Article Date: 3/1/2008

NEWS spectrum

The second Global Keratoconus Congress (GKC) took place Jan. 25 to 27, 2008 in Las Vegas, drawing nearly 500 participants, including 375 registrants from 28 countries. More than 100 sponsors/exhibitors also attended.

Contact Lens Spectrum and the Lippincott, Williams & Wilkins Health Care Conference Group hosted the two-and-one-half day meeting, which focused on the latest diagnostic methods and treatments for keratoconus. The meeting included information for vision care professionals in all disciplines and offered 17.5 credit hours of continuing education accredited under COPE, NCLE and JCAHPO. The education committee was comprised of Craig Norman, FCLSA; Joseph Barr, OD, MS, FAAO; Ed Bennett, OD, MSEd, FAAO; Patrick Caroline, FAAO; Eef van der Worp, BSc Optom; and Carla Mack, OD, FAAO. The faculty provided a truly international snapshot of current diagnosis and treatment standards.

GKC speakers Loretta Szczotka-Flynn, OD, MS, FAAO; M. Cristina Kenney, MD, PhD; Charles McGhee, PhD, FRCS, FRCOphth; and Jan Bergmanson, OD, PhD.

Fundamentals

Charles McGhee, PhD, FRCS, FRCOphth, of New Zealand kicked off the education sessions with a discussion of what keratoconus is and how to diagnose it. He discussed the roles of genetics and eye rubbing and questioned whether the condition is truly ectatic.

Eef van der Worp moderated a session on The Importance of Topography Measurements in Keratoconus and Irregular Astigmatism with presenters Randy Kojima of Precision Technology/BE Enterprises; Pete Kollbaum, OD, PhD, FAAO; and Timothy McMahon, OD, FAAO. They discussed differences among placido and projection based topography systems, how to get the most accurate topography maps of irregular corneas and how to use the maps for fitting.

Dr. Mack moderated a session on contact lens designs for keratoconus. Daniel P. Ehrlich, MCOptom, DipCLP, from the United Kingdom discussed GP lens design for keratoconus. Mark André, FAAO, discussed when to consider soft and hybrid lenses for keratoconus and how to custom design them. The session wrapped up with an interactive panel discussion led by Pat Caroline, FAAO, and including participants Paul Rose, OD, FNZCLS; BW Phillips, Jr., FCLSA; S. Barry Eiden, OD, FAAO; and Randy Kojima. These experts gave their opinions on how to determine when you have a good fit for keratoconus with different lens designs. This same group later presented a second part to this interactive session that concluded the Fundamentals session.

In a Platinum Sponsor's Forum moderated by Keith Harrison, FCLSA, and sponsored by Bausch & Lomb Boston, Craig Norman, FCLSA, and Daniela Nosch, MSc, MCOptom of Germany, discussed how autofitting of contact lenses for keratoconus using fluorescein pattern simulation software may help streamline the fitting process. Dr. Rose presented a second Platinum Sponsor's Forum sponsored by Blanchard Contact Lens on new GP designs for irregular corneas, including the Rose K 2 IC.

General Sessions

The second day of the education program began with a research session moderated by Dr. Barr. M. Cristina Kenney, MD, PhD, discussed cellular changes associated with keratoconus, and Dr. McGhee explained how in-vivo confocal microscopy reveals alterations in ocular nerves in keratoconus. Jan Bergmanson, OD, PhD, discussed the entity and etiology of keratoconus and what causes the ectasia. The session ended with Loretta Szczotka-Flynn, OD, MS, FAAO, discussing which genes are associated with keratoconus development.

A Clinical Controversies session also moderated by Dr. Barr began with a discussion about whether eye rubbing really is a contributing factor in keratoconus presented by Charles Mc-Monnies, MSc, FAAO. Daniel R. Neal, PhD, discussed whether wavefront designed lenses helped improve vision for keratoconus patients. This session concluded with Karla Zadnik, OD, PhD, discussing the personalities of patients who have keratoconus, why they behave the way they do and how practitioners can better manage them.

Dr. Bennett moderated a Free Papers session that began with L. Gina Sorbara, OD, MSc, FAAO, who discussed videokeratoscopy in fitting GP lenses for keratoconus and pellucid marginal degeneration. Jessica Horne Mathew, OD, presented information about the epithelium in keratoconic corneas. Edward Boshnick, OD, FAAO, discussed using 2-phase hybrid lens designs for PMD and surgically-induced irregular corneas. Jennifer Fan, BHB, MBCh, of New Zealand added to the discussion about in vivo confocal microscopy and what it has revealed about keratoconic corneas. Finally, Antonio Calossi, OD, FBCLA, of Italy discussed a relatively new idea of using overnight orthokeratology to treat keratoconus.

