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Sunday, July 14, 2013  
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Last question:
Which of the following contact lens complications is related most to purchase of contact lenses over the internet?

 Corneal inflammatory events

 Corneal or conjunctival infection
 Contact lens discomfort and dryness
 Corneal hypoxia

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

This is the time of year that our editorial team at Contact Lens Spectrum begins planning its 2014 editorial calendar. As always, we solicit editorial ideas from both our team of contributing editors and editorial staff in addition to our readership. Please let us know if you have ideas for articles and content for next year. We look forward to hearing from you in this regard. Email us at cltoday@pentavisionmedia.com.

Allergan Appoints Ingram as President

Allergan, Inc. announced that David E.I. Pyott, Chairman of the Board and Chief Executive Officer, Allergan, and the Allegan Board of Directors have named Douglas S. Ingram as President of Allergan. In this newly established role, Mr. Ingram will report directly to Mr. Pyott and will lead the company's global commercial operations, with responsibility for the company's broad portfolio of pharmaceutical, consumer and medical device products.

With more than 25 years of professional experience, Mr. Ingram has a strong background in the health care industry, both in the U.S. and internationally. For the past three years, Mr. Ingram has served as Executive Vice President and President, Europe, Africa and Middle East (EAME). In this role, he was responsible for Allergan's regional pharmaceutical and medical device operations, with a focus on strategic planning, sales and marketing, development and general management.

Prior to leading the EAME region, Mr. Ingram served as Executive Vice President and Chief Administrative Officer. During Mr. Ingram's tenure in this role, at various times, he led Allergan's Global Legal Affairs, Compliance, Internal Audit and Internal Controls, Human Resources, Regulatory Affairs and Safety, and Global Corporate Affairs and Public Relations departments. Mr. Ingram also served as Allergan's Secretary and Chief Ethics Officer from July 2001 to July 2010. Mr. Ingram joined Allergan in 1996 as Senior Attorney and Chief Litigation Officer and was promoted to Associate General Counsel and Assistant Secretary, and later, to General Counsel.

Before joining Allergan, Mr. Ingram was an attorney practicing in the area of complex commercial litigation.

AOA Elects Officers and Bestows National Awards at Annual Meeting

The American Optometric Association's (AOA) 2013-2014 Board of Trustees was sworn into office at the 116th Annual AOA Congress & 43rd Annual AOSA Conference: Optometry's Meeting recently held in San Diego, California.

Mitchell T. Munson, OD, takes the office of president of the AOA. Other AOA officers and their positions include David A. Cockrell, OD, president-elect; Steven A. Loomis, OD, vice president; Andrea Thau, OD, secretary-treasurer and Ronald L. Hopping, OD, MPH, immediate past president.

New elected members of the board of trustees include Robert Layman, OD and Greg A. Caldwell, OD. The other trustees of the AOA continuing to serve are Barb Horn, OD, Christopher Quinn, OD, Sam Pierce, OD, and Bill Reynolds, OD.

The AOA also presented its annual awards to six recipients at the opening general session of the meeting. The 2013 AOA Award recipients are Thomas L. Lewis, OD, PhD, Distinguished Service; Neil Draisin, OD, Optometrist of the Year; Sandra Fortenberry, OD, Young OD of the Year; Michael J. Earley, OD, PhD, Optometric Educator of the Year; Senator Tom Harkin, The Apollo Award; and Amy Godeaux, CPOT, Paraoptometric of the Year.

For more information about the AOA Board of Trustees and annual awards, visit the recently relaunched www.aoa.org.

Registration Now Open for 25 CEs - December in Orlando
Plan now to attend the Optometric Management Symposium on Contemporary Eye Care, December 6-8, 2013 at Disney's Contemporary Resort in Lake Buena Vista, Florida. This popular annual symposium provides the perfect balance of timely, disease management courses and practice-building courses with plentiful networking and leisure time to enjoy all that Disney resorts and theme parks have to offer.

The educational program is presented by the Pennsylvania College of Optometry, Salus University. For agenda, more information and to register visit http://www.springervisionevents.com/event.aspx?eid=3.
Contact Lens Patient Educational Resource Available
To assist practitioners in helping new and current contact lens wearers better understand how to safely wear and care for their contacts, Johnson & Johnson Vision Care, Inc. has developed Healthy Vision & Contact Lenses, an educational resource for in-office, website, and social media use.

Healthy Vision & Contact Lenses offers helpful "Do's and Don'ts" for handling and wearing contact lenses and offers some easy-to-follow steps on how to reduce the risk of contact lens-related infection through proper use and care of lenses as well as lens-care products such as contact lens cases. It also includes a section for eyecare professionals and/or staff to fill out with patients to reinforce replacement schedules, proper cleaning and disinfecting techniques, and a reminder on when to change their contact lens case. Information about other resources where consumers can find helpful information about proper wear and care is also included.

