It is our tradition to select an "Event of the Year" in the January issue of Contact Lens Spectrum, which is something we consider to be the landmark issue or event that has had or will have a major impact on our field. I would like to know your nominations for our "Event of the Year." What events or issues occurred in 2011 that you consider to be critical to our field? Please send your thoughts and feedback to me at jnichols@optometry.uh.edu.

Vistakon has given its www.orderacuvue.com e-commerce site a facelift, adding additional features to enhance the ordering experience for Acuvue Brand Contact lenses, and to provide more tools for eyecare professionals to manage their patient information. Among the new features are streamlined navigation, more patient management tools, ease of entry on direct ship orders, and additional payment options.

For more information, visit www.orderacuvue.com or call 1-800-876-4596.

Dakota Sciences and Metro Optics have entered into an agreement allowing Metro Optics to manufacture and distribute the patented So2Clear Lens Technology throughout North America.

Based in Sioux Falls, South Dakota, Dakota Sciences is a leader in large diameter GP lens technology distributing the SoClear design of lenses in the U.S., Europe, and Asia. Metro Optics, of Austin, Texas, is a premier manufacturer of GP and custom soft contact lenses serving eyecare professionals across North America.

The patented So2Clear Lens is a larger diameter GP that, when coupled with advanced GP materials, delivers both comfort and excellent visual acuity, according to the companies. The result is a lens that offers optimum centration and extreme stability and delivers clear, comfortable, healthy vision.

Metro Optics will manufacture the lens exclusively in Boston XO2 material and will roll out the SoClear lens Technology in January, 2012. For more information, please contact info@metro-optics.com or call 800-223-1858.

Plan now to attend the Global Specialty Lens Symposium in January 2012. With an expert international faculty and a CE-accredited agenda, the 2012 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.
--ADVERTISING

During the month of Thanksgiving, eyecare practitioners can give someone in the developing world something to be thankful for with the click of a button. Each new "Like" of the AllAboutVision.com Facebook page will generate a $5 donation to Optometry Giving Sight, which can provide an eye exam and glasses to one person.

There are at least 670 million people worldwide who are blind or vision impaired due to uncorrected refractive error. Optometry Giving Sight supports programs that provide eye exams and glasses, establish vision centers and train local eye care professionals in communities with little or no access to eye care services.

In addition to generating a donation, eyecare practitioners will be the first to hear about eye care news and new articles when they "Like" AllAboutVision.com on Facebook.

To "Like" AllAboutVision.com on Facebook, go to www.facebook.com/allaboutvision. For information about the site and practice-building services, visit www.allaboutvision.com/ecp/.

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I know how we don't grow this market: by reducing contact lens education in our institutes, which seems to be a trend. As I am in the lucky situation of lecturing at many optometry schools in North America and in Europe, I can't help but note that education in the field of contact lenses, including soft specialty and GP lens fitting, is under pressure of the ever evolving scope of the profession into the direction of diagnostics and, in many parts of the world, also therapeutics. While this is a logical development, more time in the schools is devoted to ocular disease, while basic and surely advanced contact lens fitting is not getting the attention it deserves.

Eef van der Worp
Optometrist, PhD, FAAO, FIACLE, FBCLA, FSLS
Amsterdam, the Netherlands; Washington, DC

In my view, some percentage, and arguably a majority, of the 3.5 billion people in need of vision correction have little-to-no access to vision care. It could be a matter of financial condition, location, affordable transportation, etc. So a more accurate view of the "available" in-need population might, again arguably, be in the range of 1.25 billion.

That would place the percentage of served CL wearers at about 9.6%. Certainly, a vast opportunity still exists to grow the contact lens market. Keeping the realities of the demographic constraints of the world's population in the strategic planning mix should, however, help to make any such planning be more effective.

Cosmo Salibello, OD, FAAO
Fairview, Oregon

In almost 19 years of practice, I've heard and seen all the "game-changing" ideas or technologies that were supposed to expand the contact lens market and take us to the Promised Land — more comfortable and permeable materials and easier to use products with fancy packaging. Perhaps one day there will be a Steve Jobs-type visionary in the CL industry who revolutionizes the way consumers think about contact lenses, but I'm still waiting and my patience is wearing thin.

Perhaps we need to change. Maybe we need to ask ourselves why eyeglasses are our first choice and our typical default recommendation for new refractive error patients. Those 12 year-old myopes or 46 year-old presbyopes we see every day, what if tomorrow I decided to recommend CLs first to them? Imagine saying, "Jaime you have myopia and I recommend contact lenses." It's not groundbreaking, but it's that simple. Sure some patients will resist and give a number of reasons why CL wear is impossible for them, but I wonder, do they say the same thing to their orthodontist about braces? I doubt it.

If we want more patients wearing contact lenses, we need to change ourselves first and recommend them as the best overall solution. Maybe we need to be a little more like Tony La Russa, the manager of the World Series winning St. Louis Cardinals, in the exam room. Focus on the basics, be a leader and believe what you're doing is best to deliver results.

