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Sunday, December 4, 2011  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

Thinking ahead a few weeks, we will all become busy with holiday festivities, family gatherings and probably a few good meals. But, I'd also ask you to keep your New Year's Resolution on your "to do" list, particularly as it relates to your practice of contact lenses. Perhaps you plan to implement new staff training procedures that relate to improving patient compliance? Perhaps you will learn to fit a new type of specialty lens? Or perhaps you will begin to market your dry eye care as a specialty element of your practice? Nothing is too small to consider as each can benefit your practice and patients.


B+L Acquires Waicon

Bausch + Lomb (B+L) has acquired 100% of the outstanding shares of Laboratorio Pförtner Cornealent SACIF, the controlling entity of Waicon. Waicon is the Argentinean market leader in contact lenses and lens care products. As a result of this combination, B+L will be the leading eye health company in Argentina. The Pförtner family will continue to operate their retail chain of optical shops under the brand name "Pförtner" and as an independent company, unrelated to B+L.

While B+L plans to combine Waicon with its Vision Care operations in Argentina, the businesses will continue to operate separately as the companies proceed through the integration process. For the time being, Carina Tarzia will continue as Argentina Country Manager for B+L and Maximo Pförtner will continue as the General Manager of the Waicon business. Tomás Pförtner, founder of Waicon and a globally recognized opinion leader in the eye health field, will serve as Special Scientific Advisor to B+L.

The terms of the agreement were not disclosed.

Essilor Contact Lens Specialists Launches Blast Off With Essilor Promotion

Essilor Contact Lens Specialists (Essilor CLS) is giving eyecare professionals nationwide the chance to win Complimentary Registration to the Global Specialty Lens Symposium taking place in Las Vegas from January 26-29, 2012. From now until December 31, 2011, every order of MVP, ContinuVu, Advantage Plus and EZ Eyes multifocal/bifocal GP contact lenses may qualify for entry into a monthly drawing to win. Four winners will be selected in all. Additionally, the first 500 Eye Care Professionals who respond to the promotion, may receive a $5 Starbucks Gift Card.

Essilor CLS will be exhibiting at the upcoming Global Specialty Lens Symposium in booth #321. The promotion is sponsored by Contamac, makers of Optimum GP material.

For further information, to place an order and have a chance to enter to win, please call 1-800-366-3933 or visit www.essilorcontacts.com.

Don't Miss the Global Specialty Lens Symposium, January 26 - 29, 2012

There is still time to plan to attend the Global Specialty Lens Symposium in January 2012 at the Paris Hotel & Casino in Las Vegas. 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 Contact Lens Spectrum and online at www.GSLSymposium.com.
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Consumers Use Unconventional Alternatives for Contact Lens Solution

Recent research reveals that consumers have occasionally used unconventional solutions when they need to clean, disinfect, and store their contact lenses. Baby oil, beer, Coke, petroleum jelly, lemonade, fruit juice, and butter are among the most unconventional and damaging alternatives to contact lens solution that contact lens wearers confessed to using in a study recently conducted in the United Kingdom. The survey of 2,000 adult contact lens wearers was conducted by Bausch + Lomb in August 2011.

Twenty percent of respondents reported using an unconventional solution/lubricant when putting lenses in their eye. In addition to the inappropriate and unusual alternatives to contact lens solution, an overwhelming proportion of people reported using saliva or tap water as a solution when putting lenses in their eyes.  

BCLA Announces 2012 Conference Theme

The British Contact Lens Association (BCLA) has chosen an Olympics inspired theme for its 36th Clinical Conference and Exhibition — Competing for Excellence.

To be held at the ICC Birmingham, May 24-27, 2012, the BCLA Clinical Conference and Exhibition will once again feature education in the field of contact lenses and the anterior eye, plus practical workshops and clinical and manufacturer presentations.

The Olympics theme will be brought in via the event's first ever session on contact lenses and sport in conjunction with the UK Sports Vision Association. Within this session, Dr. Martin Cardall of Birmingham and Midlands Eye Centre at City Hospital will present the Irving Fatt Memorial Lecture, entitled "The Effect of Exercise on the Cornea and Contact Lens Wear."

Further details about the conference and speakers are available on the new 2012 Clinical Conference section of the BCLA website, www.bcla.org.uk. A provisional program and registration will be available in January 2012.

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Recurrent Corneal Erosion Syndrome
By William Townsend, OD, FAAO

A 64-year-old female presented with complaints of foreign body sensation in her left eye that she first experienced after undergoing a facial microdermal abrasion. She had self-treated the condition with over-the-counter artificial tears for six weeks, but continued to be symptomatic. The pain was severe enough to wake her up at night. She stated that during these episodes it was difficult for her to open her eyes.

Her health history was significant for type I diabetes that was controlled by diet, Crohns' disease, and bronchitis. Her current medications included ibuprofen and multivitamins. Best-corrected visual acuities were 20/20 OU. Pupils were equal in size and reacted briskly without APD.

