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Sunday, November 9, 2014  
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How often do you think your full time contact lens patients “top-off” their contact lens care solution?

 Rarely (1 day/month)

 Sometimes (~5-7 days/month)

 Frequently (> 5 days/week)

29 total responses.

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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO
Each year, we see several professional organizations reminding us and the public of the potential dangers associated with the cosmetic wear of “decorative” contact lenses by patients who are not prescribed contact lenses. These organizations should be commended for their public health messaging, as I think the problems with this issue may be even greater than we think. If you have had an experience with a patient self-prescribing contact lenses that you think deserves sharing, please send us a note to

Alcon Joins Think About Your Eyes Initiative

Alcon is the latest industry partner to join Think About Your Eyes, a national public awareness campaign aimed at educating consumers on the benefits of vision health. This addition, coupled with the existing partnerships with Essilor and Luxottica, continues the impressive growth and momentum of the industry initiative presented by The Vision Council and the American Optometric Association, which speaks directly to consumers and promotes the importance of getting an annual comprehensive eye exam.

Since the national launch of the Think About Your Eyes campaign, eye exams have increased 4.5 percent, leading to an additional 5.2 million annual eye exams and the diagnosis of more than 525,000 previously undiagnosed eye diseases. The initiative employs national television, radio, print and online/digital advertising to share educational and motivational messages about eye disease, eye strain, children’s vision and how regular eye exams can positively affect overall health. The campaign is designed to encourage consumers to schedule an eye exam by visiting The site, which has received more than one million visitors, features a comprehensive locator tool where visitors can easily find local Think About Your Eyes member eyecare providers.

Eyecare providers who wish to become Think About Your Eyes members should visit or contact Jon Torrey, director of professional relations, at

CLX 2.0 Contact Lens Management System Now Available

Opti-Port has released latest version of its contact lens management system, CLX. The upgraded system, CLX 2.0, streamlines contact lens ordering and introduces a new inventory and return module, practice and doctor benchmarking reports, and national comparative pricing analysis.

The CLX System was originally designed to reduce contact lens administration time and allow eye care practices to better manage their contact lens business. The updated CLX System is said to not only simplify contact lens ordering, inventory and returns, but also to provide robust reporting on key metrics such as annual supply percentage, national retail pricing comparisons, sales by product modalities, and product usage by doctor or office location. This reporting functionality can provide practice owners and operators access to real-time data on which to continuously evaluate their contact lens businesses.

CLX 2.0 is now available to any eyecare provider interested in implementing or improving their contact lens management system. To learn more, please visit

Register Now for GSLS 2015 and Save

Join us January 22 - 25, 2015 for the Global Specialty Lens Symposium at Bally’s Hotel & Casino in Las Vegas. The GSLS is a comprehensive meeting focusing on the latest techniques and technologies for the successful management of ocular conditions using today's specialty contact lenses. The meeting includes information for vision care professionals in all disciplines, with both surgical and non-surgical options covered. Accredited for continuing education under COPE, NCLE, and JCAHPO, the meeting will offer approximately 30 credit hours.

Attended annually by more than 500 participants from 30+ countries it is the largest conference of its kind in the U.S.

Register before December 15th and save! For complete conference details and to register now, visit


B+L Launches New Consumer Campaigns

Bausch + Lomb is launching several patient-facing initiatives aimed at helping patients learn how common vision issues may be addressed by the latest advancements in contact lens and lens care technology. The educational campaigns are designed to reach patients where they seek health information, largely on digital platforms and social media platforms, including Facebook and Twitter, as well as other media outlets, including radio, e-magazines and newspapers. The campaigns include:

Alden Names Shelly VP Sales

Alden Optical has promoted Bill Shelly to Vice President Sales for the company’s North American business. Shelly will assume responsibility for sales strategy and execution in coordination with Alden Optical partners ABB Optical Group in the USA and HJS Consulting in Canada.

Mr. Shelly joined Alden Optical in 2011 and has been integral to Alden’s substantial growth since then. Prior to Alden Optical, Shelly enjoyed positions in the contact lens industry with CooperVision and Paragon Vision Sciences.

