One of the things we try to impress upon our staff, and students, is that getting it right the first time matters. While patients, as customers, will often forgive an error, multiple errors are usually not tolerated. Think about this from your perspective and how frustrating it is to repeatedly take your car in to the shop. Without question, some contact lens fits are more challenging than others, but accuracy in your routine business is a necessity.

The American Society of Cataract and Refractive Surgery (ASCRS) has formed an Integrated Ophthalmic-Managed Eyecare Delivery (IOMED) Task Force to investigate and recommend ways in which the organization and its membership can advance an eyecare delivery model based on a synergistic collaboration between optometry and ophthalmology.

The IOMED Task Force includes three representatives from ophthalmology and five from optometry, and is chaired by ASCRS Governing Board member, Stephen S. Lane, MD, of St. Paul, MN. The IOMED Task Force members are: Jeff Azus, OD, of Altos Eye Physicians in Los Altos, CA and Kaiser Permanente, San Francisco; Marlane J. Brown, OD, FAAO, of Minnesota Eye Consultants, in Minneapolis, MN; Derek N. Cunningham, OD, FAAO, of Dell Laser Consultants, Austin, TX; Richard C. Edlow, OD, of Katzen Eye Group, Lutherville, MD; Howard Fine, MD, of Oregon Eye Associates, Eugene, OR; David I. Geffen, OD, FAAO of Gordon Weiss Schanzlin Vision Institute, San Diego, CA; David A. Karcher, Executive Director of ASCRS; and Douglas D. Koch, MD, of Baylor College of Medicine, in Houston, TX.

In addition to completing a comprehensive membership needs assessment, the IOMED Task Force will consider creating new educational tracks at the ASCRS Annual Symposium as well as an entirely separate society designed to meet the educational needs of integrated eyecare practitioners.

The IOMED patient centered model, which is endorsed by the ASCRS Executive Committee and Governing Board, encourages greater efficiency and coordination of care with ophthalmologists and optometrists working together to meet the growing demands for service and address the pending changes in Medicare and general healthcare delivery. The Task Force is expected to make formal recommendations to the ASCRS leadership in the coming months.

ABB CONCISE announced that its laboratory in Pinole, CA is now authorized to manufacture Bausch + Lomb's KeraSoft IC silicone hydrogel contact lenses. The technology behind the KeraSoft IC lens allows for authorized laboratories to custom-make contact lenses for patients with irregular corneas, including patients with keratoconus.

Interested eyecare professionals may visit www.abbconcise.com to complete the necessary training to become a certified KeraSoft IC professional. ABB CONCISE is sponsoring live "Introduction to Bausch + Lomb KeraSoft IC" webinars at the end of August. To learn more about those webinars dates and times, email marketingrequest@abbconcise.com.

Upon completion of the online training, ECPs may contact ABB CONCISE's Contact Lens Consultation at 800-772-3911 CA or 800-225-1812 MA, and choose option 4 for trial set information and to place orders.

Each year the American Academy of Optometry recognizes distinguished individuals who have made countless contributions to advancing the profession of optometry. The Academy announces the 2012 award recipients:

• Charles F. Prentice Medal and Lecture Award, Larry N. Thibos, PhD, FAAO
• Glenn A. Fry Award and Lecture (AOF award), Susana T.L. Chung, OD, PhD, FAAO
• Irvin M. and Beatrice Borish Award, Melissa D. Bailey, OD, PhD, FAAO
• AAO-Essilor Award for Outstanding International Contributions to Optometry, Olanrewaju Matthew Oriowo, BSc(Optom), MSc, PhD, FAAO
• William Feinbloom Award, P. Sarita Soni, OD, MS, FAAO
• Carel C. Koch Memorial Award, Roger J. Wilson, OD, FAAO
• Julius F. Neumueller Award in Optics (AOF award), Kenneth Headington, OD, MS
• Michael G. Harris Award for Excellence in Optometric Education (AOF award), Dennis L. Smith, OD, MS, FAAO
• Eminent Service Award, Richard E. Weisbarth, OD, FAAO and Joe Yager, OD, FAAO
• Life Fellow Award, John F. Amos, OD, MS, FAAO
• Honorary Fellow Award, Susan I. Eger and James F. Jorkasky
• Garland W. Clay Award, Fiona Stapleton, BSc, MSc, MCOptom, PhD, FAAO; Lisa Keay, BOptom, PhD; Isabelle Jalbert, OD, PhD, FAAO and Nerida Cole, MSc, PhD

VSP Vision Care announced that more than 775,000 adults and children throughout the United States have received free eyecare and eyewear, as a result of VSP charity care programs.

Since 1997, VSP has invested nearly $150 million for the purpose of providing comprehensive eye exams and glasses if needed to low-income, underinsured adults and children through programs such as Sight for Students and VSP Mobile Eyes.

VSP's longest running charitable program, Sight for Students, provides free comprehensive eye exams and glasses, if needed, to more than 50,000 children each year. The program works with non-profit community organizations that identify eligible children — including Boys & Girls Clubs of America, Communities in Schools, Head Start, National Association of School Nurses, and Prevent Blindness America.

Partnering with VSP network doctors, the VSP Mobile Eyes program evolved from VSP relief efforts following Hurricanes Katrina and Rita. The program now features three deluxe mobile clinics with state-of-the-art exam rooms, dispensaries and finishing labs in two of the clinics to make eyewear on site. To date, VSP has responded to more than 100 natural disasters. When not at disaster sites, the mobile eyecare clinics travel to community events across the U.S. to provide eyecare and eyewear to the underserved. Since the first mobile clinic debuted in 2007, more than 1,000 VSP doctors have volunteered their time and services at more than 480 events.

