In a recent article (Szczotka-Flynn 2010), we highlighted that under normal wearing conditions, the incidence of microbial contamination on traditional hydrophilic or silicone hydrogel contact lenses is approximately 55-85%. Even when removed aseptically from the eye, over half of lenses are found to harbor microorganisms, almost exclusively bacteria. The bacteria isolated are mostly considered normal microbiota, the greatest percentage being coagulase negative staphylococci. Lens deposits influence bacterial adherence differentially depending on lens substrate. Silicone hydrogel lenses do not appear to differ from traditional pHEMA lenses in terms of levels or frequency of bacterial colonization in vivo. Lens handling greatly increases the incidence of lens contamination, and the ocular surface has a tremendous ability to destroy organisms.

The process of contact lens related microbial keratitis and inflammation is thought to be preceded by the presence and/or transfer of microorganisms from the lens to the ocular surface. Thus, this detailed understanding of lens related bioburden is important in the understanding of factors associated with infectious and inflammatory complications. I look forward to what other presenters have to say and will update you in my next column.

Reference:
Szczotka-Flynn L, Pearlman E, Ghannoum M. Microbial Contamination of Contact Lenses, lens care solutions, and their accessories: a literature review. Eye & Contact Lens. 2010. 36(2):116-29.

Bausch + Lomb has introduced PureVision 2 HD silicone hydrogel contact lenses. This is a redesign of the PureVision lens with a thinner overall profile, improved edge design, and new ComfortMoist technology. The material is the same Balafilcon A with a Dk of 91. But with a thinner design, Dk/t shoots up to 130, and initial comfort is improved. B+L states that 84% of subjects who were fit into the new lens report good comfort on insertion, an issue for some patients with the original PureVision. The new lens maintains aberration-correcting optics with some modifications to improve consistency across the power range.

This illustrates the importance of lens design on initial comfort. Even with a relatively high modulus material like Balafilcon, patients can enjoy comfortable lens wear if the lens is designed well. Lens thickness, edge profile, front and back surface curves, and even zone junctions all play roles in comfort. This holds true for GP lenses too. Of course, there are limits to how thin a lens can be made, and the lens also has to fit well to the ocular surface. But careful selection of lens design can help improve initial comfort and overall fitting success.

Vistakon Introduces Acuvue Advance Plus

Vistakon, Division of Johnson & Johnson Vision Care, Inc., announced the launch of Acuvue Advance Plus Brand Contact Lenses with Hydraclear Technology.

Acuvue Advance Plus is a redesigned and enhanced successor to Acuvue Advance Brand Contact Lenses. Along with Hydraclear Technology, Acuvue Advance Plus offers improvements in initial and overall comfort, as well as visual clarity, along with the highest level of UV protection in a contact lens, blocking more than 90 percent of UV-A rays and 99 percent of UV-B rays that reach the lens, according to the company. Acuvue Advance Plus also employs Ultra-Clean Technology to help resist deposits.

For patients, Acuvue Advance Plus provides the freshness of a two-week modality at a price comparable to a monthly lens. The lens comes six to a box, and the 24-pack value packaging makes the purchase of an annual supply more affordable for wearers.

The lens is available in base curves of 8.3mm and 8.7mm at parameters of -0.50D to -6.00D and +0.50D to +6.0D in 0.25 increments and from -6.50D to 12.0D and +6.50D to +8.0D in .50D increments.

Acuvue Advance Plus will gradually replace Acuvue Advance. Vistakon will discontinue providing Acuvue Advance diagnostics effective November 1, 2010.

More information on Acuvue Advance Plus is available at www.jnjvisioncare.com/ap.

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TearLab Reports Reimbursement for Osmolarity Test

TearLab Corporation announced that the Committee for Medicare and Medicaid Services (CMS) has published their recommended payment determination for new test codes, which includes a proposed reimbursement rate for the TearLab Osmolarity Test, effective January 2011. The new Current Procedural Terminology (CPT) code that will apply to the TearLab Osmolarity test will be reimbursed by CMS at $24.01 per eye (national limit). The actual CPT code will be published by the American Medical Association in December 2010.

Reimbursement by CMS will only be available for offices that have a Moderate Complex CLIA certificate until TearLab receives a CLIA Waiver categorization from the Food and Drug Administration (FDA). This waiver is currently under review by the FDA.

