Summer is just around the corner and many of our patients are headed out for a long days or weekends of fun in the sun. It's an important time to remember UV protection—not only for your skin, but also for your eyes. Brimmed caps, sunglasses, and UV blocking contact lenses are important considerations in working with our patients on this important issue. It's best to use a variety of approaches to protect against UV associated damage, and don't forget to continually educate your patients as well.

Bausch + Lomb (B+L) introduced Biotrue ONEday, a daily disposable contact lens, at the British Contact Lens Association's Annual Conference last weekend. The lens is made from HyperGel, a bio-inspired material that, according to the company, helps the lens to retain moisture and optical shape even after hours of wear and allows oxygen to flow freely through the lens. The lens offers high water content and delivers more oxygen than a traditional hydrogel, without the need for silicone, while maintaining the comfort of conventional hydrogels.

Biotrue ONEday was created by the scientists at B+L to be the first daily disposable lens inspired by the biology of your eye. The bio-inspired lenses contain 78 percent water, the same water content as the cornea, while delivering virtually the same oxygen level as the open eye. The outer surface of the lens is designed to mimic the lipid layer of tear film, which prevents dehydration of the lens, so maintaining consistent optics and delivering the oxygen level the open eye needs to maintain healthy, white eyes. The company states that Biotrue ONEday lenses provide the maximum amount of moisture of any daily disposable lens on the market today, even after 16 hours of wear.

Biotrue ONEday lenses are being introduced in Europe, initially in Italy followed by the UK and Nordics later in the year. The company is awaiting U.S. FDA approval before announcing when the lens will be available in the United States.

ABB CONCISE announces the launch of the ICD (Irregular Corneal Design) 16.5mm scleral lens. This lens is for the diseased, asymmetrical and post surgical eye. It employs a unique series of tangent zones (as opposed to curved surfaces) to create an optimal alignment with the straight line shape of the peripheral cornea, limbus and sclera.

With a close match of tangent lens shape to tangent eye surface, the ICD 16.5mm design provides an exceptional first fit success rate, according to the company. Practitioners simply choose from the 14 lens fitting set and assess three principle fitting zones: apical clearance, limbal clearance and scleral landing.

ABB CONCISE, with the support of Paragon Vision Sciences, is offering an exclusive one and a half hour certification training webinar on Tuesday, June 26th, at 6:00pm PDT (9:00pm EDT) with Patrick Caroline, FAAO, of Pacific University, called Contemporary Scleral Lens Design and Fitting. Those who complete the certification training can purchase a 14-lens diagnostic set.

To register for the webinar, go to: www2.gotomeeting.com/register/829840314. Accounts interested in learning more about the lens or placing orders can contact consultation at 800-772-3911 CA or 800-225-1812 MA, choose option 4.

Paragon CRT Corneal Topography Software, a program for facilitating the selection of Paragon CRT, Paragon CRT Dual Axis and Paragon RG-4 corneal reshaping contact lenses based on topography data, is now available from Paragon Vision Sciences.

The program imports corneal topography data from a variety of commercially available systems, including Medmont Studio 4 -5, Oculus Easygraph, Oculus Keratograph 4, Tomey Version 1-4 and Keratron-Scout/Piccolo, and displays simulated fluorescein patterns of various Paragon corneal reshaping contact lens designs. Adjusting parameters of the corneal reshaping lens to view the alternate fitting and treatment patterns is simple.

Paragon CRT Corneal Topography Software is available for $99 and maybe ordered at http://www.paragoncrt.com/crtsoftware. For a limited time, purchase the software and earn a $25 American Express Gift Card within 60 days when you order a new pair of Paragon CRT, Paragon CRT Dual Axis or Paragon RG-4 corneal reshaping lenses.

For Paragon CRT Corneal Topography Support, call 800-528-8279 x 7600.

For the last few years the "Buy One, Give One" craze has been gaining popularity in the mass market. It has been pioneered successfully with Tom Shoes and One Laptop per Child, and now there is a way for the optometric community to participate through Optometry Giving Sight's Seeing Eye to Eye program.

Here's how the Seeing Eye to Eye program works:

• The patient comes in for an eye exam and new glasses.
• The practice sets a donation of $2-$5 for each eye exam, frame or glasses purchased.
• The donation funds glasses and sustainable eye care services for young children and people with limited or no access to eye care.

