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Sunday, October 6, 2013  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

Many practitioners use a sort of tiered fee system for their contact lens wearing patients, based on the difficulty of the lens fit. This system usually includes a period of post-fit follow-up care—perhaps out to 60 or 90 days following the fitting. However, another fee structure commonly used is to charge lens wearers a fit fee and then a visit fee following the fitting. This option is appealing as I think it motivates the patient towards success, rather than allowing for an open door to the practitioner when true problems may not really exist but the patient is focused on perfection. Consider these options when reviewing or revising your contact lens practice fee structure.

B+L Receives U.S. FDA Clearance for Novel Monthly Disposable Contact Lens

Valeant Pharmaceuticals International, Inc. and Bausch + Lomb (B+L) announced that the U.S. Food and Drug Administration (FDA) has issued marketing clearance for B+L's newest frequent replacement silicone hydrogel contact lenses made with MoistureSeal Technology.

MoistureSeal Technology is the latest vision care innovation from B+L building on the track record of breakthrough innovations including Biotrue ONEday contact lenses and Biotrue multi-Purpose solution. According to the company, this novel technology combines a breakthrough material with new manufacturing processes to produce a contact lens that offers superior comfort and vision.1

1. Results from a 22-investigator, multi-site study of Bausch + Lomb contact lenses with MoistureSeal technology, with a total of 380 eligible subjects. After 7 days of wear, subjects completed an online survey. Subjects rated Bausch + Lomb contact lens performance across a range of attributes and compared the performance to their habitual lenses.

Participate in the Contact Lens Spectrum Practice Profile Study

How does your practice and optical business stack up against those of your peers? The best answer is determined by you. We need your feedback for our annual Practice Profile Study that we field to vision care professionals only. Your responses, trended with previous years' results, will be featured in an upcoming issue of Contact Lens Spectrum. Please take a few minutes (it will most likely take 10 minutes or less) to complete the questionnaire to which we provided a link below. Thank you for your time and valuable feedback.

Please click here to begin the survey.

SynergEyes to Streamline Its Policies and Procedures

SynergEyes, Inc. announced that it will modernize its policies for ordering and returning lenses. To make it easier to do business with the company, SynergEyes is also streamlining other customer-facing procedures.

The policy and procedure changes will include enhancements that save practitioners time and money, give them peace-of-mind when prescribing SynergEyes lenses and also give them the opportunity to "go green." Effective November 1st, prescribers will no longer need to return lenses in order to receive credit for discontinued fits, whether they are working with Duette, UltraHealth or SynergEyes lenses. In addition, the warranty period for all lenses will be 90 days and receiving credit, when necessary, will be easy and hassle-free. SynergEyes also will be automating a number of procedures, from account setup to billing. Accounts will have the option to receive printed versions of their statements or go paperless by using an online account management system.

Registration Open for Global Specialty Lens Symposium – January 23 – 26, 2014
Plan now to attend the Global Specialty Lens Symposium to be held January 23 – 26, 2014 at the Rio All Suites Hotel and Casino in Las Vegas, Nevada. This meeting will include insightful presentations by international experts in the field, hands-on demonstrations of cutting-edge products and valuable continuing education credits.

Visit www.GSLSymposium.com for more information and registration.
On World Sight Day Vistakon Encourages People to Take the #Eyepledge

Vistakon Division of Johnson & Johnson Vision Care, Inc. (JJVCI) has launched a worldwide campaign asking people to "Take the #EyePledge" and promise to get their eyes tested in honor of World Sight Day, October 10. The #EyePledge campaign supports a global call-to-action to "Get Your Eyes Tested" by the International Agency for the Prevention of Blindness (IAPB), coordinator of World Sight Day.

