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Sunday, November 3, 2013  
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In the last year, approximately how many contact lens dropouts have you been able to successfully fit in daily disposables, if even for part-time wear?





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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO
I've both surveyed practitioners and seen a tremendous amount of data over years on lens care prescribing habits of eyecare practitioners. A small percentage of practitioners are very proactive about prescribing a specific lens care system, in addition to promoting high standards of lens care habits within their staff's training and directly to patients. Alternatively, a large percentage of practitioners do not do either of these things. Why have the masses become complacent about lens care? We'll address this and other related matters in future issues of this newsletter and Contact Lens Spectrum.

Barr Wins Ohio State Alumni Award
Joseph T. Barr, OD, longtime Ohio State College of Optometry faculty member and former editor of Contact Lens Spectrum and Contact Lenses Today, is a recipient of the Ohio State Alumni Association's 2013 Ralph Davenport Mershon Award. The Mershon Award is presented to alumni who have demonstrated exceptional leadership and service to Ohio State.

Barr received two degrees from Ohio State's College of Optometry – an OD and an MS in physiological optics. Barr's first job after graduating was with Dow Corning, where he managed clinical and material research and helped bring to market a silicon-based, gas-permeable lens that was thinner and more comfortable for patients, including one for babies who had had congenital cataracts removed.

In 1983, Barr joined the Ohio State faculty as chief of the contact lens service at the College of Optometry and then as chief of optometry clinical services. By 2000, he was a professor of optometry and physiological optics. Over the years he served as assistant and then associate dean, both for clinical affairs and for clinical services and the professional program. During his tenure, he was the E.F. Wildermuth Foundation Professor in Optometry, advised graduate students, and served on the Council on Student Affairs.

In 2008 Barr took a position at Bausch + Lomb. While there, he has led a major effort in collaboration with the Lions Club International Foundation and the Pediatric Cataract Initiative to sponsor studies in Nepal, India, Nigeria, South Africa, and China with the goal of eliminating childhood blindness from cataracts.

Barr has served his profession as a long-time Fellow of the American Academy of Optometry; editor of Contact Lens Spectrum for 20 years; and founding editor of the Contact Lenses Today. He has garnered many awards—from Ohio State, the American Academy of Optometry, the European Federation of the Contact Lens and IOL Industries, and the National Eye Research Foundation, to name a few.
Clinical Grading Scales – There’s Now an App for That!
The Vision Care Institute, LLC (TVCI), a Johnson & Johnson Company, has launched The Vision Care Institute Clinical Grading Scales App, an educational tool designed to help eyecare practitioners assess the severity and evaluate the progression of complications associated with contact lens wear.

Based on the clinical assessment guide derived from the grading scales developed by Prof. Nathan Efron, eyecare professionals can use this innovative, easy-to-use resource during patient evaluations and follow-up.

The new app allows users to do the following:
  • Evaluate nine common eye conditions (bulbar redness, corneal staining, lid redness, lid roughness, limbal redness, meibomian gland dysfunction, pterygium, pinguecula, cortical cataract) with severity levels that lessen and increase with real-time animation based on touch.
  • Evaluate the progression of complications by comparing severity levels in 0.1 increments side-by-side.
  • Demonstrate clinical assessment to patients.
  • Export a report for office records without collecting personal data.
  • View a comprehensive assessment guide including slit lamp illumination techniques, corneal inflammation vs. infection, signs of oxygen deficiency, staining and lid assessments and more.
The Vision Care Institute Clinical Grading Scales is a free app, compatible with the iPhone, and can be downloaded via the Apple App Store. It is not intended as, and does not constitute medical or optometric advice. It is only available in the U.S. App Store at this time.
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.
CooperVision Adds -2.25 Cylinder for Avaira Toric Lenses
After expanding its Avaira toric lens parameters with plus powers this summer, CooperVision Inc. is launching a -2.25 cylinder power to further broaden the brand's range and potential wearer base. This allows potential contact lens wearers with more significant astigmatism to wear Avaira toric lenses.

With this addition, Avaira toric lenses are available in sphere powers of -6.00D to +6.00D in 0.25 steps; -6.50D to -10.00D in 0.50 steps; cylinder powers of -0.75, -1.25, -1.75, and -2.25; and axes from 10 degrees to 180 degrees in 10 degree steps.

