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Sunday, October 20, 2013  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

Several weeks ago, I wrote about the importance of the use of fitting guides particularly when fitting multifocal contact lenses. I stand by this, but also wanted to point out that manufacturers are making this resource easier to find. Of course, you can find fitting guides on the web, and through information found in many publications, but we're also likely to see more and more of this information available through apps on our smartphones and tablets as well.

Art Optical Introduces New Simultaneous Vision GP Multifocal

Art Optical announces mPower! a new custom GP multifocal lens designed specifically for presbyopes with high near vision demands.

Featuring multiple front-surface power zones and minimal base-curve eccentricity, mPower! provides maximum near vision without compromising distance VA or creating corneal molding concerns, according to the company. The simultaneous power effect ensures effortless and translation-free accommodation. A controllable first front zone allows practitioners to adjust for pupil diameter, providing an individualized, high-performance multifocal contact lens experience for each patient. Unlike other simultaneous vision designs, the central front surface zone of the lens is spherical, providing a larger area of distance clarity and easily accessible, crisp near acuity. The lens is easy to fit empirically with a simple 4-step method; or for those who prefer diagnostic fitting, a 10-lens trial set is also available.

mPower is indicated for patients who have worn high-eccentricity back-surface multifocals and experienced the typical problems with corneal molding, and for those patients who have experienced poor near vision with other multifocal designs. Featured in the Optimum family of materials from Contamac, the lens is backed by Art Optical's Risk-Free Signature lens guarantee.

With a wide-range of custom parameters available, mPower offers fitters the design flexibility to meet the needs of a larger percentage of their over-40 patient base, making it a great addition to any presbyopic lens management strategy. Complete product details can be found at the company website, www.artoptical.com.

Clariti Receives FDA Approval

Sauflon announced the recent FDA approval of the clariti family of daily disposable and reusable contact lenses, paving the way for the launch of the silicone hydrogel family into the United States.

This is a landmark achievement for an independent, British manufacturer and represents an opportunity for greater access to these innovative, unique and ground-breaking products. With its availability in daily disposable and reusable modalities across sphere, toric and multifocal designs, the comprehensive clariti silicone hydrogel family is ideally suited to satisfy a wider range of practitioner and patient needs in the U.S.

The company expects that Sauflon's steadfast ECP Only policy will resonate with U.S. practitioners, empowering them to achieve higher levels of practice protection and patient retention.

Details of Untied States launch timing are not yet available.

TFOS Presents Lifetime Achievement Awards

Dr. Kelly K. Nichols and Dr. Gary N. Foulks were presented with TFOS Lifetime Achievement Awards at the Tear Film & Ocular Surface Society Business Meeting held during the organization's recent conference. Both of these individuals have performed extraordinary services for TFOS. Each of them has served as Steering Committee members and Subcommittee Chairs of the TFOS Dry Eye Workshop and the TFOS Workshops on Meibomian Gland Dysfunction (MGD) and Contact Lens Discomfort (CLD). Dr. Nichols also chaired, and Dr. Foulks was vice-chair, of the MGD Workshop. In addition, as Editor-in-Chief of The Ocular Surface (TOS) for many years, Dr. Foulks has facilitated and promoted a stronger relationship between TOS and TFOS. They have both played an outstanding role in the growth of TFOS. Accordingly, the TFOS Governing Board recognized their exceptional energy and tireless commitment with Lifetime Achievement Awards.

Register Now for Global Specialty Lens Symposium – January 23 – 26, 2014
Plan 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.
Cambridge Award for Holden

The Cambridge Ophthalmology Society has acknowledged Professor Brien Holden, CEO, Brien Holden Vision Institute, with its prestigious Peter Watson Medal for distinguished service. Since it was launched, Professor Holden is the first awardee in the Southern Hemisphere.

Professor Holden chaired the 2013 Cambridge Ophthalmic Symposium, which took place in September, focusing on refractive error. The Peter Watson medal is given to the Chairman of the meeting, a two-day symposium which brings together scientists and clinicians to discuss a well-defined topic in detail under the chairmanship of one of the leaders in that field. The symposium encourages stimulating discussions at the highest levels.

The award was launched in 2010 to commemorate the 40th anniversary of the meeting; previous winners of the medal include Professors Robert Weinrab, John Dart, Bertil Damato and Peter Watson himself.

The Cambridge Ophthalmology Society promotes ophthalmology as a clinical speciality and as an area of research within the University of Cambridge, UK. They provide support, information and teaching opportunities for Clinical School students and Foundation Year doctors with an interest in Ophthalmology.

Optometry Students Eligible for Optometry Cares Grants

Third-year optometry students (class of 2015) are encouraged to submit an essay for each of two scholarships administered though Optometry Cares – The AOA Foundation. The Dr. Seymour Galina Grant, established at the bequest of the late AOA member Dr. Seymour Galina, and the InfantSEE Scholarship Grant, which is sponsored by Vision West, Inc., a leading national eye-care business group offering Optometric Business Services, including group purchasing services to its members.

The winner of the 2014 Dr. Seymour Galina Grant will receive an award of $2,500. The 2014 InfantSEE Scholarship Grant will have two victors; the student with the winning essay will be awarded $5,000, while the runner-up will receive $2,500.

Interested applicants for these scholarships must check with the Student Affairs Office to determine your institution's on-campus deadline to submit the appropriate materials for consideration. From the applications received, each school and college will select one candidate for the Dr. Seymour Galina Grant and one candidate for the InfantSEE Scholarship Grant. Institutions will forward the individuals' names and essays to Optometry Cares in St. Louis by January 13, 2014. The winners for the scholarships will be announced in May 2014.

For scholarship application documents and more information about each scholarship's criteria, visit www.aoafoundation.org/endowment-fund/scholarship-grant-information.

