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Sunday, March 2, 2014  
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Results from Last Question

What do you believe is the most common visual reason for failure in soft multifocal fitting?

 Poor distance vision
   39%

 Poor intermediate vision
   2%

 Poor near vision
   30%

 Ghosting
   29%


Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO
Allergy season is soon upon us in many parts of North America. Don't forget to be diligent when examining your patients for both current and previous ocular allergy. A simple question or two will help prompt and remind both the patient and you to write that allergy prescription for when the time is right. This proactive approach will no doubt stand out in your patients’ perception of your care for them.

Essilor International Agrees to Acquire Coastal.com for $430 Million

Essilor International announced that it has entered into a binding agreement to acquire all of the outstanding common stock of Coastal Contacts (Coastal.com), one of the world's leading online vision care retailers.

Based in Vancouver, British Columbia, Canada, Coastal.com is listed on the Toronto Stock Exchange and on NASDAQ and reported revenue of CAD 218 million for the fiscal year ended October 31, 2013. Founded in 2000, the company designs and distributes one of the widest online selections of optical equipment, including contact lenses, prescription and non-prescription eyeglasses, sunglasses and various accessories. Products are sold through several local websites covering mainly North America and Europe as well as the Asia-Pacific region and Brazil. The company has more than five million customers worldwide.

According the Essilor announcement, online sales account for roughly 4% of the global vision care market, which is estimated at some USD 100 billion based on retail prices. They are likely to continue growing at a double-digit rate for the foreseeable future. Essilor has been involved in online distribution for several years through its subsidiaries FramesDirect and EyeBuyDirect and through MyOnlineOptical, a turnkey e-commerce engine that enables American eyecare professionals to offer an online complement to their in-store offerings. Essilor intends to leverage online distribution to improve the quality of vision care information, optimize the deployment of its products and of new online technologies, and provide wider access to vision correction solutions for existing eyeglass wearers and for the 2.5 billion potential wearers worldwide.

The transaction will be structured as an arrangement under the Canada Business Corporations Act and is subject among others to the approval of the Competition Bureau in Canada and to that of Coastal.com's shareholders. The transaction is expected to be completed by the end of April 2014.

SpecialEyes Website Upgrade Adds Calculators & Tools for Custom Soft Contact Lenses

SpecialEyes, LLC recently unveiled a website upgrade featuring expanded user-specific content and added functionality, including an array of free tools and calculators for eyecare professionals. Practitioners can navigate to the SpecialEyes Learning Center to access a prescribing nomogram, custom contact lens fitting guides, horizontal visible iris diameter (HVID) measuring tips, optical zone assessment tips, and other useful tools and information.

To ensure accurate fitting of custom contact lens prescriptions, SpecialEyes also offers two easy-to-use online calculators. The SpecialEyes Arc Length Calculator was developed by P. Douglas Becherer, OD, FAAO. According to Dr. Becherer, the software yields a similar contact lens design as some sagittal-depth fitting techniques and requires just a few simple measurements - HVID, central K values, and spectacle prescription - to accurately calculate arc length of the cornea. This enables SpecialEyes to successfully produce a custom sphere, toric, or multifocal contact lens design for even the most difficult-to-fit patients. The site also hosts an Over-Refraction Calculator , which determines the resultant prescription after a successful in-office over-refraction is performed.

Eyecare practitioners can learn more about SpecialEyes' custom soft contact lenses, online tools and calculators, and industry-leading warranty at www.specialeyesqc.com/practitioner.php. To speak with a specialist, call 1-866-404-1060, or contact SpecialEyes via online form, email, or live chat at www.specialeyesqc.com/contact.php.

Gordon Joins Visionary Optics

Visionary Optics, LLC, manufacturer of the Jupiter and Europa brands of scleral lenses, has appointed Cassandra Gordon, NCLEC, as the Vice President of Sales and Marketing.

Gordon comes to Visionary Optics after spending 6 years with X-Cel Contacts as a National Key Account Manager and the Academic Program Coordinator. She brings a wealth of specialty contact lens experience including assisting practitioners with patient fittings as well as facilitating scleral lens workshops. She has been actively involved with the contact lens programs at virtually all of the U.S. optometry schools.

