The United States Federal government, through the Department of Health and Human Services, is implementing new conflict of interest guidelines. While there is much sensitivity associated with this topic, it ultimately is a good thing for clinical practice. Hopefully we will continue to see journals and their editors embrace these new policies and ensure, as much as possible, the disclosures are reported when appropriate.

Art Optical Contact Lens, Inc. introduces an online ordering option for eyecare practitioners involved in specialty contact lens fitting. The new online order page is accessible at https://www.artoptical.com/ordering/online-order-form/ and offers a comprehensive listing of the custom lens options available from Art Optical.

The custom lens ordering portal guides users through material and color choices by lens design, provides a secure site to protect the privacy of patient information, offers a print option so copies of orders are instantly available for patient records, and simplifies/expedites the transfer of file attachments like topography maps, fluorescein images, stock lens orders, etc. All online orders are processed by Art Optical on the same day, or on the next business day for orders placed over the weekend. When the online lens order goes into process, the practitioner is automatically notified via e-mail and provided an order number for future reference.

Menicon Company Ltd. announced the appointment of Jennifer Choo, OD, PhD, as Manager of Specialty Lens Clinical Affairs for Menicon Holdings B.V. Dr. Choo will oversee the company's Rose K business while also handling professional and clinical affairs for the company's growing specialty lens portfolio.

For the last three years, Dr. Choo has been Project Leader at Adventus Technology Inc. and the Brien Holden Vision Institute (BHVI) based in Sydney, Australia. She previously served as Project Director for Orthokeratology Research at BHVI while completing her PhD.

Dr. Choo obtained her Doctor of Optometry from the Pacific University College of Optometry in Portland, Oregon, and received her PhD in Vision Science from the University of New South Wales in Sydney, Australia. Dr. Choo has strong global experience as a lecturer and educator and is a recipient of several research awards. She will be based in Vancouver, Canada.

Plan now to attend the Global Specialty Lens Symposium in January 2012. With an expert international faculty and a CE-accredited agenda, the 2012 GSLS will include insightful presentations by experts in the field, hands-on demonstrations of cutting-edge products as well as scientific papers and posters. Look for more detailed information in future issues of Contact Lens Spectrum and online at www.GSLSymposium.com.
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The management team at Medlens Innovations LLC announced the new name of the company, Visionary Optics LLC. Visionary Optics will continue to provide the same specialty lens designs including Jupiter, I-Kone, K-Max and HydroKone, as well as custom soft designs.

As a welcome to new customers and a thank you to its current loyal customer base, Visionary Optics is offering free trial lens sets from now until December 31, 2011. Please contact Customer Service for details at 877-533-1509. The company has also revamped their price list that includes spherical GP lenses and spherical soft lenses at a reduced price of $29.00.

For details about the company's product portfolio, visit www.visionary-optics.com.

On the new edition of Healthy Vision with Dr. Val Jones, top national experts discuss how early identification of vision problems and different types of vision correction can impact a child's self esteem, confidence and performance.

Guests on the program include AOA president Dori Carlson, OD, who speaks about the importance of children's eye exams and catching vision problems early on. Optometrist and researcher Jeffrey Walline, OD and Clinical Psychology Professor Mitchell Prinstein, PhD join Dr. Val to share research results which suggest that contact lenses may have added benefits to children beyond vision correction, and offer advice to parents on how to know if your child is ready for contacts. Also, actress Meaghan Martin tells Dr. Val about how she overcame "poke-a-phobia" and offers advice to teenagers on what they can do to improve their self esteem.

The program is supported by Acuvue Brand Contact Lenses and is hosted by Val Jones, MD, CEO of Better Health. Free podcasts of the program can be found in the iTunes Store (for best results, search for the show by its complete title. You will find it in LifeMinute.TV Health), BlogTalk Radio (www.blogtalkradio.com/healthyvision) and on http://getbetterhealth.com/healthyvision. A link to the show also can be found at. www.acuvue.com/healthyvision.

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A Drop in the Bucket

Many practitioners ask, "Why should I start a dry eye clinic in my practice? It just takes time and does not generate revenue." Practice management consultants disagree—happy dry eye patients bring in medically billed dollars as well as friends and relatives. Recently at a meeting I was asked by a practitioner why (in his experience in a referral refractive surgery center) some clinicians were hesitant to treat dry eye unless it was severe enough to be called keratoconjunctivitis sicca. In pressing him further, he distinguished "dry eye" from "KCS" via testing AND diagnostic code. When he examined a dry eye patient with (any) corneal staining, he coded BOTH 375.15 (dry eye) AND keratoconjunctivitis sicca (370.33), akin to coding diabetes (250.0) and diabetic retinopathy (362.XX).

