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Sunday, June 17, 2012  
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Last question:
Last week's question: What do you believe is the most significant obstacle to further growth of the contact lens market?

 1. Dryness and discomfort

 2. Refractive surgery

 3. Lack of new, innovative products

 4. Costs to patients

Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

As we all know to well, its frustrating when the patient's symptoms don't correlate with the tests we use to diagnose, but its important to remember that mild disease doesn't have to have a symptom component. Strides have been made in understanding the neurobiology of symptoms in dry eye and in contact lens dry eye, but we still have a long way to go.

B+L Completes the Acquisition of ISTA Pharmaceuticals

Bausch + Lomb (B+L) completed its acquisition of ISTA Pharmaceuticals, Inc. The addition of ISTA bolsters B+L's product portfolio and pipeline, increasing the company's therapeutic offerings for physicians and their patients and creating opportunity for future growth.

ISTA's four prescription products, Bromday, Bepreve, Istalol, and Vitrase, will complement B+L's existing prescription ophthalmology products and branded OTC eye vitamins. The company's pharmaceutical pipeline now has nearly double the number of mid-to late-stage innovations. The newly combined pipeline includes Prolensa, T-Pred, Bepomax and Beposone, ISTA's candidates to treat ocular inflammation and pain and allergy-related nasal conditions, and B+L's pharmaceutical innovations, including the first of a new class of ocular anti-inflammatory agents as well as a promising approach to reducing intra-ocular pressure in patients with open-angle glaucoma or ocular hypertension.

The all-cash transaction with ISTA, valued at approximately $500 million, is expected to add more than $150 million to B+L's annualized sales and be accretive to B+L's EBITDA this year.

B+L is committed to ensuring its combination with ISTA is as seamless as possible for its customers, suppliers and other partners, and will be providing updates throughout the integration process. A list of frequently asked questions regarding the acquisition can be found www.bausch.com/en/Our-Company/Recent-News/Frequently-Asked-Questions.

Social Media Gives You a Voice in CSR Debate at the IAPB General Assembly

The International Agency for the Prevention of Blindness (IAPB) 9th General Assembly will include a session addressing Corporate Social Responsibility (CSR), and the questions will be generated through social media. Ideas for questions and discussion can be suggested on Facebook (VISION 2020/IAPB) or via Twitter (@VISION2020_IAPB) or emailed to communications@iapb.org. The panel of international business leaders will focus on what is important to you and will share their knowledge and experience of CSR.

The CSR panellists include, Claude Darnault, Chief Sustainability Officer at Essilor (France); Caroline Roan, Vice President for Corporate Responsibility / President of The Pfizer Foundation (USA); Standard Chartered Bank representative, Karuna Bhatia, Head of Sustainability (India and South Asia); Alcon's Strategic Markets Medical Director — Asia, Dr. Hunter Cherwek (China), and a representative from TOMS (USA) who will share their experience with the One for One campaign.

Today, multi-national and small businesses alike recognize the importance of CSR. Not only can CSR breed customer loyalty and increase profits but the internal impact has been found to be invaluable in terms of recruitment, staff retention and staff motivation.

The meeting will take place in Hyderabad, India, September 17-20, 2012. Following the theme, Eye Health: Everyone's Business, the Assembly will play host to 150 of the world's leading experts in global blindness prevention,

cataract, refractive error, glaucoma, diabetic retinopathy, age-related macular degeneration, childhood blindness, corneal blindness and eye banking.

The CSR panel discussion is one of 40 courses, keynote lectures and symposia discussing new approaches and practical solutions to improving eye care designed to appeal to optometrists, ophthalmologists, public health specialists and other professionals involved in blindness prevention.

To register or to find out more about the Assembly visit www.9ga.iapb.org.

CLSA Announces Next Annual Meeting

The Contact Lens Society of America (CLSA) has chosen the dates and location for the CLSA 58th Annual Education Meeting. The meeting will be held at the Hotel Albuquerque in Old Town Albuquerque, New Mexico from April 12-13, 2013. Education that Makes a Difference is the theme of the meeting.