For additional information on the company's designs, visit www.visionary-optics.com.

IACLE Announces New Awards Program

The International Association of Contact Lens Educators (IACLE) is offering educators around the world the chance to become IACLE International Contact Lens Educator of the Year. The awards, which will recognize and reward achievements in contact lens education worldwide, will be awarded to three individuals, one from each of IACLE's three regions: Asia Pacific; Europe, Middle-East and Africa; and Americas.

The awards will be presented at the British Contact Lens Association Clinical Conference & Exhibition, taking place in Birmingham, UK, June 6-9, 2014. IACLE's Education Day will be held in on June 5th to coincide with the conference.

All three regional winners will each receive:

  • A generous award towards the cost of travel and accommodation, thanks to sponsorship from CooperVision.
  • A full delegate package to attend the British Contact Lens Association Clinical Conference & Exhibition, thanks to the generous support of the BCLA.
  • A place at the IACLE Education Day featuring lectures and workshops, followed by a dinner in the evening.
  • A certificate to mark the regional awards, to be presented at the events.

The awards are open to all IACLE members from any country, with preference given to members who are active Fellows of IACLE and / or have attempted the IACLE Fellowship Exam. The awards will recognize work by those who are established contact lens teachers. Equally, the award may be given in recognition of a useful educational contribution by an Associate Member, actively involved in IACLE and in contact lens education.

The IACLE Travel Award is a travel grant for an IACLE Educator Member starting out on his / her career who would not otherwise be able to attend the BCLA conference and IACLE Education Day. The recipient will receive the same benefits as the IACLE Contact Lens Educator of the Year Awards winners. The 2014 IACLE Travel Award is sponsored by IACLE and supported by the BCLA.

The deadline for all entries for the 2014 awards is midnight on Friday, March 14th. Entries should be submitted by email to IACLE Director of Operations Bonnie Boshart at b.boshart@iacle.org. The winner will be announced by March 28th at the latest.

Brown Becomes President of IDOC

Dave Brown, former president of Vistakon, North America, Johnson & Johnson Vision Care, Inc., was appointed president of IDOC, an alliance of independent optometrists. Mark Feder, OD, founder of IDOC, will continue as CEO of the group. Brown will be responsible for running the day-to-day operations of the business, overseeing sales, marketing and member services, and he will be based out of the IDOC corporate office, reporting to Dr. Feder.

Brown's career spans the consumer OTC, pharmaceutical and medical device sectors. He is a proven professional and consumer marketing expert, with experience in creating programs that excel, company turnaround and entrepreneurial start-ups. Brown joined the Vistakon division of Johnson & Johnson Vision Care as vice president of the worldwide franchise in 2006, and in 2009, Brown was appointed president of Vistakon - North America Region.


Reader Experience with LipiFlow

In last week's editorial, http://www.cltoday.com/new/issue_022314.asp, we requested readers to share their experience using the LipiFlow system with contact lens wearing patients. Here is one of the comments we received.

We have had the LipiFlow unit in our practice for about a year and a half now. Our results with contact lens patients is directly related to their amount of meibomian gland dysfunction. If their primary issue is aqueous deficiency, we of course do not recommend the procedure. However, the majority of our patients have evaporative dry eye, and thus we have seen significant improvement in regards to contact lens comfort. We have had several patients that are able to go back into contact lens wear after dropping out several years prior, and we are seeing patients wearing their contact lenses for longer hours as well.

Anith Pillai, OD
San Antonio, TX

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MATERIALS & DESIGNS
David Kading, OD, FAAO

Are you stable?

This is the first of a series of articles highlighting designs and innovative technology from our industry partners including some of the specialty contact lens laboratories.

Last time I spoke about technology. (http://www.cltoday.com/new/issue_021614.asp) If you don't know me as a person or clinician, I LOVE techy things. Unfortunately it means that I buy way too many gadgets for my office, but we stay ahead of the curve and have fun doing it. In the next couple of months, I'd like to share with you innovative technology from some of our contact lens manufacturing companies.

