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Sunday, September 8, 2013  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO

As you know, most of North America has just gone through "back-to-school" days, as the academic calendar in the Northern Hemisphere typically begins in late summer or early autumn and ends during the following spring or summer. Hopefully parents of these children going back to school brought them in to see you for a comprehensive eye examination. I think this is a fantastic time of year to have kids in for their annual examinations. Keep this in mind as you interact with parents during the remainder of the year—it's a great tip for helping them remember the importance of caring for their kids' eyes.

New On Demand NovaKone Resources Available

Alden Optical has expanded the on demand resources available on their website. Now available is a streaming video of the well-attended 2013 Global Specialty Lens Symposium NovaKone workshop. This workshop featured NovaKone case reviews by Susan Resnick OD, FAAO, Bruce Baldwin OD, PhD, FAAO and Clark Chang OD, FAAO. The workshop explored the real world performance of this novel custom soft lens for keratoconus and included fitting insight from these accomplished NovaKone fitters. This on demand video can be viewed at http://www.aldenoptical.com/products/soft-specialty/novakone

New App Puts a Kerasoft IC Expert at Your Fingertips

UK-based UltraVision CLPL's new mobile and web fitting app can help make prescribing KeraSoft IC faster and easier for practitioners. The fitting app for KeraSoft IC reduces chair time in assessing irregular cornea patients and acts as a data recording and transmission center.

The free app guides practitioners step by step through the KeraSoft IC MoRoCCo VA process. After assessing Movement, Rotation and Centration, the app will produce an intermediate report indicates whether the lens is showing signs of being a sub optimal fit. If this is the case, you can either proceed to gain more information from Comfort and VA or remove the lens and choose a more suitable one.

The app also provides the ability for practitioners to store fitting data for both eyes in one session. Other benefits of the app include real time animations of lens behavior, the ability to view fitting history for the patient in one glance, emailing lens orders and requesting support from authorized laboratory of choice (ECP inputs email of their preferred lab), and much more.

To download the MoRoCCo VA app please go to www.ultravision.co.uk/mapp/.

Global Specialty Lens Symposium – January in Las Vegas
Plan now to attend the Global Specialty Lens Symposium to be held January 23 – 26, 2014 at the Rio All Suites Hotel and Casino in Las Vegas, Nevada. This meeting will include insightful presentations by international experts in the field, hands-on demonstrations of cutting-edge products and valuable continuing education credits.

Visit www.GSLSymposium.com for more information.
AllAboutVision.com Offers Incentive for Practitioners Who Take the World Sight Day Challenge

AllAboutVision.com will add $25 to any contribution made to the World Sight Day Challenge (WSDC) by practices listed in its free Practitioner Directory.

The WSDC is Optometry Giving Sight's largest annual global fundraising campaign. The organization funds sustainable programs that provide eye exams and glasses in communities with little or no eye care. The added donation that practitioners generate by participating in this promotion is enough to provide five people with eye exams and glasses through Optometry Giving Sight funded programs.

To qualify for this $25 promotion, practices must be listed in the AllAboutVision.com Practitioner Directory. Practices that don't already have listings are encouraged to sign up for free before contributing to the WSDC, in order to make a bigger impact with their donation. Free Directory listings are available to any practice that links their website to AllAboutVision.com.

Only donations made through AllAboutVision.com's Online Contribution Form before October 31 apply. Eye care practices, and all members of the ophthalmic community, can participate in the World Sight Day Challenge by hosting in-office fundraising events, collecting staff donations, or making personal contributions.

For more information about how to get involved in the WSDC and generate an extra $25 donation, please visit www.allaboutvision.com/wsdc.

Toric Sclera in an Advance Keratoconus Case
By Jaime Ibanez, OD, Villavicencio, Colombia

Scleral GP lens with edge lift off the superior quadrant, which shows a highly toric sclera in an advance keratoconus case.

We thank Dr. Ibanez for this image and welcome photo submissions from our other 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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Susan J. Gromacki, OD, MS, FAAO

Scleral Lens Application: Filling the Lens

Scleral gas permeable lenses represent one of the fastest-growing contact lens modalities. Utilized primarily for diseased and disfigured corneas, they are designed to vault the cornea, landing on the sclera. As a result, they must be filled with ophthalmic solution prior to insertion to avoid air between the cornea and lens.

One survey1 discovered that most practitioners recommend non-preserved saline solution for this purpose, even though it, along with anything else that can be used to fill a scleral lens, is considered off-label in the United States. The non-preserved aspect is an important one. Because scleral lenses provide minimal tear exchange, the solution remains in contact with the cornea all day long; any preservatives might induce allergic or hypersensitivity reactions.