The growth in "dry eye practice" in eye care is very evident, however. Optometrists and ophthalmologists alike, regardless of patient severity, are treating dry eye more frequently, and are filling up the buckets, so to speak. Early identification of the dry eye patient (by staff and early in the exam process) and continued follow-up for the chronic condition of dry eye (and to keep patients on therapy) can help ensure the "drop" turns into a river.

Is "Solution-Induced Corneal Staining" Really Corneal Staining?

It has been widely reported that the utilization of certain multipurpose solution (MPS)/soft contact lens material combinations, in some patients, causes more solution-induced corneal staining than others, www.staininggrid.com. But is this really true corneal staining that we are seeing?

Recent research by Frank Bright, PhD, of the University at Buffalo, State University of New York, suggests otherwise. He believes that what we are seeing is not a breach in the epithelium (i.e. pathological staining), but rather a preservative-associated transient hyperfluorescence (PATH) caused by sodiumfluorescein binding with the multipurpose solution preservative and accumulation at the ocular surface. Contact lenses themselves, while soaking in MPS, bind some of the solution's preservatives. After lens application to the ocular surface, the preservatives gradually release into the tear film. Dr. Bright concludes that the reason we see this clinical finding more prominently with polyhexamethylene biguanide (PHMB)-containing care solutions is that PHMB interacts with fluorescein as much as 50 times greater than polyquaternium-1. In addition, PHMB has a peak release time from contact lenses of about 2 hours, corresponding exactly to the time when we see the most corneal staining. There are still many other unanswered questions that need to be addressed on this topic, but it is fascinating new research...it will be interesting to see where other researchers go from here, as well as the ultimate clinical implications for our patients.

Bright FV, Maziarz P, Liu M, Zhang JZ, Merchea M. Poster presented at: The 6th Biennial Scientific Symposium of the Contact Lens Association of Ophthalmologists Education & Research Foundation; September 23-25, 2010; Las Vegas, Nevada, USA.
Bright FV, Maziarz P, Liu M, Zhang JZ, Merchea M. PHMB and PQ-1 impact on a liposome corneal surface membrane model. Invest Ophthalmol Vis Sci 2011; 52: E-abstract 6491.

The objective of this study was to estimate the prevalence and risk factors of dry eye disease (DED) in a rural setting in Japan.

This cross-sectional study included 3294 subjects, aged >/=40 years who were in the residential registry for Koumi town, a rural mountain area. Subjects completed questionnaires designed to detect dry eye diagnosis and risk factors.

Clinically diagnosed DED was defined as the presence of a previous clinical diagnosis of DED by ophthalmologists or severe symptoms of DED (both dryness and irritation constantly or often). Current symptoms of DED and possible risk factors such as age, gender, educational history, smoking history, alcohol drinking history, height and weight, visual display terminal (VDT) use, and contact lens (CL) wear, and past/current history of certain common systemic diseases were the main outcome measures. The researchers used logistic regression analysis to examine associations between DED and other demographic factors.

Of the 3294 eligible residents, 2791 residents (85%) completed the questionnaire. The percentage of women with a composite outcome of clinically diagnosed DED or severe symptoms (21.6%; 95% confidence interval [CI], 19.5-23.9) was higher than that of men (12.5%; 95% CI, 10.7-14.5; P<0.001). A low body mass index (BMI; odds ratio [OR], 2.07; 95% CI, 0.98-4.39), CL use (OR, 3.84; 95% CI, 1.46-10.10), and hypertension (HT) (OR, 1.39; 95% CI, 0.94-2.06) were risk factors for DED in men. Use of a VDT (OR, 2.33; 95% CI, 1.12-4.85), CL use (OR, 3.61; 95% CI, 2.13-6.10), and myocardial infarction or angina were the risk factors (OR, 2.64; 95% CI, 1.51-4.62), whereas high BMI was a preventive factor (OR, 0.69; 95% CI, 0.48-1.01), for DED in women.

The researchers concluded that, among a Japanese cohort, DED leading to a clinical diagnosis or severe symptoms is prevalent. Use of CLs was a common dry eye risk factor in both genders. The condition is more prevalent in men with low BMI, HT, and in women with myocardial infarction or angina and VDT use. Relevant measures directed against the modifiable risks may provide a positive impact on public health and quality of life of Japanese.

The authors have no proprietary or commercial interest in any materials discussed in this article.

Uchino M, Nishiwaki Y, Michikawa T, Shirakawa K, Kuwahara E, Yamada M, et al. Prevalence and Risk Factors of Dry Eye Disease in Japan: Koumi Study. Ophthalmology. 2011 Sep 1. [Epub ahead of print]

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