Valley Contax is a nationally known family-run laboratory in Oregon. A couple years ago they launched the Custom Stable (CS) family of scleral lenses. The CS lens family is a full size sclerals that the lab has researched to be optimized at 15.8 and 14.8 diameters. (They do make larger and smaller, but these are their bread and butter lenses.) The CS lens series utilizes a quick reverse curve which helps to clear the limbus (what I call the "Holy Grail" of the cornea). Valley says that their lenses are great for irregular corneas (and that is where they started) but they have worked to simplify things so that they are available for the astigmat, presbyope or dry eye patients as well. Valley hopes to bring a fresh take to the scleral, or custom stable, world with their integrated "patient care system" dealing with lens care, insertion and removal tools, and of course a custom stable lens for any condition.

Please send me a message on twitter with any ideas, news or concepts that you encounter @davekading. Happy Fitting.

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RESEARCH REVIEW
S. Barry Eiden, OD, FAAO

The eye’s natural defense mechanisms are amazing; however we need to “protect” them!

Over 37 million individuals currently wear contact lenses in the United States. Considering the number of wearers it is remarkable that the incidence of ocular infections seen in clinical practice is relatively low. One of the key reasons for this is the presence of antimicrobial constituents in the tear film. A review of the literature concerning antimicrobial tear compounds was recently published. The authors stated that the tear film is an important component of the innate defense system of the eye providing protection against a range of potential pathogens. They further stated that tears, like all mucosal fluids, contain a plethora of molecules with known antimicrobial effects. They indicate that many studies show synergistic and additive interactions between several of the tear antimicrobials and it is highly likely that cooperation between molecules is the primary way tears are able to afford significant antimicrobial protection to the ocular surface in vivo. Although the antimicrobial constituents of the tear film typically are highly effective, the authors indicate that various factors can negatively impact tear immunity, specifically dry eye and contact lens wear.

Consideration and management of the influences that dry eye, ocular surface disease and contact lens wear can have on the eye's natural defense mechanisms will allow the contact lens practitioner to maximize the likelihood of successful lens wear and minimize the chances of ocular infection.

McDermott AM. Antimicrobial compounds in tears. Exp Eye Res. 2013 Dec;117:53-61. Epub 2013 Jul 20.

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Vision-Related Quality of Life in Patients with Infectious Keratitis

The purpose of this study was to determine the vision-related quality of life (VR-QOL) in patients with infectious keratitis using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25).

Sixty-five patients with infectious keratitis (IK) were enrolled in the study. The NEI VFQ-25 scores and clinical and demographic data, including age, gender, pathogen, best corrected visual acuity (BCVA), and duration of the disease, were collected from the subjects. The subscale and composite scores were calculated and analyzed. Correlations between the VFQ-25 scores and the clinical and demographic features were also explored.

The mean age of enrolled subjects was 48.4 years (SD, 16.2), with 44 males (67.7%). The microbial pathogens were viruses (n = 48, 73.8%), fungi (n = 13, 20.0%), and bacteria (n = 4, 6.2%). The mean scores of each VFQ-25 subscale ranged from 31.9 (SD, 28.6) for role difficulties to 92.7 (SD, 13.1) for color vision; the mean composite score was 58.1 (SD, 19.2). Significant differences in scores were observed only in the subscale of dependency among educational levels and in the mental health subscale and the composite among the three pathogen groups. Multivariate regression analysis revealed that VFQ-25 composite score correlated significantly with the BCVA of the worse-seeing eye, duration of the disease, history of operation (for IK treatment), and gender.

The researchers concluded that infectious keratitis has extensive impacts on patients and VR-QOL. The BCVA of worse-seeing eye, duration, history of operation for IK treatment, and gender contributed independently to VR-QOL. Early treatment should be encouraged to obtain better visual prognosis and VR-QOL for patients with IK.

Li Y, Hong J, Wei A, Wang X, Chen Y, Cui X, Sun X, Liu Z, Xu J. Vision-Related Quality of Life in Patients with Infectious Keratitis. Optom Vis Sci. 2014 Jan 23. [Epub ahead of print]


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