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Sunday, December 15, 2013  
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Editor's Commentary - Jason J. Nichols, OD, MPH, PhD, FAAO
Contact Lens Spectrum's annual meeting—the Global Specialty Lens Symposium—is just around the corner. Set in Las Vegas from January 23 to 26 (2014), the venue is packed full of a wide range of contact lens topics, from our preconference fundamentals courses to our main conference agenda. Topics span virtually all aspects relevant to the modern contact lens practice today. Register today so you don't miss out on this fantastic event (www.GSLSymposium.com).

American Academy of Optometry 2014 Call for Program Submissions

How can you participate in the American Academy of Optometry's upcoming 93rd annual meeting in Denver, Colorado from November 12 to 15, 2014? If you would like to present a lecture or workshop, a scientific paper or poster, review the information below.

The Lectures and Workshops Committee invites you to submit up to three course proposals for consideration for Academy 2014 Denver. The submission window will be open January 1 - February 1, 2014. To get more information, visit the Call for Courses webpage.

The Academy's Scientific Program offers scientists, educators, and clinicians the opportunity to exchange the latest information in optometry and vision science in two formats, research paper presentations and scientific posters. Please visit the Scientific Program webpage for more information or to download resources on how to construct your Scientific Program abstract. Please note that you do not need to be an Academy member in order to participate.

Nominations for the 2014 Annual Awards are due April 1, 2014. Nominations must be received from an Academy Fellow, with an explanation of why the nominee is particularly deserving of the award for which the nomination has been made. A letter seconding the nomination must come from another Academy Fellow. These documents, as well as a CV of the nominee, should be emailed to Helen Viksnins at HelenV@aaoptom.org. For more information and a list of Academy Awards, visit the Awards webpage.

In May 2014 the program preview will be available and registration opens. Look for more information on Academy 2014 Denver at http://www.aaopt.org.

Don’t Miss the 2014 Global Specialty Lens Symposium – January 23 - 26
Register today 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. Brought to you by Contact Lens Spectrum, this 3 1/2 day comprehensive meeting focuses on the latest techniques and technologies for the successful management of ocular conditions using today's specialty contact lenses. It includes 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 and registration.
Safilens to Launch Open 30 for German Market at Opti 2014

Safilens, an Italian contact lens company, will be at Opti 2014 for the German market launch of Open 30 – the first monthly silicone hydrogel lens based on the patented Fusion Technology.

Open 30 is the outcome of a three year research project and was presented for the first time at MIDO 2013. The goal was to develop a contact lens that has minimal side effects, and according to the company, this objective was reached by using an innovative material Filcon V – the patented bio-silicone hydrogel the lens is made of – and also by carefully analyzing each aspect of the interaction between the contact lens and the anterior segment to eliminate the most common causes of “rejection” with leading-edge solutions.

The Open system consists of the contact lens, all-in-one Reload solution and sonic wave generator. With Fusion Technology, the lens benefits from the combined action of hyaluronic acid (HA) and Tamarind Seed Polysaccharide (TSP); this synergy increases the hydrating, lubricating, protective and cellular regeneration effect of the two single polymers, and promotes tear film stability. Open Reload is an all-in-one solution containing a highly-concentrated Fusion co-polymer based on a superior quality hyaluronic acid, a pharmaceutical-grade acid that does not use raw materials of animal origin or organic solvents, for safety, stability and minimal risk of side effects. The sonic wave generator assures that any deposit build-up is removed and HA and TSP are reabsorbed during the night, for a regenerated lens every day.

In 2005 Safilens patented the first hyaluronic acid releasing contact lenses. This was the first step toward the development of the Safe-Gel line, a complete range of contact lenses and solutions. In 2009 Safe-Gel contact lenses obtained an American patent and are currently marketed in the United States under the name Safigel. Now, the company is focusing on its patented Fusion Technology, based on a bio-copolymer composed of hyaluronic acid and TSP, two natural substitutes for tear film.

Shifted IOL
Bo Lauenborg, OD, Aarhus, Denmark

A 31 year-old female patient came to our clinic with symptoms of shadows and blurry vision in her right eye. In her childhood, the patient had undegone surgery for congenital cataract and had IOL implants in both eyes. Examination was difficult due to a small displaced and distorted pupil, but I suspected that the IOL had maybe ever so slightly shifted position. Although in comparing to previous photos taken during contact lens fitting it was difficult to see any difference, a referral to an ophthalmologist was arranged. The patient returned two days later while waiting for her ophthalmology appointment, reporting a sudden drop in vision. Examination revealed a dislocation of the IOL to such a degree that it could now no longer be seen within the pupil. After talking directly with the local hospital ophthalmology department, an immediate appointment was organised.

