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Sunday, March 10, 2013  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

In last week's Contact Lenses Today Quick Poll, it was interesting to note that the vast majority of respondents (over 80%) felt that less than 10% of their spectacle prescriptions are filled on-line. We asked a similar question for contact lens prescriptions filled over the internet about six months ago (http://www.cltoday.com/issues/CLToday_060312.htm) and it is interesting to note that you estimate that a much greater percent of contact lens prescriptions are filled over the internet. In fact, over 40% of respondents felt that more than 20% of their contact lens prescriptions are filled over the internet.

Will this trend continue, or will we see more and more patients filling spectacle prescriptions over the internet? We would love to hear your thoughts on the topic. Please email us at cltoday@pentavisionmedia.com.

Visionary-Optics Introduces the Europa Scleral Lens

Visionary-Optics LLC announces the launch of Europa Scleral with Universal Fit Technology, a second generation version of its Jupiter scleral lens. The Europa Scleral lens is a true scleral lens designed to deliver optimized fit, comfort, and vision for successfully managing patients with a wide range of irregular corneal conditions and ocular surface disease.

As developed by Greg DeNaeyer OD, this lens provides several upgraded attributes to the Jupiter lens design. The lens has an increased optic zone which will allow increased sagittal depth and corneal clearance without having to steepen the base curve or peripheral curves allowing for better corneal vault. A reverse geometry curve has been incorporated fitting a wider range of corneas and simplifying the fitting process for patients with irregular corneas. The Europa Scleral lens has a four curve peripheral design, with an enhanced profile designed to reduce lens compression and seal-off. Europa is exclusively manufactured in Boston XO and Boston XO2 materials.

Visionary-Optics offers low-priced Europa Scleral fitting sets, including both a 7-lens and 14-lens diagnostic set, making it easy for new fitters and existing Jupiter fitters to upgrade to Europa.

For more information or to order a diagnostic fitting set contact consultants at 877-533-1509 or visit www.visionary-optics.com.

HVC Introduces New Lens and New One-Week Modality

Hydrogel Vision Corporation (HVC), makers of H2O disposable soft contact lenses, has expanded their product line with a new lens and a new modality: Icuity H2O, one-week replacement. It's an option for patients who would benefit from a more frequent replacement, but don't want to incur the cost of a daily disposable lens.

According to the company, Icuity H2O will allow patients to replace their lenses weekly for about the same price they are now paying for two-week and one half the price of one-day. The company also believes that weekly replacement will help with compliance - start a new week, start a new lens.

Icuity H2O is made with hioxiflcon A, a non-ionic ultra hydrating material that retains 99% of its water content throughout the wearing time. Icuity H2O comes in a Median and Steep base curve. Available parameters are: Median +6.00 to -10.00 and Steep -0.25 to -10.00. Free diagnostic sets are available directly through Hydrogel Vision and through any of their authorized distributors.

For more information about Hydrogel Vision and their full product line, call 1-877-336-2482 or visit www.hydrogelvision.com.

Art Optical Presents the Rose K2 XL Lens with Special Savings on Fitting System

As a Rose K manufacturing partner, Art Optical is pleased to feature the new Rose K2 XL semi-scleral lens design with an affordable, guaranteed, and easy-to-follow fitting system.

The new Rose K2 XL semi-scleral lens, manufactured and shipped from Art Optical within 24 hours, is indicated for Keratoconus, PMD, Post Graft, Post-Lasik ectasia and other irregular cornea conditions that cannot be successfully fitted within the limbus. The use of a fitting set is required.

Available for immediate order, the 16-lens Rose K2 XL Fitting Set from Art Optical is offered at just $250, making the easy-to-use lens system an exceptional value. Through March, practitioners can save an additional $50 on a set purchase. Also there is a 100% money-back satisfaction guarantee on the purchased set and a loaner fitting set program - making product trial virtually risk-free.

Complete product details can be found at www.artoptical.com, or by contacting the company at 800-253-9364.

Healthy Vision with Dr. Val Jones Show Now Available on All About Vision

Vistakon announced its Healthy Vision with Dr. Val Jones podcast series is now available on AllAboutVision.com. Episodes of the program, devoted to educating and improving the eye health of Americans, can be found at www.allaboutvision.com/healthy-vision.

Launched in 2011, Healthy Vision with Dr. Val Jones provides consumers with timely and relevant information and resources to help them manage eye health for themselves and their families. The program is supported by Acuvue Brand Contact Lenses and is hosted by Val Jones, MD, CEO of Better Health, LLC.

All About Vision site includes information on more than 50 eye conditions and diseases, sections on special-interest topics like computer vision, sports vision, nutrition and eyes, and children's vision, as well as helpful information on eyeglasses, contact lenses, and surgical procedures that address vision problems. Site content is developed with the input of an advisory board of optometrists, ophthalmologists and opticians and the site is certified for trustworthiness by the Health on the Net Foundation. The site recorded more than 17 million unique visitors and nearly 30 million page views in 2012.

Free podcasts of the show can also be found on BlogTalk Radio (www.blogtalkradio.com/healthyvision).

Vision Source's Artis Promoted

Texas-based optometric alliance, Vision Source, announced the promotion of Derrick L. Artis, OD, MBA from Vice President of Vendor Relations and Member Services to Executive Vice President of Operations.

In his new role, Artis will be responsible for leading the operations group in delivering value to the Vision Source members and vendor partners. Key leaders in the operations group are Sr. Vice President, Dr. John McCall and the vendor relations team, Vice President of Practice Development, Dr. Walt West and the practice development team, and Vice President of Professional Development, Dr. Hans Kell who leads the administrator network and member services teams.

Prior to his employment at Vision Source, Artis was the Director of Professional Affairs at Vistakon and a private practice optometrist for 10 years.

