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Friday, July 18, 2014  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO
Taking the unpredictable next step is always an uncertain, and perhaps nerve-racking, one. The question I’d like you to consider is what is your next step in the area of contact lenses this coming week? Is it a move into fitting more specialty contact lenses? Is it to manage your patients with contact lens discomfort more aggressively, like you would a patient with dry eye disease? Or perhaps you might consider over-hauling your fee structure as it relates to your contact lens business. Whatever it is, have confidence in your approach and remember that the changes you make will benefit not only your practice, but ultimately your patients as well.

Novartis to License Google “Smart Lens” Technology
Novartis announced that its eye care division, Alcon, has entered into an agreement with a division of Google Inc. to in-license its “smart lens” technology for all ocular medical uses. The agreement with Google[x], a team within Google that is devoted to finding new solutions to big global problems, provides Alcon with the opportunity to develop and commercialize Google’s “smart lens” technology with the potential to transform eye care and further enhance Alcon’s pipeline and global position in contact lenses and intraocular lenses. The transaction remains subject to anti-trust approvals.

According to the Novartis announcement, the agreement between Google and Alcon represents an important step for Novartis, across all of its divisions, to leverage technology to manage human diseases and conditions. Google's key advances in the miniaturization of electronics complement Novartis's deep pharmaceuticals and medical device expertise. Novartis aims to enhance the ways in which diseases are mapped within the body and ultimately prevented.

Under the agreement, Google[x] and Alcon will collaborate to develop a “smart lens” that has the potential to address ocular conditions. The smart lens technology involves non-invasive sensors, microchips and other miniaturized electronics which are embedded within contact lenses. Novartis’ interest in this technology is currently focused in two areas:

  • Helping diabetic patients manage their disease by providing a continuous, minimally invasive measurement of the body’s glucose levels via a “smart contact lens” which is designed to measure tear fluid in the eye and connects wirelessly with a mobile device;
  • For people living with presbyopia who can no longer read without glasses, the “smart lens” has the potential to provide accommodative vision correction to help restore the eye’s natural autofocus on near objects in the form of an accommodative contact lens or intraocular lens as part of the refractive cataract treatment.
The agreement marries Google’s expertise in miniaturized electronics, low power chip design and microfabrication with Alcon’s expertise in physiology and visual performance of the eye, clinical development and evaluation, as well as commercialization of contact and intraocular lenses. Through the collaboration, Alcon seeks to accelerate product innovation based on Google’s “smart lens” technology.
Registration Now Open for 10th Annual OMS – CE in December in Orlando
Learn from the best. Experience the motivation. Move your practice forward. Plan now to attend the Optometric Management Symposium on Contemporary Eye Care, December 5-7, 2014 at Disney's Yacht & Beach Club Resort in Lake Buena Vista, FL.

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.

OMS offers a comprehensive program, flexible schedule, ABO, COPE and Florida Board approved credits included 12 CEE's (TQ credits)! The education is also sponsored by a school of optometry meeting the requirements of several states. Rejuvenate yourself and expand your education while visiting exhibitors to learn about their products and services during our refreshment breaks.

For agenda, more information and to register visit
2014 World Sight Day Challenge: Optometry Giving Sight Sets $1 million fundraising goal
Optometry Giving Sight invites all members of the global eye care community to help create a world where there is no more avoidable blindness, by taking the World Sight Day Challenge, throughout September and October 2014. World Sight Day is Thursday, October 9th.

Now in its 7th year, the World Sight Day Challenge is the largest annual global fundraising campaign to address avoidable blindness caused by uncorrected refractive error- the need for an eye exam and glasses. The campaign has set a fundraising target of $1 million in 2014 and will once again build on the concept of ‘strength in numbers’. The colorful new aqua blue logo and materials encourage fundraisers to join hands together and show the world just how important eye and vision care are, and how the eye care community is making a difference.

Participating is easy and can be as creative as you like – simply make a fundraising pledge, or a monthly or annual donation on or before World Sight Day, October 9th. Optometry practices and optical companies can also be creative and engage patients, customers and employees with fundraising events throughout the Challenge period.

Manny, the new face for the 2014 Challenge, was one of the tens of thousands of women, children and men who lost everything when tropical cyclone Yolanda smashed into the Philippines last November. Optometry Giving Sight was pleased to support the efforts of Third World Eye Care Society from Canada who mobilized volunteers and resources to visit the country in late January. More than 8,000 people received glasses as a result of their efforts.

To make or pledge your donation, or register your intention to fundraise, or to find out more, visit or call 1888 OGS GIVE.

From 20/200 to 20/20 with Scleral Lenses
Nathan Schramm, OD, CNS, Weston, FL

This 20 year old, obese male patient with keratoconus and a history of high blood pressure, high cholesterol, and seasonal allergies was referred by a local cornea specialist for scleral lenses. His presenting VA in small diameter GPs was 20/200 with apical scarring and Munson's sign (see photo). BCVA with refraction 20/100.

Patient was successfully fit in a high DK scleral lens: -8.50 15.0 mm, 7.18 BC, STD LZ, 3FLT SZ. BCVA with refraction 20/20.

