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Sunday, December 5, 2010  
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Care Solution Corner
Susan J. Gromacki, OD, MS, FAAO

The second new multipurpose solution in the last five months has been launched in the United States. Abbott Medical Optics (AMO) introduced RevitaLens Ocutec Multi-Purpose Disinfecting Solution at the recent American Academy of Optometry annual meeting in San Francisco, California. Click here for Contact Lens Spectrum article.

The formulation includes a dual disinfection system of a biguanide, alexidine dihydrochloride, at a 0.00016% concentration, and a quaternary ammonium compound, polyquaternium-1 (PQ-1) at a 0.0003% concentration. Recall that PQ-1 is also a preservative in Alcon's Opti-Free Express and RepleniSH, and in B+L's new product, BioTrue. The chelant ethylenediaminetetraacetate (EDTA) contributes to the solution's antimicrobial properties, while also preventing lens deposition by binding free metal ions such as calcium and magnesium.

Tetronic 904 - a block copolymer surfactant - helps provide lubrication, and sodium borate serves as a buffer. The added benefit of borates is their ability to contribute to the antimicrobial properties of the solution. AMO has labeled the product as a rub-and-rinse regimen with a 4-hour soak for disinfection.

There are more products in the pipeline, so stay tuned to CL Today for news on the next launch.

Ocular Surface Update
Kelly K. Nichols, OD, MPH, PhD, FAAO
With the recent interest in meibomian gland dysfunction as a component of ocular surface disease, there has been renewed discussion of the normal bacterial flora on the lid margin and in the meibomian glands.

It is generally accepted that the normal flora of the lids and conjunctiva is predominantly coagulase-negative staphylococci (CNS), followed to a much more minor degree by coagulase-positive staphylococci, Corynebacterium, gram-negative bacilli, and streptococci. Most cultured CNS are susceptible to vancomycin, gentamicin. ciprofloxacin, doxycycline, and chloramphenicol. A lesser percentage is thought to be susceptible to penicillin, ceftriaxone, tetracycline, and erythromycin; thus the debate regarding the utility of erythromycin ointment for blepharitis management.

There appears to be one paper that has described the positive culture of bacteria from the meibomian glands in patients with blepharitis (Dougherty and McCulley, 1984) although the impact of scraping the swabbed lid margin following meibum expression on the culture findings is unclear. Given such, the authors reported coagulase-negative staphylococcus, propionibacterium acnes, and cornyneform bacteria were the most commonly isolated bacteria from the lid and meibomian gland secretions. While the role of bacteria in MGD is suggestive at best, topical antibacterials should be considered in the management of blepharitis if there is clinical evidence to support their use.

Dougherty JM, McCulley JP. Comparative bacteriology of chronic blepharitis. Br J Ophthalmol. 1984 Aug;68(8):524-8.

NEWS

B+L Recommends a "Rub and Rinse" Regimen

Bausch + Lomb (B+L) is providing a rub and rinse regimen in the directions for use of its multi-purpose contact lens solutions. The initiative includes the removal of the phrase "no rub" from the product labeling of its Renu Fresh multi-purpose contact lens solution globally.

B+L's product labeling transition has been under way since the beginning of 2010. Two of the company's multi-purpose contact lens solutions, Biotrue and Renu Sensitive, already include labeling directions to rub and rinse lenses as part of the care and cleaning regimen. In the U.S., the transition from "no rub" to "rub" directions for use of the Renu Fresh brand will be completed by May 2011.

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Intelliwave Lenses Now Offered in Definitive Silicone Hydrogel Material

Art Optical announced the availability of their Intelliwave custom soft lens designs in the new Definitive silicone hydrogel lens material from Contamac. Definitive is the first latheable silicone hydrogel material with high water content (74%) available in the U.S.

