There's always something to discuss in the contact lens care and solution arena. Hot topics this past year have included compliance with replacement schedules, the impact of new components in care systems, and insights into the basic etiology of "solution-induced corneal staining." One issue I've frequently noticed in various lectures and articles is discussion of compliance with the two general classes of care systems—multipurpose (MPS) and hydrogen peroxide. I've often noticed that those taking the pro-multipurpose position (or anti-hydrogen peroxide position) often claim that because hydrogen peroxide based systems require additional steps, patients using these systems are likely to be less compliant with these systems. According to our last quick poll (results of which are in this issue of Contact Lenses Today), that doesn't seem to be your belief as nearly 80% of you responded that you actually believe hydrogen peroxide users to be more compliant that MPS users. Stay tuned for more discussion on compliance in Contact Lens Spectrum and Contact Lenses Today.

TearLab Corporation announced that, based on a supervisory review of the Company's appeal, the U.S. Food and Drug Administration (FDA) has granted its petition for a waiver under CLlA (Clinical Laboratory Improvement Act) for the TearLab Osmolarity System. Upon the Company's submission of labeling acceptable to the Agency, the CLIA waiver will be issued.

The company management believes that in order for the TearLab Osmolarity System to become widely adopted, it is essential that it be accessible at the point-of-care, which the CLIA waiver allows.

The TearLab Osmolarity System uses a novel lab-on-a-chip approach that requires less than 50 nL (nanoliters) of tear fluid in order to measure tear Osmolarity. According to the company, the TearLab System can produce a sample-to-answer result in less than 30 seconds. For more information, visit www.tearlab.com.

Art Optical Contact Lens, Inc. will be conducting a series of introductory webinars to acquaint practitioners with KeraSoft IC, the completely customizable soft lens design for Keratoconus and most Irregular Cornea conditions. Presented by Craig Norman, FCLSA, Director of the Contact Lens Section, Department of Ophthalmology at the South Bend Clinic, South Bend, Indiana, and moderated by Mike Johnson, FCLSA, Director of Consultation Services, Art Optical Contact Lens, Inc., the webinars will highlight key features of the KeraSoft IC design, introduce practitioners to the proven MoRoCCo fitting technique, and define the ordering processes required to get started.

Choose from one of five webinar sessions to attend (beginning on December 14th) by registering here: http://www.artoptical.com/kerasoft-ic-webinar-registration.

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.
--ADVERTISING

Prevent Blindness America (PBA) has introduced the Prevent Blindness America "Healthy Eyes Educational Series," a free program designed to build public awareness of eye and vision basics, common adult vision disorders, eye safety precautions and proactive behaviors that give the best chance for a lifetime of healthy vision.

Participants may simply visit www.preventblindness.org/healthy-eyes-education-series on the PBA website and download modules to conduct formal presentations or informal one-on-one sessions that can be customized utilizing topics most appropriate to the audience or clients. The modules each include a Presentation Guide and corresponding PowerPoint presentation.

Healthy Eyes Educational Series module topics include: Adult Eye Disorders, Contact Lens Safety, Eye Anatomy, Low Vision, Refractive Errors, Sports Safety, Workplace Safety and more.

The program is ideal for a variety of groups. In addition, factsheets on a variety of eye health and safety topics can be downloaded free-of-charge from the PBA website for use as handouts to accompany the presentation.

The European Academy of Optometry and Optics is set to hold its next annual conference April 20-22, 2012 in Dublin, Ireland. The event will bring together key figures in optometry, optics and vision sciences from across Europe to discuss and share the latest research and best-practice.

The conference will appeal to delegates with a diverse range of clinical, research and educational interests, and offers a wide range of learning opportunities. The conference will feature keynote speeches from Professor Pablo Artal (University of Murcia, Spain) on adaptive optics with a focus on new research; and Dr. Kathryn Saunders (University of Ulster, UK) on clinical practice in relation to pediatric care.

Please visit www.eaoo.info/dublin for information.

Last week's Materials & Designs column incorrectly stated that Kerasoft IC is available in hydrogel materials in the United States. In the U.S. the lens, which is licensed by Bausch + Lomb and available from Art Optical, is only offered in Definitive silicone hydrogel (Contamac).

We apologize for the error and any confusion it may have caused.

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A 53-year-old female patient underwent bilateral myopic LASIK surgery OU and developed mild regression OD a few years later. The patient underwent an enhancement OD in which her original flap was lifted. A scalloped border of her inferior flap was noted one-day post op. Three weeks later she started to develop a 5mm band of epithelial ingrowth adjacent to the irregular flap junction. The patients uncorrected visual acuity OD was 20/70, corrected to 20/25 with a +2.50 sphere manifest refraction. Topography of her right eye showed significant irregularity.

For more on this patient, including management and discussion, see http://www.clspectrum.com/article.aspx?article=&loc=archive\2008\june\cls_june_a02.html.