Post RK Problem Cornea
By Adolfos Kannetis, Limassol, Cyprus

This cornea was operated on for correction of myopia with old RK method that went wrong. Visual acuity was 20/200. Correction with a 9.2 diameter RGP BCOR 7.99 resulted in VA of 20/15.

We thank Adolfos Kannetis 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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Katherine M. Mastrota, MS, OD, FAAO

Sutureless Amniotic Membrane ProKera for Ocular Surface Disorders: Short-Term Results.

From the Cornea Service at Wills Eye Institute comes a 2013 chart review study on the use of amniotic membrane therapy (AMT) in corneal disease. The authors evaluated ProKera, a PMMA ring-mounted, sutureless amniotic membrane biologic bandage, in the management of ocular surface disorders.

Chart review of patients who had ProKera (Bio-Tissue, Inc.) implantation for ocular surface disorders between June 2008 and May 2012 at three ophthalmology practices in Philadelphia, PA was done. The parameters evaluated included age, sex, indication for AMT, any other combined procedure, duration of retention of amniotic membrane, the effect of amniotic membrane on ocular surface healing, follow-up time, and complications.

Thirty-five eyes of 33 patients with a mean age of 68.2±19.5 years (range: 17-99 years) were included. Median follow-up was 110 days (mean: 164.6 days; range: 30-960 days). The indication for insertion of ProKera was non-healing corneal ulcers of infectious origin (group 1) in 9 eyes (25.7%), neurotrophic keratopathy (group 2) in 11 eyes (31.4%), chemical injury (group 3) in 5 eyes (14.3%), and other indications (group 4) in 10 eyes (28.6%). Complete or partial success was seen in a total of 44%, 64%, 80%, and 70% eyes in groups 1 to 4, respectively. Discomfort with the device was seen in 6 (17.1%) of 35 eyes, and recurrence of primary pathologic condition occurred in 5 (14.3%) of 35 eyes.

The authors conclude that ProKera treatment is easy to use and reasonably well tolerated, with moderate success in corneal ulcers and encouraging results in acute moderate chemical injury. Recurrence of primary pathologic condition is seen particularly associated with neurotrophic keratitis and dry eye syndrome.

Suri K, Kosker M, Raber IM, Hammersmith KM, Nagra PK, Ayres BD, Halfpenny CP, Rapuano CJ. Sutureless Amniotic Membrane ProKera for Ocular Surface Disorders: Short-Term Results. Eye Contact Lens. 2013 Sep;39(5):341-7.
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Susan J. Gromacki, OD, MS, FAAO

The Contents of a Scleral Lens Care and Handling Guidelines Document

At their insertion, removal, and care training visit, each one of my new scleral contact lens patients receives detailed verbal instructions from our practice's contact lens technician. We also present them a written copy of our Scleral Lens Instructions. In addition, I give the document to any existing patients who I feel need a review of lens insertion, removal, and care.

There are many good ways to present written contact lens information,1 and how it is organized depends on personal preference. For my practice, I composed a Contact Lens Policy brochure and a CL Agreement (the latter of which the patient signs). Patients also receive one of two separate instruction sheets: 1. soft and corneal GP lenses, or 2. Scleral GP lenses. I would advise that each document not exceed one or two sides of 81/2 X 11 inch paper; otherwise some patients may find it too lengthy to read. The directions can also be placed on your practice's website, but this should not be the exclusive method of education, since some patients may not log on to read them.

My scleral lens document includes information on:
1. Hand washing
2. Lens application
3. Lens removal
4. Lens care
5. Wearing time and follow-up schedule
6. Abnormal symptoms and when to call our office immediately
7. Office phone numbers, including a 24-hour number

In my next column, I will print my instructions for scleral contact lens application.

1. http://www.clspectrum.com/articleviewer.aspx?articleID=107606
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The Influence of Soft Contact Lens Wear and Two Weeks Cessation of Lens Wear on Corneal Curvature

Accurate corneal measurements are crucial in corneal refractive surgery (CRS) to ensure successful outcomes. Soft contact lens (SCL) wear may result in changes to corneal curvature and structure. United States Food and Drug Administration (FDA) pre-operative guidelines recommend that prior to CRS, SCL wearers cease SCL wear for "at least two weeks before examination and treatment." Corneal curvature changes induced by SCL wear may take longer than two weeks to resolve.

The purpose of this study was to examine the effect of SCL wear on corneal curvature before and following two weeks SCL wear cessation. To explore the possible impact of different SCL materials and years of SCL wear.

Retrospective data analysis, between a group of SCL wearers (SCL: n=45); and a non-contact lens control group (NCL: n=45). Corneal curvature parameters were measured using the Pentacam (Oculus, Germany), before and following two weeks cessation of SCL wear.

No significant differences in keratometry or sagittal radius of curvature between SCL and NCL groups prior to or following SCL cessation. Tangential radius of curvature showed significant inferior steepening for the SCL group prior to SCL cessation (SCL vs. NCL; 7.77±0.30mm vs. 7.90±0.30mm; p=0.04). Following two weeks cessation of SCL wear this appeared to have resolved.

Two weeks cessation of SCL wear appears sufficient for resolution of corneal curvature changes with modern SCL materials and years of SCL wear. However, further studies with longer lens deprivation periods are required to ensure stability for all SCL wearing patients.

Lloyd McKernan A, O'Dwyer V, Simo Mannion L. The influence of soft contact lens wear and two weeks cessation of lens wear on corneal curvature. Cont Lens Anterior Eye. 2013 Aug 21. pii: S1367-0484(13)00098-2. doi: 10.1016/j.clae.2013.07.014. [Epub ahead of print]
Source: Dublin Institute of Technology, Ireland.

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