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Sunday, October 21, 2012  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

We've come a long way in our understanding about the critical elements of contact lens care—the rub, rinse and soak steps each playing a major roll. It wasn't that long ago that most of us were using the "no-rub" multipurpose care solutions brought to the market more than a decade ago. We know that most contact lens practitioners now actively tell their patients to rub their lenses (http://www.cltoday.com/issues/CLToday_111410.htm) but this doesn't mean that patients will actually go out and practice this step. Changing behaviors can sometimes be difficult and take active engagement, so continue to be proactive in your approach.

Alden Optical Announces EZ-Exchange

Alden Optical, Inc., manufacturer of custom and specialty soft and GP contact lenses, announced a new policy regarding lens exchanges that the company has branded EZ-Exchange. EZ-Exchange allows practitioners to make lens adjustments without the need to return the original lens. In rare situations where fitting adjustments are necessary, practitioners can simply contact Alden Optical with the new lens order and dispose of the original lens. The new policy is designed to improve office efficiency and decrease shipping and handling costs.

Lens orders that result in patient cancellation, as well as any defective lens claims, will continue to require lenses to be returned in order to receive full credit. The new policy will go into effect on November 1, 2012.

For more information on Alden Optical and its products visit www.aldenoptical.com.

Tis the Season for Ghoulish Eyes - and Legal Crackdowns

As Halloween approaches, eyecare professionals' organizations including the American Optometric Association and the American Academy of Ophthalmology release their annual warnings on the dangers of wearing non-prescribed decorative contact lenses sold illegally. The FDA consumer site also contains recently updated information, Decorative Contact Lenses: Is Your Vision Worth It?

Individual practitioners also approach their communities with warnings and too true horror stories like the recently reported one of a woman in Mobile, Alabama who lost vision in one eye from an infection developed after several days of wearing a cosmetic lens purchased at a beauty supply shop.

But at least in one state authorities are taking some action as well. According to the Associated Press, Illinois regulators recently confiscated $1600 worth of novelty contact lenses (over 40 boxes) from a convenience store in central Illinois. They were operating on a tip provided by a school nurse after a student developed an eye injury reportedly caused by lenses bought at the store. According to a spokesperson for the Illinois Department of Financial and Professional Regulation, details on the location are not available as the investigation is ongoing.

This is indeed a small event given the broad availability of illegal lenses on the Internet and many other outlets. Let's hope that as media outlets pick-up on this story, as many already have, this ripple effect will register with some parents and their children enough to protect the sight of a few more people.

Plan Now to Attend GSLS 2013 in January

Plan now to attend the Global Specialty Lens Symposium January 24-27, 2013, at the Rio All Suites Hotel and Casino, Las Vegas, Nevada. With an expert international faculty and a CE-accredited agenda, the 2013 GSLS will include a fundamentals pre-conference, insightful presentations by experts in the field, hands-on demonstrations of cutting-edge products, as well as scientific papers and posters and networking opportunities with your colleagues from over 30 different countries.

Look for more detailed information in future issues of Contact Lens Spectrum and online at www.GSLSymposium.com.

Prescribing Punctal Plugs
Irwin Azman, OD, Dry Eye Center of Maryland, Timonium, MD

When contact lens patients have dry eye symptoms together with some degree of MGD (majority do have MGD) I usually discuss with patient the following. I focus initially on treating the MGD and then will refit the patient with a lens material with a low dehydration rate. At the same time I evaluate the size of the patient's punctum. If they have large openings I will discuss the possibility of prescribing plugs. Of course plugs will not be done unless the inflammation is under control.

At the initial visit I also measure osmolarity using the TearLab Osmolarity Test (TearLab Corporation). If the osmolarity is high, I will also prescribe eye drops that may help reduce osmolarity while treating the MGD. I wait to prescribe punctal plugs until MGD and osmolarity is normal or close to normal.

This explanation is time consuming but must be given if you want the patient and doctor to be successful.

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Sunset in a Fluoresceinical Sea
By Marco Tovaglia, Vittuone, Italy

A keratoconus TK4 Tetra-Conical TSLAC RGP lens in a curious photo.

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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Ronald K. Watanabe, OD, FAAO

Cosmetic Enhancement

It's Halloween, and my thoughts go to crazy colored contact lenses and how easy it is to get a pair through the internet. Today, one of my patients asked me if I sell these lenses. I explained that I could fit her with the lenses to make sure she didn't have any problems. She said never mind. Even though these lenses may be well-designed using FDA-approved materials, they can create complications unless fit properly. Internet sellers know this, and some even recommend limiting wearing time to 6 hours - presumably to prevent complications.

