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Sunday, October 7, 2012  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

We are all well aware of issues our contact lens patients face in terms of discomfort and end of day dryness. But yet, we do not have an accepted definition of what that means as there is with both dry eye and now, meibomian gland dysfunction. I would very much like to hear your thoughts on this topic. If you were defining contact lens discomfort, what terminology would you use in doing so. Please email your thoughts to me at jnichols@optometry.uh.edu.

SynergEyes Introduces Minutes-to-Fit 2.0 for Duette Lenses

SynergEyes, Inc. is introducing a new fitting approach for Duette lenses called Minutes-to-Fit 2.0. The updated fitting philosophy and methodologies are intended to make fitting everyday patients simple, successful and rewarding.

With the new approach, the rigid center is fit like an RGP lens and the soft skirt is fit like a soft lens. The methodology is simple, does not require fluorescein and can fit into even the busiest practice's workflow, according to the company. An empirical ordering option is also available for practitioners who prefer to avoid diagnostic lenses altogether.

Practitioners interested in fitting Duette lenses with the new approach have a number of ways to be trained on Minutes-to-Fit 2.0. SynergEyes is hosting live webinars, Duette representatives are providing in-practice training and web-based training will be available soon.

ABB CONCISE Offers Contact Lens Annual Supply Training Tutorial for Office

ABB CONCISE has developed an online Annual Supply Tutorial exclusively for ABB CONCISE accounts and their office staff. This 13 minute tutorial provides doctors and their staff with strategies for presenting and closing the sale on annual supplies of soft contact lenses.

The Annual Supply Tutorial was developed to help show doctors and their office staff the importance of selling annual supplies not only for their practice's benefits of patient retention and office efficiencies but also for the patient's overall cost savings, comfort, and visual acuity that comes with patient compliance. The tutorial walks through scenarios on how to handle objections for purchases of annual supplies of contact lenses, in addition to providing scripts for those scenarios.

The Annual Supply Tutorial is the latest tool developed by the company to help increase annual supply sales. Other tools include: Quarterly Soft Lens Retail Price Monitor, Annual Supply Card, Annual Supply Comparison Worksheet, and free Yourlens.com practitioner webstore with Auto Ship Program. The company also has a pencil-sell tear sheet that offices can use to present the added benefit of annual supplies when using manufacturer rebates and insurance benefits where applicable. Later this year, the tool will also be made into an interactive document available for use on an IPad.

To view the tutorial, ABB CONCISE accounts can log onto abbconcise.com and find it on the ECP tools page. For further assistance with developing role playing scenarios and office staff training, accounts can contact their ABB CONCISE sales representative to schedule an appointment.

CooperVision Establishes New Operating Region

To accelerate growth in key emerging markets, contact lens manufacturer CooperVision, Inc. will establish a new operating region. Effective November 1, 2012 the new operating unit will include the fast growing economies of India, Pakistan, the Middle East, Turkey, Russia, and Africa.

Michael Wilkinson, the company's current vice president of Marketing for Europe, the Middle East and Africa, has been named General Manager for the new region. He joined CooperVision in 2006 as General Manager for the UK and Ireland, and previously held roles with Parfums Givenchy and Gillette.

AllAboutVision.com Donates to Optometry Giving Sight for New Facebook "Likes"

Eyecare professionals can provide an eye exam and glasses to someone in a developing country with the simple click of a button. During October, AllAboutVision.com will donate $5 to Optometry Giving Sight when someone "Likes" AllAboutVision.com on Facebook.

Optometry Giving Sight funds sustainable programs that provide eye exams and eyeglasses in communities with little or no eye care. Through these programs, a $5 donation — or one "Like" — can provide an eye exam and glasses to one person.

The promotion helps commemorate World Sight Day on October 11, an annual event to raise awareness of blindness, visual impairment and rehabilitation of the visually impaired. It is estimated that at least 670 million people worldwide are blind or vision impaired due to uncorrected refractive error. In one village in Malawi, Africa, a team of optometrists funded by Optometry Giving Sight found that only seven of 120 children in a program for the blind were in fact permanently blind. The remainder simply needed refractive correction.

