CONTACT LENSES TODAY

December 9, 2007

Contact Lenses Today® is edited by Dr. Carla Mack and the staff of Contact Lens Spectrum. This week CLToday® reaches more than 14,000 readers in 74 countries.

Independent ECPs’ Retail Soft Contact Lens Prices Stable in 2007
Just released data reveal that the average soft lens price per box charged by independent eye care practitioners was unchanged during 2007. Among the major soft contact lens categories, clear sphere and colors pricing was unchanged compared to 2006, as soft toric pricing declined one percent and multifocal pricing increased one percent.
     Pricing averages are derived from the ABB/CON-CISE Soft Lens Retail Price Monitor, a quarterly audit of ECP pricing of more than 30 leading soft contact lens brands. Included in the analysis are prices for 27 brands that were continuously monitored over the past eight quarters. Average per box retail price of independents for the 27 brands was $43.92 in 2007, compared to $43.99 in 2006, an insignificant decline of just 0.2%.
     In a separate analysis of retail pricing trends of Wal-Mart and 1-800-Contacts, ABB/CON-CISE reports that Wal-Mart’s retail pricing for 22 brands monitored during both years, was unchanged in the fourth quarter, 2007 versus the prior year, while 1-800-Contacts’ prices were up 6%. During the fourth quarter 2007, Wal-Mart’s average price per box was 23% less than that charged by independent ECPs, while 1-800-Contacts’ prices averaged 11% less than independents.
     A copy of the Fourth Quarter Soft Lens Retail Price Monitor is available in December from ABB/CON-CISE sales representatives.

Preliminary Results Show Lotemax with Restasis Effective for Relief of Dry Eye Signs and Symptoms
At the recent American Academy of Ophthalmology meeting, Eric D. Donnenfeld, M.D. and John D. Sheppard, M.D. presented the preliminary results of a prospective, multi-center, randomized controlled study of the effect of Bausch & Lomb's Lotemax (loteprednol etabonate ophthalmic suspension 0.5%) on initiation of therapy with cyclosporine (Restasis).
     Dr. Donnenfeld reported that use of loteprednol etabonate (Lotemax) with topical cyclosporine ophthalmic emulsion 0.05% (Restasis) provided more rapid relief of dry eye signs and symptoms with greater efficacy than the combination of topical cyclosporine and artificial tears. Long term treatment (60 days) with loteprednol etabonate did not affect IOP (p=0.22).
     In this analysis, 118 patients with clinically diagnosed dry eye disease were randomized to receive either loteprednol etabonate ophthalmic suspension 0.5% (test) or an artificial tear (control) in masked bottles QID for 2 weeks and then received the masked test or control drop BID plus cyclosporine BID from day 15 to day 60. Additional use of artificial tears was allowed as needed.
     At day 60, there was significant improvement in corneal (p<0.005) and conjunctival staining (p<0.05) in patients randomized to the loteprednol etabonate group. Although both treatments reduced corneal staining and lissamine green staining, Lotemax with Restasis was more effective in all cases.
     When normalized to baseline, Lotemax with Restasis significantly increased tear production by 27%, compared to 17% with artificial tears and cyclosporine over a 60-day period (p<0.005). Both treatments reduced OSDI scores over a period of 60 days (p<0.05). Lotemax with Restasis reduced OSDI scores significantly more than artificial tears and cyclosporine (p<0.001).

World Bank and Merck Announce $50 Million Funding Initiative to Eliminate River Blindness in Africa
The World Bank and Merck & Co., Inc. announced an initiative to raise $50 million to help eliminate river blindness, a leading cause of preventable blindness, in 28 African countries. Merck has pledged up to $25 million over the next eight years to help eliminate this public health problem which puts the health and livelihood of 100 million people at risk worldwide mostly in sub-Saharan Africa. The World Bank will work with Merck and other partners to raise the remaining $25 million. This funding will supplement the $20 million already raised by the Bank from international partners, for a total of $70 million to support the program through 2015.
A devastating disease spread by black flies found near river banks, river blindness (onchocerciasis) causes intense itching, disfiguring skin disease, and eye lesions that often result in permanent blindness. It has been largely eliminated in 10 of the 11 targeted West African countries under a program started by the World Bank and the World Health Organization (WHO) in 1974. This has enabled resettlement and cultivation on over 25 million hectares of fertile land, boosted farm productivity and rural incomes, and prevented 600,000 people from going blind.

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AMO Announces Election of New Board Members
Advanced Medical Optics, Inc. (AMO) announced the election of Daniel J. Heinrich and G. Mason Morfit to its board of directors, increasing the company's board to 10 members. Since 2003, Mr. Heinrich has been senior vice president and chief financial officer of The Clorox Company. He will serve on the AMO board's audit and finance committee. Mr. Morfit, who will serve on the board's science and technology committee, is a partner at San Francisco-based ValueAct Capital Partners, a private investment partnership. ValueAct Capital is AMO's largest stockholder.

