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Sunday, December 16, 2012  
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Last question:
Do you believe that the risk of microbial keratitis is reduced with the overnight wear of silicone hydrogel materials, compared with the overnight wear of hydrogel materials?

 1. Yes

 2. No

Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

Our annual meeting, The Global Specialty Lens Symposium, is right around the corner. The meeting will be held January 24-27, 2013 at the Rio Hotel and Casino in Las Vegas (http://www.springervisionevents.com/event.aspx?eid=4). One thing I always like to remind people about regarding our meeting is that while the emphasis is on specialty lenses, as the title suggests, the meeting is much more than that. The meeting covers pretty much every aspect of contact lenses from A to Z, and its likely there is something at the meeting for every contact lens practitioner. Hope to see you there next year!

Vision Source Moody to Retire

Texas-based optometric alliance, Vision Source, announced the retirement of Tracy Moody effective December 31st. Moody has held various positions within the organization since 2000, including the most recent position of President and Chief Growth Officer. A search for Moody's replacement will occur in the coming weeks. This announcement comes at the end of the organization's most successful year in its 21-year history.

Prior to his employment at Vision Source, Moody was the Director of Professional Relations at Alcon Laboratories. He joined Vision Source as the VP of Growth and Development in 2000 and became the Sr. VP of Growth and Development before taking the role of COO then President and Chief Growth Officer. Moody will continue to have a significant ownership stake and connection to the organization.

Eleven Biotherapeutics Initiates Phase 1b Clinical Study of Dry Eye Treatment

Eleven Biotherapeutics, a biopharmaceutical company designing and engineering novel and differentiated protein-based biotherapeutics, announced that it has initiated a Phase 1b clinical trial to evaluate EBI-005, its lead ophthalmic protein product, in patients with dry eye disease. Eleven is rapidly advancing EBI-005, a rationally-designed topical protein that inhibits the IL-1 (Interleukin-1) receptor to treat ocular surface inflammatory disorders. The company believes that EBI-005 is a prime example of a protein with the potential to be a game-changing product because it is applied topically and designed to effectively address both the signs and symptoms of dry eye disease.

Eleven's clinical development program with EBI-005 builds upon previous proof-of-concept clinical studies conducted by Reza Dana, MD, Director of the Cornea and Refractive Surgery Service at Massachusetts Eye and Ear Infirmary and one of Eleven's founders, in which he validated that IL-1 blockade was generally safe and well-tolerated with significant improvements in both signs and symptoms of dry eye disease. Further support for the clinical advancement of EBI-005 comes from promising preclinical studies conducted by Eleven in which it demonstrated optimal properties for the treatment of dry eye disease, including, high potency and efficacy in a mouse model of dry eye, high thermal stability and very low systemic exposure.

The Phase 1b clinical trial study is designed as a double-blind, multi-center, randomized, placebo-controlled study to evaluate two doses of EBI-005 over a six-week period in subjects with dry eye disease. The trial is expected to enroll up to approximately 80 subjects and will be conducted in approximately nine centers throughout the United States. The primary objective of the study is to determine the safety of EBI-005 and, in addition, an assessment of biological activity of EBI-005 will be measured by the Ocular Surface Disease Index (OSDI) and corneal fluorescein staining. The Phase 1b clinical study is expected to complete in the first half of 2013. To learn more about this trial please visit http://www.clinicaltrials.gov/ct2/results?term=EBI-005+dry+eye.

Plan Now to Attend GSLS 2013 in January

Plan now to attend the Global Specialty Lens Symposium January 24-27, 2013, at the Rio All Suites Hotel and Casino, Las Vegas, Nevada. With an expert international faculty and a CE-accredited agenda, the 2013 GSLS will include a fundamentals pre-conference, insightful presentations by experts in the field, hands-on demonstrations of cutting-edge products, as well as scientific papers and posters and networking opportunities with your colleagues from over 30 different countries.

Look for more detailed information in future issues of Contact Lens Spectrum and online at www.GSLSymposium.com.

Ben-Menachem Appointed CEO of OphthaliX Inc.

OphthaliX Inc. announced that it has appointed Dr. Gil Ben-Menachem as Chief Executive Officer effective January 1, 2013. OphthaliX Inc. is an advanced clinical-stage biopharmaceutical company focused on developing therapeutic products for the treatment of ophthalmic disorders. OphthaliX's product candidate, CF101, is being developed to treat three ophthalmic indications: dry eye syndrome; glaucoma and uveitis.

Ben-Menachem joins OphthaliX from Teva Pharmaceutical Industries Ltd., a generic drug maker, where he served since 2008 as Director of Business Development at the Global Branded Products division. Prior to that, he served as Director of Business Development at Paramount Bioscience LLC, a New York based drug development, life sciences merchant bank, and biotechnology venture capital firm, where he participated in the founding of several biotechnology companies.

Ben-Menachem received his BSc in Biology, MSc in Biotechnology, and PhD in Microbiology from the Hebrew University, and his MBA from the University of Maryland. He concluded his postdoctoral training in immunology and microbiology at the NIH.

Why the push for daily disposables?