Last week’s Editorial requested reader comments on how to discourage patients from “topping off “ lens care solution. Below is one reader’s shared thought.

I have always used the analogy of food. A mental image often does the trick so I ask if the patient would top up, the following day, a half-used, warm glass of milk, without first washing the glass.

If the patient can associate a distaste for unclean food or dishes with an unclean contact lens case, it seems to do the trick. Reminding the patient that the eye, like the stomach, is an organ, and susceptible to infection from an unclean contact lens or case usually reinforces the concept.

Jane Marr
Vancouver, BC, Canada

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S. Barry Eiden, OD, FAAO

Let It Simmer a Bit…A Comparison of Scleral Lens Settling Over Time

The utilization of scleral lens designs is gaining popularity over the past number of years for the management of both medically necessary and normal ammetropic contact lens cases. These lenses physically “land” and contact the bulbar conjunctiva and will settle into this tissue over time of wear. This results in reduction of corneal vaulting from the time of initial insertion.

A study was conducted to quantify the mean total settling and mean rates of settling for three scleral lens designs: Onefit P&A (Blanchard Contact Lens, Inc), Mini Scleral Design (MSD) (Blanchard Contact Lens, Inc), and Jupiter (Visionary Optics). Measurements of central lens vault over the cornea were taken with anterior segment OCT at the geometric pupil center. Randomized repeat measures were taken for all three lens designs. After insertion, lens settling was measured at 0 minutes, 15 minutes, 30 minutes, 45 minutes, 1 hour, 2 hours, 4 hours, 6 hours, and 8 hours. Statistical analyses were performed using analysis of variance and two-stage, nonlinear regression analyses of settling over time. Results found that on average, the Onefit P&A, MSD, and Jupiter lenses settled a total of 113.7, 133.7, and 88.1 μm, respectively. Although the rates of settling were not linear, analysis of variance revealed a significant difference in the average settling rates (p < 0.05) among the groups. Nonlinear regression analyses predicted that the lenses settled to about 80% of the final estimated values for the Onefit P&A lens, 90% for MSD, and 99% for the Jupiter, after 8 hours. The authors concluded that the amount of settling varied significantly among the three lens designs. Settling rates were greatest shortly after insertion. Larger lenses were estimated to be settled by 8 hours. Based on the results of this short-term study, careful consideration to the settling patterns of individual scleral lens designs should be given.

Successful scleral lens fitting can provide patients with excellent visual, comfort and physiological outcomes. By vaulting the entire cornea and providing a “bath” of tears between the lens and the cornea we can protect the corneal surface and dramatically impact ocular surface anomalies in a positive way. Understanding the keys to successful physical fitting of these lenses which includes full corneal vaulting (especially over the limbal region) and conjunctival/scleral alignment landing is critical. Further understanding of the dynamics of scleral lens fitting behaviors, as evidenced in this study, is also imperative.

Kauffman MJ, Gilmartin CA, Bennett ES, Bassi CJ. A Comparison of the Short-Term Settling of Three Scleral Lens Designs. Optom Vis Sci. 2014 Oct 2. [Epub ahead of print].

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Katherine M. Mastrota, MS, OD, FAAO

Demodex Mites

Demodex mites are implicated in several ocular surface diseases such as blepharitis, ocular rosacea and dry eye syndrome. Demodex eyelid infestation is classically diagnosed by analyzing epilated eyelashes under the light microscope or via eyelash rotation. The ability of in vivo confocal microscopy (IVCM) to identify Demodex was evaluated and compared with the epilation method in a recent British Journal of Ophthalmology study.

Eight healthy subjects, 22 patients with dry eye syndrome without anterior blepharitis and 18 patients with anterior blepharitis were examined using lower eyelid IVCM (lash follicles and meibomian glands). Twenty-five of the 48 subjects underwent both an IVCM examination and classic epilation to compare the two methods. IVCM found 100% of the mite presence among patients with anterior blepharitis, 60% among dry eye patients without blepharitis and 12% in healthy subjects, whereas the epilation technique found 100%, 50% and 0%, respectively. Demodex brevis and Demodex larvae inside the lash follicles were better detected by IVCM. The authors conclude that IVCM is an efficient and reliable tool for the diagnosis of eyelid mite infestation.