We thank Dr. Lauenborg for this image 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 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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Materials & Designs
Ronald K. Watanabe, OD, FAAO

Reverse Geometry

Reverse geometry (RG) has become a more frequent lens design feature for various contact lens options. Most commonly, RG is used in orthokeratology GP designs that allow lenses with very flat central curves to maintain centration on the cornea, an important requisite for successful treatment. Another growing use of RG is in the limbal area of scleral contact lenses. In this case, RG allows the scleral lens to achieve adequate limbal clearance, an important fitting characteristic to ensure long-term health of the cornea. RG is even used in some keratoconus corneal GP designs to attain a good mid-peripheral fitting relationship.

The most logical use of RG is with surgically induced oblate corneas, such as post-LASIK or post-penetrating keratoplasty. RG GP lenses are available through most GP laboratories and can provide a close fitting relationship for this type of cornea. Several soft RG options are also available from Metro Optics, Visionary Optics, X-Cel Contacts, and others. These options provide good stability and comfort, and they can deliver good vision even when there is central corneal irregularity. For highly oblate corneas where standard soft lenses do not fit acceptably, a reverse geometry soft lens may be a good answer.

As this is my final column for Contact Lenses Today, I would like to thank the CL Today staff for all of their support, and most of all thank the readers who felt my column was valuable enough to spend some time on every two weeks. Happy Holidays to all!

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

Acanthamoeba Keratitis Revisited

The outbreak of Acanthamoeba keratitis (AK) first reported a few years ago has been formally evaluated by federal agencies and universities to establish the risk factors for poor outcomes. They conducted a retrospective, population-based case series of 116 patients with AK and collected data via a medical record review by diagnosing ophthalmologists and by phone interviews with patients.

The vast majority of patients in their series (93.3%) wore contact lenses. The median time from symptom onset to care seeking was two days, whereas the median time from symptom onset to diagnosis was 27 days. Keratoplasty was performed in 27 of 81 patients and was about five times more likely in patients >40 years old. Patients with ring infiltrates were 40 times more likely to proceed to keratoplasty and patients with any sign of stromal invasion were 10 times more likely to proceed to keratoplasty. Ring infiltrates also predicted worse visual acuity, with a three times increased risk of best corrected visual acuity <20/200.

This data reflects what we have known for years, that AK remains challenging to diagnose. Consequently, patients with advanced disease are more likely to have poor outcomes, such as worse visual acuity and progression to keratoplasty.

Ross J, Roy SL, Mathers WD, Ritterband DC, Yoder JS, Ayers T, Shah RD, Samper ME, Shih CY, Schmitz A, Brown AC. Clinical Characteristics of Acanthamoeba Keratitis Infections in 28 States, 2008 to 2011. Cornea. 2013 Dec 6. [Epub ahead of print]

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Debridement-Scaling: A New Procedure That Increases Meibomian Gland Function and Reduces Dry Eye Symptoms

The purpose of this study was to evaluate whether a new in-office procedure, the mechanical debridement-scaling of the line of Marx (LOM) and keratinized lid margin, improves meibomian gland (MG) function and reduces dry eye symptoms.

Twenty-eight patients symptomatic for and diagnosed with evaporative dry eye (16 test patients and 12 controls), who also evidenced anteroplacement and a thickened LOM, were enrolled and consented. Symptoms were evaluated with the Standard Patient Evaluation of Eye Dryness questionnaire. The MG function was evaluated with the standardized MG function evaluator. The LOM was stained with lissamine green (Odyssey Medical, TN) for evaluation. For the test group only, the stained LOM and the entire width of the keratinized lower lid margin were debrided-scaled using a stainless steel, foreign body, golf club spud (Hilco Wilson Ophthalmics, Plainville, MA). All the patients were monitored for change in symptoms and MG function approximately 1 month later.

The mean ages of the patients were 55.9 ± 15.0 years (test) versus 53.7 ± 15.3 years (control). There was a significant improvement in the symptoms and MG function 1 month post-debridement-scaling in the test group. The controls evidenced no significant change in either parameter. Symptoms: baseline mean pre-debridement-scaling: 13.4 ± 4.6 (test) versus 13.9 ± 5.5 (control); 1 month post-debridement-scaling: 10.5 ± 3.8 (test, population level statistic < 0.0001) versus 14.3 ± 7.5 (control, population level statistic > 0.05). Number of functional MGs: baseline mean pre-debridement-scaling: 2.6 ± 1.3 (test) versus 2.7 ± 1.5 (control); 1 month post-debridement-scaling: 3.8 ± 1.4 (test, P = 0.0007) versus 2.4 ± 1.1 (control, P > 0.05). Only data for the right eye are reported.

The authors concluded that the debridement-scaling of the LOM and lower lid margin provides statistically significant symptom relief and improvement in the MG function. The novel procedure should be considered in the management of MGD and evaporative dry eye.

Korb DR, Blackie CA. Debridement-scaling: a new procedure that increases meibomian gland function and reduces dry eye symptoms. Cornea. 2013 Dec;32(12):1554-7. doi: 10.1097/ICO.0b013e3182a73843. Source *TearScience Inc, Morrisville, NC; and †Korb Associates, Boston, MA.

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