CONTACT LENSES TODAY

December 10, 2006

Contact Lenses Today® is edited by Dr. Joseph T. Barr and the staff of Contact Lens Spectrum. This week CLToday® reaches more than 12,000 readers in 74 countries.

No Difference in CL Wear for Kids Vs. Teens
Vistakon released the results of a company-sponsored survey comparing contact lens wear in children and teens. The Contact Lens in Pediatrics (CLIP) Study was conducted at three sites: the Ohio State University College of Optometry, the New England College of Optometry and the University of Houston School of Optometry. One section of the study compared chair time at fitting and follow-up for two groups of first-time CL wearers, classified as children (ages 8 to 12) or teens (ages 13 to 17). Total chair time required for contact lens fitting and evaluation after four visits was estimated to be an average of 15 minutes greater for children than teens. Mean fitting time was 43.3 minutes for children and 41.1 minutes for teens, while total follow-up during exams at one week and one month averaged 27 minutes for children and 24.9 minutes for teens. The greatest difference seen was during application and removal training, which took an average of 39.6 minutes for children and 30.3 minutes for teens.
Another section of the survey examined the function and quality of life benefits of silicone hydrogel contact lenses among first-time wearers in the same age groups. Participants completed the Pediatric Refractive Error Profile (PREP) survey at baseline, and completed another PREP for contact lens wearers at one-week and one-month visits. The PREP survey compares the vision-specific quality of life between children wearing contact lenses and those who wear glasses and rates them on a scale from one to 10. Both groups reported similar PREP scores for contact lenses and glasses. The PREP overall score for contact lenses at one week was 74.7 for children and 71.8 for teens. At one month, children’s overall PREP score for contact lenses was 74.5 and teens average score was 72.1. The survey also queried parents about their children’s wearing time with similar results.

Menicon Introduces MeniCare GP Care System
Menicon America recently launched its new MeniCare GP lens care system in the U.S., replacing CLARIS products. The system consists of two solutions: the MenicCare GP Cleaning, Disinfecting and Storage (CDS) solution and the MeniCare GP Wetting and Rewetting Drop. The DCS solution must be completely rinsed from the lenses before patients use the wetting drop. Both solutions are preserved with benzyl alcohol and neither contains potentially cytotoxic preservative components such as polyquad, thimerosal, chlorhexidine, BAK or polyaminopropyl biguanide, according to the company.

California Optical Law Unconstitutional
District Judge Lawrence Karlton has ruled that California laws that forbid nationwide optical chains from offering eyewear and eye exams in the same location violate the Constitution’s commerce clause. The challenge was brought by the National Association of Optometrists and Opticians and two national retailers: LensCrafters and Eye Care Centers of America. Evidence submitted to the judge shows that more than 90% of the state’s optometrists in private practice sell glasses and that they have a 60% market share of eyewear sales.
“The challenged regulations prohibit all interstate firms from competing with in-state optometrists on the same terms,” Mr. Karlton said. The Attorney General’s office is reviewing the ruling and whether to appeal.

Attention NCLE-certified Contact Lens Fitters
The December issue of Contact Lens Spectrum states that the November 2006 Continuing Education article titled, "Comanagement of Laser Corneal Refractive Surgery," is not approved for NCLE credit. This is incorrect. The article has NCLE approval for 1 credit. Contact Lens Spectrum regrets the error.

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Global Keratoconus Congress 2007 – Room Block Deadline
The deadline for making room reservations at the group rate for the first-ever Global Keratoconus Congress is rapidly approaching. Make reservations by December 22nd in order to secure the group rate of $135 plus tax per night.
The Global Keratoconus Congress will be held January 26-28, 2007 at Bally’s in Las Vegas. Please visit http://www.gkc2007.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 and information for making your hotel reservations.

CLMA Awards Certificate of Manufacturing Excellence
Based on the results of its independent quality control evaluation of GP contact lenses produced by member laboratories, the Contact Lens Manufacturers Association (CLMA) has awarded its Certificate of Manufacturing Excellence for 2007 and 2008 to the following labs:

ABB Optical
ABBA Optical Inc.
Accu Lens Inc.
Advanced Vision Technologies
American Contact Lens Service
Art Optical Contact Lens Inc.
Blanchard Contact Lens Inc.
Con-Cise Contact Lens Co.
Con-Cise East
Corneal Design Corporation
Corneal Lens Laboratory
Custom Craft Lens Service
Diversified Ophthalmics Inc.
Firestone Optics Inc.
Westlens

International Contact Lens Lab
Lens Dynamics Inc.
Lens Mode Inc.
LENSCO (Ariz.)
Luzerne Optical Labs Ltd.
Paracon Inc.
Precision Optics Inc.
Rooney Optical Inc.
The Lifestyle GP Company L.L.C.
Tru-Form Optics Inc. (Texas)
Tru-Form Optics Inc. (N.M.)
Universal Contact Lenses of Fla.
Valley Contax
Visionary

The CLMA Certificate of Excellence signifies a high degree of manufacturing expertise needed to meet a demanding level of inspection and to produce high quality contact lenses, which meet or exceed applicable industry standards.

