If you think about it, we have seen a transition over the last 10 years in a move back toward high water content materials, even in the silicone hydrogel category of materials. The first silicone hydrogel materials were obviously low water content, but subsequent generations of silicone hydrogels gravitated toward increased water content. There is even a new, non-silicone hydrogel, very high water content material being launched as this prints. I think the question is whether or not we will continue to see such a trend as contact lens material technologies advance.

Guy J. Sherman of Covington, LA, passed away October 30, 2012 at the age of 85.

Guy Sherman was a pioneer in the rigid contact lens solution industry. His company, Sherman Pharmaceuticals, produced Stay-Wet and De-Stat which was among the first products designed to remove the lipids and proteins from the lens surface as well as create a lens surface that was more wettable. In addition his products reduced or eliminated the "biofilm" present in most contact lens cases of the day.

Menicon America, Inc. has expanded its North American Rose K Network with the appointment of Art Optical Contact Lens, Inc. (Grand Rapids, MI) as an authorized manufacturer of its Rose K lenses.

According to the company, Rose K is the single most frequently prescribed lens design for correction of keratoconus and irregular cornea conditions in the world. Currently sold in 88 countries, the Rose K family of lenses consists of five designs, including Rose K, K2 (keratoconus), PG (post graft), IC (irregular cornea), and NC (nipple cone). The addition of Art Optical as a licensed manufacturer coincides with the upcoming introduction of the Rose K2 XL semi-scleral design that will be launched at the Global Specialty Lens Symposium in Las Vegas in January 2013.

With the addition of Art Optical, practitioners will have the option to purchase their Rose K lenses from Art Optical, Blanchard Contact Lens Inc. (Manchester, NH), Les Laboratoires Blanchard (Sherbrooke, Quebec) or from their local Rose K distributor.

For more information, please contact Menicon America.

GP Specialists has developed an advanced ortho-k lens design, the new iSee ortho-k lens. Based on the company's FDA approved Fargo ortho-k contact lens, the iSee corneal reshaping design incorporates a more aggressive treatment zone that allows practitioners to treat patients with higher degrees of myopia, thus increasing the number of likely candidates for ortho-k treatment.

The company rebranded the Fargo ortho-k lens to iSee ortho-k brand in an effort to make orthokeratology a more consumer friendly eye treatment solution.

The iSee ortho-k lenses are approved up to -3.00, while extended powers are manufactured as doctor customized designs. More information is available at www.gpspecialists.com or by calling 800-889-0379.

Unilens Vision Inc. and Bausch + Lomb (B+L) announced that Unilens has been named an authorized Boston GP Manufacturer. The partnership will provide Unilens' GP independent practitioner accounts with the convenience to choose from a wider variety of GP lens materials that best fit the practitioner's individual patient needs.

Unilens' best selling GP design technology, including the all new C-Ray Multifocal GP and C-Vue GP Multifocal, will now be available in a variety of Boston materials including Boston ES, Boston EO and Boston XO.

All Unilens, C-Ray and C-Vue GP lens options are customizable, sold exclusively to independent eye care professionals, feature advanced lens design technologies and offer exceptional deliverability.

For information on Unilens products visit www.unilens.com.

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.
--ADVERTISING

Academy 2012 Phoenix was the 91st annual meeting of the American Academy of Optometry (AAO) and the 3rd largest meeting for the Academy with 5,155 total registrants. This included 3,016 optometrists and vision scientists and 936 students and residents. Attendees engaged in high-quality learning, experienced new products and technologies in a packed Exhibit Hall, and met the optometrists and vision scientists who are not only conducting the research, but also bringing the results to their clinics and practices.

A highlight of the meeting was the President's Banquet on Saturday where 204 new Fellows were inducted into the American Academy of Optometry. Fellows of the Academy must complete a candidacy process that includes submitting written work demonstrating their skills as an optometrist and sitting for an oral exam at the Annual Meeting of the Academy. About 10% of practicing optometrists in the United States are Fellows of the AAO. Optometrists, scientists, educators, librarians, administrators and editors are eligible to become Fellows of the Academy and earn the right to use FAAO after their name.

In addition, nine individuals were awarded Diplomate status by sections of the AAO. Diplomates are Fellows of the Academy who wish to demonstrate their skill in a specific area.

For a complete list of new Fellows and Diplomates click here.

A 41 year-old Caucasian female presented with a history of Salzmann's nodular degeneration in both eyes. She had previously worn soft and gas permeable contact lenses, but did not get adequate vision with soft lenses or adequate comfort with GP lenses. The patient also reported blurry vision with glasses and dry eyes. With scleral Lenses, best corrected VA with manifest refraction was 20/20 in each eye.

My patient reported "extreme improvement" with ocular dryness and eyes being no longer sensitive to light or watery. She noticed good vision and very good comfort with the lenses.

Salzmann's nodular degeneration presents with bluish-white superficial nodules in the mid-peripheral cornea as seen in this image. The nodules are composed of clumped masses of collagen fibers anterior to Bowman's membrane. Descemet's membrane and the corneal epithelium are intact. Management of Salzmann's nodular degeneration includes topical lubricants or bandage contact lenses, superficial keratectomy or phototherapeutic keratectomy (PTK) to remove the nodules or lamellar or penetrating keratoplasty if there is significant scarring or chronic epithelial breakdown. In this case, scleral lenses were a successful treatment option.

1. Graue-Hernandez EO, Mannis MJ, Eliasieh K, et al. Salzmann nodular degeneration. Cornea. 2010 Mar;29(3):283-9.
2. Stone DU, Astley RA, Shaver RP, et al. Histopathology of Salzmann nodular corneal degeneration. Cornea. 2008 Feb;27(2):148-51.

