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Sunday, September 19, 2010  
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Ocular Surface Update
Kelly K. Nichols, OD, MPH, PhD, FAAO

Every three years the Tear Film and Ocular Surface Society holds an international scientific meeting dedicated to ocular surface research. The mission of the meeting is to present and evaluate the current knowledge and 'state of the art' research on the structure and function of tear film-producing tissues, tears and the ocular surface in both health and disease, as well as to promote an international exchange of information that will be of value to basic scientists involved in eye research, to clinicians in the eye care community, and to pharmaceutical companies with an interest in the treatment of tear film or ocular surface disorders.

This year the meeting will be held September 22-25 in Florence, Italy. It is expected that over 600 scientists, clinicians and industry representatives from 30 countries will be in attendance, and the meeting promises to provide the most current and relevant basic and translational science overview. It has been 18 years since the first International Conference on the Tear Film & Ocular Surface: Basic Science & Clinical Relevance (Bermuda, 1992), and in that timeframe ocular surface disease has become a globally accepted condition. The conference program can be viewed here, and critical presentations will be highlighted in this column over the next weeks and months.

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

Many of us are probably aware that Clear Care (CIBA Vision) is FDA-approved for the cleaning and disinfection of gas permeable lenses, but probably fewer of us know that its approval includes the use of a digital rubbing step. And perhaps even less of us realize that this care system and One Step (Sauflon Pharmaceuticals), although labeled "no rub," can be utilized with a digital rubbing step in soft contact lens wearers.

For my dry eye patients and heavy depositors, I frequently prescribe a rubbing step with one bottle hydrogen peroxide systems. I feel that this is especially important with silicone hydrogel materials, which tend to deposit more lipids than their HEMA counterparts. A few years ago, I devised a new cleaning method. The twist: have the patient remove his right lens first, then his left, and place them next to each other into his contralateral palm (see image in the article linked below) before applying any H2O2 solution. This prevents introducing hydrogen peroxide into the left eye with the index finger after cleaning the right lens.

For the complete 12-step technique, please see the full article, A New Method for Cleaning Soft Contact Lenses, in the April 2008 Contact Lens Spectrum.


Vistakon Names Olivares Director of Professional Education and Lakkis as Clinical Research Fellow

Vistakon has named Giovanna E. Olivares, OD, FAAO, Director, Professional Education, responsible for developing strategies for the implementation of the company's professional educational programs.

Dr. Olivares joined Vistakon in 2004 as Manager of the R&D Design Clinical Research Group, where she led a multidisciplinary group overseeing the clinical development of new products, including Acuvue Oasys for Astigmatism. Her team also developed novel methodologies and equipment to test vision and to measure patients' contact lens user experience.

Before joining Vistakon, Dr. Olivares was a practicing optometrist. She also served as the Director of Professional Affairs and Clinical Development at Unilens Corporation and was an Assistant Professor at the State University of New York College of Optometry.

Vistakon also named Carol Lakkis, BScOptom., PhD, Clinical Research Fellow, Contact Lens Products, responsible for research and development of innovative new products.

Dr. Lakkis brings nearly two decades of clinical research experience to the position. She joins Vistakon from Clinical Vision Research Australia at the Australia College of Optometry where she served as Research Director. Prior, Dr. Lakkis held several positions in the Department of Optometry and Vision Sciences at the University of Melbourne as well as positions at the School of Optometry at the University of California at Berkeley.


Academy for Eyecare Excellence Continues To Expand Its Online Education Offerings

The CIBA Vision Academy for Eyecare Excellence has expanded its professional education programs with sixteen new online learning modules. The modules cover both advanced and basic topics, ranging from multifocal soft lens fitting to ocular anatomy. Selected modules are designated for the eye care practitioner and others are designed for staff members.

Over the next few months, more clinical content will be added to include modules that cover corneal staining, contact lens induced dry eye and lens care. Additional business and management content will also be added and include patient communication strategies, business simulation exercises and guidance on how to maintain patient loyalty.

For more information, visit www.cibavisionacademy.com/us.

1-800 Contacts Announces "Free Contacts for Life" Sweepstakes Promotion

1-800 Contacts' "Free Contacts for Life" sweepstakes will reward winners with all the contact lenses they will need for life, without any special clauses or criteria other than maintaining a valid contact lens prescription.