I then thought about prosthetic lenses for disfigured eyes. I have fit many of these lenses to very grateful patients, and have felt a sense of fulfillment with each case. Though Alcon (Ciba) and CooperVision no longer offer their prosthetic lenses, they are available through several labs. Hand-painted lenses are offered by Adventure in Colors, Crystal Reflections, Custom Color Contacts, and Marietta Vision. Other "standard" color options are available through Alden Optical and Advanced Vision Technologies.

To me, this is a reminder that we should continue to educate our patients about the potential hazards of contact lenses sold without a prescription so that they can continue to enjoy clear, healthy vision.

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Loretta B. Szczotka-Flynn, OD, PhD, MS, FAAO

Tinted Contact Lenses for Therapeutic Treatments

Many of us have fit the occasional patient with tinted contact lenses for therapeutic reasons: improvement of photosensitivity secondary to aniridia and fixed surgical pupils, iris colobomas, iris transillumination in ocular albinism, and even color deficiency. However, another indication that has been recently brought to my attention is photogenic seizures in epilepsy.

Two studies in the epilepsy literature have shown that blue tinted lenses may help in the reduction of the photoparoxysymal response and may assist epilepsy patients with photosensitivity. Capovilla et al (2006) have shown that the blue Z1 (spectacle) lens from Zeiss with a peak wavelength transmittance of about 470 nanometers was highly effective in controlling the photoparoxysmal response in a large number of photosensitive epilepsy patients. Another case report of a 2 year-old patient with severe myoclonic epilepsy and self-induced photogenic seizures showed that a blue tinted contact lens reduced photosensitivity and inhibited the effect. (Takahashi 1995). The effectiveness of the tinted lenses could be related to the reduction of light frequencies between 550 and 700 nanometers.

More about this and the ability of tinted contact lenses assist in treatment of medical conditions will be in the December issue of Contact Lens Spectrum.

Capovilla G. et al. Suppressive Efficacy by a Commercially Available Blue Lens on PPR in 610 Photosensitive Epilepsy Patients. Epilepsia. 47(3): 529-533, 2006.
Takahashi Y et al. Self Induced Photogenic Seizures in a Child with Severe Myoclonic Epilepsy in Infancy: Optical Investigations and Treatments. Epilepsia. 36(7): 728-732. 1995.

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Impact of Pupil Diameter on Axial Growth in Orthokeratology

The purpose of this study was to compare axial elongation between myopic orthokeratology (OK) contact lens and spectacle wearers, and to investigate the impact of pupil diameter on axial growth in myopic children after OK treatment.

Fifty-two Chinese children aged 9 to 14 years were enrolled in this study, 27 for the OK group and 25 for the single vision spectacle lenses (SVL) group. Subjects in each group were further divided into two subcategories according to their baseline scotopic pupil diameters. Axial length (AL) was measured at baseline and at every 6-month visit through to 24 months. Linear mixed-effect model was used to determine myopia progression (AL changes from baseline). In this model, repeated visits were taken as within-subject effect, and treatment group as well as pupil size were taken as between-subject effects. The interaction of treatment group pupil size was analyzed. Relationships between axial growth at 24 months and baseline pupil area were analyzed in both lens groups.

Twenty-five subjects in the OK group and 22 subjects in the SVL group completed the 24-month study. AL increased significantly throughout the observed 24-month period (F = 32.09, p < 0.001). Pupil size significantly affected axial growth (F = 15.95, p < 0.001) and different treatment modalities (OK vs. SVL) interacted with the effect of pupil size on axial growth (F = 24.66, p < 0.001). To be more specific, axial growth was significantly slower in subjects with above average pupil sizes than those with below average pupil sizes in the OK group (F = 25.04, p < 0.001). Contrarily, pupil size did not affect axial growth in the SVL group (F = 0.46, p = 0.50). Baseline scotopic pupil area was significantly correlated to axial growth in the OK group (r = 0.405, p < 0.001) but not in the SVL group (r = 0.171, p = 0.056).

The researchers concluded that large pupil diameters facilitate the effect of OK to slow axial growth in myopia. They speculated that this is because of enhancement of the myopic shift in the peripheral retina.

Chen Z, Niu L, Xue F, et al. Impact of Pupil Diameter on Axial Growth in Orthokeratology. Optom Vis Sci. 2012 Sep 28. [Epub ahead of print]
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Important Links:
To report adverse contact lens reactions visit: http://www.accessdata.fda.gov/scripts/medwatch/ or call (800) FDA-1088.
To report possible grievances related to the Fairness to Contact Lens Consumers Act or associated Contact Lens Rule visit: https://www.ftccomplaintassistant.gov/.

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