We thank Dr. Barnett for her photo and commentary and 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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OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD, FAAO

Acupuncture and Dry Eye

The benefit of acupuncture for patients with dry eye has been explored in the past with conflicting study results. However a recent study from China suggests that acupuncture can increase tear lactoferrin levels, extend tear breakup time and promote tear secretion in patients with diagnosed dry eye versus artificial tear therapy (control group).¹

Lactoferrin, a tear film protein, through its unique combination of antimicrobial action and anti-inflammatory activities, plays an important role in the maintenance of ocular health.² Lactoferrin has been demonstrated to be reduced in Sjogren syndrome and non-Sjogren syndrome and Stevens-Johnson syndrome dry eye compared with controls.³

In this study, compared with before treatment, the lactoferrin content in the tears of patients in the treatment group increased, break-up time was prolonged and the result of the Schirmer I test showed improvement after 3 weeks of treatment. The indexes mentioned above did not change in the control group after treatment.¹

I await additional studies/information regarding the utility of acupuncture and dry eye.

1. Shi JL, Miao WH. Effects of acupuncture on lactoferrin content in tears and tear secretion in patients suffering from dry eyes: a randomized controlled trial. Zhong Xi Yi Jie He Xue Bao. 2012 Sep;10(9):1003-8. [Article in Chinese]
2. Flanagan JL, Willcox MD. Role of lactoferrin in the tear film. Biochimie. 2009 Jan;91(1):35-43. Epub 2008 Jul 31.
3. Ohashi Y, Ishida R, Kojima T, Goto E, Matsumoto Y, Watanabe K, Ishida N, Nakata K, Takeuchi T, Tsubota K. Abnormal protein profiles in tears with dry eye syndrome. Am J Ophthalmol. 2003 Aug;136(2):291-9.

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CARE SOLUTION CORNER
Susan J. Gromacki, OD, MS, FAAO

The FDA's Research Plans

Two new publications by the United States Food and Drug Administration (FDA)^1,2 describe the FDA's research plans regarding the development of test methods for contact lens care products.

Regarding multipurpose solutions, the current recommended microbial testing regimen does not utilize lenses in cases. The FDA's experiments have shown that certain solution-lens combinations lead to greater uptake by the material, leading to depletion of the disinfectant to levels no longer effective against microbes such as Staphylococcus aureus or Fusarium solani. This is especially important when considering that some patients "top off," adding new solution to what remains in the case—with the latter demonstrating little-to-no disinfection efficacy.

Prior to the 2007 Acanthamoeba keratitis outbreak, the FDA did not recommend that new solutions be tested against Acanthamoeba. Since then it has been trying to devise the best way to incorporate this important pathogen into the testing protocol. For instance, amoebas must be grown under appropriate conditions, or the efficacy of an MPS can be overestimated. As a result, the FDA has been growing Acanthamoeba bacterized and has allowed it to encyst naturally. This will be an important part in standardizing future Acanthamoeba testing.

1. Eydelman MB, Kiang T, Tarver ME, Alexander KY, Hutter JC. Preclinical Research to Aid in the Development of Test Methods for Contact Lenses and Their Care Products. Eye Contact Lens. 2012 Nov;38(6):385-7. Published ahead of print.
2. Eydelman MB, Tarver ME, Kiang T, Alexander KY, Hutter JC. The Food and Drug Administration's Role in Establishing and Maintaining Safeguards for Contact Lenses and Contact Lens Care Products. Eye Contact Lens. 2012 Nov;38(6):346-9. Published ahead of print.

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These researchers wanted to investigate the effects of eight different soft contact lenses on disinfection efficacy of a multipurpose solution (MPS) containing polyhexamethylene biguanide (PHMB) against Fusarium solani.

Six silicone hydrogel lenses (galyfilcon A, senofilcon A, comfilcon A, enfilcon A, balafilcon A, and lotrifilcon B) and two conventional hydrogel lenses (polymacon and etafilcon A) were placed in polypropylene lens cases filled with MPS containing 0.0001% PHMB and soaked for 6, 12, 24, 72, and 168 hours. After each interval, depleted MPS from lens cases were removed and assayed for activity against F. solani according to International Organization for Standardization (ISO) 14729 stand-alone procedure. A portion was aliquoted for chemical analysis.

Soaking etafilcon A, balafilcon A, and polymacon lenses for 6 hours reduced the concentration of PHMB in MPS by more than half the stated labeled concentration, with concentrations below the limit of detection for etafilcon A-depleted and balafilcon A-depleted solutions after 12 and 72 hours of soaking, respectively. Except for comfilcon A-depleted solutions, all others failed to consistently obtain one log reduction of F. solani. The solutions soaked with etafilcon A, balafilcon A, and polymacon lenses for 24 hours or more lost all or almost all fungicidal activity against F. solani.

The researchers concluded that, over time, the disinfectant uptake by some lenses can significantly reduce the PHMB concentration and the fungicidal activity of the MPS against F. solani. Current ISO methodology does not address the reduction in microbiocidal efficacy when lenses are soaked in MPS. The ISO committee should consider adding "soaking experiments" to quantify the effect that contact lens materials have on the performance of MPSs.

Clavet CR, Chaput MP, Silverman MD, et al. Impact of Contact Lens Materials on Multipurpose Contact Lens Solution Disinfection Activity Against Fusarium Solani. Eye Contact Lens. 2012 Nov;38(6):379-84.

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