Keep an eye on the CLSA website, www.clsa.info, for information on the educational programs and other details about the meeting.

VOSH/International to Hold Annual Meeting after AAO

VOSH/International will be celebrating 40 years of humanitarianism at their annual meeting October, 28, 2012, immediately following the American Academy of Optometry meeting, at the Marriott Renaissance Phoenix Downtown Hotel.

Meeting topics will include: The Future of VOSH (Volunteer Optometric Services to Humanity), Reasons for Change and breakout groups on: fabricating glasses on site; standards of care; fundraising ideas; transition from recycled to new product; where to get supplies and potential country collaborations: Haiti, Nicaragua.

The VOSH/International Humanitarian of the Year 2012 will be presented to Fr. Pierre Labine, Founder of VOSH-Santa Cruz.

To register visit http://vosh-california.org/voshinter/annual12.html.

Band Keratopathy
By Gregory W. DeNaeyer, OD, FAAO

This photograph shows the right eye of a 41-year-old female patient who has band keratopathy. She reported previous trauma to her eye at the age of 3. The patient complained of longstanding irritation and discomfort in her right eye. She was using a beta blocker once daily OD and also GenTeal (Novartis) q.i.d. OD. Her right eye measured light perception vision.

Band keratopathy is a calcium deposition of the anterior cornea that can occur after an ocular trauma, keratitis, inflammation, glaucoma, or juvenile rheumatoid arthritis. It is usually white or yellow in color with a reticular or swiss-cheese pattern in the area of the palpebral fissure. Depending on its severity, it can cause decreased vision, erosions, and irritation. Band keratopathy can also become a cosmetic concern for the patient if it is visibly noticeable.

For more on this patient and management of band keratopathy, see http://www.clspectrum.com/articleviewer.aspx?articleID=105911.

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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Guest Columnist: Ashley Wallace-Tucker, OD; Kelly K. Nichols, OD, MPH, PhD, FAAO

Why SiHy for Dry Eye?

I would venture to guess that most of us would select a frequent replacement silicone hydrogel lens for any patient with a history of dry eye as first line management. But, if you are like me, you don't know if this is dogma or if there is solid scientific backing to support this choice.

Some clinical studies have confirmed that patients experience improved contact lens comfort when wearing silicone hydrogel lenses. For example, Chalmers et al found that the percentage of patients who reported frequent dryness was decreased by half when switched from daily wear hydrogel lenses to daily wear silicone hydrogel lenses.1 However, there also are studies reporting the opposite. The most recent study was performed by Coles-Brennan et al in 2006; they found that adapted hydrogel lens wearers were generally more comfortable in their hydrogel lenses than a silicone hydrogel lens.2

Although there are varying reports in the literature, there are certain characteristics of silicone hydrogels that support them being a reasonable selection for dry eye patients. First, silicone hydrogels provide increased oxygen transmission (Dk) when compared to hydrogel lenses. Low Dk lenses create a hypoxic environment on the cornea, but silicone hydrogels help alleviate corneal hypoxia. Secondly, in order to further enhance wettability, some silicone hydrogel contact lens manufacturers have incorporated hydrophilic humectants like polyvinyl alcohol (PVA) and polyvinyl pyrrolidone (PVP) into their materials. These high molecular weight molecules within the contact lens attract and maintain moisture resulting in improved hydration throughout the patient's wear time.3 Although we don't have a silver bullet for solving this issue, think through your options in terms of best managing these challenging patients.

1. Chalmers R, Long B, Dillehay S, Begley C. Improving contact-lens related dryness symptoms with silicone hydrogel lenses. Optom Vis Sci. 2008; 85:778-84.Senchyma M. Jones L, Louis D, et al.
2. Coles-Brennan C, Brennan NA, Connor HR, McIlroy RG. Do silicone-hydrogels really solve end-of-day comfort problems? Invest Ophthalm Vis Sci. 2006;47:E-Abstract 106.
3. Fonn, D. Targeting contact lens induced dryness and discomfort: What properties will make lenses more comfortable. Optom Vis Sci. 2007; 84:279-85.