By "Liking" AllAboutVision.com, not only will eyecare professionals help support the work of Optometry Giving Sight, but they will be the first to hear about new patient-education articles and significant news updates on the website. To "Like" AllAboutVision.com on Facebook, go to www.facebook.com/allaboutvision. For information about the site and practice-building services, visit www.allaboutvision.com/ecp/.

B+L Announces Research Partnership with Cirle

Bausch + Lomb announced a new research partnership with Cirle, Inc., a medical technology incubator, based in Miami, Florida. Established in 2010, Cirle is focused on curing diseases that lead to blindness through the use of translational medical research and innovative technologies. The company develops and acquires early stage technologies and creates best-in-class partnerships for each of its projects.

The partnership brings together the experience and expertise of some of the world's leading eye health experts and medical researchers and B+L global business and commercial capabilities. As a result, the two organizations will be better positioned to explore novel, early stage technologies and develop them into breakthrough innovations that fill previously unmet needs for the eye health community and the patients they serve.

The partnership with B+L's Pharmaceutical business will encompass a wide variety of cutting edge research projects including new compounds and technologies, and may ultimately be extended across B+L's Surgical and Vision Care divisions to include devices as well. Cirle has engaged leading eye health experts and engineers to contribute to this collaboration, in addition to working with the technology licensing group at the University of Miami Miller School of Medicine's Bascom Palmer Eye Institute.

A Menu of Options or...?

We received several comments from readers about our Editorial of September 23, 2012 on how eyecare practitioners present "additional" testing to patients. Here are some of them. Please share your thoughts with us via email to cltoday@wolterskluwer.com.

I agree with your commentary completely. I use the dentist example frequently when discussing fundus photos with my staff. Having patients choose their options devalues that test. I would love to present it differently to patients, but have not come up with the solution. I would be interested in seeing a discussion on what other offices do when presenting the "menu".

Laura Rosanova-Philipp, OD
Palatine, IL

Thank you for your timely comment on charging for additional services and the comparison with dentistry.

Unfortunately we now have an optical chain (in New Zealand) that advertises "Free Retinal Photography" which makes it even more difficult to maintain appropriate professional charges for additional tests or services.

Your point of allowing patients to self-select from a menu of services is undesirable as well. The recommendations of additional tests and procedures can surely only be made by the eyecare practitioner; only then can the patient make an informed choice.

I hope your comments are heeded.

Roger B. Apperley, Optometrist
Auckland, New Zealand

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Non-wetting Scleral Lens
By Boris Severinsky, MOptom, Jerusalem, Israel

The right image represents an example of non-wetting areas on the anterior surface of scleral contact lens fitted on a keratoconic eye. The patient reported blur and fluctuations in vision that appeared about 10 minutes following lens insertion. Multiple cleaning procedures and lens replacement were required during the day, but proved ineffective.

On the left side is the same lens after it was polished and plasma coated.

We welcome photo submissions from our 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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Loretta B. Szczotka-Flynn, OD, PhD, MS, FAAO

Corneal Collagen Crosslinking and Future Applications

Although corneal collagen crosslinking (CXL) is frequently performed around the world, it is still not FDA approved in the United States. Not a day goes by that I don't have a discussion with my keratoconus patients about CXL, although few at this point are actually having it performed. Nonetheless, recent literature reports on the use of this technology in combination with other refractive surgical procedures.

In Turkey, CXL was applied concurrently with LASIK in a small group of patients (8 eyes).1 In 2010, patients had LASIK with concurrent accelerated CXL in one eye and LASIK only in the fellow eye to treat myopia or myopic astigmatism. At the end of 12 months follow-up, there were no differences between the LASIK-CXL group and the LASIK only group in terms of manifest refraction, visual acuity, endothelial cell loss, or adverse events. They conclude "LASIK with accelerated CXL appears to be a promising modality for future applications to prevent corneal ectasia after LASIK treatment."