The Avaira brand has polyethylene glycol (PEG) bound at the lens surface and throughout the interior. This provides a distinct comfort advantage, not only at the end of each day, but during the entire wearing cycle, according to the company. The benefit is due in part to the compound's well-established ability to tightly bind water and help maintain hydration. Avaira toric lenses with Aquaform Technology also incorporate a high level of oxygen transmissibility (91 Dk/t), rounded edges that promote minimal lid interaction, and a smoother lens surface. The lenses feature optimized lens geometry, uniform horizontal ISO thickness and wide ballast design, plus a larger toric optic zone that provides astigmatic patients with stability and visual acuity. An ultraviolet radiation blocker helps protect wearers' eyes, limiting 75 percent of UVA and 99 percent of UVB rays.

For more information, please visit www.CooperVision.com/contact-lenses/avaira-toric.
EyeXam App Featured on ABC World News
EyeXam, the leading mobile eye care app with over a million free downloads to date, was featured on ABC World News with Diane Sawyer in its popular 'Real Money' series. The segment headlined a family using the EyeXam app on their smartphones and tablets. Family members downloaded it for free, took a free self-guided vision screening, found a local eye care provider and saved money on their eye care purchases.

One of the tips ABC reporter Paula Faris emphasized involved the free vision screening on the EyeXam app. The purpose of the screening is to motivate consumers to visit an eye care professional, as the family's mother did when she visited a local Vision Source office, a VSP provider, for a comprehensive eye exam. The app also makes it easier and more convenient to find an eye doctor, make an appointment, see promotions and communicate with the doctor.
The Cooper Companies Appoints McBride Chief Operating Officer
The Cooper Companies, Inc. announced the appointment of Daniel G. McBride to executive vice president, chief operating officer and general counsel, effective November 1, 2013.

Mr. McBride most recently served as vice president, general counsel and chief risk officer and has held positions of increasing responsibility within the legal organization focusing on operations, business development and long-term growth. Prior to joining Cooper in February 2005, Mr. McBride was an attorney with Latham & Watkins LLP concentrating on mergers and acquisitions and corporate finance.

Cooper operates through two business units, CooperVision and CooperSurgical.
Holden Honored with Inaugural Optometry Giving Sight Humanitarian Award
Professor Brien Holden has been awarded the inaugural Optometry Giving Sight Humanitarian Award in recognition for his outstanding contribution in support of global efforts to help eliminate avoidable blindness and impaired vision and reduce the disability, poverty and lack of opportunity associated with vision loss.

Professor Holden received the award at a dinner held in Seattle, Washington, where he also announced that he would be stepping down as Executive Chair of Optometry Giving Sight after 10 years.

Professor Holden said that while he would stay on the Board, it was now time for someone new to take on the role of Chair. He announced that the Directors have elected Dr. Juan Carlos Aragon to succeed him as Chair of Optometry Giving Sight. Dr. Aragon is currently Chair of Optometry Giving Sight's Global Development Board and Senior Vice President, Global Professional & Clinical Affairs, CooperVision.

Invasive Pterigia
By Jaime Ibanez, OD, Villavicencio, Columbia

This image depicts invasive pterigia over the nasal and temporal quadrants of the corneo-conjunctival areas. Even though the pupillary area is unaffected, the head (apex) of these benign growths are located onto the mid-periphery sector of the cornea which induced a surface irregularity and prevented the appropriate fitting of a contact lens.

We thank Dr. Ibanez for this image and we 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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Susan J. Gromacki, OD, MS, FAAO

Instructions for Scleral Lens Application

In my previous two columns, I discussed the importance of providing patients with written educational materials. This is especially important for the care and handling of scleral gas permeable (GP) lenses. Both new wearers and existing corneal GP patients benefit from verbal and written instructions on their new scleral lenses.

The explanations should be thorough enough to benefit a new wearer, but brief enough that s/he will read them. The following are the lens application instructions from my own Scleral Lens Care and Handling Guidelines.

ALWAYS WASH YOUR HANDS with a lotion-free soap before handling your lenses. This will minimize the potential for eye infection.

