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Sunday, December 2, 2012  
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Last question:
Do you routinely express the meibomian glands in your patients with meibomian gland dysfunction?

 1. Yes

 2. No

Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

I can't emphasize enough that it is critical not to dismiss low levels of astigmatism in your contact lens patients. Common clinical dogma is that soft spherical lenses "mask" this cylinder, but this has been shown in several studies through the years to not be the case (Harris et al, 1979; Snyder, 1989). The visual benefits of fitting these patients in toric lenses will certainly be appreciated. With so many modern toric designs and materials, there is virtually no reason not to proceed with a toric option.

Harris MG, Goldberg T, McBride D, Thromburg L. Residual astigmatism and visual acuity with hydrogel contact lenses: a comparative study. J Am Optom Assoc 1979;50:303-6.
Snyder C, Talley DK. Masking of astigmatism with selected spherical soft contact lenses. J Am Optom Assoc 1989;60:728-31.

Vistakon Introduces Acuvue Oasys 24-Pack

Vistakon Division of Johnson & Johnson Vision Care, Inc. announced the launch of Acuvue Oasys Brand Contact Lenses with Hydraclear Plus Technology 24-pack.

According to the company, new data has shown that wearers with more contact lenses on hand had a significantly better wearing experience and were more likely to recommend their eyecare practitioner to friends and family.1

Acuvue Oasys Brand is indicated for daily wear vision correction and may also be worn overnight (up to one week) as recommended by an eye care professional. This silicone hydrogel lens is made from senofilcon A and also features second generation Hydraclear Plus Technology, which builds a tear attracting polymer into the silicone hydrogel material itself as the lens is being made, not added after. This helps to provide comfort all day long — even in challenging environments that can result in contact lens dryness, per the company.

More information on Acuvue Oasys Brand Contact Lenses with Hydraclear Plus Technology 24-pack is available at www.ACUVUEProfessional.com.

1. Schnider, C, Jedraszczak, AM, "The 'Pantry Load' Effect — Can It Help Drive More Compliant Contact Lens Replacement," Presented October 24, 2012 at American Academy of Optometry Annual Meeting.

B+L Offers New Cap Features for Renu MPS

With Bausch + Lomb's most recent development of the new Renu consumer-preferred cap design, Renu now offers an overseal snap on the cap that also provides an auditory signal for added security of bottle closure to avoid an accidental unclosed cap. The new Renu cap design joins B+L's other packaging innovations including the Renu clear bottle design that easily indicates the amount of contact lens solution in the bottle and the easier-to-open tamper evident seal, providing convenience and ease of use to consumers.

The new cap is currently available for:

  • Renu fresh 12oz
  • Renu fresh 2x12oz
  • Renu sensitive 12oz
Inspirational Theme for 2013 BCLA Clinical Conference

Inspiring for the future is the theme of the 37th British Contact Lens Association (BCLA) Clinical Conference and Exhibition, to be held June 6-9, 2013 at Manchester Central, UK.

From world-class speakers on topics such as innovations in lens materials, contact lens comfort and keratoconus management, to the meeting's first-ever business session and peer discussion groups, the organization hopes to inspire all delegates — in contact lens practice, in research and in business.

An inspiration to many in the profession is the recipient of the 2013 BCLA Medal, Judith Morris (UK), who will present "Two steps forward, one step back." Dr. Mitra Tavakoli (UK) will present the Irving Fatt Memorial Lecture, "Corneal confocal microscopy: beyond corneal defects. Translational studies in diabetes and neurology."

The Clinical Conference will also welcome as keynote speakers: Dr. Florence Malet (France), "Management of keratoconus," Associate Professor Eric Papas (Australia), "Through my aching eyes: reflections on the perennial problem of contact lens discomfort," and Professor Brian Tighe (UK), "Surface properties and ocular compatibility of silicone hydrogels."

Conference registration will open in January. Visit www.bcla.org.uk for the latest details of the 2013 Clinical Conference and Exhibition and other BCLA events.

Plan Now to Attend GSLS 2013 in January

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.

OD Mobility Launches

OD Mobility, a new tech company, offers customized mobile apps and education in mobile marketing and e-business solutions. In an ever-changing industry, optometry is going mobile to strengthen connections with patients, build brand loyalty, and increase sales through purchases done using customized apps created by OD Mobility.

The OD Mobility App offers the opportunity to create a customized app, featuring your practice name and logo. The OD Mobility app offers several features to allow you to communicate with your patients. Basic Practice information includes staff, hours, pertinent phone numbers, Google maps and other necessary information. The app offers an easy Book Your Appointment option that allows the appointment request to be booked within seconds. Offer your patients a convenient way to Purchase Contact Lenses at their fingertips. Remind patients to replace their contact their lens through Contact Lens Reminder. Style Center provides an interactive experience for the patient to try the latest frames and sunglasses of the practice's choice. Use News/Social Media to keep your patients updated on practice promotions, important news, links to your social media pages and surveys.

OD Mobility also offers Eye-Connections, an educational program that provides tools for mobile marketing and social media strategies. Education is provided via monthly webinars with a focus on maximizing app downloads, an overall increase of social media presence, a stronger online reputation, and growth with optometry practices and overall sales revenues.

To learn more about the OD Mobility visit www.odmobility.com.

The Vision Council Announces Year-End CE Promotion

Now through December 31, eyecare providers can earn free CE credits through The Vision Council's online education portal, available at www.thevisioncouncil.org/ecp/CE.

With courses focusing on sales, marketing, communication and business building skills, there's something for everyone. The current online offerings consist of high-quality, product generic content designed to engage the learner and get results. Each course is one-hour long and combines industry research and data with subject matter experts on a variety of ABO and COPE approved topics. The interactive course content delivery is supported by audio, video, and print to address a variety of adult learning styles.