The educational piece is not brand specific. Healthy Vision & Contact Lenses is available in both PDF and print versions. The PDF copies, which practitioners can customize/personalize to include their contact information can be viewed and downloaded at www.ACUVUEProfessional.com/HVCL. The print versions include 50 tear-sheets on a pad. To request a pad, send your name and address to healthyvision@its.jnj.com.
Eleven Biotherapeutics Announces Positive Topline Data on EBI-005
Eleven Biotherapeutics, a biopharmaceutical company designing and engineering novel and differentiated protein-based biotherapeutics for ocular diseases, announced positive topline clinical results from their Phase 1b/2a clinical trial study of EBI-005 in patients with dry eye disease (DED). According to the company, EBI-005 reflects a new approach to the treatment of DED and is the first IL-1 (Interleukin-1) signaling inhibitor designed for topical ocular administration. In the efficacy results from the study, EBI-005 demonstrated statistically significant improvements in signs and symptoms of dry eye disease compared to baseline. In addition, EBI-005 met the predefined efficacy criteria of the study and showed a differential effect between patients who received EBI-005 and those who received only the vehicle control (EBI-005 drug formulation without the active pharmaceutical ingredient). Data from the study showed that EBI-005 was generally safe and well tolerated.

The Phase 1b/2a clinical trial study was a double-masked, multi-center, randomized, placebo-controlled study to evaluate two doses of EBI-005 over a six-week period in subjects with dry eye disease. The trial enrolled 74 subjects and was conducted in multiple centers throughout the United States. The primary objective of the study was to determine the safety and tolerability of EBI-005, along with additional assessments of efficacy of EBI-005 in patients with dry eye disease. The study was designed to assess activity of EBI-005 to determine improvements in signs and symptoms of dry eye disease with EBI-005 as compared to baseline as well as differentiation of EBI-005 as compared to vehicle control. The efficacy of EBI-005 in relation to improvement in signs and symptoms of dry eye disease from baseline and EBI-005 compared to vehicle control was measured by the Ocular Surface Disease Index (OSDI) and corneal fluorescein staining.

Based on these results, Eleven plans to rapidly advance EBI-005 into late stage clinical studies in dry eye disease and additional ocular surface inflammatory diseases, including severe allergic conjunctivitis. .
CooperVision Celebrates Summer with #no2views Social Media Photo Contest
CooperVision launched a consumer promotion to celebrate summer with its #no2views social media photo contest. During four weeks, which began July 8, CooperVision will announce a new summer theme on its Facebook page every Monday. Participants only need to post an image or photograph on Instagram that best describes their unique view of the theme and include the hashtag #no2views.

Fans can vote for their favorite image via CooperVision's Facebook page, and the entry with the most "likes" will win one of four weekly prizes including a movie night package, digital camera, professional photo shoot or $500 shopping spree, plus where applicable a six-month supply of CooperVision contact lenses. At the end of the contest, the four weekly winners will be posted on CooperVision's Facebook page, and the fans will vote for the most unique image overall. The grand prize winner will receive an iPad with Retina Display and where applicable a year's supply of CooperVision contact lenses.

The #no2views contest will run from July 8, 2013, to August 12, 2013, with winners announced Mondays, July 15, 22, 29, August 5, and the Grand Prize winner announced on August 12. For more information, visit http://www.facebook.com/CooperVision.
Fibrovascular, Pterygium-Like Growth
By Jaime Ibanez, OD, Villavicencio, Colombia

This photo shows an unusual fibrovascular, pterygium-like, elastotic membrane in a patient from the southern Colombia, an equatorial country where benign growths are very common. Contact lenses are indicated after surgical removal.

We thank Dr. Ibanez for sending this image and 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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Ronald K. Watanabe, OD, FAAO


In a previous column, I wrote about the off-label use of orthokeratology lenses to correct high myopia beyond what is currently approved by the FDA. Though this can work for some patients, it does carry more safety concerns as compared to correcting lower levels of myopia. A more conservative approach to slowing myopia progression in highly myopic children is being studied at the Hong Kong Polytechnic University (Charm, Cho 2013). In this study, researchers are using overnight orthokeratology to correct a target of 4D of myopia in their highly myopic subject population. Then, spectacles that correct the residual myopia are prescribed and worn during the day. The study aims to show whether this partial correction is as effective at slowing myopia progression as full correction. This seems to be a logical approach since presumably there would still be a reduction in relative peripheral hyperopia even with partial correction. The subjects also seem to enjoy the lower residual refractive error, which allows them to do casual activities without correction and to wear thinner glasses for more detailed visual tasks. If it is shown to be as effective as full correction, it can be a more appealing method to correct a wider range of children with high myopia.

