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Sunday, November 7, 2010  
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Research Review
Loretta B. Szczotka-Flynn, OD, PhD, MS, FAAO

In a recent paper in IOVS, the topographic and tomographic properties of forme fruste keratoconus were presented (Saad and Gatinel IOVS 2010). This paper lends more evidence that in order to properly screen for subtle keratoconus, or corneas at risk for ectasia after LASIK, Placido-based anterior topography systems should not be used. The authors retrospectively reviewed 143 eyes separated into normal, forme fruste keratoconus, and keratoconus with various topography and tomography indices to assess the usefulness of the data to discriminate between the three groups. They found that the maximum posterior central elevation and indices derived from the "percentage of thickness increase" from the thinnest point to the periphery were the most important contributors to the discriment function.

This solidifies what we and many othe cornea/refractive practices already do when screening for subtle corneal disease. I have shifted to looking at abnormal posterior corneal elevation as my first index for forme fruste keratoconus. Once the diagnosis is made, and contact lens fitting is my main objective, then anterior Placido-based topography is sufficient.

For a good review of modern corneal topographers, see Dr. Michael Twa's 2009 Contact Lens Spectrum article at

Saad and Gatinel. Topographic and Tomographic Properties of Forme Fruste Keratoconus Corneas. IOVS 2010; 51; 5546-5555.

Materials & Designs
Ronald K. Watanabe, OD, FAAO

The hot topic in GPs these days is scleral lenses. The October Annual GP Issue of Contact Lens Spectrum has a great fitting guide for scleral lenses co-authored by Drs. Jason Jedlicka, Lynette Johns, and Steve Byrnes. They differentiate between corneo-scleral, mini-scleral, and full scleral lenses, each of which has different indications and fitting goals.

Corneo-scleral lenses are the smallest in diameter, usually less than 15.0mm. They are meant to rest on the cornea as well as the sclera, and work well on normal and mildly irregular corneas. However, they are not good choices for highly diseased corneas that cannot tolerate bearing by the contact lens.

Mini-scleral and full scleral lenses are larger and can be over 20mm in diameter. They are intended to vault the cornea and rest entirely on the sclera, and so are better choices for highly irregular and diseased corneas where bearing of the contact lens can create problems. Bypassing the cornea eliminates the challenges of fitting irregular corneas, but the larger the scleral lens you use, the more difficult it can be to adjust for scleral toricity and conjunctival irregularities.

Read this article to learn more about scleral lens fitting for your patients, http://www.clspectrum.com/article...


New SiHy Material Gets FDA Approval

Contamac US announced U.S. Food and Drug Administration (FDA) clearance of the new silicone hydrogel polymer material Definitive, now available through several partner laboratories including Art Optical, Metro Optics, Unilens and X-Cel/Walman.

Each of the respective manufacturing laboratories will introduce specialty contact lenses produced in their own designs. Alcon's Opti-Free Replenish Multi-Purpose Disinfecting Solution also will be featured as the preferred contact lens solution for the rollout of the new lens designs by Contamac's partner laboratories.

Definitive, which has been available globally for nearly two years, has sold more than 500,000 units prior to receipt of this recent FDA clearance.


VSP, B+L Join to Offer Rebate Program

VSP Vision Care and Bausch + Lomb are now providing additional rebates to VSP members. As of Nov. 1, members who purchase an annual supply of B+L lenses from one of VSP's 27,000 network providers will receive an additional rebate amount on top of the current national rebate program offered by B+L.

For more information about the rebate program and to download a copy of the rebate form, visit www.specialoffers.vsp.com/bausch.

Research Grants Awarded

Vistakon and the American Optometric Foundation (AOF), announced recipients of the Vistakon Ezell Fellowship program and AOF-Vistakon Research Grants.

The recipients of the Vistakon Ezell Fellowships are Nicole Putnam, MS University of California-Berkeley, School of Optometry; and Johanna Tukler-Henriksson, BS, University of Houston, College of Optometry. Each will receive $8,000 toward their graduate education and $750 in travel grants to the annual meetings of the American Academy of Optometry and the Association for Research in Vision and Ophthalmology.

The recipients of the AOF-Vistakon Research Grants are Loretta Szczotka-Flynn, OD, PhD and Ilene Gipson, PhD Department of Ophthalmology & Vision Sciences, University Hospitals Case Medical Center and Schepens Eye Research Institute, Harvard Medical School for "Uncovering the Role of Mucins in Contact Lens Induced Corneal Infiltrates,"($25,00 Grant). The $10,000 Grant was awarded to Alex Hui, OD and David McCanna, BSc, MA, PhD Centre for Contact Lens Research, School of Optometry, University of Waterloo for "Engineering of Novel Contact Lens Materials for Ciprofloxacin Drug Delivery." These award winners were selected by an international panel of scientists from many qualified applicants.

Eyecare Summit Held in Rome

European eyecare practitioners gathered in Rome on Oct. 28-30 for the Ciba Vision European eyeLife Summit. The meeting brought together more than 750 leading ECPs, plus world-renowned experts, to explore key conditions and developments in eyecare research and products.

Under the theme of "Learn. Lead. Succeed Together," the summit served as a forum for peer-to-peer learning, arming attendees with the most up-to-date information and tools to help them identify and care for differing patient needs.