Alcon Receives FDA Approval of Triesence Injectable Triamcinolone Suspension
Alcon announced that the United States Food and Drug Administration (FDA) has approved Triesence (triamcinolone acetonide injectable suspension) 40 mg/mL, a preservative-free synthetic corticosteroid for treatment of sympathetic ophthalmia, temporal arteritis, uveitis, and ocular inflammatory conditions unresponsive to topical corticosteroids and for visualization during vitrectomy.
The active ingredient in Triesence, triamcinolone acetonide, has been used for many years to treat retinal disease. This new approval brings ophthalmologists a sterile, preservative-free formulation of the compound specifically developed for use in the eye to treat various retinal inflammatory conditions.

Global Keratoconus Congress 2007
Register now for the second Global Keratoconus Congress to be held January 25-27, 2008 in Las Vegas. This meeting will be hosted at Bally's on the Las Vegas Strip. Please visit http://www.GKCongress.com. There you will find the most up-to-date educational program agenda and information on hotel accommodations, as well as the ability to register for the event.
Companies interested in exhibiting should contact Heather Seasholtz at 215-643-8073.
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Abstract: Bandage Contact Lens and Topical Indomethacin for Treating Persistent Corneal Epithelial Defects after Vitreoretinal Surgery
Persistent corneal epithelial defect is a complication of vitreoretinal surgery. The researchers assessed the efficacy of using bandage contact lenses in conjunction with topical indomethacin to facilitate wound healing and control pain safely. Patients presenting with a persistent corneal epithelial defect after vitreoretinal surgery were assigned randomly to one of two treatment groups. Patients in both groups received a therapeutic contact lens and chloramphenicol eyedrops, whereas group A received indomethacin eyedrops and group B received placebo eyedrops. This study was conducted in a single-masked randomized fashion. Patients were evaluated daily to monitor subjective symptoms and to measure the maximum and minimum dimensions of the epithelial defects.
Sixteen patients were analyzed. The subjective evaluation of photophobia, foreign-body sensation, and tearing on the day after starting treatment did not differ significantly between the two groups (P > 0.05), whereas the difference in the mean pain decrease between groups A and B at day 1 was significant (P = 0.01). The rate of epithelial healing quantified as the days needed to heal the epithelial defect did not differ between the two groups (P = 0.823).
According to the researchers, the study showed that topical indomethacin ophthalmic solution improves comfort in patients with a persistent corneal epithelial defect (after vitreoretinal surgery) treated with bandage contact lenses.
Oskouee SJ, Amuzadeh J, Rajabi MT. Bandage contact lens and topical indomethacin for treating persistent corneal epithelial defects after vitreoretinal surgery.Cornea. 2007 Dec;26(10):1178-81.

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Editor's Commentary: Two-week or One-month
Someone recently noted that I wear a lot of hats but when I write and speak I most often do so with the voice or perspective of a clinician. In the U.S., silicone hydrogels are still gaining market share, meaning that clinicians are prescribing two-week and monthly silicone hydrogels often for patients. When considering hydrogel contact lenses, the daily disposable modality still lags far behind conventional, disposable and planned replacement hydrogel market share. Whether U.S. clinicians are fitting a hydrogel or silicone hydrogel contact lens they are most often making the choice to recommend a monthly or two-week replacement lens.
I believe that most clinicians or most practices have an office or a practice culture that either embraces and recommends two-week disposables or embraces and recommends monthly disposables. Some recommend two-week disposables because they prefer the more frequent replacement schedule of a two-week over monthly replacement. Practices that recommend monthly replacement lenses may argue that the monthly modality offers a better price point for the practice and your so-called two-week replacement patients are overextending their two-week lens life anyway. Recently, a practitioner suggested that those patients who are prescribed a monthly replacement contact lens are more likely to follow your recommendation to return for annual care or will return earlier than patients who are prescribed a two-week replacement contact lenses.
Regardless of your office or practice culture, culture by nature is difficult to change. I wouldn't imagine that this commentary will sway any of you to change your prescribing nature. I do hope it makes you think and question why your practice culture and prescribing habits are the way they are. Hopefully, it is marked by sound clinical rationale and not just habit.
Carla Mack, O.D., F.A.A.O.

This month at http://www.siliconehydrogels.org explore the significance of the recent “no-rub” solution recalls, learn about atypical upper lid margin staining in dry-eyed silicone hydrogel wearers and review the latest in silicone hydrogel research.

Report adverse contact lens reactions here: http://www.accessdata.fda.gov/scripts/medwatch/ or call (800) FDA-1088.

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