that was predictive of future severe adverse events in contact lens wear such as microbial keratitis. I am certain we will see much research activity in the field of ocular biomarkers in the next five to ten years.
Abstract

Effect of Contact Lenses on the Protein Composition in Tear Film: A ProteinChip Study

The aim of this study was to analyze and compare the effects of rigid gas permeable and soft contact lenses on the protein composition in the tear film of contact lens wearers.

Wearers of soft contact lenses (CL_S, n = 13) and rigid gas permeable contact lenses (CL_H, n = 13) were recruited for this study. Thirteen non-contact lens wearers were also included as the control. Tears were collected using Schirmer strips and frozen until use. The tears were eluted and analyzed on ProteinChips SELDI-TOF (surface-enhanced laser desorption and ionization in time of flight mass spectrometry; Bio-Rad, USA) with different chromatographic surfaces (cationic and anionic exchanger and reversed phase surface). The SELDI spectra were analyzed by multivariate statistical analysis and artificial neural networks in order to find a biomarker panel which differentiates best between the groups. In order to identify protein/peptide peaks from SELDI spectra which showed a significant difference between groups, fractionated tear samples were analyzed using MALDI-TOF MS (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry). For validation of biomarkers, the researchers used an antibody microarray approach.

Complex patterns of tear proteins and peptides were detected in the control group and in both contact lens groups. The tear protein composition in both wearers of rigid gas permeable (CL_H) and soft contact lenses (CL_S) differed significantly from protein composition in non-contact lens wearers (p < 0.01). The identification of biomarkers revealed an increase of Protein S100 A8 in the group of wearers of CL_S and a decrease of a main tear protein, lysozyme, in both contact lens groups. The identified biomarker cystatin was upregulated in the group of CL_H wearers, whereas the protein intensity of secretoglobin was significantly reduced in this group. Using the microarray approach, detected alterations could be confirmed.

The researchers concluded that contact lens wear alters the protein profiles in a complex manner. This study demonstrates that significant changes can be found in CL_S wearer and CL_H wearer. Some biomarker intensities are significantly altered only in the CL_H group.

Kramann C, Boehm N, Lorenz K, et al. Effect of contact lenses on the protein composition in tear film: a ProteinChip study. Graefes Arch Clin Exp Ophthalmol 2010.


Important Links:
To report adverse contact lens reactions visit: http://www.accessdata.fda.gov/scripts/medwatch/ or call (800) FDA-1088.
To report possible grievances related to the Fairness to Contact Lens Consumers Act or associated Contact Lens Rule visit: https://www.ftccomplaintassistant.gov/.

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