CONTACT LENSES TODAY
December 26, 2004
Contact Lenses Today® is edited by Dr. Joseph T. Barr and the staff of Contact Lens Spectrum. This week, CLToday® reaches more than 10,000 readers in 74 countries.
FDA Approves Macugen to Treat AMD
The FDA has approved Macugen (pegatanib sodium injection) for the treatment of wet age-related macular degeneration (AMD), making the drug the first in a new class known as VEGF inhibitors to be approved for use in wet AMD. Eyetech Pharmaceuticals, Inc., which is commercializing and further developing Macugen with Pfizer, Inc. for the treatment of neovascular AMD, announced last week that the list price will be $995 for each injection.
AAO Welcomes New Fellows, Diplomates and Board Members
The American Academy of Optometry (AAO) announced the results of its Board of Directors election at its recent Business Meeting. The following Officers and Board of Director members will serve two-year terms (from January 1, 2005 to December 31, 2006):
- President: Joe Yager, Orlando
- President-Elect: Richard E. Weisbarth, Duluth, Ga.
- Secretary-Treasurer: Mark W. Eger, Coraopolis, Pa.
- Immediate Past President: Thomas L. Lewis, Elkins Park, Pa.
- Board Members: Brett G. Bence, Seattle; Bernard J. Dolan, San Francisco; Thomas F. Freddo, Boston; and Karla Zadnik, Columbus, Ohio.
The AAO also recognized the newest Diplomates to its Section on Cornea & Contact Lenses; and Binocular Vision, Perception, and Pediatric Optometry; Low Vision, Primary Care, Public Health and Environmental Optometry Sections. Also at the 2004 meeting, the Academy reported that the number of its Fellows increased by 144 to 3,039.
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CooperVision Announces Second MINI Cooper Winner
Brian Galeucia, an optician and practice manager at Hopkinton Eye Associates in Mass. is the second person (of two) to receive a 2004 MINI Cooper as part of CooperVision's nationwide promotion to help raise awareness for the company's newly named Vertex Toric line of contact lenses.
Abstract:
Contact Lenses and Corneal Ulcers
Researchers retrospectively reviewed the charts of 376 patients (seen at the Corneal Service of the Wills Eye Hospital from July 1, 1999 to December 31, 2002) who had corneal ulcers to analyze the frequency of contact lens-related corneal ulcers and its relationship to the type of contact lens and care. The researchers identified all patients who had contact-lens related ulcers and then obtained information regarding cultures, lens type, usage and cleaning. Of the 376 cases, 113 (30%) were related to contact lens use. The contact lens history was recorded in 83 of the 113 cases and the researchers noted that soft daily wear frequent replacement lenses were the most common lens type associated with corneal ulcers (n=36/83, 43%). They took corneal cultures in 71 of 113 cases (63%) and they were positive in 51 of 71 cases (72%). The most common microorganism involved was Pseudomonas aeruginosa (n=17/51, 33%). They concluded that a significant increase in the number of contact lens-related corneal ulcers was evident between 1999 and 2002 (n=113/376, 30%) compared with previous years (n=37/299, 12% for 1996-1999).
Mah-Sadorra JH, Yavuz SG, Najjar DM, Laibson PR, Rapuano CJ, Cohen EJ. Trends in Contact Lens-Related Corneal Ulcers. Cornea 2005 Jan;24(1):51-58.
Editor's Commentary:
Explain Yourself
Regarding our tip this week: No matter what you recommend regarding lens prescription and lens care, there's no substitute for communicating with your patients why you prescribe what you prescribe, how to use it properly and the benefits of good compliance with your treatment plan.
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Fitting Tip:
Combatting Poor Patient Compliance
As we all know, there's no simple answer to poor patient compliance, but I think Dr. Anderson's method (CLToday "Fitting Tip," November 28, 2004) will likely not work for everyone.
Consider why patients might "prescribe" their own monthly replacement schedule. A common scenario might see the patient originally fitted with a two-week replacement lens, as prescribed by his optometrist and confirmed by his dispensing optician. The patient likely starts out following the schedule, then may consciously or accidentally try them for a third week. If all goes well, he may stretch it to four weeks before he perceives discomfort. IF you ask him about replacement when he returns for his next exam, he may not confess to his actual replacement schedule, as he knows the "right answers" you've told him and would prefer not to be reprimanded. What to do at this point is the question.
Unfortunately, I don't have any magic answers either. I will step through the cleaning regimen with virtually every single contact lens patient I see, primarily to explain the trick behind no-rub solutions (a five-second power wash makes for good marketing on behalf of the solutions manufacturers, but rubbing is still to your advantage). As I finish my cleaning review, I ask how often the patient replaces his lenses. Often I'll get an answer indicating the patient replaces the lens when it becomes bothersome. I'll explain that contact lens wear desensitizes the nerves on the eye and while that's a good thing in that it keeps the lens comfortable, it can be bad if the patient wears the lens until it becomes uncomfortable because that means the eye is being damaged. With that said, I'll describe how often I believe that individual should replace his lenses, based on the appearance of the lenses he wore in relevant to the reported age of the lens. Of course, if the patient asks specifics, I'm happy to share with him the things that can go wrong, as well as the timeline, inconvenience and expense involved in reversing the damage. Some people actually listen and apply what I've said and I like that because I know they're listening.
Incidentally, I consider it important that I do the contact lens cleaning review, rather than my staff. Patients seem to take news and information more seriously if it comes from the doctor.
--Robert Kessen, O.D.
Wausau, Wis.
This month at http://www.siliconehydrogels.org, read about the hyperopic shift that occurs with silicone hydrogel lenses, GP-silicone hydrogel piggyback systems and a study testing the presumption that wearing inverted contact lenses decreases comfort and vision.
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.
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