Human nature often dictates our behaviors and interpretation of successes and failures in all aspects of our lives—both personal and professional. If we succeed, we like for credit to be given as such in our interpretation of the events leading to the success. If we fail, our natural instincts often focus our interpretation of the failure externally—perhaps at times to our colleagues and even our patients. Many successful business owners have long followed the old adage—"the customer is always right" and that applies to our patients as well. Or, at least they should be left thinking they are always right.

The Vision Care Institute, LLC announced that its ODLean Consulting Program is expanding its program offerings to include seminars, e-learning modules and an iPad application.

Available to doctors and their staff, Operating a Lean Practice is a one-day seminar covering three areas: patient scheduling, clinical balance, and effective communication. Attendees will learn how to create a customized patient schedule taking under consideration different patient types and shared office resources. The seminar will be conducted in multiple locations across the country at a fee of $350 per attendee.

ODLean Consulting is also launching a series of e-learning modules that are based on learnings from more than 300 ODLean consulting engagements. The modules will be available through www.ODLean.com starting in mid to late 2013. The first module, entitled "What is 'Lean'?", addresses the "Lean" business philosophy of making multistep improvements to drive meaningful change across every aspect of your business. Future module topics include scheduling, clinical balance, communications, change management, and slit lamping, among others. The modules range in duration from five to 20 minutes, and are intended to be "bite-sized" for quick learning and implementation.

The new ODLean iPad application, called ODLean Patient Experience, is a diagnostic tool that allows eyecare practices to track patient flow, see in real-time where there are bottlenecks, and immediately make changes that will improve flow and efficiency. The application will send data to a web portal (available mid to late 2013) on www.ODLean.com where subscribers can access their metrics.

For more information, including seminar locations and registration, visit www.ODLean.com.

The Scientific Program Committee of the American Academy of Optometry invites the submission of abstracts for Academy 2013 Seattle, to be held October 23-26, 2013. The Academy's Scientific Program offers scientists, educators, and clinicians the opportunity to exchange the latest information in optometry and vision science in two formats, research paper presentations and scientific posters.

The abstract submission window will be open through May 31, 2013. This year, the Scientific Program Committee will present focused sessions on special topics that will include extended discussion, integration of clinical topics, and debate on current controversies. The Scientific Program Committee is soliciting original research and clinical case report submissions on the following special topics:

1. Controversies in corneal inflammation and infection
2. Myopia: mechanisms and methods of control
3. Glaucoma: insights on vascular, structural and other disease mechanisms

The Scientific Program Committee will consider all presentations including those from students and residents. Abstracts will be judged for originality, quality of writing, organization and delivery of the presentation. First authors (excluding students and residents) of accepted papers/posters are also eligible to register for Academy 2013 Seattle at reduced rates.

To read more about the submission guidelines or to submit an abstract, visit http://www.aaopt.org/meetings/academy2013/scientificprogram

Bausch + Lomb (B+L) announced that Colonel Donald Gagliano, MD, has joined the company as Vice President, Global Development Operations. Dr. Gagliano will lead the scientific review of global business development opportunities and strategic initiatives for the company's Pharmaceuticals business, as well as support special projects in its surgical business.

A retinal ophthalmologist and a Fellow of the American College of Health Care Executives, Dr. Gagliano has served since 2008 as Executive Director, Department of Defense (DoD)/Department of Veterans Affairs (VA) Vision Center of Excellence (VCE), in Bethesda, Maryland. He established and led this Congressionally-mandated Center of Excellence to be the nation's leader in the prevention, clinical care, research, education, advocacy and information management for military eye injuries and diseases and vision disorders with traumatic brain injury across the DoD and VA continuum.

Over a military career spanning more than 30 years, Dr. Gagliano has led soldiers at every level of command, including the 30th Medical Brigade in Iraq from February 2003 until February 2004. Under his command, the 30th Medical Brigade was awarded the Meritorious Unit Citation for exemplary performance. Since 1998, he has served as a Clinical Adjunct Professor of Surgery, Uniformed Services University of Health Sciences, in Bethesda, Maryland.

The American Academy of Optometry congratulates the recipients of the 2013 Student Travel Fellowship Awards. The travel fellowships, supported by an educational grant from The Vision Care Institute, will allow five students to present their research at the Association for Research in Vision and Ophthalmology (ARVO) annual 2013 meeting this week. The 2013 winners and their respective schools are:

• Tao Liu - Indiana University, School of Optometry
• Julie Mocko - University of Houston, College of Optometry
• Yvonne Wu - University of California Berkeley, School of Optometry
• Naveen K. Yadav - State University of New York, College of Optometry
• Wanyu Zhang - University of Houston, College of Optometry

This image shows a 20.2 mm scleral lens on the patient's 3rd cornea transplant. Previous corneas were rejected due to infection. Patient has 20/30 VA with this lens.

