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Research Review
Loretta B. Szczotka-Flynn, OD, PhD, MS, FAAO |
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Contact lens care noncompliance continues to lead the list as a factor involved in contact lens complications. Carnt et al in a preprint version of a new article in Contact Lens and Anterior Eye determined whether a risk taking personality was associated with compliance in contact lens wear. They recruited optometrists in Australia to enroll up to 10 current contact lens wearers each. Wearers completed a questionnaire assessing risk-taking propensity, noncompliant behavior and demographics. The only independent significant factor predicting noncompliance was risk taking propensity, explaining 24% of the variation in behavior.
They concluded that risk taking is a better predictor of compliance than age, gender and practitioner perception and helps explain the individual characteristics of wearers that may influence lens care and maintenance. So next time you attempt to judge your patient based on gender, age or appearance on what type of solution or lens you will prescribe to enhance compliance, consider asking them if they desire to bungee jump instead.
Congratulations to Nicole Carnt who is also this year's Ezell Fellow sponsored by the American Academy of Optometry's Section on Cornea, Contact Lenses, and Refractive Technologies.
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Materials & Designs
Ronald K. Watanabe, OD, FAAO |
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One of my keratoconus patients recently asked me about a new "Pillow Lens" that he had read about in the latest newsletter from the National Keratoconus Foundation (www.NKCF.org). The "Recess Pillow Lens System" (RPLS) is a soft lens with an angled anterior surface recess that allows it to hold a GP lens in place. Similar in concept to the Flexlens Piggyback lens, it is indicated when a patient requires a GP lens for vision but cannot tolerate the feel of the lens. It is also helpful in cases when good centration is needed but cannot be achieved with the GP alone.
The RPLS is unique in that the recess cutout is only 0.3 mm larger than the GP lens and is designed to "bury" the GP into the "soft pillow" to create a smooth anterior lens surface that minimally interacts with the eyelids. Once the GP lens is placed into the RPLS carrier, the combination moves as a single unit. It is available in custom parameters to allow it to carry virtually any GP lens, including bitorics, multifocals, and keratoconus designs. The Pillow Lens was developed by Fusion Contact Lens Inc.
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Reader Commentary
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When I receive a prescription for a pharmaceutical agent from my primary care physician and present it to a pharmacy for filling, that is the last I see of the paper prescription. Refills and other usage limits are in the hands of the pharmacist.
When I write a contact lens prescription for my patients, the paper often stays with the patient, who can then have it filled at as many contact lens supply sources as desired. I limit all my contact lens prescriptions to a one-year expiration date and also limit quantity depending on the specified discard-cycle. If the first fill source for my contact lens prescription would keep the prescription paper, noncompliance with lens replacement, which is often associated with hoarding boxes from different suppliers and increased years between exams, would be curbed.
Conversely, I would argue that until the doctors' contact lens prescriptions are kept by the agency filling the prescription, the many discussions about other factors of contact lens compliance are moot as we may have already lost the compliance battle.
In my opinion, contact lenses are medical devices with potentially nasty side-effects, not benign conveniences for those patients who do not want to wear glasses. The FDA and the eyecare profession need to start behaving as if they believe that.
Cosmo Salibello, OD, FAAO
Wood Village, OR
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Air Optix for Astigmatism Now Offered in Expanded Parameter Range
Air Optix for Astigmatism contact lenses from CIBA Vision are now available in one of the widest in-stock parameter ranges of any silicone hydrogel toric lens, resulting in increased patient coverage from 88% to 99%, among astigmatic patients with 0.75 to 2.75D cylinder.
According to the company, Air Optix for Astigmatism lenses combine Precision Balance 8|4 design with a highly breathable silicone hydrogel material, resulting in a healthy, comfortable contact lens option that provides consistent performance and crisp, clear vision. The lenses are approved for daily wear, and up to six nights of extended wear, and are recommended for monthly replacement.
Air Optix for Astigmatism lenses are made of lotrafilcon B with a Dk/t of 108 @ -3.00D, -1.25D x 180. They are available from +6.00 to -6.00 in 0.25D steps, with cylinder powers of -0.75, -1.25, -1.75 and -2.25, and from -6.50 to -10.00 in 0.50 steps in -0.75, -1.25, -1.75 and -2.25 cylinder powers. They are available in axes around-the-clock in 10° steps, have a diameter of 14.5 mm and a base curve of 8.7 mm.
For more information, visit www.cibavision.com.
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ABO Releases Exam Content Overview
The American Board of Optometry (ABO) has completed the development of the Board Certification Examination Test Specifications/Content Outline for the inaugural examination. The examination window is scheduled for June 1-18, 2011, at over 400 Prometric Test Centers in the United States and throughout the world.
