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Sunday, September 25, 2011  
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Last week's question:
When you fit a patient with keratoconus in gas permeable contact lenses, are you more likely to use a custom or proprietary design?

 1. Custom

 2. Proprietary

Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

The American Academy of Optometry's annual meeting is just around the corner—October 12-15, 2011 in Boston, MA. As always, the meeting is filled with top-notch scientific and continuing education materials, including coverage of contact lenses and the ocular surface. This year, Professor Mark Willcox will be receiving the Max Shapero Memorial Lecture Award and the Cornea and Contact Lens Research Unit of the Brien Holden Vision Institute is receiving the Founder's Award. Make sure you check this out in particular.

B+L Launches Vision Experts Facebook Page

Bausch + Lomb (B+L) launched the Vision Experts Facebook page, which is an aggregated site of industry news and events. According to the company, the site is unique from any other online forum, as it will provide commentary from B+L experts and a venue to encourage discussion among the optometry community on the latest happenings in the industry.

As part of the Vision Experts Facebook page, B+L will provide commentary from the following internal experts:

  • Joseph T. Barr, OD, MS, FAAO - VP of Global Clinical & Medical Affairs and Professional Services, Vision Care
  • Carla J. Mack, OD, MBA, FAAO - Director, Global Medical Affairs, Vision Care
  • Mohinder M. Merchea, OD, PhD, MBA, FAAO, FBCLA - Director Medical Affairs, Vision Care North America
  • Michael Pier, OD - Director, Professional Relations, Vision Care North America
  • Christopher Snyder, OD, MS, FBCLA - Director, Professional Relations, Vision Care North America
  • Stephanie Su, OD, FAAO - Manager of Research Clinic Operations

You can find more information on Vision Experts at www.facebook.com/VisionExperts. Vision Experts will also participate on Twitter at www.twitter.com/VisionExperts.

Cornea, CL and Contemporary Vision Care Symposium Set for December

The 28th Cornea, Contact Lens and Contemporary Vision Care Symposium will be held December 3-4, 2011. This continuing education course, presented by University of Houston College of Optometry at the Omni Houston Hotel, is truly a tradition. Hosted by Dr. Jan Bergmanson, the symposium features world renowned researchers and clinicians who address current and future issues in a rapid but friendly fire atmosphere.

This year's speakers include: Jason Nichols, Kelly Nichols, Edward Bennett, Earl Smith lll, William Miller, William Townsend, James Walsh, Norman Leach and Michael Twa. Also this year, the University of Houston College of Optometry Award for Distinguished Research in Cornea and Contact Lenses goes to Fiona Stapleton, MSc, PhD, MCOptom, who is currently serving as Head of the School of Optometry at University of New South Wales, Sydney, Australia. Her award winning work, Microbial Keratitis, Incidence, Management and Prevention, will be the keynote lecture.

Other topics covered include dry eye in contact lens wearers; myopia control; latest in corneal and scleral contact lenses; why ultraviolet radiation can no longer be ignored; updates on keratoconus and acanthamoeba, and recent releases of therapeutic agents.

For more information and to register, visit http://ce.opt.uh.edu/live-events/CCLCVC-annualSymposium2011.

Global Specialty Lens Symposium, January 26 - 29, 2012, Paris Hotel & Casino in Las Vegas

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.

AOA Survey Looks at Patient Habits

Younger generations are the most diligent about following their practitioner's contact lens wear and care instructions, according to the American Optometric Association's (AOA) 2011 American Eye-Q survey. Gen Y-ers (1978-1994), are the most likely to replace their daily disposable lenses as directed (43 percent), while 67 percent of baby boomers (1946-1964) admitted to wearing lenses longer than recommended.

Gen Y respondents also had the highest marks for appropriate lens storage, with nearly half (49 percent) reporting that they replace their contact lens case every one to three months as directed. Only 28 percent of baby boomers said they replace their case every one to three months.

The survey revealed that all ages were unsure about proper lens care, with nearly a fifth of generation X (1965-1977, 19 percent) and Y (22 percent) making the mistake of soaking or cleaning contact lenses with water, compared to just 8 percent of baby boomers. Across the generational board, nearly one-third of respondents reported using rewetting drops to clean or disinfect their lenses.

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Bilateral Keratoglobus
By Augusto Rossé, Catholic University of Valparaiso, Chile

This is a 42 year-old male with Bilateral Keratoglobus. In this picture you can also see the neovascularization induced by the soft contact lens (HEMA). Tangential illumination.

We thank Augusto Rossé for his 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.

