I recently heard that Polycon II will be discontinued at the end of this year. Though I have not fit a patient in Polycon II for many years, I feel that it is an important lens in contact lens history. It was one of the first GP materials that had good parameter stability and on-eye performance. It also had a thin design that allowed good long-term comfort. But like many other great innovations, progress has made it somewhat obsolete.

Today's GP materials are much more oxygen permeable, and many of them can be made in thin designs. Manufacturing technology makes it possible to make virtually any type of design, including sophisticated multifocal, reverse geometry, scleral, and quadrant-specific designs. And normal eyes can be fit empirically with GP lenses by taking good ocular measurements and using the most appropriate fitting philosophy (e.g., lid attachment vs. interpalpebral). In a way, I am sad to see Polycon II go, but I am very happy with what's available in GP materials and designs today.

See this month's Annual GP Issue of Contact Lens Spectrum for a look at what's hot in GP lenses today.

Recently I have had three patients in clinic with what I thought was limbal stem cell deficiency (LSCD) associated with contact lens wear. Although LSCD may be suspected, there are few publications documenting the characteristic appearances and associated findings for comparison. A new paper hopefully will shed some light on this topic.

Jeng and coworkers¹ presented the varying manifestations of and the treatment methods for corneal epitheliopathies secondary to LSCD associated with soft contact lens wear. They reviewed medical records of patients seen at three institutions who developed focal LSCD, based on clinical examination, which was attributed to SCL wear.

Eighteen eyes of 10 SCL wearers were found to have varying degrees of corneal epitheliopathy secondary to focal LSCD. Nine of the 10 patients (90%) were women, and the mean age of all patients was 35.1 years (range: 20-58 years). The mean duration of SCL wear was 15.2 years (range: 4-30 years). Two patients wore the lenses for 20 hours per day. The focal LSCD was found superiorly in all involved eyes and inferiorly in only 5 of 18 eyes (27.8%). Fortunately, the epitheliopathy resolved or stabilized in 11 eyes (61.1%) with cessation of SCL wear and use of artificial tears. Five eyes required topical corticosteroid eye drops, and two eyes required surgical intervention. Although the abstract only is available now, I hope some clear photos will be available in the printed version.

This paper reminded me of a great article written by Kathy Mastrota in Contact Lens Spectrum last year: http://www.clspectrum.com/article.aspx?article=103008. She described the limbus as a stem cell microenvironment and the renewal process of undifferentiated stem cells. Take a look at her article while waiting for Jeng's paper to come out in print.

1. Management of Focal Limbal Stem Cell Deficiency Associated With Soft Contact Lens Wear. Jeng BH, Halfpenny CP, Meisler DM, Stock EL. Cornea. 2010 Sep 15. [Epub ahead of print]

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 are seeing lots of interesting data being discussed--some new and some old--on compliance as it relates to contact lens wearing habits, contact lens care, and contact lens complications. It's interesting to me that this seems to have become quite a popular topic of discussion this year, although I admit that I don't understand why it's not always an important issue that is being discussed. In this week's Quick Poll, we are asking a question that relates to the rub step in contact lens care regimens in order to get your thoughts on what your patients are doing. Please assist us by responding.

Role of Corneal Mechanical Adaptation in CL Related Dry Eye Symptoms

Researchers wanted to compare corneal mechanical adaptation measured psychophysically in contact lens wearers with or without dry eye symptoms.

Two groups of contact lens wearers were recruited. One group (symptomatic) consisted of subjects with dry eye symptoms (according to the SeSoD questionnaire). The second control group (asymptomatic) consisted of subjects reporting no symptoms. There were 32 (aged 20 to 42 years, 6 males and 26 females) and 29 subjects (aged 21 to 36 years, 9 males and 20 females) in the symptomatic and asymptomatic groups respectively.

Mechanical stimulus thresholds of the cornea were determined using a Belmonte pneumatic esthesiometer and the ascending method of limits. Then 3 stimulus intensity groups (subthreshold, threshold and suprathreshold) were applied to the eye in random order, each 20 times. Subjects rated the intensity of the stimuli using a scale of 0 to 4. The rating data from the two groups were compared by Friedman non-parametric ANOVA. Adaptation was defined as the reduction in subsequent ratings compared to earlier ones.

There was no significant difference of subjects' thresholds in both groups (p=0.22). The symptomatic group rated their sensations to suprathreshold stimuli higher than the asymptomatic group. More importantly, there was significant adaptation with suprathreshold mechanical stimulation in the asymptomatic group (p=0.006), but not in the symptomatic group (p=0.08). There was no adaptation during threshold and subthreshold stimulus sessions in either group. Conclusion. Adaptation was found to suprathreshold mechanical stimuli in the asymptomatic group, but not in the symptomatic group.

Chen J, Simpson TL. A Role of Corneal Mechanical Adaptation in Contact Lens Related Dry Eye Symptoms. Invest Ophthalmol Vis Sci 2010.