The examination content overview is available on the American Board of Optometry Web site at www.abopt.org under News and Events. The test specifications for the ABO Board Certification examination are based on the results of the Job/Profession Analysis Survey that was sent to the profession earlier this year.
Active Candidates who have had their post-graduate educational requirements verified by May 16, 2011 will be able to reserve a slot for the inaugural examination in June. The exam will take approximately 6 hours (a morning and an afternoon session) and contain
240 test items. Optometrists may apply to become Active Candidates for ABO Board Certification on the American Board of Optometry Web site at www.abopt.org.
Newman Appointed Chief Technical Officer for Menicon
Menicon Company Ltd. announced the appointment of Steven Newman as Chief Technical Officer for Menicon Company Ltd.
Newman joined Menicon Company with the acquisition of the ClearLab Flat Pack technology in June 2007. Since that time, he and his team have been developing the first production lines for the introduction of Menicon One Day Flat Pack early next year. In addition to the Flat Pack Project, in his new capacity Newman will direct Product Planning, Brand Strategy, Packaging Strategy and Manufacturing Strategy on a global basis.
X-Cel Adds Definitive Silicone Hydrogel Material to Flexlens Line
X-Cel Contacts announced the addition of Definitive silicone hydrogel lens material from Contamac to the Flexlens specialty lens designs portfolio. All Flexlens specialty lens designs are now available in the Definitive material, including Flexlens Keratoconus.
Definitive, which has been available globally for nearly two years, has sold over 500,000 units prior to receipt of the recent FDA clearance. According to the company, Definitive materials require no surface treatment for this optimally comfortable, custom-manufactured silicone hydrogel polymer.
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.
--ADVERTISING
Lens Alert Timer Featured in Parenting
The Lens Alert timer, which can be set to count down the time to replace both contact lenses and the lens case, was featured in the December issue of Parenting magazine. The Lens Alert system is availble directly from the company, eyecare professionals and a variety of retailers.
For more information, please visit www.lensalert.com.
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.
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Editor's Commentary
Jason J. Nichols, OD, MPH, PhD, FAAO
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I was recently in a discussion with a good colleague about daily disposables and their impact on physiological complications. Although many believe that contact lens complications are generally reduced with daily disposable contact lenses, he cited an article by Dart and colleagues (2008, Ophthalmology) which showed an increase in the risk of microbial keratitis with patients using certain brands of daily disposables. Fortunately, they tended to be less severe cases of microbial keratitis.
As discussed in the article, there could be a variety of peripheral factors involved in interpreting this finding (e.g., practitioners tend to fit daily disposables in patients who may have additional problems with other lens types). We'd like to get your thoughts on this issue. Please respond to our Quick Poll so that we may better assess your thoughts on the topic.
Reference: Dart JK, Radford CF, Minassian D, Verma S, Stapleton F. Risk factors for microbial keratitis with contemporary contact lenses: a case-control study. Ophthalmology 2008 Oct;115:1647-54.
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CLToday Quick Poll
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If you are having problems voting, your email settings may be blocking you. Click here to vote through your browser.
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Survey of Contact Lens Complications in Singapore
The objectives of this study were to describe the type of complications related to contact lens wear seen in a hospital setting in Singapore.
Data were collated over a two-year period from April 1999 to March 2001, from all public hospitals in Singapore. A standardized clinical record form was completed by the attending doctor when a patient presented for contact lens-related complications.
Nine hundred and fifty-three contact lens-related complications were recorded. The mean age of presentation was 26.4 years. Women made up the majority n=491 (68%). Most patients were Chinese (555, 77%). Six hundred and seventy-six (93.7%) patients were soft contact lens wearers. Most patients, 585 patients (85.2%) wore their lenses on a daily basis.
Two hundred and forty-four cases (25.6%) of infective keratitis were seen, with 55 patients requiring hospital admission for management of the infection. Soft disposable contact lens wear was associated with the majority of the infective keratitis (178, 73%). Epithelial keratitis occurred in 229 patients (24.0%) with punctuate epithelial erosions being the most common presentation in 139 (14.6%). Allergic conjunctivitis occurred in 179 (18.8%) of the cases with giant papillary conjunctivitis accounting for 147 (15.4%) of them. Dry eyes (77, 8.1%), sterile infiltrates (71, 7.5%) and neovascularization of the cornea (75, 7.9%) were the next most common complications seen. Corneal edema, solution- and lens-related complications occurred in small numbers, accounting for less than 5% of the complications reported.
The researchers concluded that infective keratitis secondary to soft lens wear was the most common complication, followed by epithelial keratitis and allergic conjunctivitis seen in public hospitals in Singapore.
Teo L, Lim L, Tan DT, Chan TK, Jap A, Ming LH. A Survey of Contact Lens Complications in Singapore. Eye Contact Lens. 2010 Dec 3.
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