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Sunday, November 17, 2013  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO
Hopefully you have seen the recently published Contact Lens Discomfort Workshop, sponsored and organized by the Tear Film and Ocular Surface Society (http://www.iovs.org/content/54/11.toc). If not, please do have a look. It contains the most up-to-date information about contact lens discomfort (CLD), in addition to new and novel consensus based information about the condition. We will be publishing more information on the workshop findings in due course, so please stay tuned.

Nicox Launches Sjö

Nicox S.A. has launched Sjö, an advanced diagnostic panel for the early detection of Sjögren’s Syndrome, in the U.S. Nicox also announced that it has formed a partnership with the Sjögren’s Syndrome Foundation to raise awareness of the disease among eyecare professionals.

Sjögren’s Syndrome causes patients’ immune cells to attack moisture-producing glands resulting in dry eye, which is one of the early and hallmark symptoms of the disease. Many Sjögren’s patients first see their eyecare practitioner with dry eye symptoms which are often mistaken for routine dry eye. It is estimated that more than 20 million patients aged 40 years and older suffer from dry eyes in the U.S.,1 and as many as 1 in 10 dry eye patients may also have Sjögren’s Syndrome.2 Eyecare practitioners are therefore in a unique position to help identify patients with Sjögren’s Syndrome.

Sjö is a proprietary laboratory test developed by Immco Diagnostics Inc. which combines traditional markers with three novel, proprietary biomarkers, allowing earlier detection of the disease. It will be promoted to U.S. eyecare professionals by Nicox’s U.S. sales force under an exclusive North American agreement with Immco. Sjö is the second product launched by Nicox in the U.S. following the launch of AdenoPlus, a rapid point-of-care diagnostic test that aids in the differential diagnosis of acute conjunctivitis, in October 2012.

Sjö is available to eyecare practitioners in the U.S., Canada, Puerto Rico, Mexico. The simple, in-office test can be easily incorporated into dry eye screening. For more information call 855-696-4269.

1. 2010 Datamonitor report.

2. Liew M, Zhang M, Kim E, et al. Prevalence and predictors of Sjögren’s syndrome in a prospective cohort of patients with aqueous-deficient dry eye. Br J Ophthalmol. 2012;96: 1498-1503.

The Cooper Companies Completes Divestiture of Aime

The Cooper Companies, Inc. announced that it has completed the sale of Aime, its rigid gas permeable contact lens and solutions business in Japan, to Nippon Contact Lens Inc. effective October 31, 2013. The Company will recognize a fiscal fourth quarter 2013 charge to GAAP earnings per share of $0.25-$0.30. This charge will be excluded from fiscal fourth quarter 2013 non-GAAP earnings per share. Aime revenues for fiscal 2013 were $25.3 million, and post divestiture the Company expects the transaction to be neutral to earnings per share.

Don’t Miss the 2014 Global Specialty Lens Symposium – January 23 - 26
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.
BCLA Appoints New CEO

The British Contact Lens Association (BCLA) has appointed Cheryl Donnelly to Chief Executive Officer (CEO). In the newly created role of BCLA CEO, Cheryl will be responsible for the day-to-day running of the Association; she will also support the BCLA Council and staff in driving development, delivering on the Association’s investment and business plans, and increasing membership and conference delegate numbers.

A qualified contact lens optician and former President of the BCLA, Cheryl joins the Association from Bausch + Lomb where she held the position of Director, Medical Affairs, Vision Care for Europe, the Middle East and Africa (EMEA), providing the clinical lead for the region.

Cheryl joined the BCLA Council as Dispensing Section Chair in 1997, was elected BCLA President in 2000 and awarded BCLA Fellowship in 2007. With an interest in education, Cheryl was a Clinical Demonstrator at Aston University for the final year contact lens clinics, and was a part-time lecturer and course leader in Contact Lens Practice at Anglia Ruskin University, Cambridge.

AOA Outlines Six Steps Optometrists Can Take Now to Access New Patients

A robust pediatric vision essential health benefit will be integrated with health plan coverage starting in January. According to the American Optometric Association (AOA), this increased demand for children’s eye care services will require many health plans to add optometrists as participating providers starting now. Accommodating coverage expansion for ODs will occur in two major ways – through new insurance carriers entering the market and offering new health plans (products), or through existing carriers already in the market offering new health plans.

The AOA, through its Third Party Center, has suggested six steps to take advantage of coverage expansion. ODs should:

  1. Determine which of your existing health plan and vision plan contracts include an “all-products clause.” These clauses—common in health plan and vision plan contracts with providers--allow the insurance carrier or vision plan company to add new plans/products which typically include new terms and conditions not found in the original provider agreement.
  2. Be aware of new alliances between health plans and vision plans.
  3. Determine whether you are listed as a participating provider in all new plans.
  4. Pay attention to prevalent trends – the narrowing of provider networks and/or changes in plan terms or operations, including changes in your reimbursement.
  5. Seek expert help when needed.
  6. Employ the Power of the Pen (a free tutorial PowerPoint available to AOA members). Perform a detailed review of all contracts. This is critical to ensuring that the individual is making smart business decisions and provider agreements are working consistently in his or her best interests.

The AOA Third Party Center offers more details on the ideas outlined above and a variety of resources its members which may be accessed (member log-in required) at www.aoa.org/x3746.xml.

