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Sunday, September 7, 2014  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

Diabetes is a condition that is becoming more and more prevalent in today’s society, and Type 2 makes up the vast majority of those cases in the adult population. The United States has one of the highest rates of diabetes worldwide. As eye care practitioners, we play a vital role in perhaps detecting diabetes, or long-term changes associated with diabetes (retinopathy). One question that comes up in practice is the safety of wearing contact lenses with known diabetic status. Of course, we don’t prescribe these patients overnight wear, but otherwise, diabetic patients can very safely wear daily wear contact lenses. Prescribe lenses that offer the most ideal physiological and health benefits to these patients—whatever you deem those to be.

Salus PCO Launches Nation’s First Accelerated Doctor of Optometry Degree

The Salus University Pennsylvania College of Optometry (PCO) is now offering the nation’s first accelerated Doctor of Optometry degree program. Presented as a highly selective, continuous, three-year Scholars Program, the first class of 10 students recently began course work and is scheduled to graduate in June 2017. Students enrolled in the Scholars Program earn the credit equivalency of students in a traditional four-year program.

The unique curriculum emphasizes lecture and laboratory instruction, small group learning, case-based learning and online and web enhanced instruction. Guided independent study offers students the ability to work individually and in small groups with faculty mentors. Students accepted into this program are carefully screened and accepted based on qualifications, history of academic performance and career path.

CooperVision Increases AFOS Sponsorship to
Patriot Level

To continue its support of the U.S. military community, CooperVision, Inc. has increased its sponsorship to the “Patriot” level, becoming a premier sponsor of the Armed Forces Optometric Society (AFOS).

The Armed Forces Optometric Society’s mission is to improve the eye care of the nation’s military personnel, veterans, and their families through the education of and communication with the optometrists who serve them.

AFOS currently counts nearly 3,500 doctors of optometry, residents and externs throughout federal services. The society estimates that military and federal optometry make eye health services available to a total of 1.5 million active duty military personnel, 20 million veterans, and 500,000 dependents.

For more information, visit

Alden Expands NovaKone Distribution

Alden Optical has named ABB Optical Group as an authorized distributor of NovaKone, the company’s soft lens for the correction of vision in patients with keratoconus. Alden Optical and ABB Optical have conducted extensive joint customer service and consultation training to ensure the quality of support afforded practitioners ordering NovaKone through ABB Optical is second to none. As announced last month, ABB Optical was recently named as Alden’s exclusive U.S. distributor. Practitioners can enjoy world class service and support by working with Alden directly or via the ABB Optical team.

ABB Optical has been an authorized distributor for all Alden lenses except NovaKone since 2008.

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

Optometry Cares – The AOA Foundation and Essilor of America Announce the Bernard
Maitenaz Scholarship

A new scholarship is now available for third-year optometry students: the Bernard Maitenaz Scholarship sponsored by Essilor and administered by Optometry Cares – The AOA Foundation. One winner will be selected annually for the $10,000 scholarship.

The scholarship honors Bernard Maitenaz, one of the foremost authorities in optical science and engineering. Maitenaz is the inventor of the Varilux lens. In 2012 alone, 50 million progressive addition lenses were prescribed and dispensed in the U.S.

To be eligible for the scholarship, the third-year optometry student must complete the following requirements:
  • The applicant must compose a two-page/1,500 word essay and either a five-slide PowerPoint or a three-minute video. All entries must focus on the impact of vision on performance, economics education and lifestyle in the United States and beyond. Applicants must demonstrate leadership and participation in school and community activities, honors, and work experience, as well as include goals and aspirations, and unusual personal or family circumstances.
  • Submit two letters of recommendation. One of the letters must be from an academic advisor/teacher/dean where the applicant attends school.
  • These applications must be submitted to the school or college where the applicant is enrolled first.

Schools of optometry will determine their top applicant and send his or her materials to Optometry Cares by November 11, 2014. Applications will be reviewed by Optometry Cares Endowment and Scholarship Fund Advisory Committee, and a winner will be determined in December 2014.

For more information on the Bernard Maitenaz Scholarship, please contact Optometry Cares Development Officer, Rebecca Hildebrand, at 314-983-4154 or For video and additional submission requirements, visit

Stevens-Johnson Syndrome
Edward Boshnick, OD, Miami, FL

This is the Stevens-Johnson Syndrome eye of a 19 year-old female. The visual acuity is this eye is finger counting at 6 inches. With a 16mm reverse geometry scleral lens she can achieve 20/150 VA. This patient developed Stevens-Johnson Syndrome as the result of a penicillin injection at the age of 9.

We thank Dr. Boshnick 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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David Kading, OD, FAAO
The “Perfect-Imperfect” System

I had an interesting follow up visit in the office this week. Gwen is a 46-year-old female glasses only wearer who recently decided she would like to wear contact lenses for certain occasions. I love part time contact lens wearers. These are people who are curious about lens wear, but not certain that they want to commit. Gwen has -1.25 DC in her dominant eye and -1.00 DC in her non-dominant eye and she wants multifocal vision. Where to go? Hybrids? Corneal GPs? Soft toric multifocals? Sclerals?