Other non-preserved solutions in unit-dose vials may also be utilized. For example, an artificial tear may benefit dry eye patients or provide extra lubrication and corneal protection for patients whose lenses may exhibit areas of touch or minimal clearance.2 In addition, Refresh Celluvisc (Allergan) can be used to partially or completely fill a lens in an attempt to prevent solution loss upon application. Its increased viscosity helps prevent spillage.3

It must be noted that the use of non-preserved saline in a bottle has a couple of drawbacks. First, if used past its expiration date, there is the potential for contamination. And secondly, the solution typically contains buffers, which have been implicated in the presence of debris or mucin underneath a scleral contact lens. As a result, 0.9% sodium chloride inhalation/irrigation solution supplied in 3 mm vials is quickly becoming the standard of care.4,5 In my next column, I will discuss where and how your patients can obtain this solution.

1. http://archive.constantcontact.com/fs030/1101462388342/archive/1103899240059.html
2. Byrnes S. Beyond the Limbus Seminar, Manchester, New Hampshire, August 10, 2013.
3. DeNaeyer G. Personal communication, July 29-August 4, 2011.
4. http://www.clspectrum.com/articleviewer.aspx?articleID=106171
5. http://www.clspectrum.com/articleviewer.aspx?articleID=106545

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Katherine M. Mastrota, MS, OD, FAAO

Tear Osmolarity in Early Rheumatoid Arthritis

A recent study from Turkey investigated the frequency of dry eye (DE) by measuring tear osmolarity (TO) in patients with early rheumatoid arthritis (ERA) and the relationship between the severity of DE and ERA disease activity.1 Sixty-four eyes of 64 newly diagnosed and untreated patients with ERA were enrolled in this study.

TO measurements, tear break-up time (TBUT), and Schirmer tests were performed. ERA disease activity was evaluated according to the disease activity score 28 (DAS28-the DAS28 is a measure of disease activity in rheumatoid arthritis (RA). DAS stands for 'disease activity score' and the number 28 refers to the 28 joints (commonly affected by RA) that are examined in the assessment). The patients were divided into three groups according to DAS28 scores as follows: mild moderate and severe.

The results of this study demonstrated a relationship between the ERA disease activity and severity of DE by using TO measurements. Therefore, the authors conclude, TO measurement could be added to other classical DE tests for diagnosing DE and for assessing the degree of disease activity of ERA.

1. Türkyilmaz K, Küçükali Türkyilmaz A, Kurt A, Kurt EE, Sevim MS, Oner V. Investigation of tear osmolarity in early rheumatoid arthritis: relation to disease activity. Can J Ophthalmol. 2013 Aug;48(4):235-9.
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Corneal Swelling Caused by Conventional and New-Design Low-Dk Soft Contact Lenses

These researchers wanted to investigate the efficacy and safety of a fenestrated and channeled soft contact lens (F-SCL) compared to a standard and non-fenestrated soft contact lens (S-SCL) in experienced soft contact lens (SCL) wearers.

This was a randomized, crossover, single-blinded (subject), and multicenter clinical trial. Sixteen experienced SCL wearers were randomly divided into two groups (FS and SF). The FS group first wore F-SCLs followed by S-SCLs, each for 10 days, separated by a 1-week washout period, whereas the SF group wore the S-SCLs first and crossed over to F-SCLs in the same manner. The F-SCLs were designed with three equally spaced, symmetrical fenestrations and a partial-thickness, connecting, circumferential channel on the back surface of the mid-periphery of the lens. Measurement of central corneal thickness using ultrasonic pachymetry was performed on the day of screening, after the 1-week washout period, and after 10 days of wearing each kind of lens, based on which central corneal swelling was calculated and compared. One eye in each subject was chosen at random for analysis.

Central corneal swelling was 1.92+/-1.73% vs. 5.26+/-2.14% in F-SCLs vs. S-SCLs wearers, which was statistically significant (P<0.001). There was no significant difference between the groups in terms of SCL-corrected visual acuity or SCL-related adverse events.

The authors concluded that the use of F-SCLs led to reduced corneal swelling compared to S-SCLs. The newly incorporated features appear to improve tear mixing and thereby the oxygen supply to the cornea, which results in reduced corneal edema.

Rho CR, Pandey C, Kim SY, Kim MS. Corneal swelling caused by conventional and new-design low-Dk soft contact lenses following a 10-day daily wear trial regime. Cont Lens Anterior Eye. 2013 Jul 31.

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