For more information about VSP community outreach programs, please visit https://vspglobal.com/cms/vspglobal-outreach.html.

The unusual fluorescein pattern seen in this photo resulted from a series of events that began 20 years ago. At that time, the patient was a 6.00D myope with severely dry eyes that made contact lens wear difficult and uncomfortable. She elected to undergo bilateral radial keratotomy (RK) and had an eight-incision procedure. Initially, she had an excellent surgical result but, over time, began to develop hyperopic astigmatism and significant diurnal fluctuations in refractive error.

Our patient tolerated this situation for years, but when corneal collagen cross-linking with riboflavin became a viable option, we referred her for this procedure. Her ultimate goal was to be able to wear contact lenses. She underwent the procedure, and over the next three months her refractive error stabilized, with minimal fluctuation noted over the latter segment of the postoperative period.

For more on this patient and incidence of post RK hyperopic shift see http://www.clspectrum.com/articleviewer.aspx?articleID=106164.

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

The Role of Demodex in Blepharitis

A colleague recently brought my attention to the potential of significant under diagnosis of Demodex infestation in blepharitis patients. In fact there has been a recent meta-analysis published on this topic.

Zhao et al¹ from China published a meta-analysis this past April in Ophthalmic Epidemiology. The goal was confirm whether there was an association between Demodex infestation and blepharitis. After reviewing 11 articles on 4741 participants there was almost a five times risk of Demodex infestation in blepharitis patients (OR 4.89 95% CI 3.00-7.97). In international studies, the prevalence of Demodex infections in blepharitis patients ranges from 30%² to 74%.³

In chronic blepharitis patients unresponsive to conventional therapy, examination of Demodex mites and appropriate therapy should be initiated.

1. Zhao YE, Wu LP, Hu L, Xu JR. Association of blepharitis with Demodex: a meta-analysis. Ophthalmic Epidemiol. 2012 Apr;19(2):95-102.
2. Türk M, Oztürk I, Sener AG, Küçükbay S, Afsar I, Maden A. Comparison of incidence of Demodex folliculorum on the eyelash follicule in normal people and blepharitis patients. Turkiye Parazitol Derg. 2007;31(4):296-7.
3. Garbacewicz A, Udziela M, Grytner-Ziecina B, Szaflik JP, Szaflik J. Demodex infections in general Polish population, in patients suffering from blepharitis, and among people who work with microscopes. Klin Oczna. 2010;112(10-12):307-10.
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GPs Are Great for Astigmatism

Astigmatism can sometimes be challenging to correct with soft toric lenses, although soft toric lenses have come a long way over the years. In cases when soft toric lenses don't work, the unpredictability of axis orientation and lens draping can result in inaccurate correction of the patient's astigmatism and over time, axis adjustments, oblique crossed cylinders, and settling for suboptimal vision can become frustrating. For patients who are not attaining acceptable vision with soft lenses, GP lenses can be a great answer.

Spherical GP lenses create a lacrimal lens that automatically corrects corneal astigmatism. For those with more than 3 D of corneal astigmatism, back surface toric and bitoric designs can also correct astigmatism with automatic axis alignment while providing a better fitting relationship. Of these designs, the spherical power effect (SPE) bitoric is unique in that it is the only toric lens that acts optically like a spherical lens when placed on the eye. Therefore, even if it rotates on the eye, vision will not blur. This is because the toricity in the base curve and power are equal, so as the base curve changes through each meridian, the power changes the same amount. So, if your patient has a lot of corneal cylinder but very little internal cylinder, consider the SPE bitoric GP design.
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The researchers' goal was to identify the microbiological profile and evaluate the clinical course and outcomes in patients who developed severe infectious keratitis after colored cosmetic contact lens wear.

This case series includes 13 patients who developed severe infectious keratitis after colored cosmetic contact lens wear. A detailed history regarding contact lens availability and storage and handling techniques was taken. All patients underwent standard diagnostic microbiological evaluation followed by culture-guided topical antimicrobial therapy.

Of 13 patients, eight were male and five were female, with mean age at presentation of 19 +/- 3.8 years. All patients were emmetropic, and lenses were worn solely for cosmetic purposes. Seven lenses were dispensed without prescription or fitting from an unlicensed optical shop, five patients had shared lenses with friends/relatives, and one patient obtained the lens from the garbage. None of the patients followed the recommended contact lens handling and storage techniques. The causative microorganisms included Pseudomonas aeruginosa (54%), Staphylococcus aureus (25%), and Staphylococcus epidermidis (17%), with one case of viral keratitis. In 62% of cases, ulcer size was >/=5 x 5 mm and post-treatment corrected visual acuity was 6/24 or less. All patients responded well to topical antimicrobials, and none required surgical intervention.

The authors concluded that over-the-counter use of decorative lenses as a cosmetic aid is rapidly increasing. Easy and unmonitored availability of these cosmetic lenses is followed by severe sight-threatening complications in young emmetropic individuals.

Singh S, Satani D, Patel A, Vhankade R. Colored Cosmetic Contact Lenses: An Unsafe Trend in the Younger Generation. Cornea. 2012 Jul;31(7):777-9.
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