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Ocular Surface Update
Kelly K. Nichols, OD, MPH, PhD, FAAO |
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Recent studies have shown a strikingly high prevalence of meibomian gland dysfunction in Asia, with values ranging in the literature from 60-70%. This is significantly higher than that reported in Caucasians, where MGD prevalence ranges from 4-20%. Without any data to support the reasons for this difference, one can question why this may be the case.
The Asian eye may be different structurally, thus a different etiological path to MGD may exist. Alternately, the external environment may be different in Asia. Certainly air pollution and climate may play a role; however, the prevalence is equally high in less populated areas of mainland China with arguably reduced air pollution. Lastly, and perhaps convincingly, the clinician researchers in Japan have been using similar diagnostic protocols and have been at the forefront of MGD research for some time--perhaps the best argument is that they have been looking for MDG with more detail and consistency, and thus, seeing more.
Some of the more provocative data by Arita and colleagues has shown that contact lens wearing subjects have distal meibomian gland drop out measured with infrared meibography. It is unclear what the role of the contact lens is in this scenario -- causative, or an innocent bystander. Time and future research will help unravel this mystery.
1. Jie Y, Xu L, Wu YY, Jonas JB. Prevalence of dry eye among adult Chinese in the Beijing Eye Study. Eye 2009;23:688-693.
2. Lekhanont K, Rojanaporn D, Chuck RS, Vongthongsri A. Prevalence of Dry Eye in Bangkok, Thailand. Cornea 2006;25:1162-1167.
3. Lin PY, Tsai SY, Cheng CY, Liu JH, Chou P, Hsu WM. Prevalence of dry eye among an elderly Chinese population in Taiwan: The Shihpai Eye Study. Ophthalmology 2003;110:1096-1101.
4. McCarty CA, Bansal AK, Livingston PM, Stanislavsky YL, Taylor HR. The epidemiology of dry eye in Melbourne, Australia. Ophthalmology 1998;105:1114-1119.
5. Lemp MA, Nichols KK. Blepharitis in the United States 2009: A Survey-based Perspective on Prevalence and Treatment. Ocul Surf 2009;7:S1-S14.
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Care Solution Corner
Susan J. Gromacki, OD, MS, FAAO |
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As we await new guidance recommendations from the United States Food and Drug Administration (FDA) regarding the testing of multipurpose contact lens products before they are cleared to market, it is important for both eye care practitioners and consumers to understand that the FDA has been working diligently on this process. Utilizing the input it sought from both the Ophthalmic Devices Advisory Panel meeting in June 2008 and the Microbiological Testing of Contact Lens Care Products Workshop in January 2009, here are the FDA's recommendations to contact lens consumers, as listed on its website.
- Follow recommended wearing schedule.
- Do not substitute sterile saline solutions for multi-purpose solutions.
- Rub and rinse your contact lenses as directed by your eye care professional.
- Do not "top-off" the solutions in your case. Always discard all of the leftover contact lens solution after each use. Never reuse any lens solution.
- Clean, rinse and air-dry your lens case each time lenses are removed.
- Do not expose your contact lenses to any water: tap, bottled, distilled, lake or ocean water.
- Contact your eye care professional if you experience any symptoms of eye irritation or infection.
http://www.fda.gov/MedicalDevices/
ProductsandMedicalProcedures/
HomeHealthandConsumer/
ConsumerProducts/
ContactLenses/default.htm
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Alcon and Novartis Agree to Merger Terms
Alcon, Inc. announced that its board of directors approved a merger agreement with Novartis AG, whereby Novartis will pay a total merger consideration valued at $168 per share for the Alcon shares it does not currently own. Under the terms of the deal, the merger consideration will be comprised of a combination of Novartis shares and, if necessary, a cash contingent value amount to result in a total value of $168 per share.
Upon completion of the merger, Alcon will become the second largest division within Novartis. CIBA Vision and select Novartis ophthalmic medicines will be integrated into Alcon, forming an organization with more than $8.7 billion in sales covering over 70 percent of the eye care segment.