The first point is that there is no wrong answer here. Thinking that the patient would not adapt to corneal GP lenses as a 1-2 times per week wearer, I chose hybrid lenses. Through the fitting process, ordering process, visits in office, we spent around two months to get to a place where we abandoned these lenses. Hybrid lenses have come a long way, but Gwen refused to accept the cost, the vision or comfort of the lenses realizing that she was going to be a part time wearer. Realizing that I was about to lose the patient to the “I’ll stick with glasses” statement—I went in a new direction. I fit her into a toric one-day lens in her dominant eye and a one-day multifocal in her non-dominant eye. Some may ask, why not just go with monovision altogether? The main reason is because I report to a Binocular Vision expert-- her name is Kristi Kading, OD, FAAO, FCOVD and I highly respect her take on the cortical connections that are challenged with single-eyed vision verses binocular.

Although this is certainly not a “perfect” system, Gwen was able to get 20/20 vision binocularly with a mild loss in distance vision in her near eye. Her near vision was decreased, but not enough that it kept her from her cell phone use (our standard near chart). Realizing these lenses would be used for distance activities and for occasional text messages (to check on the kids/husband), Gwen and I concluded that we had come up with the “Perfect-Imperfect” system. Being a contact lens specialist isn’t always about getting it “right”, but instead, finding what works for your patients. However, first you have to know the lens designs and materials and how they can benefit the patient’s needs and wearing schedule.

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Susan J. Gromacki, OD, MS, FAAO

A Case of Scleral Lens Noncompliance

A 16 year-old high school academic honors student was fitted for a new scleral gas permeable (GP) contact lens in the right eye following her keratoconus diagnosis and corneal collagen crosslinking procedure. The scleral lens improved her best-corrected vision from 20/50 to 20/20-2. (She did not wear a contact lens on her left eye.) At the dispensing visit, her lens fit well and she demonstrated good insertion, removal, and care techniques. Her first progress evaluation was uneventful. However, on her 1 month follow-up visit, I detected a diffuse 1-2+ superficial punctate keratitis throughout her right cornea. I asked her how she cares for her lenses; the cleaning and disinfection were performed properly, but she had resorted to filling the lenses with conditioning and disinfecting solution prior to application.

This case illustrates three primary points. First, no matter how intelligent a patient, there is always the potential for noncompliance with the prescribed treatment regimen.1 Secondly, although there are many good options to disinfect scleral GP contact lenses overnight, what a patient fills them with in the morning upon application is critical. It must be a non-preserved solution, and I and many others prefer 0.9% sodium chloride inhalation solution in 3-5 ml vials.2-4 Lastly, it is imperative to review lens care with your contact lens patients at each and every one of their visits to your practice.5


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Another Look at the Association Between Diabetes and Keratoconus

The aim of this study was to evaluate the association between diabetes mellitus (DM) and keratoconus.

The researhcers conducted two substudies: (1) Retrospective comparison of the prevalence of DM in patients with keratoconus with that of control patients without keratoconus and (2) Cross-sectional study of the severity of keratoconus in diabetic keratoconus-affected patients and non-diabetic keratoconus-affected patients. Patients seen at the Wills Eye Hospital Cornea Service from January 2008 to August 2012 were included. Study 1 included 1377 patients with keratoconus and 4131 controls without keratoconus. Study 2 involved 75 type 2 diabetic keratoconus-affected patients and 225 non-diabetic keratoconus-affected patients, excluding patients with bilateral keratoplasty. In patients with a history of a corneal transplant in one eye, the other eye was included. Keratoconus severity was based on the topographic mean keratometry in the more severely affected eye.

Two of 1377 (0.15%) keratoconus-affected patients had type 1 DM, which was similar to that of 20 of the 4131 (0.49%) matched controls (P = 0.139). The prevalence of type 2 DM was higher in patients with keratoconus (93/1377, 6.75%) than in matched controls (200/4131, 4.84%) (P = 0.005). When categorized by age group, the prevalence of type 2 DM was higher in patients with keratoconus than in those without keratoconus in patients aged between 25 and 44 years (P = 0.036) and 45 and 64 years (P = 0.047). Using multinomial logistic regression analyses, the probability/risk of being in the severe keratoconus-affected group as opposed to the mild keratoconus-affected group was higher in patients with DM than in those without DM (P = 0.006; odds ratio = 2.691; 95% confidence interval, 1.330-5.445).

The authors concluded that there may be a positive association between type 2 DM and the presence and severity of keratoconus.

Kosker M, Suri K, Hammersmith KM, Nassef AH, Nagra PK, Rapuano CJ. Another Look at the Association Between Diabetes and Keratoconus. Cornea. 2014 Aug;33(8):774-9.

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