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Sunday, September 23, 2012  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

My dentist and her staff regularly take x-rays of my teeth when I visit her office. I am never really consulted about the procedure as the office staff just do it as part of my regular dental care—and I am fine with that. Depending on your dental insurance, you may incur additional fees for this service. What strikes me odd, though, is that I don't think we are good at generally practicing eye care in this manner. That is, conducting "additional" tests that we deem necessary. We often present eye care services, such as baseline fundus photography or corneal topography, as a menu from which the patient should choose their options. Perhaps we should reconsider this practice.

Are pet drugs like contact lenses?

This question is posed in a recent article published online by the Veterinary Information Network. The article discusses aspects of the fallout related to the Fairness to Contact Lens Consumers Act in enacted in 2003 which required eyecare professionals to provide prescriptions to their patients, and draws parallels to current activity within the animal health arena. It specifically examines and compares the expansion of internet contact lens sales and that of internet sales of pet medications and the effects on the professional providers in the respective industries.

Apparently the FTC is also drawing comparisons as one of three panels within its Washington, D.C. October 2 workshop, which is being held to examine the competitive market and consumer protection issues within the pet medication industry, will be devoted to "lessons learned from the contact lens industry."

Last year legislation was introduced in congress, the Fairness to Pet Owners Act, which is reportedly modeled after the contact lens act.

The article's author, Edie Lau, interviewed several optometrists as well as veterinarians when researching the article which also includes interesting perspectives and statistics on the contact lens market.

Check out http://news.vin.com/VINNews.aspx?articleId=24419 to read the entire article.

Two-Thirds of U.S. Adults Report Discomfort While Using Digital Devices per New Report

Nearly 70% of U.S. adults experience some form of digital eye strain while using digital devices. In a new report, Keeping Your Eyes Safe in a Digital Age, The Vision Council examines how the prolonged use of digital devices impact eye health.

Digital device use is on the rise, and the mounting reliance on technologies like tablets and smartphones is expected to grow. According to the report, more than one-third of U.S. adults now spend four to six hours a day on electronic devices; 14% report daily use at 10 to 12 hours. These digital behaviors have contributed to increased reports of digital eye strain.

Despite the fact that more than two-thirds of Americans experience digital eye strain, many do nothing to lessen their discomfort.

To view or download a copy of Keeping Your Eyes Safe in a Digital Age, visit The Vision Council at www.thevisioncouncil.org.

Alden Optical Acquires New Manufacturing Facility

Alden Optical, Inc., manufacturer of custom and specialty soft and GP contact lenses, announced that it has acquired a new manufacturing facility in Western New York. This 14,000 square foot facility will significantly increase the production capacity as the company continues to grow. The company plans to consolidate all manufacturing and administration activities in the new facility by late 2012. This new facility provides both the square footage and efficient layout to meet growing demand for key products such as the HP Toric design and NovaKone and new products through the foreseeable future.

TheRightContact.com Is Now Free

TheRightContact.com announces that its services are now free to eyecare professionals. Using a state of the art website and mobile application, the site provides a comprehensive contact lens database which is now available to their users at no charge.

When the website was originally designed, users were able to register for a free trial, but were required to obtain a paid membership plan once that time period elapsed. After receiving a recent sponsorship, The Right Contact, Inc. has decided to forward the benefits over to its users according to the company's president, Jason E. Compton, OD.

The registration structure is designed in 12 month cycles. At the end of the year, users will only be required to answer a short survey to renew their account.

TheRightContact.com holds a database of more than 2,000 contact lens products from more than 150 manufacturers. Users can search for and review products based on dozens of criteria. In addition to the product information, the website keeps its users informed with news, articles, fitting tools, videos and social media connections.

A Lifetime of Contact Lens Wear
Eef van der Worp, BOptom, PhD, FAAO, FIACLE, FBCLA, FSLS, Amsterdam, Netherlands

In the discussion on internet and contact lens sales (a world wide point of discussion is my impression), we maybe underutilize the fact that contact lens wear is not a static situation, but rather a dynamic process. Today, a standard monthly replacement lens could be the best for your eye. But maybe soon, a lens (or care solution) especially for dry eye may be desired. At some point in the contact lens wearing 'career' correction of that cylinder may be needed - again asking for a change in lens modality. And, for all of us, the moment is awaiting when presbyopia kicks in - which may ask for other modifications to the modality, again.