The following is in response to last week's Editor's Commentary on market penetration of daily disposables in the United States as opposed to other countries. (http://www.cltoday.com/new/issue_120912.asp)

Why is our industry so insistent on converting everyone to daily disposables and wiping out an entire retail industry of multi-purpose solution sales? Two-week and 30-day contact lens wearers are CONSUMERS who go to great stores like Walgreens, CVS, Target and Walmart and shop in their eye care aisle. The products these stores sell help contact lens wearers enjoy wearing their lenses which ultimately sends them back to their practitioner for an annual eye exam, renewal of their contact lens prescription, and an opportunity to sell them contact lenses. And that brings me to my second point, as prices rise (like dailies) more consumers will shop online for the best deal. Dailies will wipe out practitioners' sales. The only winner will be contact lens manufacturers and online retailers. Don't drink the Kool-Aid.

Thank you for the opportunity to voice a different opinion.

John O'Hara, President of The WatchDog Group, a lens care products company based in St Louis, MO.
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Katherine M. Mastrota, MS, OD, FAAO

Humidity and Tear Film
Intuition suggests that low ambient environmental humidity would challenge the hydration of the ocular surface. A recent United Kingdom study examined the effects of low relative humidity on tear film physiology. In this experiment, a controlled environment chamber was used to create two different environmental conditions, one "normal" (40% humidity) and the other "desiccating" (5% humidity). Ambient temperature was constant in both conditions (21°C). Tear evaporation, noninvasive tear break-up time, lipid layer thickness, osmolarity, ocular comfort, tear production, and ocular surface temperature were assessed in normal humidity and over a period of 60 minutes in the dry environment.

The results of this study demonstrated that there was significant, adverse affect in tear evaporation rate, noninvasive tear break-up time, lipid layer thickness, ocular comfort, and tear production after exposure to the desiccating environment. No significant differences were observed between normal and dry environmental conditions in tear osmolarity and ocular surface temperature. The conclusion of this study supports the commonly accepted notion that arid environments adversely affect the tear film. The tear film parameters observed after exposure to a desiccating environment for 1 hour were similar to those of the dry eye patient. Therefore, the authors suggest, to avoid tear film disruption and possible ocular surface damage, the environmental conditions of dry locations need to be improved or the tear film should be protected against adverse environmental conditions.

1. Abusharha AA, Pearce EI. The Effect of Low Humidity on the Human Tear Film. Cornea. 2012 Sep 27. [Epub ahead of print]

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Guest Columnist: Lindsay A. Sicks, OD, FAAO; Susan J. Gromacki, OD, MS, FAAO

Special Case Cases
Sometimes unique contact lens patients require a little more innovation with respect to prescribing contact lens cases and solution. You are probably aware that it isn't the best idea to mix soft contact lens solutions and more viscous GP lens solutions when fitting a piggyback system. An easy solution to such an issue may be simply switching the patient to a single solution that is compatible with both lens types, such has a hydrogen peroxide-based system. Just prescribe the solution and advise the use of two cases per bottle of solution — one for the pair of soft lenses and one for the pair of GPs. It will be fairly easy for the patient to tell which lenses are in the case based on the size and/or feel of the lenses. Alternatively, they may have a case marked "right" and a case marked "left" instead.

One other thing to remember when educating patients who are using the method mentioned above is that the steps for using hydrogen peroxide systems may differ between soft and GP lenses. With Clear Care (Alcon) solution, the directions state that for soft lenses you can remove the lenses, place them in the holder, and rinse with solution for 5 seconds. Then, fill the lens case with solution and add the holder, storing for at least 6 hours. With GPs, the directions include an additional rub step. The patient should remove the lenses, place them in their palm, apply 2-4 drops of solution and then rub prior to placing them back into the case. After this step, the directions are the same again — rinse for 5 seconds, fill the lens case to the line, add the holder, and store for at least 6 hours.

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Which soft contact lens power is better for piggyback fitting in keratoconus?

Researchers wanted to evaluate the impact of different soft contact lens power in the anterior corneal curvature and regularity in subjects with keratoconus.

Nineteen subjects (30 eyes) with keratoconus were included in the study. Six corneal topographies were taken with Pentacam Eye System over the naked eye and successively with soft lens (Senofilcon A) powers of -3.00, -1.50, 0.00, +1.50 and +3.00D. Corneal measurements of mean central keratometry (MCK), maximum tangential curvature (TK), maximum front elevation (MFE) and eccentricity (Ecc) at 6 and 8mm diameters as well as anterior corneal surface high order aberrations (i.e. total RMS, spherical- and coma-like and secondary astigmatism) were evaluated.

Negative- and plano-powered soft lenses flattened (p<0.05 in all cases), whereas positive-powered lenses did not induce any significant changes (p>0.05 in all cases) in MCK in comparison to the naked eye. The TK power decreased with negative lenses (p<0.05 in both cases) and increased with +3.00D lenses (p=0.03) in comparison to the naked eye. No statistically significant differences were found in MFE with any soft lens power in comparison to the naked eye (p>0.05 in all cases). Corneal eccentricity increased at 8mm diameter for all lens powers (p<0.05 in all cases). No statistically significant differences were found in HOA RMS and spherical-like aberration (both p>0.05). Statistically significant differences were found in coma-like and secondary astigmatism (both p<0.05).

The authors concluded that negative-powered soft contact lenses provide a flatter anterior surface in comparison to positive-powered lenses in subjects with keratoconus and thus they might be more suitable for piggyback contact lens fitting.

Romero-Jimenez M, Santodomingo-Rubido J, Flores-Rodriguez P, Gonzalez-Meijome JM. Which soft contact lens power is better for piggyback fitting in keratoconus? Cont Lens Anterior Eye. 2012 Oct 26. pii: S1367-0484(12)00277-9. doi: 10.1016/j.clae.2012.10.070. [Epub ahead of print]

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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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