Dr. Jeffrey Krohn from Fresno, CA, has been participating in the Seeing Eye to Eye program since inception. Dr. Krohn has put a promise to his patients up in his practice: "When you see better, you provide sight for another." And since January 2011, Dr. Krohn has lived up to his promise and his donations have provided sight to the equivalent of 2,000 people in need!

Please consider joining Dr. Krohn and the other Seeing Eye to Eye doctors in helping the 600 million people around the world, who are blind or vision impaired simply because they don't have access to an eye exam and glasses. Email usa@givingsight.org or call 888-OGS-GIVE for more information.

This injury occurred in the left eye of a 17-year-old male who was playing with his peers and was accidently "poked in the eye" with a toy arrow. He presented with mild pain, foreign body sensation, and uncorrected visual acuities of 20/20 OD and OS. Pupillary reflexes were intact, and no afferent pupil was noted. Extraocular muscle function was unrestricted in all positions of gaze, and intraocular pressures were OD 17mmHg and OS 18mmHg.

Conjunctival lacerations may occur independently or in conjunction with trauma to other ocular or adnexal structures. Accompanying signs typically include edema, hemorrhage, and laceration of the conjunctiva. This condition is usually self-healing without sequele, but it is essential that you thoroughly evaluate the patient to rule out the presence of a foreign body, penetration of the globe, and other conditions that pose a threat to sight.

For more on this patient and treatment of conjunctival lacerations, see http://www.clspectrum.com/articleviewer.aspx?articleID=105285.

We welcome photo submissions from our 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

Protein and Lipid Contact Lens Deposition

It is not uncommon to hear authors or lecturers state, regarding soft contact lens materials, "Silicone hydrogels deposit more tear film lipids and traditional HEMA lenses deposit more tear film proteins." But is that really true?

Indeed, the literature contains many papers concluding that most SiHy lenses deposit less protein, such as lysozyme, than conventional hydrogel lenses. This is true especially compared to negatively charged, high-water-content contact lens materials, which readily bind proteins.^1,2,3

It is also common to find papers that report that SiHys build up more lipids (which attract to more hydrophobic components) than conventional hydrogels.^4,5,6 But, other studies have drawn different conclusions. Pucker and colleagues found that etafilcon A deposited more phospholipids than five SiHys tested at 1 day and one SiHy at 14 days.⁷ Carney found the phospholipid deposition to be lower for the HEMA lens, but not significantly so.⁸ The take home message is that it is important to consider the type and concentration of the deposit tested, the contact lens material, and the study methods when coming to a conclusion on contact lens deposition.

So we should be careful in simply concluding that SiHys deposit more lipids than other materials—it is more complex than that. Even when it is true for specific materials, we still do not fully understand the clinical implications of many of these differences.

1. Subbaraman LN, Glasier MA, Senchyna M, Sheardown H, Jones L: Kinetics of in vitro lysozyme deposition on silicone hydrogel, PMMA, and FDA groups I, II, and IV contact lens materials. Curr Eye Res 2006; 31;10: 787-96.
2. Suwala M, Glasier MA, Subbaraman LN, Jones L: Quantity and conformation of lysozyme deposited on conventional and silicone hydrogel contact lens materials using an in vitro model. Eye Contact Lens 2007; 33;3: 138-43.
3. Santos L, Rodrigues D, Lira M, Oliveira ME, Oliveira R, Vilar EY, Azeredo J: The influence of surface treatment on hydrophobicity, protein adsorption and microbial colonisation of silicone hydrogel contact lenses. Cont Lens Anterior Eye 2007; 30;3: 183-8.
4. Cheung SW, Cho P, Chan B, Choy C, Ng V: A comparative study of biweekly disposable contact lenses: silicone hydrogel versus hydrogel. Clin Exp Optom 2007; 90;2: 124-31.
5. Jones L, Senchyna M, Glasier MA, et al. Lysozyme and lipid deposition on silicone hydrogel contact lens materials. Eye Contact Lens. 2003;29:S75-S79; discussion S83-S74, S192-S194.
6. Maziarz EP, Stachowski MJ, Liu XM, et al. Lipid deposition on silicone hydrogel lenses, part I: quantification of oleic acid, oleic acid methyl ester, and cholesterol. Eye Contact Lens 2006;32:300-307.
7. Pucker AD, Thangavelu M, Nichols JJ. In Vitro Lipid Deposition on Hydrogel and Silicone Hydrogel Contact Lenses. Invest Ophthalmol Vis Sci. 2010;51(12):6334-6339.
8. Carney FP, Nash WL, Sentell KB. The adsorption of major tear film lipids in vitro to various silicone hydrogels over time. Invest Ophthalmol Vis Sci. 2008;49:120-124.

