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Sunday, September 9, 2012  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

It's back-to-school time again this year, and hopefully your offices have been filled with kids and parents who are getting ready for the next school year. As we know, fitting kids in contact lenses has many benefits, one of which is the joy that they get from not having to wear glasses. Although many practitioners have focused on an age criteria for fitting kids over the years, most of the field now embraces the idea of evaluating other facets of the child when deciding if contact lenses are appropriate for each child. Likewise, don't forget to keep the parents involved in the discussion as well, as communication is key to successful wear.

J&J Launches New Website for Eyecare Professionals

Johnson & Johnson Vision Care, Inc. has launched a new website for eyecare professionals, www.ACUVUEprofessional.com.

The new website, designed to function on desktops, tablets, and mobile devices, features a unique contact lens finder, which includes the entire line of Acuvue Brand Contact Lenses, as well as products from other major manufacturers. This new tool was designed to help doctors quickly find the right contact lens for their patients by easily searching through different lens parameters, manufacturers, modalities and materials.

Visitors to www.ACUVUEprofessional.com can also access detailed product information on all Acuvue Brands such as Dk/t, lens designs and the latest rebate information.

Patient instructional videos are also a new feature on the site. These short, consumer-friendly videos were designed as a resource for doctors to help patients understand common refractive errors, proper lens care, how to insert and remove contacts, Acuvue Brand technologies and more. Plus, eyecare professionals can embed these videos on their practices' web pages.

On www.ACUVUEprofessional.com, eyecare professionals can also find a variety of useful practice resources, including interactive videos and articles offering sound advice from peers on how to increase patient satisfaction and practice growth. Doctors will also have the opportunity to sign up for the free "Find a Doctor" interactive online map, which will be listed on the consumer site, www.ACUVUE.com.

SynergEyes Changes Duette Policies and Pricing

SynergEyes, Inc. announced that it has completely retooled its policies and procedures for Duette lenses to make it easier to fit everyday patients.

The new policies, which went into effect at the beginning of August, completely transform Duette pricing and return procedures to better align with customer's normal business practices. They include a satisfaction guarantee and establish a Reorder Reminder Program to bring Duette patients back to the practice each year to reorder their lenses.

The Duette family of lenses includes Duette HD for vision demanders and Duette Multifocal for patients over 45 seeking great vision from every point of view. SynergEyes also manufactures and markets a line of contact lenses for irregular corneas including ClearKone, SynergEyes A, KC, PS and Multifocal.

For more information, visit www.duettelens.com.

Acculens Appoints Cogger Professional Services Consultant

Acculens announced the hiring of Steve Cogger, FCSLA as Professional Services Consultant for the North East Region of the country. Cogger has over 10 years experience as a specialty contact lens fitter at Theo E. Obrig, Inc., a referral based practice for challenging contact lens fits in the New York City area. He is a Fellow of the Contact Lens Society of America and a former member of the Board of Directors at the CLSA. Aside from fitting his own patients, Steve served as the Director of Clinical Support and Training for Wave Contact lenses for the past four years where he helped others fit and design specialty gas permeable contact lenses for their patients.

For more information on their specialty lenses, including the Comfort SL, a simple alternative to soft toric lenses for the correction of none distorted ametropia, and the Maxim Scleral lens for the management of ocular surface disease, contact Acculens at 1-800-525-2470 or visit www.acculens.com.

Allergan Opens New R&D Center

Allergan, Inc. marked the opening of the company's first large facility in the state of New Jersey. Company leaders were joined by federal, state and local government officials, community leaders, physicians and employees as they officially opened Allergan's new Research and Development (R&D) Center in Bridgewater, New Jersey.

The new R&D Center, which will be specifically focused on clinical development, is a significant expansion of the company's footprint in New Jersey and is expected to eventually house several hundred employees. In line with Allergan's commitment to the environment and efforts regarding sustainability issues, the 93,000-square-foot facility features high-performance, energy-efficient and environmentally responsible energy systems that produce low emissions and optimal indoor air quality. The facility was awarded the U.S. Environmental Protection Agency's prestigious Energy Star recognition, the national symbol for superior energy efficiency and environmental protection, and is registered with Leadership in Energy and Environmental Design (LEED), which is the path to seeking LEED Existing Building - Operating & Maintenance certification.