Intelliwave lenses are available in aspheric, aspheric toric, multifocal and multifocal toric design options in a quarterly replacement modality and are offered in virtually unlimited parameter ranges. The lenses are custom manufactured and ready for shipment in just four business days, and are backed by Art Optical's Precise Protection Plan, which provides lens exchanges and full cancellation privileges, allowing practitioners a no-risk trial opportunity.

For complete product details visit www.artoptical.com.

AzOA Announces Annual Bronstein Seminar

The Arizona Optometric Association's (AzOA) 37th Annual Bronstein Contact Lens & Cornea Seminar will be held January 14-16, 2011 at the Doubletree Paradise Valley Resort in Scottsdale, Arizona.

The program includes 19 Hours of COPE-Approved CE (approvals pending) and features presentations by Patrick J. Caroline, COT, FCLSA, Dr. Timothy B Edrington, Dr. Arthur Epstein, Dr. Brett Larson, Dr. Earl L. Smith III and Dr. Barry Weissman.

Early registration discounts are available until December 17th. For program details visit www.AZOA.org or call 602-279-0055.

Call for BCLA 2011 Papers, Posters and Photos

The British Contact Lens Association (BCLA) is now inviting submissions of papers and posters for BCLA 2011. The deadline for submitting abstracts is January 7, 2011.

Scientific abstracts will be considered on any topic related to contact lenses and/or the anterior eye, and authors can choose between "poster only" and "poster/oral presentation" at the point of submission. Clinical case studies may also be submitted in this category.

Also invited are images for the BCLA photographic competition, which takes place at the Clinical Conference. The winning entries will be published in the Association's journal, Contact Lens & Anterior Eye. The closing date for electronic entries is April 15, 2011.

Visit www.bcla.org.uk or email events@bcla.org.uk for more information on how to make your submission.

Record Attendance at American Academy of Optometry

With over 5,800 in attendance, Academy 2010 San Francisco was the highest attended annual meeting in Academy history. Vision scientists, optometrists and optometric students gathered to participate and the conference included over 600 international attendees representing 39 countries, including 129 attendees from Canada and 42 from Australia.

Karla Zadnik, OD, PhD, FAAO, acceded to the position of President for the next two years, and is joined on the Board by the following individuals: President-Elect: Bernard J. Dolan, OD, MS, FAAO; Secretary-Treasurer: Brett G. Bence, OD, FAAO; Immediate Past-President: Mark Eger, OD, FAAO and members at-large: Barbara Caffery, OD, PhD, FAAO; Michael G. Harris, OD, JD, MS, FAAO; Timothy T. McMahon, OD, FAAO and Joseph P. Shovlin, OD, FAAO.

A highlight of the meeting was the induction of 212 new Fellows, a record number. In addition, three individuals were awarded diplomate status by sections of the Academy.

Next year's annual meeting will be October 12-15, 2011 in Boston, MA. For information about the meeting, Fellowship or Diplomate programs contact the Academy at 301-984-1441, aaoptom@aaoptom.org or visit www.aaopt.org.

ABB Concise Launches "RX for the Holidays" to Support Optometry Giving Sight

ABB Concise has launched "RX for the Holidays." During December, in partnership with Paragon Vision Sciences, ABB Concise will donate a percentage of practitioner purchases of GP lenses manufactured in Paragon material to Optometry Giving Sight.

ABB Concise's GP Signature Series lenses, manufactured in Paragon material, are available in standard, bifocal/multifocal, and irregular cornea designs. ABB Concise and its practice development division, Primary Eyecare Network (PEN), also support Optometry Giving Sight through its "Say Yes Today" campaign, which asks for a monthly contribution of $15 to Optometry Giving Sight. Year- to-date contributions have exceeded $10,000.

To learn more, visit www.abbconcise.com or www.primaryeye.net.