Charm J, Cho P. High myopia-partial reduction orthokeratology (HM-PRO): Study design. Contact Lens Ant Eye. 2013 Aug;36(4):164-70.

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Loretta B. Szczotka-Flynn, OD, PhD, MS, FAAO

Contact Lens Fitting after Herpes Simplex Virus Corneal Infection

A few weeks ago, I wrote about contact lens fitting opportunities after DSAEK or DMEK surgery; where up to 10% of such patients may best be served with contact lenses to correct anterior corneal surface irregularities and diffuse irregular astigmatism. Similarly, patients that have suffered from Herpes Simplex Keratitis (HSK) have long been known to benefit from contact lenses made of gas permeable materials when their anterior corneal surface is irregular and vision is decreased.

However, a new study reveals clinically significant optical aberration in patients with recurrent herpes simplex keratitis and apparently normal vision. Kaswin et al from France studied fifteen patients with a history of recurrent unilateral HSK and normal Snellen visual acuity. Eyes with HSK were statistically compared with their normal fellow eyes. Higher order aberrations (HOA), modulation transfer function (MTF) and Strehl ratio were measured using the OPD-SCAN II (Nidek Co, Gamagori, Japan) aberrometer at least 3 months after the last episode of herpes.

Despite apparently normal vision in both eyes, significantly higher total HOA, trefoil and tetrafoil were present in the HSK group compared with the control group, even in eyes with corneal opacities. However, eyes with corneal opacities tended to present with greater optical aberrations than eyes with a clear cornea. This outcome may explain some visual complaints of HSK patients, such as a decrease in contrast quality or reduced color perception, despite apparently normal vision in both eyes.

Gas permeable lenses are good suggestions for such patients (HSK with good visual acuity, status post DSAEK) in which we may not routinely consider fitting contact lenses. Gas permeable fitting skills are important to maintain so that one may readily consider fitting GP lenses when these patients present to us in practice.

Kaswin G, Rousseau A, M'garrech M, Barreau E, Pogorzalek N, De Monchy I, Legras R, Labetoulle M. Optical aberrations in patients with recurrent herpes simplex keratitis and apparently normal vision. Br J Ophthalmol. 2013 Jul 3. [Epub ahead of print]

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Assessment of UVB-Blocking Effects of Weekly Disposable Contact Lenses on Corneal Surface in Mouse Model

Weekly disposable soft contact lenses have been widely used recently, but their shield effects against ultraviolet (UV) irradiation remain to be evaluated. This study investigated the bioprotective effects of several weekly soft contact lenses against UVB irradiation on the corneal surface in a mouse model.

Fifty ICR mice were randomly divided into five groups: (1) blank control, (2) exposed to UVB without contact lens protection, (3) exposed to UVB and protected with Vifilcon A contact lenses, (4) exposed to UVB and protected with Etafilcon A contact lenses, and (5) exposed to UVB and protected with HEMA+MA contact lenses. The exposure to UVB irradiation was performed at 0.72 J/cm(2)/day after anesthesia for a 7-day period, followed by cornea surface assessment for smoothness, opacity, and grading of lissamine green staining. Tissue sections were prepared for hematoxylin and eosin staining and immunohistochemical detection by using antibodies against myeloperoxidase, cytokeratin-5, P63, Ki-67, nuclear factor-kappa B (p65), cyclooxygenase-2, Fas L, and Fas.

The results showed impaired corneal surface with myeloperoxidase(+) polymorphonuclear leukocyte infiltration into the stroma after UVB exposure, in contrast to the intact status of the blank controls. The corneas with Etafilcon A and HEMA+MA contact lenses maintained more cells positive for cytokeratin-5, P63, and Ki-67 compared to those with Vifilcon A or without contact lens protection. Furthermore, less proinflammatory factors, including nuclear factor-kappa (p65), cyclooxygenase-2, Fas L, and Fas, were induced in the corneas protected by Etafilcon A and HEMA+MA.

The researchers concluded that this study demonstrated various protective effects of weekly disposable contact lenses against UVB irradiation. The mouse model used in the present study may be used extensively for in vivo assessment of UV shield efficacy.

Lin DP, Chang HH, Yang LC, et al. Assessment of ultraviolet B-blocking effects of weekly disposable contact lenses on corneal surface in a mouse model. Molecular Vision. 2013 May 29;19:1158-68.

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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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