We welcome photo submissions fromour 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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EPA/ DHA Supplementation and MGD

Many of you are aware of my interest in MGD, as well as the use of omega-3 supplements for dry eye / MGD, and thus, several times over the last month I have received notification of a recent presentation at the Cornea Society/EBAA Fall Educational Symposium* of 20 subjects receiving supplementation. In the study, red blood cell saturation of EPA and DHA using an omega-3 index test and meibomian gland secretions were analyzed, along with symptoms and clinical tests. The authors report that 82% of patients treated with Physician Recommended Nutriceuticals' brand Dry Eye Omega Benefits supplements showed EPA and DHA present in the meibum after eight weeks of treatment (compared to 0% at baseline) along with significant elevation of the omega-3 index. Additionally, 70% of patients became asymptomatic during that time, with 100% noting a decrease in their main complaint. Improvement in tear breakup time was statistically significant and all patients with corneal staining at baseline significantly improved. The authors claim "significantly greater bioavailability as a triglyceride form omega-3 EPA and DHA, [and] its unique formulation [allow for] its obvious potential in addressing a potential root cause of dry eye symptoms."

This finding is interesting in that clinically, there is a lot of discussion regarding appropriate dosing and formulation of recommended omega supplements. However, reports such as these, open label and without a comparator (placebo) are at risk for bias, in particular relative to subjective outcomes like symptoms. Pilot work is provocative and necessary, yet further work in this area is warranted prior to changing management paradigms.

*http://www.marketwatch.com/story/first-evidence-of-omega-3-epadha-effect-on-a-potential-root-cause-of-dry-eye-syndrome-presented-at-the-cornea-societyebaa-fall-educational-symposium-2011-11-02

The Global Contact Lens Care Summit

I had the pleasure of serving as an invited participant in the Global Contact Lens Care Summit, which took place in Seattle in November. The dedication of an entire meeting to lens care illustrates the significance of this topic today and going forward.

As I have mentioned in this column before, there has been a flurry of original research in contact lens care and compliance in these years following the contact lens-related keratitis outbreaks and solution recalls. This meeting assembled a veritable "who's who" of researchers in these topical areas, hailing from all over the globe. It was amazing for me to put faces to the names of all of these scientists whose papers have made a mark on the profession and whose future research will undoubtedly enlighten us even more.

The Summit provided a forum for objective, scientifically generated and evidence-supported research to be presented, through didactic presentations, debates and interactive panel discussions. Although the meeting was sponsored by Bausch + Lomb, its participants included representatives or consultants from almost all of the major lens and lens care companies; scientists; staff from the United States Food and Drug Administration (FDA); and clinicians (ophthalmologists, optometrists, and opticians). The atmosphere was amazingly collegial, which led to a positive learning experience for all. For example, Dr. Mark Willcox presented on the causes of contact lens and lens case contamination. He noted that microbes adhere more to silicone hydrogel lens materials than to HEMA ones. Regarding case contamination, he stated that the choice of multipurpose solution affected the Gram negative, but not the Gram positive, bugs; that silver-impregnated cases reduced contamination, while ridged cases enhance the adhesion of microorganisms as compared with smooth ones.

I look forward to sharing more information from the summit in my future columns. The outcomes of the meeting will be published via a peer-reviewed manuscript in the spring/summer of 2012 in Contact Lens and Anterior Eye (CLAE).

Contact lens wear is a common predisposing factor in microbial keratitis and is one of the two preventable risk factors for corneal infection in a working age population. Our understanding of the prevention and prophylaxis of contact lens-related corneal infection is informed by recent epidemiological studies describing the incidence of and risk factors for the disease, the effect of causative organism on disease severity, and an appreciation of individual immune profiles in susceptibility to and severity of the disease.

Although contemporary contact lenses have not reduced the overall incidence of keratitis, a reduction in morbidity may be achievable through recognition of appropriate risk factors in severe disease, including avoiding delays in presenting for appropriate treatment, and attention to storage case hygiene practice. Severe keratitis is most commonly associated with an environmental causative organism, and daily disposable lenses are associated with less severe disease. Pseudomonas aeruginosa remains the most common cause of contact lens-related corneal infection probably because of its unique virulence characteristics and ability to survive in the contact lens/storage case/ocular environment.

In two recent outbreaks of contact lens-related infections, there has been a strong association demonstrated with particular contact lens solutions. Since the recall of these specific contact lens solutions, the rate of Acanthamoeba keratitis has remained above the expected baseline, indicating unidentified risk factors that may include environmental exposures. Individual differences in susceptibility to microbial keratitis may be partly explained by differences in single-nucleotide polymorphisms in certain cytokine genes, particularly those with a proven protective role in corneal infection.

Stapleton F, Carnt N. Contact lens-related microbial keratitis: how have epidemiology and genetics helped us with pathogenesis and prophylaxis. Eye (Lond). 2011 Dec 2. doi:10.1038/eye.2011.288. [Epub ahead of print]

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