The #EyePledge includes two simple steps individuals can take to demonstrate their personal commitment to get an eye exam and raise awareness of the broader global cause:

  • Take an "eye selfie" photo; and
  • Post the photo through the Donate A Photo App by Johnson & Johnson with #EyePledge, or share on social media sites like Facebook, Twitter and Instagram using #EyePledge, and promise to get your eyes tested.
To further the impact of an #EyePledge, participants can use the Johnson & Johnson Donate A Photo app to generate contributions to Sight for Kids, a partner program of JJVCI and Lions Clubs International Foundation. For every photo uploaded on behalf of Sight for Kids, Johnson & Johnson will donate $1, up to $30,000*, to help the charity provide eye exams to needy children. Sight for Kids has provided free vision screenings to more than 17 million children in Asia Pacific since 2002. Participants can post up to one photo per day using the app, which is available from the App Store or Google Play.

Users without smart phones can also participate by posting their eye selfie photos and commenting using #EyePledge on Facebook, Twitter, and Instagram.

* Johnson & Johnson has curated a list of trusted causes, and you can donate a photo to one cause, once a day. Each cause will appear in the app until it reaches its goal, or the donation period ends. If the goal isn't reached, the cause will still get a minimum donation.

ToriCalc Mobile App Launched

Innovative Insights LLC has launched ToriCalc, a unique, mobile application that quickly calculates cross cylinder contact lens prescriptions. Contact lens specialists need fitting tools and ToriCalc serves this requirement while providing a mobile application opportunity for businesses or groups desiring to increase brand awareness and customer support.

ToriCalc, as a private label option, provides a cost effective business solution and can be branded to meet customer demand and is optimized to include client specific features. In the fast paced world of mobile applications it makes sense from a financial and manpower perspective to leverage an already successful platform. A monthly license model is unique in the industry and opens up mobile computing solutions to a variety of business or groups that desire to increase customer reach and tie mobility to current digital infrastructure.

ToriCalc is available initially as an IOS application with Android following later in 2013. For more information, visit www.toricalc.com.

International Vision Expo and BCLA Sign Agreement to Create 'Global Contact Lens Forum'

International Vision Expo & Conference and the British Contact Lens Association (BCLA) announced during Vision Expo West in Las Vegas that they have entered into a multi-year content exchange agreement to create a two-day Global Contact Lens Forum.

The new partnership follows months of conversations aimed at expanding and improving continuing education offerings at their respective conferences. The first program will be available in March 2014 at International Vision Expo East in New York. The BCLA will host the second forum in Birmingham, UK, in June 2014, during the 38th BCLA Clinical Conference and Exhibition.

Online registration for the Global Contact Lens Forum will open in conjunction with International Vision Expo East in late November.

Post RK Cornea
By Jaime Ibanez, OD, Villavicencio, Columbia

This is a post RK cornea with a flat (28.00 diopter), irregular and distorted anterior surface. A reverse geometry, pentacurve, thin (0.18 mm) miniscleral GP contact lens provided a new smooth optical interface and decreased the optical aberrations commonly seen in this cases.

We thank Dr. Ibanez 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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Susan J. Gromacki, OD, MS, FAAO

Composing a Scleral Lens Care and Handling Guidelines Document

Because scleral gas permeable (GP) contact lenses require their own unique handling and care instructions, I recently prepared a new scleral lens document for my practice.

Our practice's contact lens technician does an excellent job instructing our patients; and the new wearers remember most of what they learn at their initial training visit. With that said, it is still important to augment verbal instructions with written ones. Some people learn better via the written word, and other patients benefit from a document they can review at home. While we have an open policy for patients to contact us (and they do!), a document like this can save valuable time for both technician and doctor.

My practice had never composed such a document, so I was starting from scratch. And since modern scleral GP lenses are still relatively new, there are few examples available. In preparing the document, I found it helpful to refer to the following sources:

1. A Guide to Scleral Lens Fitting, by Eef van der Worp, pp. 38-39. http://commons.pacificu.edu/cgi/viewcontent.cgi?article=1003&context=mono
2. My contact lens technician. She is the one "in the trenches," instructing each one of our patients on lens insertion, removal, and care. She knows firsthand the most common questions patients ask, and which points need extra clarification.
3. My patients. One of my scleral lens patients, a detailed gentleman with a PhD in Experimental Psychology with an emphasis on vision and perception, offered to write our scleral lens instructions from his perspective. It was an interesting read. Over two pages and 823 words later, I had an excellent starting point for my own instructions.