OCuSOFT Introduces OCuSOFT Baby

OCuSOFT, Inc. introduces OCuSOFT Baby, the first and only eyelid and eyelash cleanser for children of all ages.

OCuSOFT Baby is a mild, tear-less formula that gently removes irritants and morning gunk that can contribute to discomfort associated with blocked tear ducts, pink eye, allergies and other eyelid related conditions in infants and small children. Specially formulated for children's delicate skin, it contains no parabens, fragrances, dyes or Quaternium-15 for the utmost comfort. Simply cleanse eyelids and eyelashes with gentle side-to-side strokes. No rinsing necessary.

OCuSOFT Baby Eyelid and Eyelash Cleanser is conveniently available in individually wrapped towelettes (20/box) and can be found at Walgreens and Duane Reade Pharmacies.

To request professional samples for trial evaluation, visit www.ocusoftsamples.com or call (800) 233-5469 for more information.

New Materials Welcome
D. A. Hough, BA, MBA, Huntingdon, Cambridgeshire, UK

I noted with interest the announcement in your July 1 issue that Bausch + Lomb has launched a new soft lens that is not a silicone hydrogel. At least as interesting is the sparse and muted response by readers (on the impact of silicone hydrogels) in your July 29 issue.

It is a fascinating development. Deja vu all over again. The Biotrue material is nesofilcon, a descendant of and 'substantially equivalent' to hilafilcon. Specifically it is a copolymer of 2-hydroxyethyl methacrylate and N-vinyl pyrrolidone with a little more water content than its immediate parent. Lovely to see you again, my friend, as the Moodys said.

Linked to this, I suppose, is Joe Barr's eloquently argued piece in his Joe's View B+L column where he says, essentially, that a high water hydrogel offers a better proposition for most wearers. But, and it's a very big BUT, if that is true why has the industry spent the past decade persuading ECPs that the way to go is silicone hydrogel? Some of the promotion has been embarrassing. Toe-curling, even. If it is the case, as Joe says, that a 78% hydrogel will deliver 'healthy white eyes', then we can stop looking at such topics as lubricity; there was no lubricity issue until we added silicone to soft lenses.

I would guess that the Biotrue product will be greatly more comfortable than most silicone hydrogels. Not much of a challenge, but a useful box to tick. Has the silicone hydrogel project achieved its principal objective - to have the majority of wearers using silicone hydrogels in a closed eye modality? No; and no realistic prospect of achieving it, either. Has it delivered more oxygen? Yes; that was all it could ever do. Has it improved the eye health of wearers? Not sure. And the fact that after 10 years we have no clear evidence that there has been a major improvement in the health of wearers is surely an indictment of the policy by manufacturers of promoting silicone hydrogel lenses to the extinction of other materials.

History may well show that the entire silicone hydrogel project was no more than another material development. It has applications; it is not a universal solution. We need a diverse market in soft lens materials which includes silicone hydrogels and current best form hydrogels. Go, Bausch! Ring the changes!

The author reports no commercial relationships.

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

Refining Scleral Lens Fitting

Scleral lenses have taken off as a method of fitting not only diseased corneas but also garden variety astigmatism and refractive error. Although the large tear reservoir is thought to bathe and protect the cornea, little is known about the physiological aspects of the lens fit. A new study by Michaud et al1 discusses a theoretical model to refine scleral lens fitting with regards to impact on the corneal physiology.

They used theoretical calculations to predict the oxygen transmissibility of scleral lens systems, considering several material permeabilities (Dks 100-170), varying lens thicknesses (250-500μm), the known tear permeability (Dk of 80) and expected post-lens tear layer thicknesses (100-400μm). They chose to reference the minimal threshold for Dk/t of 24 Fatt units (Holden-Mertz criteria) and 35 Fatt units for the limbal area (Harvitt-Bonanno criteria).