The promotion kicked off September 9 with full media support. The promotion also includes a referral component. If a participating customer refers a friend or family member into the sweepstakes and that referred friend wins, the referring customer also wins. One to two winners will be chosen daily throughout the September.

Contestants can enter online. Phone and web customers will also be entered automatically when they order during September.

Global Specialty Lens Symposium, January 27-30, 2011, Paris Hotel & Casino in Las Vegas

Plan now to attend the Global Specialty Lens Symposium in January 2011. With an expert international faculty and a CE-accredited agenda, the 2011 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.

ISTA Initiates Phase 3 Clinical Program for Remura in Dry Eye Disease

ISTA Pharmaceuticals, Inc. has initiated a Phase 3 clinical program of ISTA's proprietary formulation of Remura (bromfenac ophthalmic solution for dry eye) for alleviating the signs and symptoms of dry eye disease. The Phase 3 efficacy studies are being conducted under a Special Protocol Assessment (SPA) agreed upon with the U.S. Food and Drug Administration (FDA).

ISTA plans to conduct four randomized, double-masked, placebo-controlled Phase 3 studies. The recently initiated Phase 3 studies will evaluate the efficacy and safety of bromfenac in two simultaneous studies operating under a common protocol in approximately 1000 patients with mild or moderate dry eye disease. The multi-center trials will be conducted at more than 30 sites in the U.S. Two concentrations of bromfenac (both lower than the currently marketed Xibrom (bromfenac ophthalmic solution 0.09%), will be dosed in addition to placebo. Patients will be randomized at a ratio of 1:1:1 to receive either bromfenac or placebo in both eyes twice daily and will be evaluated over the course of 42 days. For both efficacy studies, the objective sign of conjunctival staining will be measured using the lissamine green test and subjective symptoms will be measured using the Ocular Surface Disease Index (OSDI). ISTA anticipates reporting results in the middle of 2011.

The two remaining Phase 3 safety studies are the subject of additional SPAs currently under review by the FDA. The Company expects to conduct a six-month and a twelve-month safety study and anticipates it will initiate one or both of these studies later this year, subject to reaching agreement with the FDA on the SPAs.

This month at www.siliconehydrogels.org: the results of the 2009 International Contact Lens Prescribing Survey, the impact of UV-absorbing silicone hydrogel lenses, fitting silicone hydrogels for patients with sub-optimal endothelial cell function, and our synopsis of silicone hydrogels at the 2009 American Academy of Optometry meeting.
Editor's Commentary
Jason J. Nichols, OD, MPH, PhD, FAAO

Following up on last week's CL Today Quick Poll, it's clear that the vast majority of eyecare practitioners do not rely solely on age as a criteria for fitting children in contact lenses. Interestingly, 15% still do use age as the primary criteria (about 1 in 6).

Related to this, the CL Today Quick Polls are a fantastic way to survey the contact lens community at large relative to current or even controversial topics. I would like to ask for your input on future Quick Polls. Please email me topics that you would like to see addressed in this regard (jnichols@optometry.osu.edu).

CLToday Quick Poll
Last week's question: Do you use age as the primary criteria for fitting children and teens in contact lenses?



Corneal Staining as a Response to Contact Lens Wear

Researchers conducted a review of the literature and in-house research of corneal staining and its various forms of presentation to provide this review of the effects of contact lenses on the corneal surface.

Corneal staining manifests in many different forms. The severity of staining or insult of the cornea is usually determined by the extent (area of coverage), density, and depth. The cause of staining is multifactorial, and its location is often linked to the type of lens that is being worn, the solution used to clean/disinfect the lens, the state of hydration of the soft lens, and the state of the cornea that has been affected by the lens.

The researchers noted that sodium fluorescein dye effectively highlights corneal integrity changes referred to as corneal staining. This review describes the manifestations, the cause, the mechanisms, and the methods of remediation of corneal staining.

Fonn D, Peterson R, Woods C. Corneal staining as a response to contact lens wear. Eye Contact Lens. 2010 Sep;36(5):318-21.

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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For more information on Contact Lenses Today including archives of previous issues or to subscribe to this newsletter, please visit our website at www.cltoday.com. For the latest articles on contact lenses, important clinical information and helpful tools related to the contact lens practice visit the Contact Lens Spectrum website at www.clspectrum.com.

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