OCT Scleral Lens Inspection
David Sweeney, OD, Atlanta, GA

Scleral GP contact lenses made with toric peripheral curves (PC) have been arriving from the lab with sharp anterior edges. We are now using optical coherence tomography (OCT) to inspect lenses with toric PCs. Plastic rubber-tip forceps for soft contact lenses are used to present the anterior edge facing OCT while the inspector’s hand is steadied using the OCT chinrest bar. After lens modification, we again use OCT to verify edge contour before calling patient for delivery of new lens. Inspection and modification before patient arrival improves the initial patient experience with optimal comfort when first placed on eye and reduces in-office time.

We thank Dr. Sweeney 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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Katherine M. Mastrota, MS, OD, FAAO

DED and Work Productivity Loss in VDT Users: The Osaka Study.

From Japan we have a 672 patient study designed to estimate the impact of dry eye disease (DED) on work performance and productivity in office workers using visual display terminals (VDTs). In this cross-sectional study, Japanese young and middle-aged office workers using VDTs completed the Japanese version of the Work Limitations Questionnaire. (The Work Limitation Questionnaire was developed by Lerner et al to measure the degree to which health problems interfere with specific aspects of job performance and the productivity impact of these work limitations.1) Using the Japanese dry eye diagnostic criteria, respondents were classified into three groups: definite DED, probable DED, and non-DED. Of the 672 office workers, 553 subjects including 366 men and 187 women completed the questionnaire and underwent clinical evaluation. For total workplace productivity loss, the non-DED group demonstrated a loss of 3.56%, those with probable DED, a loss of 4.06%, and those with definite DED, a loss of 4.82%, indicating significantly worse performance and productivity. DED was associated with significantly lower on-the-job time management and mental performance/interpersonal functioning. After controlling for age, gender, VDT working hours, and diagnosis of DED, time management, physical demands, and mental/interpersonal functioning, the results showed a significant relationship to DED. Furthermore, annual DED productivity losses were estimated to be $6,160 per employee when measured by total production. Concluding, the authors suggest that this study indicates that there is a significant impact of DED on the total productivity of Japanese visual display terminal users.

1. Lerner DJ, Amick B III, Wellcome Glaxo. Boston, MA: The Health Institute, Tufts-New England Medical Center; 1998. Work Limitations Questionnaire.

2. Uchino M, Uchino Y, Dogru M, Kawashima M, Yokoi N, Komuro A, Sonomura Y, Kato H, Kinoshita S, Schaumberg DA, Tsubota K. Dry Eye Disease and Work Productivity Loss in Visual Display Users: The Osaka Study. Am J Ophthalmol. 2013 Oct 31.

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Susan J. Gromacki, OD, MS, FAAO

Biofilm Removal from CL Cases Utilizing Manufacturer and Enhanced Guidelines

At the recent 2013 American Academy of Optometry Annual Meeting in Seattle, as always, the education was first-rate. The topic of contact lens compliance and care was well-represented in lectures, papers, and posters. One interesting note was the relatively high percentage of the Scientific Program presentations sponsored by industry (13/18, or 72%). This illustrates industry’s commitment to better understanding lens care and compliance in an effort to improve products for our patients.

Of the papers not sponsored by industry, one by Lantz and Perrigin was of interest in that it studied an often overlooked component of the lens care system: the case. They found that the manufacturers’ case cleaning guidelines were not always effective in eliminating Serratia marcescens biofilm. They concluded that the variations were potentially due to differences in lens case design, guidelines, or in the disinfecting solution itself. However, “enhanced guidelines” for case care (incorporating rubbing and tissue wiping) worked well for all case/directions/solution combinations. The authors noted that the results were for Serratia biofilms only and cannot be extrapolated for other microorganisms.


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Influence of CXL for Keratoconus on Several Objective Parameters of Dry Eye

The purpose of this study was to evaluate the potential influence of corneal cross-linking (CXL) with ultraviolet-A light and riboflavin in keratoconic eyes on several objective parameters of dry eye syndrome.

This prospective single center study included 30 consecutive eyes of 16 patients that underwent CXL with riboflavin and ultraviolet-A treatment (epithelial removal, 30 minutes soaking with riboflavin, 30 minutes of illumination with 365 nm, 3 mW/cm(2), 5 cm distance). Several dry eye syndrome parameters were evaluated preoperatively and 3 and 6 months after the procedure: intra-individual comparison of fluorescein and Rose bengal staining, height of tear film meniscus, and tear film break-up time.

Pathologic staining (more than 10 point-shaped areas or diffuse staining) with fluorescein was evident before CXL in one eye, 3 months after CXL in one eye, and 6 months after CXL in one eye. Rose bengal staining 3 and 6 months postoperatively was comparable to preoperative staining. Tear film height was reduced in two eyes before CXL and in four eyes 3 months postoperatively, and was normal in all eyes after 6 months. The number of eyes with reduced tear film break-up time was not significantly changed.

The authors concluded that CXL had no significant impact on several parameters of dry eye syndrome 3 and 6 months postoperatively

Taneri S, Oehler S, Asimellis G, Kanellopoulos AJ. Influence of Corneal Cross-linking for Keratoconus on Several Objective Parameters of Dry Eye. J Refract Surg. 2013 Sep;29(9):612-6. doi: 10.3928/1081597X-20130819-02

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