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Pediatric Dry Eye: Part 2

When was the last time you considered the possibility of Dry Eye Syndrome occurring in one of your pediatric patients? It's understandable if this isn't on your radar since less than 2% of healthy children tend to have dry eye complaints;^1-2 however, missing this diagnosis in a child can have detrimental consequences that can affect more than just the eye. As Dr. Wallace-Tucker referenced in the February 19 issue of Contact Lenses Today, underlying causes of pediatric dry eye can be attributed to malnutrition, systemic medications and environmental factors, as well as certain congenital, genetic and systemic disorders. In fact, studies show there is a ten-fold increase in dry eye complaints among children with type one diabetes, and more than a seven-fold increase in those with juvenile arthritis.^1-2 As primary eye care providers, we should be acutely aware of this link and consider a medical work-up, or at the very least, a thorough Review of Systems with careful follow-up. Obviously, any delay in diagnosing these systemic conditions can have devastating and sometimes life-threatening effects, especially in children. Kids don't often complain about their health, and what may seem like an innocent grumbling about dry or uncomfortable eyes may be the only clue that something is brewing under the surface.

1. Akinci A, Cetinkaya E, Aycan Z. Dry eye syndrome in diabetic children. Eur J Ophthalmology. 2007 Nov-Dec;17(6):873-8.
2. Akinci A, Cakar N, Uncu N, et al. Keratoconjunctivitis sicca in juvenile rheumatoid arthritis. Cornea. 2007 Sep;26(8):941-4.

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The goal of this retrospective study was to report the clinical characteristics of infectious endophthalmitis after Boston type I keratoprosthesis (K-Pro) implantation.

A retrospective chart review was performed of all adult eyes receiving a K-Pro at the University of Rochester from May 2004 through July 2008. Study group totaled 141 adult eyes. Those patients identified as having been treated for exogenous bacterial endophthalmitis were reviewed for demographic data, indication for K-Pro, bandage contact lens use, prophylactic antibiotic use, timing and clinical presentation of endophthalmitis, gram stain and culture results of intraocular fluid, timing and presentation of any subsequent episodes of endophthalmitis (recurrent endophthalmitis), and preoperative and postoperative visual acuity through August 2010. Main outcome measures included: incidence of endophthalmitis, time to occurrence, recurrence rates, visual outcomes, and risk factors associated with K-Pro endophthalmitis.

Ten (7.1%) of 141 eyes of 130 adult patients were diagnosed and treated for bacterial endophthalmitis. Average time to endophthalmitis developing after K-Pro was 9.8 months (standard deviation [SD], 6.2 months; range, 2-25 months). Coagulase-negative staphylococci were identified in seven eyes. In seven of the ten eyes, recurrent endophthalmitis developed that occurred at a mean of 4 months (SD, 3.9 months; range, 1-13 months) after resolution of the initial episode. At each episode of endophthalmitis, no eye was receiving vancomycin ophthalmic drops and most eyes were receiving only fluoroquinolone ophthalmic drops for prophylaxis.

The researchers concluded that infectious endophthalmitis after K-Pro implantation has a higher incidence, delayed onset, and high risk for recurrence compared with postoperative endophthalmitis associated with more common intraocular procedures such as cataract surgery. The concurrent use of topical vancomycin is recommended because it seems to be important in reducing the incidence and recurrence of endophthalmitis and because fluoroquinolone ophthalmic drops do not seem to be sufficient prophylaxis in these eyes.

Ramchandran RS, Diloreto DA, Jr., Chung MM, et al. Infectious endophthalmitis in adult eyes receiving Boston type I keratoprosthesis. Ophthalmology 2012;119:674-81.

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