I will continue the discussion in my next column.
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Katherine M. Mastrota, MS, OD, FAAO

Is Conjunctivochalasis the Precursor to Pterygium?

In an article published in the August 2013 Medical Hypotheses journal, researchers from the Singapore Eye Research Institute propose that under specific conditions, conjunctivochalasis in the nasal part of the conjunctiva can progress to pterygium.

Pterygium is a fibrovascular proliferative condition of the ocular surface with no known pathological mechanism. This condition can affect vision due to dry eyes, astigmatism or physical occlusion of the visual axis. The only definitive treatment for this condition is surgical excision. Interestingly, pterygium is a lesion that may be related to UV radiation and elaboration of proteases. Conjunctivochalasis is a dry eye-related condition that is exemplified by excessive conjunctiva. Both pterygium and conjunctivochalasis are associated with elaboration of matrix metalloproteinases as well as inflammatory cytokines. The progression of conjunctivochalasis to pterygium may be related to special kinds of oxidative or inflammatory damage that affects only the part of the loose conjunctival tissue adjacent to the cornea. Protease expressed may then breakdown the conjunctival and corneal epithelium causing the head of pterygium to be adherent to the cornea. The implications of this hypothesis, as suggested by the authors, are that first, treatment should be directed to the protection of conjunctivochalasis before it transforms to pterygium. This may be achieved by anti-inflammatory measures, anti-protease treatment, or preventing the triggering of the changes at the head of pterygium, such as avoidance of sunlight. Second, during resection of pterygium, it may not be necessary to resect the pterygium too extensively away from the cornea, since this effectively removes relatively normal conjunctiva.1

1. Tong L, Lan W, Sim HS, Hou A. Conjunctivochalasis is the precursor to pterygium. Med Hypotheses. 2013 Aug 31. 2013.08.017. [Epub ahead of print]
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Randomized Controlled Study of Ocular Lubrication vs. Bandage CL in the Primary Treatment of Recurrent Corneal Erosion Syndrome

The purpose of this study was to investigate the efficacy of bandage contact lenses (BCLs) in comparison with that of ocular lubricants (OLs) in the initial management of recurrent corneal erosion syndrome.

This was a randomized controlled trial of 29 patients with recurrent corneal erosion syndrome presenting to the ophthalmology departments of the Oxford Eye Hospital and the Royal Berkshire Hospital, United Kingdom. The patients were randomized to wear either BCLs (for a 3-month duration, replaced every 30 days) or use OLs (four times 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 complete resolution of symptoms with no noticeable corneal surface abnormality. Patients with a complete resolution were followed up for another 3 months to check for recurrence.

Fourteen patients were randomized to the BCL arm, and 15 were randomized to the OL arm. After 3 months, a complete resolution was achieved in 71% of the patients (10/14) with BCLs compared with that achieved in 73% of the patients (11/15) on OLs (P > 0.05). Partial resolution was noted in 7% of the patients with BCLs versus 13% of the patients on OLs. Twenty-one percent of the patients in the BCL group and 13% of the patients in the OL group failed to respond to the treatment. Patients on BCLs had earlier resolution of symptoms, with a mean time of 5 weeks compared with 9 weeks for OLs (P = 0.02). None of the patients with BCLs developed adverse side effects.

The researchers concluded that BCLs do not increase the likelihood of complete resolution when compared with OLs in the initial management of RCES. However, BCL treatment seems safe, and some patients experience earlier relief from symptoms.

Ahad MA, Anandan M, Tah V, Dhingra S, Leyland 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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