In Israel, simultaneous photorefractive keratectomy (PRK) and CXL was performed in keratoconus patients after previous intrastromal corneal ring segment (ICRS) implantation.2 They also reported that simultaneous wavefront-guided PRK and CXL for keratoconus after ICRS implantation was safe and effective.

Therefore, although this technology remains an unmet need in the U.S., the possibilities and advancements in this field are being felt around the world.

1. Celik HU, Alagöz N, Yildirim Y, Agca A, Marshall J, Demirok A, OF. Accelerated corneal crosslinking concurrent with laser in situ keratomileusis. J Cataract Refract Surg. 2012 Aug;38(8):1424-31.
2. Kremer I, Aizenman I, Lichter H, Shayer S, Levinger S. Simultaneous wavefront-guided photorefractive keratectomy and corneal collagen crosslinking after intrastromal corneal ring segment implantation for keratoconus. J Cataract Refract Surg. 2012 Oct;38(10):1802-7. doi: 10.1016/j.jcrs.2012.05.033. Epub 2012 Aug 2.

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Ronald K. Watanabe, OD, FAAO

Do I need a custom toric?

Correcting astigmatism with contact lenses can be a good challenge. We have a number of excellent "off-the-shelf" soft toric contact lens options, and we even have three daily disposable torics. They are all very easy to fit and work quite well for the vast majority of astigmats. But most come in only one size with a maximum of -2.25 DC, so there are times when these designs don't quite deliver the right fit and/or vision. If your patient has an unusually steep or flat cornea, a very large or small HVID, a high cylindrical (or spherical) refractive error, and/or high sensitivity to cylinder axis misalignment, he or she may need a "custom" soft toric.

Available from several laboratories and with an almost endless parameter range, custom soft toric lenses can be made for virtually any patient. Also, many of these designs are now available in 1 to 3 month frequent replacement multi-packs with competitive pricing. Some are available in silicone hydrogel materials and a few have multifocal versions.

The bottom line is that there are great options today for those challenging-to-fit astigmats.

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Is whole body hydration an important consideration in dry eye?

The prupose of this study was to identify if whole body hydration plays an important role in dry eye (DE). The researchers hypothesized that individuals classified as DE have higher plasma osmolality (Posm), indicating sub-optimal hydration, compared with those classified as non-DE.

Using a hospital-based observational cross-sectional design, assessment of DE and hydration was performed upon admission in 111 participants (N=56 males and 55 females; mean +/- SD age 77 +/- 8 years). Assessments of DE included, tear osmolarity (Tosm), the 5-item dry eye questionnaire (DEQ-5), rating of eye dryness using a visual analogue scale (VAS) and non-invasive tear film breakup time (NITBUT). Hydration assessment was performed by measuring Posm using freezing-point depression osmometry.

Posm was higher in DE than control (CON), indicating sub-optimal hydration, when using the 316 mOsm/L Tosm cut-off for DE (mean Posm + 11 mOsm/kg vs. CON, P = 0.004, Cohen's effect size (d)= 0.83) and the more conservative Tosm classification for DE where Tosm >324 and CON <308 mOsm/L (mean Posm + 12 mOsm/kg vs. CON, P = 0.006, d= 0.94). Posm was also higher in DE than CON when using composite DE assessments; including, Tosm and DEQ-5 (P = 0.021, d= 1.07), Tosm and NITBUT (P = 0.013, d= 1.08), and the VAS and DEQ-5 (P = 0.034, d= 0.58).

According to the researchers, these are the first published data to show that individuals classified as DE have higher Posm, indicating sub-optimal hydration, compared with non-DE. These findings indicate that whole body hydration is an important consideration in DE.

Walsh NP, Fortes MB, Raymond-Barker P, et al. Is whole body hydration an important consideration in dry eye? Invest Ophthalmol Vis Sci. 2012 Sep 25;53(10):6622-7. Print 2012 Oct.
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