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Susan J. Gromacki, OD, MS, FAAO

A Lens Care Tip for Borderline Dry Eye Patients

When a borderline dry eye patient struggles with comfortable contact lens wear, a small change in his lens care routine may be all it takes to resume successful lens wear. One such modification is the installation of an artificial tear drop just prior to inserting his lenses.1,2

The scientific basis for this includes physical lubrication, which enhances comfort; an improved barrier to ocular surface desiccation, which protects the cornea3; increased viscosity/ lower tension of the tear film, and the ability to bind water.

In addition, carboxymethylcellulose (CMC) a common ingredient in artificial tears, is negatively charged, which possibly enables it to bind to the preservatives in some multipurpose solutions, decreasing irritation and corneal staining.4 It also binds readily to corneal cells, enhancing retention on the eye or under a contact lens.5 This may aid in wound healing.6 For all of these reasons, the minimal effort of applying one eye drop has the potential to pay great dividends.

1. http://www.clspectrum.com/articleviewer.aspx?articleID=13057
2. Cohen S, Potter W, Christensen M, et al. Prospective case history study using Systane lubricant eye drops to help reduce symptoms of dry eye associated with contact lens wear. Optom 2004;75(6):372-373.
3. Brennan N, Coles M-L, Simmons P et al. Tear thickening and duration of effect with different lubricant drops. Optom Vis Sci 2004;81(suppl):234.
4. Paugh J, Marsden H, Edrington T et al. Can polyhexanide preservative staining be ameliorated in vivo? Optom Vis Sci 2004;81(suppl):79.
5. Willcox M, Garrett Q, Khan S et al. The binding of CMC to human corneal epithelial cells and effect on cell migration/proliferation. Optom Vis Sci 2005;82:E-abstract 055067.
6. Qian Garrett Q, Simmons PA, Xu S et al. Carboxymethylcellulose binds to human corneal epithelial cells and is a modulator of corneal epithelial wound healing. Invest. Ophthalmol. Vis. Sci. April 2007;48(4):1559-1567.

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Hand Hygiene Prior to Contact Lens Handling Is Problematical

The author's goal was to establish guidelines for contact lens wearers' hand hygiene practices which achieve a balance between minimizing risk of infection and reasonable expectations on the ability of patients to follow them.

Evidence was obtained from publications via PubMed, Advanced Medline Search, Cochrane Reviews, Google Scholar and using the key words hand hygiene, washing and contact lens.

Guidelines for effective hand washing and the bother involved vary according to the level of hygiene required. High levels of non-compliance with hand hygiene practices, even among healthcare workers, gives an indication of how important the level of bother involved when following guidelines can be in contributing to non-compliance.

The author concluded that better patient education to improve hand washing techniques as well as patient attitudes toward hand hygiene are needed to reduce high non-compliance levels. Better hand hygiene techniques and higher frequency of their application give the prospect of reduced risk of infection and of any discomfort that arises from increased lens and ocular bioburden. In order that adoption rates might be maximized, the guidelines which have been distilled from this review attempt to strike a balance between technique redundancy and the associated higher levels of hygiene achieved and the possibility that the perception of too much bother involved could reduce participation rates. The guidelines have been expanded by the inclusion of suggested explanatory information in the expectation that helping patients to understand why the recommendations are made will have the effect of increasing their adoption.

McMonnies CW. Hand hygiene prior to contact lens handling is problematical. Cont Lens Anterior Eye. 2012 Apr;35(2):65-70.

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To report adverse contact lens reactions visit: http://www.accessdata.fda.gov/scripts/medwatch/ or call (800) FDA-1088.
To report possible grievances related to the Fairness to Contact Lens Consumers Act or associated Contact Lens Rule visit: https://www.ftccomplaintassistant.gov/.

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