Alcon, Inc. Names New CFO

Alcon, Inc. announced the appointment of Robert Karsunky as Senior Vice President and Chief Financial Officer (CFO) effective November 1, 2010. Karsunky comes to Alcon from Novartis AG, where he was most recently CFO in the Consumer Health Division.

Karsunky will succeed Richard Croarkin, who has served as Alcon's CFO since August 2007. Croarkin will remain a member of the executive leadership team until November 30, during which time he will assist in the transition of his responsibilities. Upon completion of this transition, Rick will return to a financial position at Nestle.

Prior to joining Novartis in 2006, Karsunky served for four years as the Vice President of Finance for the international division of Medtronic, Inc. He began his career with Eli Lilly in 1991 where he had a variety of increasingly responsible financial positions to become the Executive Director of Finance for Intercontinental and Japan from 2000 to 2002. He studied business administration at the University of Cologne and New York University, and obtained a PhD in Economics from the University of Aachen in Germany

Natural Ophthalmics Introduces Ortho-K Treatment Eye Drops

Natural Ophthalmics introduced Ortho-K Treatment Eye Drops, both day time and night time formulas. The company reports that these drops contain homeopathic ingredients to relieve the leading challenges for contact lens patient compliance such as dry eye, allergy, foreign body sensation and inflammation. They include eight ingredients indicated by Natural Ophthalmics to stimulate tear film production, counteract irritation, halt allergies, reduce foreign body sensation and promote corneal health.

The "Night Time Gel" reduces mechanical irritation according to the company. The clarifying "Day Time Drop" is preservative free and may be used as often as needed to alleviate dry, red, itchy or irritated eyes. Both drops may be used with contact lenses in place.

The drops are available only via health care practitioners. Orthokeratology Academy of America members get 10% discount. For more info call 1-877-220-9710 or visit www.naturaleyedrops.com.

Global Specialty Lens Symposium, January 27-30, 2011, Paris Hotel & Casino in Las Vegas

Plan now to attend the Global Specialty Lens Symposium in January 2011. With an expert international faculty and a CE-accredited agenda, the 2011 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.
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VSP Vision Care and Vistakon Sign Agreement

VSP Vision Care and contact lens manufacturer Vistakon announced an enhanced additional rebate program to VSP members, beginning October 1, 2010.

Members who purchase an annual supply of Acuvue Brand Contact Lenses from one of VSP's 27,000 network providers, will receive an additional $25 rebate on top of the current national rebate program offered by Vistakon.

Vistakon will support the program with a marketing campaign focusing on educating VSP members about the program and the value available from their eye care professional. For more information about the program and to download a copy of the rebate form, please visit "The Center" on www.vsp.com.

We all know very well that contact lens wearers have frequent ocular surface symptoms—dryness, discomfort, etc, etc. There are numerous studies that have quantified this very well over the years. However, what seems to be lacking is any sort of quantitative data relative to the age at which these symptoms first develop in contact lens wearers. Please provide your responses to our CL Today Quick Poll relative to your clinical experience with issue.

Soft Toric Contact Lens Prescribing in Different Countries

There have been significant improvements in toric soft contact lens design over the past decade. Data from an international contact lens prescribing survey were mined to assess recent trends in toric soft contact lens fitting.

This survey was conducted by sending up to 1000 survey forms to contact lens fitters in Australia, Canada, Japan, the Netherlands, Norway, the UK and the USA each year between 2000 and 2009. Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the forms and to return them to us for analysis.

The data revealed a gradual increase in the extent of toric soft lens fitting this century. Excluding Japan - which had a consistently low rate of soft toric lens fitting over the survey period - soft toric lenses now represent over 35% of all soft lenses prescribed; it can be assumed that, on average (and again excluding Japan), all cases of astigmatism 0.75D or less remains uncorrected among contact lens wearers. Toric lenses are fitted more to those who are older, full-time wearers and reusable lens wearers, and less to those wearing silicone hydrogel and extended wear lenses.

Efron N, Morgan PB, Helland M, Itoi M, Jones D, Nichols JJ, et al. Soft toric contact lens prescribing in different countries. Cont Lens Anterior Eye. 2010 Sep 23.