As noted below in this week's Quick Poll results, of the specialty lens options listed, most respondents indicated that they expect to see the most growth in the scleral lens category over the next 2-3 years. Scleral lenses have without question made a resurgence in the last several years, and I have even heard some practitioners state that scleral lenses are supplanting corneal GP lenses in their practices. Our next issue of Contact Lens Spectrum, out in October, will address some of these trends in much greater detail.

Bruce Bridgewater, OD passed away on September 1, 2012 after fighting a courageous battle with cancer. He was 54. A graduate of Ferris State University, College of Optometry, he served as a consultant for several contact lens manufacturers, including Paragon Vision Sciences, where he assisted in the development of novel contact lens technologies.

In 1998 he founded Acuity One which develops and manufactures custom contact lens products. The company's first product, the UltraVue hydrogel multifocal, was ultimately acquired by CooperVision, Inc. Dr. Bridgewater was widely published in ophthalmic literature, including Contact Lens Spectrum, and lectured extensively at domestic and international symposia. He also owned a private practice in Scottsdale, AZ.

Research shows that many contact lens wearers are significantly non-compliant in virtually all active steps involved in soft contact lens wear, including hand washing, case hygiene, lens disinfection, and following the recommended lens replacement schedule.

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, a new 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.

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.

You are invited the Academy version of Access Hollywood. The Optometric Historical Society's "Blast from the Past" presentation at this year's American Academy of Optometry will feature OHS Board member Dr. Morton Greenspoon. His subject will be: Lights, Camera, Contacts: A History of Contact Lenses in the Movie Industry.

Since 1951, Dr. Greenspoon has provided special effect contact lenses to the film industry. He changed Elvis Presley's eyes from blue to brown for his third movie, Flaming Star and provided Michael Jackson's wolf eyes for his transformation in the best selling video Thriller. Dr. Greenspoon received an Academy Award nomination for his work on Bram Stoker's Dracula. His most recent work has been in Pirates of the Caribbean and the Twilight Saga films.

In addition to sharing his experiences with some of Hollywood's brightest stars, he will share the story of one of the first film moguls who was a contemporary of Thomas Edison and an optometrist.

In 2008 Greenspoon received the American Academy of Optometry's Cornea and Contact Lens Section Founders Award for Innovation in contact lens science.

All attendees at the Academy meeting, guests and students are invited to this exciting presentation which will be held in Room 229A of the Phoenix Convention Center on Friday, October 26, at 10 am.

RegeneRx Biopharmaceuticals, Inc. has received a patent in Mexico for the treatment of dry eye syndrome and glaucoma, among other medical indications, using Thymosin beta 4 (TB4), or its isoforms and fragments, derivatives and analogs. The patent is projected to expire in July 2026. The Company has similar issued patents or pending applications in major countries throughout the world.

RegeneRx is focused on the development of a novel therapeutic peptide, Thymosin beta 4, for tissue and organ protection, repair and regeneration. RegeneRx currently has three drug candidates in clinical development for ophthalmic, cardiac and dermal indications, two strategic licensing agreements in China and the EU, and has an extensive worldwide patent portfolio covering its products.

Picked up this tip from one of my long term EW presbyopes. John successfully wears an approximately +2.50 high add soft multifocal for 30 day overnight wear without any corneal repercussions. His main problem is seeing the lenses for insertion at the one month new lens exchange. His novel approach is to remove the left lens one night (using the right eye to see the removal procedure) then next morning inserting the new left lens. The next evening he removes the old right lens (using the new left lens to see) and next morning puts in the new right lens. He never has to insert both lenses at the same time, saving the hassle of the bilateral blurry insertion common to hyperopes. He remarked that the only time he has to put both lenses in at the same time is in our office! Glad John has a good sense of humor...

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OCULAR SURFACE UPDATE
Katherine M. Mastrota, MS, OD, FAAO

Botulinum Toxin and Dry Eye, Part 3

In a case study series involving Sjogren's patients with dry eye and blepharospasm, Dr. Penny Asbell and her colleagues noticed a remarkable increase in tearing and a decrease in signs and symptoms of ocular surface disease in patients who received periorbital injections of botulinum toxin for the treatment of blepharospasm.¹ Although there is a paucity of well-designed, double-blind, controlled studies, botulinum toxin injection into the eyelids and eyebrows is generally considered as the treatment of choice for blepharospasm.²

Dr. Asbell proposes that the mechanical effects of the relief of blepharospasm — less shear pressure on the tear film — resulted in increased tearing in the study group. An alternate study suggests that although botulinum toxin A injections were effective in relieving blepharospasm in the study patients, it was not successful in treating dry eye syndrome.³ It is important to consider that subjects in the latter group were not characterized as Sjogren's patients and that the commercially prepared botulinum toxin was not the same as the former group (Dysport vs. BOTOX).