Their calculations for maximum central lens and post-lens tear thicknesses ranged from 250-495μm and 100-250μm, respectively. This leads to their concluding recommendations that to minimize hypoxia-induced corneal swelling scleral lenses should be fit with the highest Dk available (>150) lens with a maximal central thickness of 250μm and fitted with a clearance that does not exceed 200μm.

Although lens thickness cannot be easily manipulated by the fitter, certainly material choice and fitting relationships can be altered to meet these criteria if hypoxia is a concern.

Michaud L, van der Worp E, Brazeau D, Warde R, Giasson CJ. Predicting estimates of oxygen transmissibility for scleral lenses. Cont Lens Anterior Eye. 2012 Aug 6. [Epub ahead of print]
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Ronald K. Watanabe, OD, FAAO

Monitor IOP with a Contact Lens!

A new article in Archives of Ophthalmology (Mansouri 2012) presents results of the Sensimed Triggerfish contact lens designed to continuously measure intraocular pressure. This is a single-use silicone hydrogel contact lens imbedded with a "strain gauge" that detects changes in diameter of the corneoscleral junction presumably caused by changes in IOP. A telemetric chip and looped antenna wirelessly transmit the data collected by the strain gauge to a portable recorder. Theoretically, the lens can monitor IOP over a 24-hour period, which allows a diurnal IOP curve to be constructed even for the period when the patient is asleep. If it works, it can give a more complete picture of a patient's IOP fluctuation throughout the day and night, which will help with their glaucoma management.

The paper measured IOP on 40 subjects and concluded that the IOP measurements are fairly well reproduced with good safety, though some complications were noted. The lens is available in three base curves and one diameter, and is currently available in parts of Europe but not yet in the U.S. This is yet another innovative use of contact lenses to help manage an aspect of ocular health.

Mansouri K, Medeiros FA, Tafreshi A, Weinreb RN. Continuous 24-hour monitoring of intraocular pressure patterns with a contact lens sensor. Arch Ophthalmol. 2012 Aug 13:1-6. doi: 10.1001/archophthalmol.2012.2280. [Epub ahead of print]
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Antimicrobial Efficacy Tests of Multipurpose Contact Lens Care Solutions Simulating Poor Contact Lens Hygiene Behaviors

The aim of this study from Japan was to simulate the biofilm formation in contact lens (CL) case under poor hygiene behaviors; antimicrobial efficacies of multipurpose solutions (MPSs) against biofilm on the lens case were evaluated.

Five MPSs (Epica Cold, Complete 10 min, ReNu MultiPlus, SoftOne Mois, and OPTI-FREE Plus) were tested. Lens cases containing ACUVUE2 were inoculated with 1x10, 10, or 10 colony-forming units (CFUs) of Staphylococcus epidermidis (SE). Each lens case was treated with 1 MPS for 4 hours followed by the estimation of the number of SE by the CFU method. Disinfection efficacies of MPSs against SE biofilm were evaluated by biomicroscopy with safranin staining and scanning electron microscopy.

Lens cases, inoculated with 1x10 CFU, were disinfected by all MPSs. Epica Cold, Complete 10 min, ReNu MultiPlus, and OPTI-FREE showed almost a 2-log reduction of the CFU, whereas SoftOne Mois effect was almost a 1-log reduction, significantly lower than other MPSs (P<0.05). No biofilm formations were observed in Epica Cold, Complete 10 min, ReNu MultiPlus, and OPTI-FREE Plus-treated groups unlike significant biofilm formation in the SoftOne Mois-treated group (P<0.01).

The researchers concluded that greater efforts to educate patients regarding compliant lens care behavior are needed to reduce the incidence of CL-associated microbial keratitis.

Uno T, Ohashi Y, Imayasu M. Antimicrobial Efficacy Tests of Multipurpose Contact Lens Care Solutions Simulating Poor Contact Lens Hygiene Behaviors. Eye Contact Lens. 2012 Jun 2. [Epub ahead of print]
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