Jerry Nolfi, OD, MBA
Toronto, Ontario, Canada

I think we need to keep reminding everybody that growth in the number of contact lenses worn can be achieved by reducing the very high rate of patients who fail to continue wearing them. A patient who stops wearing lenses at 30 years of age might have continued buying (a lot of) lenses for another 30 or more years.

As you know, more comfortable lenses are not needed as much as more comfortable lenses at the end of the day and at the end of the year. However, my recent emphasis has been on the potential for poor compliance to contribute to reduced comfort. (McMonnies CW. Improving patient education and attitudes toward compliance with instructions for contact lens use. Cont Lens Ant Eye. 2011 Oct;34(5):241-8.)

The non-compliance that patients can cope with initially (older, reused, uncleaned lenses etc) becomes too great a burden on their tolerance as time passes. I think this should be part of the discussion.

Charles W McMonnies, Professorial Visiting Fellow,
School of Optometry and Vision Science,
University of New South Wales,
New South Wales, Australia

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Revisiting GP Lenses

The October Annual GP Issue of Contact Lens Spectrum contains several excellent articles discussing new products and trends in the GP market. As we all know, GP lens prescribing lags way behind soft lenses, comprising only about 8% of all fits. However, GP lenses have definite advantages, such as sharper optics, better correction of corneal astigmatism, and lower rates of microbial keratitis. Dr. Ed Bennett reports that GP lens prescribing is growing in specialty areas such as scleral lenses, multifocals and corneal reshaping.

Though these are areas where GP lenses do excel, they can also be a great option for "normal" eyes. To increase your rate of GP fitting, read Dr. Bennett's article, "The GP Decision-Making Process." He goes through key concepts in patient selection, material selection, and design and fitting of GP lenses to maximize your fitting success. Another article by Drs. Jedlicka, Malooley, and Reeder presents several cases illustrating the use of corneo-scleral and mini-scleral lenses on healthy, normal corneas. They show that patients can enjoy the benefits of GP lenses while enjoying excellent initial and long-term comfort. GP lenses should be considered for normal corneas whenever they are appropriate.

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

Biodeposits and Bioburden

At the recent American Academy of Optometry Meeting there was a two-hour symposium highlighting recent papers in Optometry & Vision Science surrounding the theme of Biodeposits and Bioburden. The compelling topics included an analysis of lens deposits that may either promote or deter lens induced complications. For example, perhaps a pellicle of deposits may be protective again certain inflammatory complications as is downregulates the inflammatory response. Conversely, certain deposits may enhance bacterial attachment and promote inflammatory or infectious complications.

One of the papers highlighted assessed the effect of phospholipid deposits on bacterial adhesion. Omali et al looked at worn balafilcon A and senofilcon A lenses and phospholipids were extracted. Additionally, unworn lenses soaked in phospholipids were exposed to Pseudomonas aeruginosa and Staphylococcus aureus. After 18 hour incubation, the numbers of P. aeruginosa or S. aureus that adhered to the lenses were measured. They found that phospholipids adsorb/absorb to contact lenses during wear, however, the major types of phospholipids adsorbed to lenses do not alter bacterial adhesion or growth.

The symposium highlighted other risk factors for bacterial adhesion to lenses which will be highlighted in future columns.

Omali NB, Proschogo N, Zhu H, Zhao Z, Diec J, Borazjani R, Willcox MD. Effect of Phospholipid Deposits on Adhesion of Bacteria to Contact Lenses. Optom Vis Sci. 2011 Oct 28. [Epub ahead of print]

The authors' aim was to identify, analyze, and celebrate the most highly cited articles relating to contact lenses and the leading authors, journals, institutions, and countries associated with these publications.

To capture all contact lens articles published since 1900, a search equation targeting specific contact lens-related terms in the titles of articles was derived and entered into "Web of Science." A rank order list of the 1000 most highly cited articles was assembled, each having received at least eight citations. The most prominent authors, journals, institutions, and countries were identified from this list by simple counts.

The most highly cited article relating to contact lenses (although cited exclusively in the physical sciences literature) is that of Phillip and Schmidt (J Non Cryst Solids 1984;63:288-92), reporting the application of the sol-gel process for the fabrication of rigid contact lenses. Eight of the top 10 articles ranked according to average number of citations/year relate to contact lens-associated microbial keratitis. Of the top eight authors, six have spent all, or a substantial proportion, of their academic careers in Australia and seven have worked in optometric research environments. Optometry and Vision Science is the leading journal. The top-ranked institution is The University of New South Wales, Sydney, Australia. The United States is the most prominent publishing country in the field, and Australia ranks highest when the numbers of highly cited articles are considered per head of population.

This work provides a unique snapshot of significant articles relating to contact lenses.

Efron N, Brennan N, Nichols JJ. Citation Analysis of the Contact Lens Field. Optom Vis Sci. 2011 Nov 2. [Epub ahead of print]

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