When fitting multifocal lenses, many practitioners tell me that they don't need to use the fitting guides as they have better ways to fit the lenses based on their experiences. While I do admit that tips and tricks can be helpful when troubleshooting, I believe it is best to stick to the fitting guide during the initial fitting. These guides are developed through rigorous processes involving numerous patient fits and are designed with this in mind. While you may not be able to fit 100% of your patients, I am sure that you will be able to get at least 70% of them fit and seeing well at a single lens fitting.

Visionary Optics LLC, home of the Europa and Jupiter scleral lenses, announced an enhanced warranty and exchange policy created to alleviate any concerns about using scleral lenses on irregular cornea patients. For parameter adjustments on exchanges and remakes the new policy is: Unlimited Exchanges within 90 days of purchase. If only a parameter adjustment is needed, the original lens does not need to be physically returned. Parameter adjustments required to improve fit, usually made in conjunction with consultation, are acceptable exchanges / remakes. This new return policy is one of several recent improvements that Visionary Optics has made with the goal of making specialty lens fitting and doing business with Visionary Optics an easy choice to make.

Please go to the website: www.visionary-optics.com for additional details on the new warranty policy.

Applications and nominations are invited for the annual British Contact Lens Association (BCLA) research awards; closing date is November 1, 2013.

Introduced in 1993, the BCLA Medal Award goes to an individual who has made an outstanding contribution to contact lenses. Any BCLA member may nominate a person for the Medal, which is awarded during the annual BCLA Clinical Conference. Professor Philip Morgan (UK) will receive the 2014 BCLA Medal at the 38th BCLA Clinical Conference and Exhibition, to be held at the ICC Birmingham, UK, from 6-9 June 2014. Nominations are now due for the 2015 Medal Award.

The £8,000 BCLA Dallos Award funds a year-long project judged likely to further understanding of a topic related to contact lenses and/or the anterior eye. Pauline Kang (Australia) will receive the 2014 Dallos Award for her project, "The influences of myopia-controlling multifocal soft contact lenses on binocular vision and accommodation in young adult myopes and the effect of varying the magnitude of the addition." Apply now for the 2015 Dallos Award.

The BCLA Da Vinci Award recognizes work by those who are not established contact lens researchers; specifically, applicants should not have published more than five papers related to the field of contact lenses and/or the anterior eye. Equally, the award may be given in recognition of a useful contribution by a member of staff within the contact lens-related manufacture and supply industry. Each successful applicant receives £1,000 and a conference delegate package. Apply now online for the 2014 Da Vinci Award.

Each year, the BCLA invites postgraduates in the field of contact lenses and/or the anterior eye to present the annual Irving Fatt Memorial Lecture. Nominees must have completed a PhD, a post-doctoral degree or MSc in the UK within the last five years and continued with their research either in private practice, hospital practice or academia. Dr. Heiko Pult (Germany) will present the 2014 Irving Fatt Memorial Lecture. Nominations are now invited for the 2015 Irving Fatt Memorial Lecture

For further details and application forms for all these awards, please visit the BCLA website at www.bcla.org.uk. Alternatively, contact Amir Khan at the BCLA office or email adminbcla@bcla.org.uk.

This is a case of a 24 year-old white female soft contact lens wearer with 2-3 month history of painless recurrent red eye OS. The photo reveals a wedge of her lens embedded under the conjunctiva with one edge abutting a conjunctival vessel causing the subconjunctival hemorrhage.

We thank Dr. Heller for this image and welcome photo submissions from our other 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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Ocular Lubrication vs. Bandage Contact Lens in Treatment of Corneal Erosion Syndrome

From the Oxford Eye Hospital in the United Kingdom comes an August 2013 study investigating the efficacy of bandage contact lenses (BCLs) with that of ocular lubricants (OLs) in the initial management of recurrent corneal erosion.

In this randomized controlled small trial of 28 patients with recurrent corneal erosion, the patients were randomized to wear either BCL (for 3 months, replaced every 30 days) or the use of OLs (4x a day with Lacri-lube ointment at night for 3 months). The patients were assessed monthly for 4 months, and their symptoms were graded by visual analog scores. The main outcome measure was the resolution of symptoms with noticeable corneal surface abnormality. Patients with a complete resolution were followed for another 3 months to check for recurrence.

Results of this study demonstrated that BCLs do not increase the likelihood of complete resolution of recurrent erosions when compared with OLs in the initial management of recurrent erosions, however BCL treatment patients experienced earlier relief from symptoms. None of the patients with BCLs developed adverse side effects.¹

Ahad MA, Anandan M, Tah V, Dhingra S, Leylaand M. Randomized controlled study of ocular lubrication versus bandage contact lens in the primary treatment of recurrent corneal erosion syndrome. Cornea. 2013 Aug 22 (Epub ahead of print).

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CARE SOLUTION CORNER
Susan J. Gromacki, OD, MS, FAAO

The purpose of this study was to estimate the incidence of microbial keratitis (MK) associated with overnight corneal reshaping contact lenses and to compare rates in children and adults.

A retrospective study of randomly selected practitioners, stratified by order volume and lens company, was conducted. Practitioners were invited to participate and those agreeing were asked to provide de-identified patient information for up to 50 lens orders and to complete a comprehensive event form for any of these patients who have attended an unscheduled visit for a painful red eye. Duration of contact lens wear was calculated from the original fitting date or January 2005 (whichever was later) to when the patient was last seen by the practitioner wearing the lenses on a regular basis. Cases of MK were classified by majority decision of a 5-member expert panel.

For the 191 practitioners who could be contacted, 119 (62%) agreed to participate. Subsequently, 11 withdrew, 22 did not respond, and 86 (43%) returned completed forms corresponding to 2202 lens orders and 1494 patients. Limiting the sample to those patients with at least 3 months of documented contact lens wear since 2005 resulted in a sample of 1317 patients; 640 adults (49%) and 677 children (51%) representing 2599 patient-years of wear (adults = 1164; children = 1435). Eight events of corneal infiltrates associated with a painful red eye were reported (six in children and two in adults). Two were classified as MK. Both occurred in children but neither resulted in a loss of visual acuity. The overall estimated incidence of MK is 7.7 per 10,000 years of wear (95% confidence interval [CI] = 0.9 to 27.8). For children, the estimated incidence of MK is 13.9 per 10,000 patient-years (95% CI = 1.7 to 50.4). For adults, the estimated incidence of MK is 0 per 10,000 patient-years (95% CI = 0 to 31.7).

The researchers concluded that the risk of MK with overnight corneal reshaping contact lenses is similar to that with other overnight modalities. The fact that the CIs for the rates estimated overlap should not be interpreted as evidence of no difference. True differences fewer than 50 cases per 10,000 patient-years were beyond the study's power of detection.

Bullimore MA, Sinnott LT, Jones-Jordan LA. The Risk of Microbial Keratitis with Overnight Corneal Reshaping Lenses. Optom Vis Sci. 2013 Jul 25.

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