1. DRY YOUR HANDS AND EYELIDS with a clean, lint-free towel. It is easiest to control your eyelids with clean, dry fingers.
2. Remove your contact lens from its case and rinse with nonpreserved artificial tears or saline.
3. To support the lens, place it on a "tripod" of your thumb, index, and middle fingers (or maybe your ring finger), or on a lens insertion tool (a large suction cup with the bottom cut off or a ring-like tool).
4. Fill the lens to the top with nonpreserved artificial tears or saline. (Overfilling is fine to avoid bubbles; underfilling is not.)
5. Place your head down, parallel to the horizontal plane (typically a table or a sink with the drain closed).
6. Spread your top and bottom eyelids wide with your fingers from one hand. Don't blink, and insert the lens by placing it gently onto the center of your eye. (Fluid from the lens may spill.) Let go of the lower eyelid first, then the upper eyelid.
7. Move your head upright and gently blink. Look into a mirror to ensure uniform lubrication and no bubbles. A small blurry spot in your vision is most likely a bubble. If present, or if the lens feels uncomfortable, remove and reinsert the lens.

For more information on scleral lens application visit: http://www.sclerallens.org/scleral-contact-lens-insertion-removal-troubleshooting-and-lens-care.

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Katherine M. Mastrota, MS, OD, FAAO

Effects of Chronic Smoking

A study from Turkey published in the Cutaneous and Ocular Toxicology journal examines the effect of chronic smoking on central corneal thickness, endothelial cell and dry eye parameters. In this prospective cross-sectional case series 49 eyes of 49 chronic smokers (smoker group) and 53 eyes of 53 age-matched, healthy non-smokers (non-smoker group) were enrolled. All participants underwent measurements of tear breakup time (TBUT), central corneal thickness (CCT) measurements with contact pachymeter and Schirmer test with anesthesia. Corneal endothelial cells were evaluated by non-contact specular microscopy and photographed for analysis of cell density and hexagonality and the coefficient of variation (CV) in cell size. The study results demonstrated that the mean Schirmer score and TBUT value were significantly lower in the smoker group compared to the non-smoker group. No statistically significant difference was found in the mean CCT, mean endothelial cell density, endothelial cell size, SD of size, and CV of size between smokers and non-smokers. However, a lower percentage of endothelial hexagonal cells were observed in smokers than non-smokers. The authors' results suggest that cigarette smoking seems to affect the Schirmer score, TBUT value, and hexagonal cells of the corneal endothelium.

Sayin N, Kara N, Pekel G, Altinkaynak H. Effects of chronic smoking on central corneal thickness, endothelial cell, and dry eye parameters. Cutan Ocul Toxicol. 2013 Oct 22. [Epub ahead of print]
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Comparing the Optical Properties of Soft Contact Lenses On and Off the Eye

The purpose of the current study was to examine the on- and off-eye optical performance of two types of soft contact lenses (hydrogel and silicone hydrogel).

The monochromatic aberrations (lambda = 850 nm) of contact lenses were measured on-eye using a clinical Shack-Hartmann ocular aberrometer. In addition, the researchers used an off-eye single-pass contact lens aberrometer (lambda = 540 nm) in which the soft contact lens was placed within a wet cell. Comparison of the lower and higher order aberrations measured with these two methods required compensation for different wavelengths and knowledge of the refractive index of the contact lens materials.

The measured on-eye sphere and spherical aberration values were generally similar to those measured off-eye and those specified by the lens manufacturers for both types of soft contact lenses. However, there were notable differences, especially for high plus-powered lenses, which typically exhibited lower sphere power on the eye than expected from the lens specifications and from the off-eye measured powers, both of which were almost identical. Longitudinal spherical aberration varied with lens power in the hydrogel lenses, as expected from geometric optics theory. Longitudinal spherical aberration measurements on- and off-eye, however, deviated significantly from that expected of a thin lens with spherical surfaces due to surface asphericities. The difference between on- and off-eye optics can be modeled as a tear lens or as relative lens thickness changes caused by lens flexure.

The authors concluded that the results of the current study reveal that the major difference between the on-eye lens optics and the manufacturers' specifications is not due to lens errors but due to eye-lens interactions, which could be either lens flexure or a tear lens forming behind the soft contact lens.

Kollbaum PS, Bradley A, Thibos LN. Comparing the Optical Properties of Soft Contact Lenses On and Off the Eye. Optom Vis Sci. 2013 Jul 25. [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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