According to the company, the new eye care division will combine Alcon's in-depth scientific knowledge of eye disease and clinical experience with the broad-based research capabilities and resources of Novartis. This will mean more new products for eye care professionals and their patients and increased opportunities for market penetration in key market segments.
The company release also noted that, after the merger, it will be able to capitalize on commercial opportunities to develop and brand contact lenses collaboratively with contact lens solutions in order to capture new patients and increase the number of patients that use contact lenses to correct their vision.
The merger will be effected under Swiss merger law. Completion is conditional, among other things, on two-thirds approval by the shareholders of both Novartis and Alcon voting at their respective meetings. The merger is expected to be completed during the first half of 2011.
| -- ADVERTISEMENT -- |
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Metro Optics Offers RevitalEyes and Other Lenses in Definitive Silicone Hydrogel Material
Metro Optics has made their RevitalEyes post refractive surgery soft lens available in the new Definitive Silicone Hydrogel.
According to the company, this unique material from Contamac makes it possible to manufacture totally custom lenses with high oxygen delivery, giving the practitioner the ability to fit all types of patients in silicone hydrogel lenses. Compared to standard hydrogel material Definitive's higher oxygen transmissibility promotes corneal health and longer patient wear time.
In addition, all of the MetroSoft line of lenses will be available in Definitive including the MetroSoft Toric, MetroFocal and MetroFocal Toric.
For more information, contact Metro Optics at 800-223-1858 or visit www.metro-optics.com.
GPLI Now on Facebook
The Gas Permeable Lens Institute (GPLI) is looking for "friends" to join their new and growing Facebook family. Please check the "like" button on their Facebook page, www.facebook.com/GPLens, and you will receive regular updates on GPLI resources and programs.
Recent addtions to the educational resources on the GPLI website include the two-part on-demand lecture series on fitting patients with keratoconus presented by Christine Sindt, OD, FAAO (www.gpli.info/gp-lecture). You can also consult the GP Lens Case Grand Rounds Troubleshooting Guide (www.gpli.info/education/book) for expert assistance on everything GP from spherical fits to multifocal fitting to contact lens corneal reshaping.
Early in 2011 look for the Optimizing Initial Comfort Module, information on how to present GPs to a patient, pearls for optimizing the initial GP experience, and lens design and fitting factors; and Click 'n Fit, an outstanding tool for those desiring more experience on viewing lens design changes and observing the effect on the fluorescein pattern. It will also include clinical pearls on how design changes impact the lens-to-cornea fitting relationship.
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
ABO-NCLE Establishes New Management and Financial Procedures
The American Board of Opticianry and the National Contact Lens Examiners (ABO/NCLE) have established new management and financial procedures and controls following the embezzlement of $1.5 million from the organizations.
Amidst concerns of inappropriate management practices, the ABO and NCLE boards launched an investigation of their office administration and management in early 2010. The investigation found suspected financial impropriety involving then ABO/NCLE Executive Director Michael Robey. Robey was immediately suspended and terminated from his position in March 2010. He pleaded guilty to four counts of embezzlement in November 2010 and is awaiting sentencing.
The investigation later found alleged financial impropriety involving ABO/NCLE Chief Financial Officer Carletta Carter-Stewart, who was terminated in August 2010. Carter-Stewart was arrested on December 9, 2010 and charged with seven counts of embezzlement.
Based on results of a complete management and financial audit, ABO/NCLE has upgraded its management procedures, implemented additional internal controls, established a lockbox for receivables, and hired a new accounting firm.
"Despite this incident, ABO and NCLE remain financially strong organizations capable of serving the certification needs of the optical community," said ABO/NCLE Executive Director Jim Gandorf. "We are implementing every measure possible to assure that no further problems of this type will be repeated."
Inspire Announces Launch of Diquas by Santen in Japan
Inspire Pharmaceuticals, Inc. announced that Diquas Ophthalmic Solution 3% (diquafosol tetrasodium) received pricing approval and was launched for sale in Japan by its partner, Santen Pharmaceutical Co., Ltd. Inspire will receive a related milestone payment of $1.25 million in the fourth quarter of 2010 and is also entitled to receive payments based upon a tiered royalty rate on net sales of Diquas in Japan.