Susan J. Gromacki, OD, MS, FAAO

Please Wash Your Hands

How many times have you asked your patient to take out his contact lenses, and to your dismay, he calmly walks up to sink, looks into the mirror above it, and extracts them without washing his hands? Patient noncompliance with all facets of contact lens care is well-documented. But only 50% of health care workers comply with hospital hand hygiene guidelines. To discover what motivates people to comply can help us all.

Two behavioral scientists (Adam Grant, University of Pennsylvania; David Hofmann, University of North Carolina) studied hand-washing compliance among health care workers, a paper soon to be published in Psychological Science. http://www.management.wharton.upenn.edu/grant/GrantHofmann_PsychologicalScienceForthcoming.pdf

They placed signs with three different messages above 66 hospital dispensers for soap and hand sanitizer. One said, "Hand hygiene prevents you from catching diseases." The other said, "Hand hygiene prevents patients from catching diseases." (The third was a control.) They recorded how frequently people washed, and measured the soap and gel consumption.

Interestingly, doctors and nurses were much more likely to wash their hands if the emphasis was placed on the patients' safety. The patient-consequences sign increased product use by 33% per dispenser, and healthcare professionals were 10% more likely to wash their hands. The personal-consequences sign did not improve behavior vs. the control. Grant and Hofmann's conclusion: to motivate people to engage in health and safety behaviors, we should point out the consequences for others as well as for themselves.

As for me, I changed my presentation years ago: "Kindly wash your hands and take out your contact lenses," or remove the patient's lenses for him—after washing my hands.

http://www.psychologicalscience.org/index.php/news/releases/patients-health-motivates-workers-to-wash-their-hands.html. Accessed September 14, 2011.

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Kelly K. Nichols, OD, MPH, PhD, FAAO

Preservatives, Glaucoma and Dry Eye: Overlap

There has always been a controversy regarding the influence of preservatives on ocular surface health. This topic applies to healthy eyes, such as in contact lens wear and care, as well as in eyes with disease, such as glaucoma, or dry eye. I was recently discussing the overlapping epidemiology of glaucoma and dry eye (more likely in postmenopausal women). Thus, it makes sense that reducing preservative load would be perhaps more beneficial in patients falling into this group. My colleague stated, "there is an abundant amount of literature regarding preservatives and the impact on the ocular surface—largely the glaucoma literature."

In a recent review article, 40 in-vivo studies were identified (Tressler CS et al., Preservative use in topical glaucoma medications. Ocular Surface; 9(3):140-58), in addition to in-vitro and ex-vivo studies. The authors conclude most glaucoma patients can use preserved drops, yet individual patient characteristics need to be considered. If a 54 year-old woman is at risk for dry eye, and she develops glaucoma and initiates preserved topical therapy for the disease, the preservatives may impact her "fragile" ocular surface more than a 17 year-old normal contact lens wearer.

We do not have a clear understanding of the mechanisms at play, but the astute clinician likely considers all patient characteristics when selecting topical medications, including preservatives, compliance, and the risk for or existing ocular surface disease.

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Prevalence of Corneal Dystrophies in the United States

The authors wanted to estimate the prevalence of corneal dystrophies in the United States. Records of almost 8 million enrollees in a national managed-care network throughout the U.S., who had an eye care visit in 2001 to 2009, were searched for a recording of corneal dystrophy on a claim submitted by an ophthalmologist or optometrist from January 1, 2001, through December 31, 2007.

Unique individuals (n = 27,372) received two or more diagnoses of any type of corneal dystrophy, for an overall corneal dystrophy prevalence rate of 897 per million (10(6)) covered lives. Endothelial and anterior corneal dystrophies accounted for most of the reported dystrophies, and granular corneal dystrophy was the least common, being reported in 167 enrollees. Age, sex, and race variations among the various corneal dystrophies were observed. The mean age of those with macular corneal dystrophy (47.3 years) was 15 years younger than the age of those with endothelial dystrophy (62.9 years), and females were most highly represented (68.5%) among those with lattice corneal dystrophy. Hispanics and blacks were underrepresented relative to enrollees undergoing eye care for reasons other than corneal dystrophy. Keratoplasty was most frequently coded among those with lattice dystrophy.

Although caveats must be considered in using claims data to estimate prevalence in a population, the authors concluded that these data provide an indication of corneal dystrophy's prevalence within insured subjects across the U.S. Variations in age, sex, and race, within and between the different types of corneal dystrophies, raise questions that warrant further study.

Musch DC, Niziol LM, Stein JD, Kamyar RM, Sugar A. Prevalence of corneal dystrophies in the United States: estimates from claims data. Investigative Ophthalmology & Visual Science. 2011;52(9):6959-63.

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For more information on Contact Lenses Today including archives of previous issues, 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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