Scleral Lens with Limbal Compression
By Boris Severinsky, MOptom, Jerusalem, Israel

This image demonstrates 18.5 mm scleral lens with mild limbal compression. Since the patient reported the lens as being very comfortable and refused refitting, two 0.5 mm wide fenestrations were added to the lens haptics in order to eliminate adherence and improve fluid ventilation.

We thank Boris Severinsky for this image and welcome photo submissions from our other readers! It is easy to submit a photo for consideration for publishing in Contact Lenses Today. Simply visit http://www.cltoday.com/upload/upload.aspx to upload your image. Please include an explanation of the photo and your full name, degree or title and city/state/country.

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Susan J. Gromacki, OD, MS, FAAO

Uptake and Release

One of the new frontiers in contact lens material science research is the study of uptake and release. Soft contact lenses can absorb the components of multipurpose solutions—including their active disinfectants—and then release them back into the tear film, and potentially the cornea. At the recent 2013 Global Specialty Lens Symposium in Las Vegas, Lyndon Jones, PhD, FCOptom, presented on this topic. According to Dr. Jones, preservative uptake is relevant in that it may reduce the biocidal activity of a multipurpose solution. Preservative release is relevant in that it may be associated with symptoms (e.g., stinging), conjunctival hyperemia, papillary conjunctivitis, corneal infiltrates or corneal staining. The topic's importance is highlighted by the attention given it by the United States Food and Drug Administration (FDA). The FDA has been thoroughly studying the concept of material uptake and release—particularly with silicone hydrogel materials—as it prepares to revise its guidance documents on contact lens care solutions.1,2,3,4

1. Green JA, Phillips KS, Hitchins VM, et al. Material Properties That Predict Preservative Uptake for Silicone Hydrogel Contact Lenses. Eye Contact Lens. 2012 Nov;38(6):350-357.
2. Schoff ME, Lucas AD, Brown JN et al. The Effects of Contact Lens Materials on a Multipurpose Contact Lens Solution Disinfection Activity Against Staphylococcus aureus. Eye Contact Lens. 2012 Nov;38(6):368-373.
3. Clavet CR, Chaput MP, Silverman MD et al. Impact of Contact Lens Materials on Multipurpose Contact Lens Solution Disinfection Activity Against Fusarium solani. Eye Contact Lens. 2012 Nov;38(6):379-384.
4. Schoff ME, Lucas AD, Phillips KS et al. The Effect of Contact Lens Materials on Disinfection Activity of Polyquaternium-1 and Myristamidopropyl Dimethylamine Multipurpose Solution Against Staphylococcus aureus. Eye Contact Lens. 2012 Nov;38(6):374-378.

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Katherine M. Mastrota, MS, OD, FAAO

Herbal Products That May Contribute to Dry Eye

Part one of this series discussed a study that concluded that the tear meniscus height of artificial eyes was significantly lower than that of normal eyes.

Oculoplastic surgeons commonly address symptomatic eye dryness as a complication of blepharoplasty. In order to address/ameliorate these symptoms, a January 2013 article (literature review) in Plastic and Reconstructive Surgery compiled those medications or herbal products that are associated with/aggravate dry eye.1 As expected, these mediations include antihistamines, decongestants, antidepressants, anticonvulsives, antipsychotics, antiparkinson drugs, beta-blockers and hormone replacement therapy. Of interest, the three main herbal products that contribute to dry eye are niacin, echinacea and kava. These three herbal supplements are popular and commercially available. Kava is taken for stress relief, echinacea as an immunity booster, and niacin (vitamin B3) to enhance metabolism. Remember to review these herbal/over-the-counter products in your dry eye patients.

1. Askeroglu U, Alleyne B, Guyuron B. Pharmaceutical and herbal products that may contribute to dry eyes. Plast Reconstr Surg. 2013 Jan;131(1): 159-67.

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The Auckland Keratoconus Study: Identifying Predictors of Acute Corneal Hydrops in Keratoconus

The researchers' aim was to identify potential factors associated with acute corneal hydrops in a New Zealand population with keratoconus referred to a hospital eye service.

In a single hospital centre, in a retrospective review, demographic and clinical features of subjects with keratoconus and corneal hydrops over a 17‑year period were compared with an age- and gender-matched control group of subjects with keratoconus but no history of corneal hydrops.

One hundred and one eyes of 101 subjects (mean age 24.6 +/- 8.4 years) were identified with keratoconus-related corneal hydrops. Subjects were more likely to be of Pacific but less likely to be of New Zealand European ethnicity than control subjects (n = 101). In comparison, Maori ethnicity was not found to have a significantly positive or negative association with hydrops. The pre-hydrops visual acuity (VA) of affected eyes was poorer than that of controls (p < 0.001) at first presentation to our tertiary referral corneal and contact lens service. Hydrops typically developed approximately four years after diagnosis of keratoconus. Subjects with hydrops were more likely to have a history of eye-rubbing (p = 0.011) but less likely to have a family history of keratoconus (p = 0.05). In 31 cases, the acute hydrops event was their first optometric/ophthalmologic contact. There were no statistically significant differences in the prevalence of atopic disease, contact lens wear or overall corneal transplantation rate between the two groups.

The researchers concluded that Pacific ethnicity, history of eye-rubbing, poor VA at first hospital presentation and lack of family history were statistically associated with developing acute corneal hydrops in keratoconus in a New Zealand population. Greater understanding of such predisposing risk factors may help develop early management strategies to delay or prevent progression of this disease.

Fan Gaskin JC, Good WR, Jordan CA, Patel DV, McGhee CN. The Auckland keratoconus study: Identifying predictors of acute corneal hydrops in keratoconus. Clin Exp Optom. 2013 Feb 21. [Epub ahead of print]

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