Pursuant to an agreement between the companies, Santen may develop and commercialize diquafosol tetrasodium for the therapeutic treatment of ocular surface diseases, such as dry eye disease, in Japan and nine other Asian countries. Diquafosol tetrasodium is currently in Phase 3 clinical testing by Santen in China.
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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Please take a look at the poll results from last week relative to your impressions on the impact of daily disposable lenses in general on complications. Specifically, you overwhelmingly believe that daily disposable lenses are associated with a reduction of complications. In future issues, we will probe further on this topic as it relates to specific complications such as infection, for example.
Have wonderful holiday season and a healthy, happy and prosperous New Year!
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Last week's question:
Do you believe that daily disposable lens use is associated with a general overall reduction in complications associated with lens wear?
Yes
 89%
No
11%
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Reader Commentary
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Bubble Induced Corneal Erosion
Patients who piggy-back their contact lenses should be thoroughly instructed that when placing the soft contact lens on the cornea they should apply a bit of pressure in order to force any trapped air out from beneath the lens before placing the gas permeable on top.
Recently one of my piggy-backing patients, a forty year old who ten years ago underwent PRK for around nine diopters of myopia, called to request an emergency visit, "As usual I placed my piggy-back lenses on my left eye this morning but after two hours I began to suffer great pain."
When she later appeared her VA had dropped from 6/7.5 to 6/15 in the eye; the eye was red and teary; and her lid was swollen. In addition, centered over her ablation was a 2.5mm air bubble. While bubbles of air contain oxygen, they are also dry, so I suspected an erosion. After removal of her piggy-back system I found, in fact, a corneal erosion.
After flushing the corneal surface and reinstructing proper placement of the soft contact lens, I prescribed artificial tears for daytime wetting and an ointment for nighttime lubrication to aid in cell repair and suggested that the patient replace her soft contact lens as a bandage to prevent the rubbing of the eyelid over the edges of the erosion from interfering with healing.
Two days later, and much more comfortable, the patient's cornea was scar free and she returned to regular use of lenses.
Bezalel Schendowich, OD
Chairperson and Education Coordinator, JOS
Sha'are Zedek Medical Center, Jerusalem, Israel
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Impact of a Rub and Rinse on Solution-Induced Corneal Staining
Researchers wanted to investigate whether the inclusion of a rub and rinse step before contact lens disinfection has an impact on solution-induced corneal staining.
This was a prospective, double-masked, single investigator study. Twenty participants were recruited for two visits, where balafilcon-A lenses were worn bilaterally for 2 hours.
Each pair of lenses was prepared using two different methodologies. The "control" lens was transferred from the blister pack directly into a storage case containing polyhexamethylene biguanide-based lens care solution. The contralateral "test" lens was rubbed and simultaneously rinsed using the same polyhexamethylene biguanide-based care solution, for either 60 seconds (visit 1) or 20 seconds (visit 2). Both lenses were then soaked in the solution overnight.
After baseline corneal staining assessments, the lenses were inserted following a randomized contralateral model. After 2 hours, lenses were removed, corneal staining was regraded, and comfort scores were obtained.
Rubbed and rinsed test lenses induced significantly less corneal staining than control lenses for all participants during visit 1 (mean +/- SD: 516 +/- 843 vs. 2170 +/- 902; p < 0.001) and visit 2 (522 +/- 417 vs. 2091 +/- 965; p < 0.001). There was no significant difference between the test lenses during visits 1 and 2 (p = 0.72) or controls (p = 0.50). Comfort scores did not differ between eyes (p > 0.05).
The researchers concluded that corneal staining induced after 2 hours of lens wear with the combination of balafilcon-A and polyhexamethylene biguanide-based lens care solution can be significantly reduced by including a rub and rinse step before overnight soaking. Further work is required to establish the longevity of this effect during the monthly wearing cycle.
Peterson RC, Fonn D, Woods CA, Jones L. Impact of a rub and rinse on solution-induced corneal staining. Optom Vis Sci 2010;87:1030-6.
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