Contact lens wear is a career. And it deserves a good coach. Indeed - the contact lens practitioner.

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Ronald K. Watanabe, OD, FAAO

Plasma anyone?

Plasma treatment for GP lenses has been available for some time. It is an option for any GP lens you order. Some materials are always plasma treated, and some labs automatically treat all of their specialty GP designs. But what exactly is plasma treatment, and when should we request it?

Plasma treatment is a process that uses cold oxygen gas in the presence of electrical energy in a reaction chamber to super-clean the surface of GP lenses. Its purpose is to remove residues leftover from the lens fabrication process. In doing so, the wetting angle of the lens surface is significantly reduced, presumably making the lens more wettable. This can be of benefit to patients with tear film or ocular surface issues who are having problems with their current GP lenses.

Are there other times when plasma treatment is desirable? Theoretically, a super-clean lens should perform better than an untreated lens. However, there is some debate about the benefits of plasma treatment. In addition, the treatment is not permanent, and improper use of cleaning products may cause rapid surface degradation. If there is any question about a GP patient's ocular surface, plasma treatment may be a good idea.

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

Multifocal Contact Lenses During Visual Field Examinations

I recently read an article that is of great interest to clinicians fitting multifocal lenses in a busy practice. How do you treat these patients if they happen to be glaucoma suspects during their visual field examinations? Do you have these patients remove the lenses or perform the visual field test while the lenses are worn? The study evaluated whether the creation of two foci (distance and near) provided by multizone refractive multifocal contact lenses affects the measurements on the Humphrey 24-2 Swedish interactive threshold algorithm (SITA) standard automated perimetry (SAP). Thirty subjects were fitted in randomized cross-over design with either a multifocal contact lens (Acuvue Bifocal, multizone design with five alternating distance and near zones) or a single vision (Acuvue Oasys) contact lens. After 1 month, a Humphrey 24-2 SITA standard strategy was performed.

There were no statistically significant differences in reliability indices or test duration between the lens types. There was a statistically significant reduction in the mean deviation with the multifocal contact lenses compared with the single vision contact lenses (P=0.001). Differences were not found in pattern standard deviation nor in the number of depressed points deviating at P<5%, P<2%, P<1%, and P<0.5% in the pattern deviation probability maps studied.

Clinicians should therefore note that a multizone refractive lens produces a generalized depression in threshold sensitivity as measured by the Humphreys 24-2 SITA SAP when evaluating the visual field results.

Madrid-Costa D, Ruiz-Alcocer J, García-Lázaro S, Albarrán-Diego C, Ferrer-Blasco T. Effect of multizone refractive multifocal contact lenses on standard automated perimetry. Eye Contact Lens. 2012 Sep;38(5):278-81.
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Associations of Systemic Diseases, Smoking and Contact Lens Wear with Severity of Dry Eye

Systemic diseases, smoking, ocular surgeries and contact lens wear have been linked with dry eye but it is not known if these factors are also associated with severity of dry eye. A cross-sectional investigation was conducted on the effect of various systemic and ocular conditions with respect to the severity of dry eye in Asian patients.

Prospective recruitment of consecutive new referral patients from a dry eye clinic was performed. Medical history, dry eye symptoms and clinical assessment were coded in a standardized form and analyzed.

Out of 510 patients (25% men), mean +/- S.D. age 53.0 +/- 14.1 years, 25 had previous diagnosis of rheumatoid arthritis, 30 had diabetic mellitus, 41 had thyroid disease, and 33 were current smokers; 23 and 41 patients had previous LASIK and cataract surgery respectively and 90 were current contact lenses wearers. A previous diagnosis of rheumatoid arthritis was associated with more severe superior corneal fluorescein staining (OR = 11.2, 95% CI 4.6-27.4).

The researchers concluded that generally, with the exception of rheumatoid arthritis, there were no associations between dry eye severity and systemic diseases, smoking, previous ocular surgeries and contact lens wear. Dry eye patients with rheumatoid arthritis tend to have more severe ocular surface damage in the superior cornea.

Lee SY, Petznick A, Tong L. Associations of systemic diseases, smoking and contact lens wear with severity of dry eye. Ophthalmic Physiol Opt. 2012 Sep 7. doi: 10.1111/j.1475-1313.2012.00931.x. [Epub ahead of print]
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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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