Survey Says!
We now have the results of our first survey on spherical lens prescribing we announced a few weeks ago in collaboration with Jeff Johnson, O.D., M.B.A., of Robert W Baird & Co. Results indicates that about 82% of respondents select silicone hydrogel lenses as their modality of choice for new contact lens patients. And, 10% select hydrogel disposable lenses, while about 6% select daily disposable lenses. You can see the complete survey results at http://www.surveymonkey.com/Report.asp?U=277212062435 and respond to our toric lens survey at http://www.surveymonkey.com/s.asp?u=147381351152.

Abstract: Trends in Fungal Keratitis
A group of researchers at the University of Florida’s Department of Ophthalmology in Gainesville recently conducted a retrospective review of records of patients diagnosed with fungal keratitis from Jan. 1999 to June 2006. They found a total of 84 patients diagnosed in this time period. Patients had an average age of 48 and 64% were male. Prior to 2004, trauma (51%) and contact lens use (40%) were the major risk factors, but after 2005, contact lens use (52%) was a more prevalent risk factor than trauma (29%). The number of non-therapeutic contact lens related fungal ulcers increased from 21% between 1999 and 2001 to 45% in 2005 and 2006. They found 84% of cultured organisms were filamentous with Fusarium being the most common (41%), followed by Candida (14%), Curvularia (12%) and Aspergillus (12%).
Visual acuity at presentation was worse than 20/200 in 56% of patients. Final visual acuity was 20/40 or better in 70% of patients treated with medication alone and 16% of patients requiring therapeutic keratoplasty. Surgical intervention in the acute phase was necessary in 23% of patients. Nearly 75% of patients treated medically had dual topical antifungal therapy. The most commonly used drugs were Natamycin 5% and amphotericin B 0.15%. The authors conclude that the incidence of contact lens-related fungal keratitis was increasing before the Fusarium outbreak and stress that good visual outcomes can be achieved by aggressive dual topical antifungal therapy.
Iver SA, Tuli SS, Wagoner RC. Fungal keratitis: emerging trends and treatment outcomes. Eye Contact Lens. 2006 Dec;32(6):267-71.

Editor's Commentary:
In late Nov. 2006, the Food and Drug Administration (FDA) issued a guidance on decorative, non-corrective contact lenses (to obtain a copy, visit www.fda.gov/cdrh/comp/guidance/1613.pdf). Although the FDA calls this guidance a less-burdensome approach and it does not bind the FDA, it makes some strong statements. In discussing the risks of contact lens wear, the FDA states risks can not be sufficiently controlled unless the wearer does the following under professional supervision: obtains advice about using contact lenses; has a valid prescription; has the lenses fitted properly and remains under appropriate professional care for contact lenses. Can manufacturers, importers, distributors, or retailers market decorative lenses over-the-counter? No, says the FDA! Are these people subject to inspection by the FDA? The FDA says Yes! How does FDA law affect imported lenses? As devices (and not cosmetics), any lenses that do not comply with prescription device rules and without pre-market authorization are considered adulterated and misbranded.

Fitting Tip: Hydrogel Alternatives
I am a big supporter of the silicone hydrogel revolution. However, in some cases I have found comfort and lens awareness are still an issue even after a prolonged trial period. For instance, I have taken the advice of one of our CL representatives and given patients a longer trial period (two weeks), as well as, mentioning possible lens awareness over the first few days of wear. I have noticed a significant number of patients returning with increased dryness and discomfort, even after two weeks.
For these patients, I typically use a hydrogel alternative, such as Proclear or Biomedics XC (CooperVision). These tend to provide more comfort and have less dryness issues. One thing to remember is that even though we have a great product with silicone hydrogels in our arsenal, patient comfort and retention are big players as well.
Troy W. Johnson, O.D.
Salem, Il.

Dr. Sudhir Bhatia, submitted the “Best Fitting Tip of the Month” for November. His tip, “Continue Educating Patients on Novelty CLs,” may be seen in the, November 19, 2006 edition of CLToday.

This month at www.siliconehydrogels.org , read part two of our BCLA summary, review the effects of silicone hydrogel lenses on corneal exhaustion syndrome, and daily wear, and explore the impact of lubricating drops on lens wearability.

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

Access a reporting form for complications you've seen that were a result of contact lenses dispensed without a valid prescription at the Association of Regulatory Boards of Optometry's (ARBO's) Web site: http://www.arbo.org/arbo.asp?dt=R&doc=Complications. Complete and send the form online or print it out and fax it to (866) 886-6164.

Send your favorite tips to tips@cltoday.com -- if your tip is selected as 'Best of the Month,' you'll receive a free golf shirt (see http://www.CLToday.com for details). Please include your full name, degree or title and city/state/country.

Visit Contact Lens Spectrum ( http://www.clspectrum.com ) for interactive clinical posters and issue archives. Visit Contact Lenses Today for our Best Fitting Tips.

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