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Sunday, August 26, 2012  
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Last question:
Which type of blepharitis do you believe is more frequent?

 A. Anterior blepharitis

 B. Posterior blepharitis

Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

I was reminded this week while in clinic just how important marketing efforts can be to the success of your practice—either through direct or indirect efforts. We successfully fitted a lapsed contact lens wearer who deeply missed her contact lenses, but was apparently neglected by her prior eyecare provider in terms of some visual and comfort issues. Once we refitted her, she was comfortable and ecstatic about getting rid of her spectacles. The next thing we knew, several of her friends and colleagues were in the clinic to see us for their eyecare needs. Making the difference for one patient can lead to many other successes.

In Memoriam: Keith W. Harrison, FCLSA(H)

Keith W. Harrison, FCLSA(H) lost his battle with cancer and passed away August 21, 2012. Keith will be remembered as a visionary in the optical industry and a leader of the Contact Lens Society of America (CLSA). Keith leaves behind his wife Linda, son Bradley and wife Brigid, and daughter Courtney.

Keith thrived on helping patients, always welcoming the most challenging of cases, and took great pride in being able to help people see better. He was an ophthalmic dispenser and certified contact lens fitter in Toronto, Ontario, Canada where he was owner of Harrison Optical Services, a contact lens practice and optical business in the Toronto Western Hospital.

Keith was an imaginative leader and constant educator while donating his time, expertise, and passion for contact lens fitting throughout his 31-year tenure as a CLSA member. He served as a member of the CLSA Board of Directors, as CLSA Secretary/Treasurer, CLSA Foundation Chair and as President of the Contact Lens Society of America. He was an Honored Fellow Member of CLSA. He was an ever-present educator at CLSA meetings.

He received the Lifetime Achievement Award from the Ontario Opticians Association, and the Clifford R. Shorney 2012 Member of the Year Award. He held membership in the Canadian Guild of Dispensing Opticians. Keith was NCLE Advanced Certified, and while serving on the NCLE Board of Directors was instrumental in the creation of the ABO-NCLE National Opticians Conference.

CLSA has established a fund in Keith's name; donations will be directed to the charity or cause chosen by the family: CLSA Foundation, c/o The Keith Harrison Fund, 441D Carlisle Drive, Herndon, VA 20170.

Be Part of a Global Movement: Take the World Sight Day Challenge 2012

Optometry Giving Sight is calling on all members of the optometric community to join the global movement to eliminate avoidable blindness by taking the 2012 World Sight Day Challenge this October.

The World Sight Day Challenge is an opportunity for everyone in the optical profession to make a personal donation and help raise urgently needed funds to support sustainable eye and vision care projects in underserved communities around the world. Optometrists and their practices are once again invited to:

  • Donate a day of eye exam fees in October, or
  • Make a small donation per frame sold or exam given, and to
  • Invite patients to donate during the month.
Information about making a donation or holding a practice fundraiser is available at www.givingsight.org or by calling 1 888 OGS GIVE (USA) / +1 403-670-2619 (Canada).

Deadline is August 31 for Submission of Papers and Posters for GSLS

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.

OCuSOFT Makes Changes in Corporate Leadership; Names Ward President, COO

OCuSOFT, Inc. announced the promotion of Patrick Ward, RPh, MBA, to President and Chief Operating Officer (COO). Cynthia L. Barratt, formerly President and Chief Executive Officer (CEO), will now serve as Co-Chairman with Nat Adkins while retaining the position of CEO. Two of the company's executives, Stacy Foster and Troy Smith have also assumed new roles within the organization. Stacy Foster will succeed Mr. Ward as Executive Vice President and Troy Smith has been named Vice President of Sales.

Prior to joining OCuSOFT in January 2011, Ward served as Vice President, Finance and Administration and co-founder of Aviara Pharmaceutical Research, a startup biopharmaceutical company. He also previously served as Executive Director of Business Development of Encysive Pharmaceuticals.

Foster joined the company in February 2009 as Vice President of Business Development after serving in many executive capacities in the technology, energy, and general manufacturing industries.

Smith has been with the company since August 1998 and has served many roles within the company ranging from Customer Service Manager to Vice President of Marketing and most recently Vice President, Professional and Technical Relations.

Your Interesting Case Photo Here

Have you seen an interesting case lately? Would you like to share it with your colleagues? An image from that case could appear in this column next week!

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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Susan J. Gromacki, OD, MS, FAAO

Contact Lenses and Swimming: A Compliance Lesson

Sometimes noncompliant patients are those we least expect. A few weeks ago, we were vacationing with friends at the beach. Our friend asked me why his contact lenses hurt so much while he was swimming. I asked him if his eye care provider had ever instructed him about the contraindication of swimming with his contact lenses and the risk of Acanthamoeba keratitis associated with it. He of course answered, "No." He was noncompliant without even knowing it.

The conversation raised a few questions. Why didn't his practitioner recommend daily disposable contact lenses? Did s/he assume that he could not afford them? (He most certainly could.) Did his practitioner attempt to educate him regarding swimming with contact lenses? (If anyone ever remembered the detail of every instruction he had ever received, it would be this engineer.)