Global Specialty Lens Symposium, January 27-30, 2011, Paris Hotel & Casino in Las Vegas

Plan now to attend the Global Specialty Lens Symposium in January 2011. With an expert international faculty and a CE-accredited agenda, the 2011 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.
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B+L Names van Zyl, Commercial Leader, Europe, Middle East and Africa

Bausch + Lomb (B+L) named Charl van Zyl as Corporate Vice President and Commercial Leader, Europe, Middle East and Africa (EMEA). Mr. van Zyl will lead the company's cross-functional, multi-market EMEA operations team. He will also have direct commercial responsibility for B+L's emerging markets in the region.

Mr. van Zyl joined B+L in 2009 as Vice President, EMEA, for the company's Pharmaceuticals business. In recent months he has taken on additional region-wide responsibilities.

Before coming to B+L, Mr. van Zyl was CEO for Jado Technologies, a German biotechnology firm. From 2004 to 2007 he held various positions at Novartis Pharma AG. Earlier in his career he held multiple positions with Eli Lilly & Co, with responsibilities spanning across Japan, the United States, Europe and Latin America.



This month at www.siliconehydrogels.org: Children and contact lenses, myopia progression, use of silicone hydrogels for patients with epidermolysis bullosa, and our synopsis of silicone hydrogels at the 2009 ARVO meeting.
Editor's Commentary
Jason J. Nichols, OD, MPH, PhD, FAAO

As noted in the Quick Poll results shown this week, it appears as though a good number of you veer from the manufacturer's recommended replacement schedule when prescribing wearing schedules for your patients. In fact, about one-third of you do it at least occasionally or frequently. I find this very interesting. Unfortunately we were not able to ask reasons for this, but I imagine that they are patient-specific in addition to financial. We very much appreciate your contributions to our Quick Polls, and as always, we welcome your suggestions and ideas in this regard for future topics and questions.

CLToday Quick Poll
Last week's question: There are times and situations that are associated with specifically prescribing contact lens replacement schedules that differ from the manufacturer's recommended replacement schedule. How often do you do this?

 Never
   18%

 Infrequently (<25% of my patients)
   51%

 Occasionally (25-50% of my patients)
   13%

 Frequently (>50% of my patients)
   18%

Abstract

How Optometrists Record Corneal Staining

The aim of this study was to determine current approaches adopted by optometrists to the recording of corneal staining following fluorescein instillation.

An anonymous "record-keeping task" was sent to all 756 practitioners who are members of the Queensland Division of Optometrists Association Australia. This task comprised a form on which appeared a color photograph depicting contact lens solution-induced corneal staining. Next to the photograph was an empty box, in which practitioners were asked to record their observations. Practitioners were also asked to indicate the level of severity of the condition at which treatment would be instigated.

Completed task forms were returned by 228 optometrists, representing a 30% response rate. Ninety-two percent of respondents offered a diagnosis. The most commonly used descriptive terms were "superficial punctate keratitis" (36% of respondents) and "punctate staining" (29%). The level of severity and location of corneal staining were noted by 69% and 68% of respondents, respectively. A numerical grade was assigned by 44% of respondents. Only 3% nominated the grading scale used. The standard deviation of assigned grades was +/- 0.6. The condition was sketched by 35% of respondents and 2% stated that they would take a photograph of the eye. Ten percent noted the eye in which the condition was being observed.

Opinions of the level of severity at which treatment for corneal staining should be instigated varied considerably between practitioners, ranging from "any sign of corneal staining" to "grade 4 staining."

The researchers concluded that although most practitioners made a sensible note of the condition and properly recorded the location of corneal staining, serious deficiencies were evident regarding other aspects of record-keeping. Ongoing programs of professional optometric education should reinforce good practice in relation to clinical record-keeping.

Efron N, Pritchard N, Brandon K et al. How optometrists record corneal staining. Clin Exp Optom 2010.


Important Links:
To report adverse contact lens reactions visit: http://www.accessdata.fda.gov/scripts/medwatch/ or call (800) FDA-1088.
To report possible grievances related to the Fairness to Contact Lens Consumers Act or associated Contact Lens Rule visit: https://www.ftccomplaintassistant.gov/.

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