Randon M, Liang H, El Hamdaoui M, Tahiri R, Batellier L, Denoyer A, Labbé A, Baudouin C. In vivo confocal microscopy as a novel and reliable tool for the diagnosis of Demodex eyelid infestation. Br J Ophthalmol. 2014 Sep 24.

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Topical Corticosteroids as Adjunctive Therapy for Bacterial Keratitis
Bacterial keratitis is a serious ocular infectious disease that can lead to severe visual disability. Risk factors for bacterial corneal infection include contact lens wear, ocular surface disease, corneal trauma, and previous ocular or eyelid surgery. Topical antibiotics constitute the mainstay of treatment in cases of bacterial keratitis, whereas the use of topical corticosteroids as an adjunctive therapy to antibiotics remains controversial. Topical corticosteroids are usually used to control inflammation using the smallest amount of the drug. Their use requires optimal timing, concomitant antibiotics, and careful follow-up.

The objective of the review was to assess the effectiveness and safety of corticosteroids as adjunctive therapy for bacterial keratitis. Secondary objectives included evaluation of health economic outcomes and quality of life outcomes.

The authors searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 6), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to July 2014), EMBASE (January 1980 to July 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to July 2014), the metaRegister of Controlled Trials (mRCT) (, ( and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) ( They did not use any date or language restrictions in the electronic searches for trials. The last search of the electronic databases on 14 July 2014. They also searched the Science Citation Index to identify additional studies that had cited the only trial included in the original version of this review, reference lists of included trials, earlier reviews, and the American Academy of Ophthalmology guidelines. The researchers also contacted experts to identify any unpublished and ongoing randomized trials.

The researchers included randomized controlled trials (RCTs) that had evaluated adjunctive therapy with topical corticosteroids in people with bacterial keratitis who were being treated with antibiotics.

They used the standard methodological procedures expected by The Cochrane Collaboration.

The researchers found four RCTs that met the inclusion criteria of this review. The total number of included participants was 611 (612 eyes), ranging from 30 to 500 participants per trial. One trial was included in the previous version of the review, and they identified three additional trials through the updated searches in July 2014. One of the three smaller trials was a pilot study of the largest study: the Steroids for Corneal Ulcers Trial (SCUT). All trials compared the treatment of bacterial keratitis with topical corticosteroid and without topical corticosteroid and had follow-up periods ranging from two months to one year. These trials were conducted in the USA, Canada, India, and South Africa.

All trials reported data on visual acuity ranging from three weeks to one year, and none of them found any important difference between the corticosteroid group and the control group. The pilot study of the SCUT reported that time to re-epithelialization in the steroid group was 53% slower than the placebo group after adjusting for baseline epithelial defect size (hazard ratio (HR) 0.47; 95% confidence interval (CI) 0.23 to 0.94). However, the SCUT did not find any important difference in time to re-epithelialization (HR 0.92; 95% CI 0.76 to 1.11). For adverse events, none of the three small trials found any important difference between the two treatment groups. The investigators of the largest trial reported that more patients in the control group developed intraocular pressure (IOP) elevation (risk ratio (RR) 0.20; 95% CI 0.04 to 0.90). One trial reported quality of life and concluded that there was no difference between the two groups (data not available). They did not find any reports regarding economic outcomes. Although the four trials were generally of good methodological design, all trials had considerable losses to follow-up (10% or more) in the final analyses. Further, three of the four trials were underpowered to detect treatment effect differences between groups and inconsistency in outcome measurements precluded meta-analyses for most outcomes relevant to this review.

The authors cncluded that there is inadequate evidence as to the effectiveness and safety of adjunctive topical corticosteroids compared with no topical corticosteroids in improving visual acuity, infiltrate/scar size, or adverse events among participants with bacterial keratitis. Current evidence does not support a strong effect of corticosteroid, but may be due to insufficient power to detect a treatment effect.

Herretes S, Wang X, Reyes JM. Topical corticosteroids as adjunctive therapy for bacterial keratitis. Cochrane Database Syst Rev. 2014 Oct 16;10:CD005430. [Epub ahead of print]

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