To ensure that your patient instruction is communicated properly, listen in on one of your staff member's care and compliance instruction sessions. Make sure that s/he is emphasizing the points that you want to make. Also, provide a written handout for your patient to take home. Some patients learn better via the written, rather than the spoken, word. Understanding that not all patients will take the time to read it, prepare a briefer version for the patient to read and sign in-office, highlighting hot-button topics such as extended wear, swimming in contact lenses, and what symptoms require a return to clinic. This can be handled by your front desk staff member, giving your patient a third point of contact in learning proper lens care and compliance. Better patient communication goes a long way towards improving compliance.

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Katherine M. Mastrota, MS, OD, FAAO

Botulinum Toxin and Dry Eye, Part 2 of 4

Although complications of the use of botulinum toxin (BOTOX) around the orbit include dry eye (see Part 1), interestingly literature suggests that BOTOX can be utilized to treat dry eye and protect the cornea at risk.

Studies have proposed that there is a sphincter-like action exerted by the orbicularis oculi pars lacrimalis muscle that compresses and contracts the lower canaliculus, causing tears to move toward the nasolacrimal sac and duct.1,2 It has been demonstrated that a medial canthal injection of botulinum toxin causes a temporary decrease in lacrimal drainage.3,4 This effect may be caused by pharmacologic denervation of the obicularis oculi pars lacrimalis muscle leading to decreased action of the lacrimal pump and prolonged lubrication of the ocular surface.

Alternately, protective ptosis by temporary paralysis of the levator palpebrae superioris muscle may be a useful tool and an alternative to tarsorraphy in the temporary treatment of dry eye disease secondary to exposure/lagophthalmos, corneal hypoesthesia and other pathologies.5,6

Therefore, targeted use of botulinum toxin has potential use in the management of dry eye disease and for ocular surface protection.7

1. Pavlidis M, Stupp T, Grenzebach U, Busse H, Thanos S. Ultrasonic visualization of the effect of blinking on the lacrimal pump mechanism. Graefes Arch Clin Exp Ophthalmol. 2005;243:228-234.
2. Lee MJ, Kyung HS, Han MH, Choung HK, Kim NJ, Khwarg S. Evaluation of lacrimal tear drainage mechanism using dynamic fluoroscopic daccryocystography. Ophthal Plast Reconstr Surg. 2010;27:164-167.
3. Sahlin S, Chen E, Kaugesaar T, Almqvist H, Kjellberg K, Lennerstrand G. Effect of eyelid botulinum toxin injection on lacrimal drainage. Am J Ophthalmol. 200;129:481-486.
4. Sahlin S, Linderoth R. Eyelid botulinum toxin injections for the dry eye. Dev Ophthalmol. 2008;41:187-92.
5. Yücel OE, Artürk N. Botulinum toxin-a-induced protective ptosis in the treatment of lagophthalmos associated with facial paralysis. Ophthal Plast Reconstr Surg. 2012 Jul;28(4):256-60.
6. Gusek-Schneider GC, Erbguth F. [Protective ptosis by botulinum A toxin injection in corneal affectations] Klin Monbl Augenheilkd. 1998 Jul;213(1):15-22. Article in German.
7. Victoria AC, Pino A. Botulinum toxin type A and its uses in dry eye disease. Plast Reconstr Surg. 2012 Jul;130(1):209e-10e.

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A Cross-Sectional Analysis of U.S. Contact Lens User Demographics

Large population studies carried out in the United States, while addressing refractive error prevalence, have published little addressing the modes of refractive correction. As such, there are little data in the biomedical literature concerning the characteristics of the contact lens wearing population in the United States. The purpose of this project was to develop estimates of the demographic characteristics of a cross section of contact lens wearers in the United States based on those who wore contact lenses on the day of their National Health and Nutrition Examination Survey (NHANES) examination.

The NHANES is a nationally representative sample of the U.S. population. As part of NHANES, the type of refractive correction used is collected during a mobile medical clinic examination along with demographic variables. Data files from the 2005-2006 and 2007-2008 NHANES were obtained from the National Center for Health Statistics. Demographic characteristics of the U.S. population using contacts during the medical clinic examination were derived. Associations between demographic variables and contact lens use were explored in age-stratified univariate and multivariate analyses taking into account the complex sampling frame.

In univariate analysis, age (p < 0.001) and the availability of health insurance (p = 0.007) have negative associations with contact lens use, while female gender (p < 0.001), higher socioeconomic status (p < 0.001), and higher educational attainment (p < 0.001) are associated with increased contact lens use. In multivariate analysis, age (p < 0.001), socioeconomic status (p < 0.001), the interaction of age with gender (p < 0.001), and the interaction of socioeconomic status with education (p = 0.002) are associated with contact lens use.

The author concluded that four demographic variables, age, socioeconomic status, age-gender interaction, and socioeconomic status-education interaction, defined those likely to be using contact lenses on any given day in the United States. Together, these four variables identify almost 9 of 10 contact lens users.

Swanson MW. A cross-sectional analysis of U.S. contact lens user demographics. Optom Vis Sci. 2012 Jun;89(6):839-48.

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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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