Initial biomicroscopic findings were unremarkable, but after lifting the patient's eyelid, we observed the lesion seen in the superior cornea of the left eye. We noted no change in its appearance after each blink. In the right eye were small irregular linear formations at the level of the epithelial basement membrane. No staining was apparent.

For more on this patient, including assessment and management, see http://www.clspectrum.com/article.aspx?article=&loc=archive\2009\november\cls_november_a02.html.

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

More on Lens Deposits and Bacterial Adhesion

In addition to examining the role of phospholipid deposition on bacterial adhesion, groups have also reported on effects of other tear film components on bacterial adhesion including cholesterol, lysozyme, lactoferrin, and albumin. In short, although cholesterol was extracted from worn PureVision or Acuvue Oasys lenses, it did not alter the total or viable adhesion of any strain of P. aeruginosa or S. aureus to the lenses. (Omali et al 2011). On the contrary, lysozyme coating on four lens types (balafilcon A, lotrafilcon B, senofilcon A, and etafilcon A) increased binding (total and viable counts) of Staphylococcus aureus but did not influence P. aeruginosa adhesion. (Subarraman 2011) Lactoferrin-coated lenses showed significantly higher total microbial counts but significantly lower viable counts of adhered P. aeruginosa strains.(Subarraman 2011)

These findings are thought provoking. As the authors conclude, lysozyme deposited on contact lenses did NOT possess antibacterial activity against certain bacterial strains, whereas lactoferrin possessed an antibacterial effect against strains of P. aeruginosa. We should rethink the conventional wisdom that all protein deposits are detrimental to contact lens surfaces. There is likely some level of a biodeposit pellicle that is beneficial for successful contact lens wear.

Babaei Omali N, Zhu H, Zhao Z, Ozkan J, Xu B, Borazjani R, Willcox MD. Optom Vis Sci. Effect of cholesterol deposition on bacterial adhesion to contact lenses.2011 Aug;88(8):950-8.
Subbaraman LN, Borazjani R, Zhu H, Zhao Z, Jones L, Willcox MD. Optom Vis Sci. Influence of protein deposition on bacterial adhesion to contactlenses.2011 Aug;88(8):959-66.

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MATERIALS & DESIGNS
Ronald K. Watanabe, OD, FAAO

New Soft Lens Options for Keratoconus

Earlier this year, this column discussed soft lens options for keratoconus, including the Kerasoft IC, a lens that was developed by UltraVision CLPL in the UK. This lens, licensed by Bausch + Lomb, is finally available in the U.S. through Art Optical. Available in Definitive silicone hydrogel (Contamac) and hydrogel materials, it has a unique design that is customizable in several ways. It comes in a wide range of sphere and cylinder powers, base curves, peripheral curves, and diameters. It also has an option for different peripheral curves in different sectors, as well as a reverse geometry periphery option.

Also being introduced is the NovaKone by Alden Optical. Available in Benz G4X material, it is also available in a wide range of sphere and toric powers, diameters, base curves, and para-central fitting curves. In addition, it has an "IT factor" (Increased Thickness) that allows the fitter to vary the center thickness depending on the amount of corneal irregularity present. Both of these new options give the practitioner additional tools to better manage keratoconus and other irregular cornea patients who may not do well with more traditional options.

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High Resolution Microscopy of the Lipid Layer of the Tear Film

Tear film evaporation is controlled by the lipid layer and is an important factor in dry eye conditions. Because the barrier to evaporation depends on the structure of the lipid layer, a high resolution microscope has been constructed to study the lipid layer in dry and in normal eyes.

The microscope incorporates the following features. First, a long working distance microscope objective is used with a high numerical aperture and resolution. Second, because such a high resolution objective has limited depth of focus, 2000 images are recorded with a video camera over a 20-sec period, with the expectation that some images will be in focus. Third, illumination is from a stroboscopic light source having a brief flash duration, to avoid blurring from movement of the lipid layer. Fourth, the image is in focus when the edge of the image is sharp - this feature is used to select images in good focus. Fifth, an aid is included to help align the cornea at normal incidence to the axis of the objective so that the whole lipid image can be in focus.

High resolution microscopy has the potential to elucidate several characteristics of the normal and abnormal lipid layer, including different objects and backgrounds, changes in the blink cycle, stability and fluidity, dewetting, gel-like properties and possible relation to lipid domains. It is expected that high resolution microscopy of the lipid layer will provide information about the mechanisms of dry eye disorders.

In this paper, illustrative results are presented, derived from over 10,000 images from 375 subjects.

King-Smith PE, Nichols JJ, Braun RJ, Nichols KK. High resolution microscopy of the lipid layer of the tear film. Ocul Surf. 2011 Oct;9(4):197-211.

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