The varied program was divided into six main seminars over the two days covering key topics including: myopia control and the research behind optical treatments that might be used to address the condition; compliance and the key tools for building a successful eyecare business; emerging trends in contact lens prescribing and advances in contact lens technology; and antimicrobial innovation in lenses and lens cases and a look at the future of eye care.

Global Specialty Lens Symposium, January 27-30, 2011, Paris Hotel & Casino in Las Vegas

Plan now to attend the Global Specialty Lens Symposium in January 2011. With an expert international faculty and a CE-accredited agenda, the 2011 GSLS will include insightful presentations by experts in the field, hands-on demonstrations of cutting-edge products as well as scientific papers and posters. Look for more detailed information in future issues of Contact Lens Spectrum and online at www.GSLSymposium.com.

New CCLR Director Named

Dr. Lyndon Jones has been named the Director of the Centre for Contact Lens Research at the University of Waterloo, succeeding its founding director, Dr. Desmond Fonn who is retiring.

Dr. Jones graduated in Optometry from the University of Wales in 1985 and gained his PhD from Aston University in 1998. He holds three of the higher clinical awards granted by the College of Optometrists in the United Kingdom, is a Fellow of the American Academy of Optometry, and holds a Diplomate from the Academy's Section on Cornea and Contact Lenses. Dr. Jones is also a Fellow of the International Association of Contact Lens Educators (IACLE). He is the current Chair of the Research Committee of the American Academy of Optometry, a Topical Editor for the journal Optometry & Vision Science and a founding member of the Ocular Surface Society of Optometry.

Dr. Jones, who currently serves as the Associate Director of the Centre, will begin serving as director on Jan. 1, 2011.

WHO Reports Reduction in Worldwide Number of Visually Impaired

According to new preliminary data released by the World Health Organization (WHO) and reported by Vision 2020, worldwide, 285.3 million people are visually impaired. In the past 10 years, Vision 2020: The Right to Sight (a joint global initiative of the International Agency for the Prevention for Blindness (IAPB) and WHO) has contributed to a 10% reduction in the number of visually impaired people worldwide, which was announced at a meeting hosted by the WHO in Geneva earlier this month, as part of World Sight Day activities. This is set against a growing global population and an 18% increase in the world's population aged over 50, those most vulnerable to visual impairment. The number of blind people has decreased by 5.2 million (from 45 million in 2004 to 39.8 million), representing a decline of 13% in the last six years.

Challenges remain if Vision 2020 is to achieve its goal of eliminating the main causes of avoidable blindness by the year 2020. Among these are that nearly half of the cases of visual impairment are due to uncorrected refractive errors (such as nearsightedness), in most of which cases normal vision could be restored with eye glasses. While blinding infectious diseases such as trachoma and onchocerciasis are on target for global eradication by 2020, chronic causes of blindness, such as cataract, AMD and diabetic retinopathy are growing in prevalence worldwide, even in the developed world.

This month at www.siliconehydrogels.org: the results of the 2009 International Contact Lens Prescribing Survey, the impact of UV-absorbing silicone hydrogel lenses, fitting silicone hydrogels for patients with sub-optimal endothelial cell function, and our synopsis of silicone hydrogels at the 2009 American Academy of Optometry meeting.
Editor's Commentary
Jason J. Nichols, OD, MPH, PhD, FAAO

Combination products (e.g., contact lenses with a pharmaceutical incorporated) are being developed by most major contact lens companies. Some in the field are speculating that we could see one introduced sooner than you might think. Are you ready to incorporate these lenses into your practice? If you think about it, they will change the way in which we care for our contact lens patients in many waysófollow-up care and procedures, education, and feesójust to list a few. Please look for future editorial content on these lenses as we anticipate their transition into clinical practice.

CLToday Quick Poll


Reader Commentary

Soft lens removal

I have always found it difficult to teach new soft lens wearers with long fingernails to remove their lenses. One of my patients with very long nails discovered that wearing surgical gloves made removal very easy. It is now not uncommon for us to send people home with a new set of gloves with their new lenses.

R. Hugh Brumley, OD Lake Grove, Oregon


Tear Proteomics in Keratoconus

The purpose of this work was to identify potential tear-film based proteins expressed in keratoconus.

Recruited subjects were normal GP contact lens wearers, keratoconus subjects wearing GP contact lenses, and keratoconus subjects without contact lenses. Subjects wearing soft lenses or having previous ocular surgeries were excluded from participating. Approximately 5 microliters of tears were sampled from both eyes of each subject using glass microcapillaries. Additional testing included a brief history, visual acuity, slit lamp examination, and topography. Proteomic analyses used to compare samples included Bradford assays, cytokine arrays, SDS-PAGE, and mass spectrometry.

Forty-four subjects were enrolled in the study including 20 normals (GP wearers-controls), 18 with keratoconus and wearing GPs, and six with keratoconus (non-lens wearers). Across all proteomic approaches, several proteins were identified as possibly being unique to keratoconus. Increased expression of matrix metalloproteinase-1 (MMP-1) was found in keratoconus subjects with and without GP contact lenses (p=0.02). Unique proteins more associated with keratoconus included several keratins, immunoglobulins alpha and kappa, precursors to prolactin, lysozyme C, and lipocalin.

Initial analyses indicate that keratoconus may be associated with the differential expression of several proteins. Further testing is needed to determine any causal relationship or correlation with the etiology of this condition.

Pannebaker C, Chandler HL, Nichols JJ. Tear proteomics in keratoconus. Mol Vis. 2010;16:1949-57

Important Links:
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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