We thank Dr. Boshnick for this image and we 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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CARE SOLUTION CORNER
Susan J. Gromacki, OD, MS, FAAO

The Case of Using a Gas Permeable (GP) Solution with a Soft Lens Material

A keratoconic patient who had received corneal collagen crosslinking (CXL) at my practice reported several months after the procedure with bilateral red eyes. Biomicroscopy revealed dozens of infiltrates just inside the limbus of both corneas and a grade 3+ bulbar conjunctival hyperemia. After discontinuing contact lens wear, the infiltrates resolved and his eyes cleared.

What happened? His referring eyecare practitioner, who had recently refitted him from GP contact lenses to hybrid lenses, made a huge oversight. He neglected to change the patient's lens care system. Although hybrid lenses do have a GP center, they also have a hydrophilic skirt, so the old adage, "Do not use GP care solutions with soft contact lenses" applies to them.

The literature states that the concentration of polyaminopropyl biguanide in GP lens solutions is 30 to 50 times that used in soft lens solutions,^1-2 thus creating a great potential for toxicity. Soft lenses absorb these ingredients much more readily than rigid do, and since there is less tear exchange as compared with rigid corneal lenses, the chemicals remain in contact with the cornea for longer periods of time. The manufacturer of my patient's hybrid lenses, SynergEyes, has specific recommendations for care in patients with keratoconus or irregular corneas: Clear Care (Alcon). (http://www.cltoday.com/issues/CLToday_042113.htm) This is what the patient will use in the future.

1. Begley CG, Weirich B, Benak J, et al. Effects of rigid gas permeable contact lens solutions on the human corneal epithelium. Optom Vis Sci. 1992;69(5):347–353.
2. Begley CG, Waggoner PJ, Hafner GS, et al. Effect of rigid gas permeable contact lens wetting solutions on the rabbit corneal epithelium. Optom Vis Sci. 1991;68(3):189–197.
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VF after Tear Therapy in Dry Eye

This month's Canadian Journal of Ophthalmology published a study that demonstrated that the use of artificial tears in patients with glaucoma with dry eye syndrome decreased visual field testing time and improved test results. Fifty eyes of 50 patients with medically treated primary open-angle glaucoma (POAG) were recruited for this study. The patients were subdivided into two subgroups: those with dry eye syndrome and those without dry eye syndrome. Tear break-up time, Lissamine green staining, and Schirmer I test with topical anesthesia were performed in the same order in all patients. The Ocular Surface Disease Index questionnaire was completed by the patients. All participants underwent automated visual field (VF) perimetry using the 24-2 SITA (Swedish interactive threshold algorithm) standard strategy before and after 1-week treatment with a lubricating eye drop four times daily. VF results were compared before and after the treatment to compare the results of the two groups. Of the 50 patients, 25 (50%) were diagnosed with dry eye syndrome. No significant differences between both groups were found with respect to age (P = 0.779) and glaucoma duration (P = 0.722). In patients with glaucoma with dry eye syndrome, there was a significant improvement in VF test duration, mean deviation, and the number of depressed points after tear therapy. Considering this, it may be prudent to repeat VF after lubrication therapy to verify suspect field change in glaucoma patients with dry eye.¹

1. Kocabeyoglu S, Cem Mocan M, Bozkurt B, Irkec M. Effect of artificial tears on automated visual field testing in patients with glaucoma and dry eye. Can J Ophthalmol. 2013 Apr;48(2):110-4.
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The authors' goal was to provide their perspective on why the cornea is resistant to infection based on their research results with Pseudomonas (P) aeruginosa. They focus on their current understanding of the interplay between bacteria, tear fluid, and the corneal epithelium that determines health as the usual outcome, and propose a theoretical model for how contact lens wear might change those interactions to enable susceptibility to P aeruginosa infection.

Use of "null-infection" in vivo models, cultured human corneal epithelial cells, contact lens-wearing animal models, and bacterial genetics help to elucidate mechanisms by which P aeruginosa survives at the ocular surface, adheres, and traverses multilayered corneal epithelia. These models also help elucidate the molecular mechanisms of corneal epithelial innate defense.

Tear fluid and the corneal epithelium combine to make a formidable defense against P aeruginosa infection of the cornea. Part of that defense involves the expression of antimicrobials such as beta-defensins, the cathelicidin LL-37, cytokeratin-derived antimicrobial peptides, and RNase7. Immunomodulators such as SP-D and ST2 also contribute. Innate defenses of the cornea depend in part on MyD88, a key adaptor protein of TLR and IL-1R signaling, but the basal lamina represents the final barrier to bacterial penetration. Overcoming these defenses involves P aeruginosa adaptation, expression of the type III secretion system, proteases, and P aeruginosa biofilm formation on contact lenses.

After more than two decades of research focused on understanding how contact lens wear predisposes to P aeruginosa infection, working hypothesis of these researchers places blame for microbial keratitis on bacterial adaptation to ocular surface defenses, combined with changes to the biochemistry of the corneal surface caused by trapping bacteria and tear fluid against the cornea under the lens.

Evans DJ, Fleiszig SM. Why Does the Healthy Cornea Resist Pseudomonas aeruginosa Infection? Am J Ophthalmol. 2013 Apr 17. [Epub ahead of print]


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