Finally, oral zinc and/or phytase supplementation has been shown to increase the degree and duration of botulinum toxin effect⁴ (commercially available by Rx as Zytaze) and administration of such may have a potentially meaningful role in the treatment of dry eye.

1. Spiera, H, Asbell, PA, Simpson, DM. Botulinum Toxin Increases Tearing in Patients with Sjogren's Syndrome: A Preliminary Report. J Rheumatol. 1997, 24(9):1842-1843.
2. Simpson DM, Naumann M, Blitzer A, et al. Practice Parameter: Botulinum neurotoxin for the treatment of movement disorders and spasticity: an evidence-based report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2008;70:1699-1706.
3. Horwath-Winter J, Bergloeff J, Floege l, Haller-Schober E-M, Schmut O. Botulinum toxin A treatment in patients suffering from blepharospasm and dry eye. Br J Ophthalmol. 2003 Jan;87(1):54-6.
4. Koshy JC, Sharabi SE, Feldman EM, Hollier LH Jr, Patrinely JR, Soparkar CN. Effect of dietary zinc and phytase supplementation on botulinum toxin treatments. J Drugs Dermatol. 2012 Apr;11(4):507-12.

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Communication Breakdown

When fitting daily disposable lenses we often extol the virtues of their simplicity, comfort, and ease of use to our patients. Since one of the reasons we may prescribe daily disposables is for improved compliance with lens replacement, we need to ensure that this is indeed occurring. By asking your daily disposable patients what solution they use (the answer should be none), you may soon realize they are re-using their lenses. Investigate whether they may be storing their lenses overnight, or whether they are using the solution to rinse before insertion. These practices may encourage further non-compliance and warrant re-education.

Since we tend to also emphasize the value of daily disposables to a patient by explaining they won't have to purchase a bottle of solution on a regular basis, let your patients know that they really don't need any solution at all. If a lens falls on the floor, in the sink, or otherwise out of their eye, it is safest and easiest to just throw it away and open a fresh lens. If they feel they must use solution to put the lens in initially, I advise them to use the blister pack solution rather than a bottled solution. You can also educate your staff on these guidelines, so that they don't erroneously hand out contact lens solution care kits to these patients and negate all the information you just emphasized to the patient. Control the solution conversation by educating patients on why they don't need it and how to deal with potential situations before they arise.

The purpose of this study was to evaluate fitting feasibility and efficacy of mini scleral contact lenses in moderate to severe dry eye patients.

A prospective interventional case series, this study included those patients with grades III and IV dry eye disease, whose symptoms could not be controlled by conventional treatments. Demographic data, UCVA, BSCVA were evaluated before fitting. Mini scleral lens fit was assessed by a single experienced practitioner and best corrected vision with mini scleral lens was assessed. After dispensing mini scleral lens, BCVA with mini scleral lens, and possible contact lens related problems were assessed in each visit. Questions regarding ocular comfort, frequency of artificial tear use and contact lens handling problems were asked in each follow up visit. For those who did not choose to wear lenses, the reason was asked. All data were analyzed using descriptive statistical tests.

Twenty eyes of 13 patients were fitted. Mini scleral lenses were dispensed for 19 eyes and the assessment of fit was either ideal (n=9) or acceptable (n=10). Seven patients got their lenses; four patients (seven eyes) were satisfied with their lenses based on decrease in discomfort and dry eye symptoms, decrease artificial tear need frequency and improvement in visual acuity during mean follow up period of 18.25 months (range: 15-20). None of the study patients were affected with any contact lens related complication.

Mini scleral contact lenses can be considered helpful in management of moderate to severe dry eye.

Alipour F, Kheirkhah A, Jabarvand Behrouz M. Use of mini scleral contact lenses in moderate to severe dry eye. Cont Lens Anterior Eye. 2012 Aug 16. [Epub ahead of print]

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