To take advantage of free continuing education, eyecare providers should use the promo code "VC-TVC2012" when registering online.

PBA Issues Call for Applications for 2013 Investigator Awards

Prevent Blindness America announced the call for applications for its 2013 Investigator Awards. The Prevent Blindness America Investigator Awards are research grants provided annually to public health projects that seek to put an end to unnecessary vision loss and blindness. Since its inception in 2003, the program has awarded more than $1 million to eye and vision research projects.

The deadline for application is March 27, 2013. Grants are for a one-year period, up to $30,000 and reviewed by a panel of scientists in coordination with the Association for Research in Vision and Ophthalmology (ARVO). The Awards will commence in the summer of 2013.

Applications will be accepted in the following priority areas in adult vision, children's vision, or eye injury:

  • Burden/economic aspects of eye disease/vision loss on society
  • Best practices to integrate vision screening/follow-up care to system care access
  • Vision program effectiveness/evaluation

For more information on the 2013 Investigator Awards please visit www.preventblindness.org/investigator-award-application-process.

Cornea Verticillata
By Elba Algarin Gonzalez, OD

This image shows the right eye of a patient with cornea verticillata, who is taking Amiodarone. It is characterized by whorl-like corneal deposits localized in the inferior corneal epithelium. Typically this doesn't cause any symptoms and is reversible on discontinuation of medication

We thank Dr. Algarin Gonzalez for this image 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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Susan J. Gromacki, OD, MS, FAAO

A Case of Noncompliance-Induced "Dryness"
A 62 year-old white female executive, a keratoconic patient new to me, presented with the chief complaint of dryness for the past 2-3 months. She was using Restasis bid and profusely wetting her contact lenses every chance she could. She was wearing scleral rigid lenses for which she never used daily cleaner, never digitally rubbed, only soaked in a GP conditioning/disinfecting solution (not a multipurpose GP solution) and rinsed with tap water prior to insertion. As expected, her lenses, less than a year old, were severely deposited.

With new lenses, new patient education—including the elimination of rinsing with tap water prior to insertion—and a new awareness of the link between deposited lenses and dry eye symptoms, she was off and running. What remains to be seen is if she truly needs the Restasis or not

It is important to ask each and every patient—even those who have been wearing contact lenses for decades—the details of how they clean, disinfect, and handle their lenses. It is up to us, the practitioners, to teach them the link between deposited lenses and dryness/discomfort—both upon initial dispensing and thereafter.


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Katherine M. Mastrota, MS, OD, FAAO

Impact of Dry Eye on Work Productivity
A recent Japanese study evaluated the impact of dry eye on work productivity of office workers, especially presenteeism,1 and cost of work productivity loss associated with dry eye. Presenteeism is a concept proposed by Auren in 19552 to describe productivity loss when employees come to work but are not fully productive. The study used the Work Limitations Questionnaire (WLQ-J, Japanese version) which is an established tool for the evaluation of presenteeism.3

This 396 patient study demonstrated a significant difference in work productivity between the dry eye groups and the control group. When work productivity was converted into an amount of money, the annual cost of work productivity loss associated with dry eye was estimated to be 741 United States dollars per person. Furthermore, the authors calculated that the medical cost for treatment of dry eye outweighs the loss of productivity, producing economic benefits.

1. Masakazu Y, Misuno Y, Shigevasu C. Impact of dry eye on work productivity. Clinicoecon Outcomes Res. 2012; 4: 307-312.
2. Auren U. How to build presenteeism. Petroleum Refiner. 1955;34:348-359.
3. Lerner DJ, Amick BC,III, Rogers WH, Malspeis S, Bungay K, Cynn D. The Work Limitations Questionairre. Med Care. 2001;39(1):72-85.

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Randomized Double-Masked Study of 0.05% Cyclosporine Ophthalmic Emulsion in the Treatment of MGD

The purpose of this study was to compare the efficacy of topical cyclosporine [0.05% cyclosporine A (CsA)] and preservative-free artificial tears in the treatment of meibomian gland dysfunction (MGD).

The 3-month prospective, randomized, double-masked, parallel-group controlled trial enrolled 70 patients with symptomatic MGD and unstable tear film [tear breakup time (TBUT) <8 seconds]. Patients were randomized to topical CsA (0.05%; group A) and 0.5% carboxymethylcellulose (control; group B) instilled twice daily for 3 months. Ocular Surface Disease Index (OSDI), lid margin inflammation, meibomian gland expression, conjunctival injection, corneal and interpalpebral dye staining, noninvasive tear breakup time (NIBUT) using the Tearscope Plus and invasive fluorescein tear breakup time (FBUT), and Schirmer I test were performed.

At the 3-month evaluation, mean OSDI, NIBUT and FBUT, lid margin inflammation, meibomian gland expressibility, and tarsal injection showed significant improvement from baseline in group A (P < 0.01, P < 0.01, P < 0.001, P < 0.05, and P < 0.001, respectively). In group B, only the OSDI improved significantly from baseline at 3 months (P = 0.003). TBUTs (NIBUT and FBUT) were significantly longer in group A at all visits, and the mean change of TBUTs from baseline was also significantly greater in group A at 3 months (P < 0.001).

The researchers concluded that topical CsA 0.05% twice daily may be helpful in the treatment of MGD mainly by improving tear film stability.

Prabhasawat P, Tesavibul N, Mahawong W. A randomized double-masked study of 0.05% cyclosporine ophthalmic emulsion in the treatment of meibomian gland dysfunction. Cornea 2012;31:1386-93.

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