We thank Dr. Schramm for these images 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 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 and Langis Michaud, OD, MSc, FAAO, FBCLA, FSLS

Tap Water and GP Contact Lenses: “The Middle of a Gray Zone”

After reporting on the United States Food and Drug Administration’s (FDA) review of whether to eliminate a tap water rinsing step from gas permeable (GP) solution packaging,1,2 I received many excellent comments on this topic from our readership.

One insightful response came from my esteemed colleague, Dr. Langis Michaud from Montreal, Canada, who has made a career fitting GP contact lenses. He wrote:

“There are some elements to consider:

1. Material of the lenses: higher silicone content raises potential adhesion of Pseudomonas species.3
2. Corneal health: If the cornea is injured (e.g. from contact lens overnight wear, overwear, noncompliance (dirty lenses), or lenses fitted too tight with no tear exchange) there is an increased risk of infection.4-7
3. Geographical location: quality of tap water supply varies from city to city... rural vs urban, etc.8,9

To sum up, we are in a middle of a gray zone...”

3. Kodjikian L, Casoli-Bergeron E, Malet F, Janin-Manificat H, Freney J, Burillon C, Colin J, Steghens JP. Bacterial adhesion to conventional hydrogel and new silicone-hydrogel contact lens materials. Graefes Arch Clin Exp Ophthalmol. 2008 Feb;246(2):267-73. Epub 2007 Nov 7.
4. Robertson DM. The effects of silicone hydrogel lens wear on the corneal epithelium and risk for microbial keratitis. Eye Contact Lens. 2013 Jan;39(1):67-72.
5. Mantelli F, Mauris J, Argüeso P. The ocular surface epithelial barrier and other mechanisms of mucosal protection: from allergy to infectious diseases. Curr Opin Allergy Clin Immunol. 2013 Oct;13(5):563-8.
6. Ramphal R, McNiece MT, Polack FM. Adherence of Pseudomonas aeruginosa to the injured cornea: a step in the pathogenesis of corneal infections. Ann Ophthalmol. 1981 Apr;13(4):421-5.
7. Lin MC, Graham AD, Fusaro RD, Polse KA. Impact of Rigid Gas-Permeable Contact Lens Extended Wear on Corneal Epithelial Barrier Function. Invest Ophthalmol Vis Sci. 2002 Apr;43(4):1019-24.
8. Booton GC, Joslin CE, Shoff M, Tu EY, Kelly DJ, Fuerst PA. Genotypic identification of Acanthamoeba sp. isolates associated with an outbreak of Acanthamoeba keratitis. Cornea. 2009 Jul;28(6):673-6.
9. Joslin CE, Tu EY, McMahon TT et al. Epidemiological Characteristics of a Chicago-area Acanthamoeba Keratitis Outbreak. Am J Ophthalmol . 2006 Aug;142(2):212-7.

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David Kading, OD, FAAO
A Little History – Rigid Gas Permeable Contact Lenses

With all the discussion and activity in scleral lenses these last few years, we cannot forget about their corneal counterparts today made from rigid gas permeable (GP) materials. In fact, corneal lenses originated from scleral lenses. In the 1940s, Theodore Obrig was a pioneer in the use of a plastic called polymethyl methacrylate (PMMA) in the manufacture of scleral lenses. Working in Obrig’s lab was Kevin M. Tuohy, who later that decade came up with a technique to make lenses that were like scleral lenses, but were much smaller. These lenses were able to fit on the cornea and move freely with the lid. PMMA corneal lenses were the mainstay of contact lenses until Norman Gaylord created the Polycon (rigid gas permeable) lens, sold it to a company called Syntex Ophthalmics who brought it to market in the late 1970s. Since then GP materials have been improving year after year. We have some materials that are extremely breathable and others that are very slippery, and some that are both. All being said, we have come a long way and certainly appreciate what corneal GP lenses do for us today. In fact lenses that are made of rigid materials (corneal and scleral) make up 8% of the total U.S. contact lens market today, and up to one-third of some global markets.

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Utility Values Among Myopic Patients in Mainland China

The purpose of this study was to elicit utility values of adult myopic patients in mainland China.

A valid sample of 442 myopia patients (spherical equivalent at least -0.5 diopters) aged 17 to 44 years who were scheduled to undergo refractive surgery were recruited. Information on time trade-off ([TTO] years of life willing to sacrifice for treatment of myopia) and standard gamble (SG) for blindness (risk of blindness from therapy, willing to sacrifice for treatment of myopia) utility values and sociodemographic and clinical data were obtained.

The mean utility values based on TTO and SG were 0.96 ± 0.05 (95% confidence interval [CI], 0.95 to 0.96; median, 0.98) and 0.93 ± 0.09 (95% CI, 0.92 to 0.94; median, 0.97), respectively. Myopic patients using contact lens had significantly higher TTO utility values than those wearing glasses (p < 0.001). There was no significant difference in the TTO and SG utility values by age, sex, occupation, educational levels, residence, reasons for refractive surgery, and severity and duration of myopia (p > 0.05).

The authors concluded that the TTO and SG produce similar mean utility values, but there is poor agreement between results for individuals from the two methods. Utility values associated with myopic patients obtained in this study or reported in the literature seem to be higher than those obtained for other ophthalmic conditions.

Li S, Wang G, Xu Y, Gray A, Chen G. Utility Values among Myopic Patients in Mainland China. Optom Vis Sci. 2014 Jun 4. [Epub ahead of print]

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