Perry Rosenthal, MD; Don Ezekiel, AM, OD, of Australia; Christine Sindt, OD, FAAO; and E. Simone Visser, MSc, of The Netherlands participated in a session about scleral lens fitting. They discussed the differences between corneo-scleral, mini-scleral, semi-scleral and scleral lens designs, when and how to fit them and patient response.

The first day of General Sessions concluded with Ezra Maguen, MD, discussing different types and causes of irregular astigmatism.

The final day of the General Sessions began with David J. Schanzlin, MD, discussing the many different surgical approaches to keratoconus.

A second Free Papers session followed in which Kenneth McCandless, OD, discussed when to refer keratoconus patients for Intacs (Addition Technology). Buddy Russell, FCLSA, next discussed contact lens management following Intacs implantation. Tomas Pförtner, PhD, of Argentina discussed findings using Ocular Response Analysis in patient who have corneal ectasias. Steve Byrnes, OD, FAAO, provided fitting tips for mini-scleral contact lens designs for keratoconus and irregular astigmatism. The final paper by Trevor Sherwin, BSc, PhD, of New Zealand considered whether keratoconus recurs following penetrating keratoplasty.

Giancarlo Montani, OD, of Italy moderated a session on contact lens fitting of irregular astigmatism, including posttrauma presented by Louise Sclafani, OD, FAAO; post-surgery presented by Michael A. Ward, MMSc, FAAO; and post-corneal disease presented by Dr. Nosch.

The final education general session dealt with keratoconus and irregular astigmatism patient issues moderated by Cathy Warren, RN, of the National Keratoconus Foundation. Clarke Newman, OD, FAAO, and Dr. Mack held a lively dual discussion about how to code contact lens management of keratoconus and irregular astigmatism.

Additional Highlights

This year's GKC meeting featured several new hands on workshops held by GKC sponsors Veatch Instruments, Blanchard, SynergEyes, Essilor, Menicon and Valley Contax. The GKC sponsors, also including Bausch & Lomb, the National Keratoconus Foundation and the CLMA, also held breakfast seminars before the education sessions on Saturday and Sunday. In addition, the conference featured 30 scientific posters on many subjects related to keratoconus and irregular corneas.

Audio CDs of the conference are available for purchase at www.GKCongress.com.

The GKC planning committee announced during the meeting that it will hold another conference next year, but the 2009 event will include a broader scope of specialty contact lens topics including multifocal and toric lens options. The next meeting will be held in January 2009 and is expected to take place in Las Vegas.

WAL-MART AND 1-800 CONTACTS FORM STRATEGIC ALLIANCE
Wal-Mart Stores, Inc. has entered into a long-term alliance with 1-800 Contacts, and the companies are expected to integrate store, Internet and phone service sometime this fall. 1-800 Contacts and Wal-Mart officials say that the agreement is designed to create efficiencies across their call centers, Web sites, purchasing and distribution efforts, which will result in customer savings they predict could reach $400 million over the next three years.
Although details of how the alliance would involve the 3,000 eyecare practitioners in Wal-Mart Stores and Sam's Clubs were not detailed, the companies said that by offering greater accessibility and savings on contact lenses, customers would find it easier to replace lenses according to the practitioner's recommended schedule, which could result in improved eye health.
For the Record

On the February issue in the No-Fee CE article "Hydrogel and Silicone Hydrogel Lens Care," by Susan J. Gromacki, OD, MS, FAAO, TearGlyde, an ingredient of Alcon's Opti-Free Replenish, was misspelled as Tear-Glide. Contact Lens Spectrum regrets the error.

Patent Granted for Keratoconus Technology

■ TruForm Optics, Inc., announced it has received a patent for its Quad Technology, which is used specifically for manufacturing its QuadraKone keratoconus contact lens design.

QuadraKone is exclusively manufactured in Paragon HDS, Paragon Thin and FluoroPerm materials. QuadraKone, with the patented Quad Technology, features a customized and symmetrical fit for keratoconus patients who have asymmetric eyes, which allows practitioners to fit irregular corneas by treating each of the four quadrants separately.

"With QuadraKone, practitioners no longer have to accept excessive inferior edge clearance, typical of traditional keratoconus lens designs," said Jan Svochak, vice president of TruForm Optics. "This level of customized GP lens manufacturing for irregular corneas will serve keratoconus patients worldwide and we're elated that we can give people the gift of sight."

INDUSTRY BRIEFS
■ A new study funded by Vistakon and appearing in Current Medical Research and Opinion found that patients who wore contact lenses made with senofilcon A (Acuvue Oasys) experienced less discomfort while wearing the lenses than they did while wearing no lenses or while wearing their usual contact lenses in a controlled adverse environment. The authors suggest that the senofilcon lens material could help wearers avoid contact lens dropout.

Bausch & Lomb and CrystalGenomics Inc. have announced a joint research and development agreement to study potential new treatments for inflammatory ophthalmic diseases. CrystalGenomics will provide new pharmaceutical candidate compounds while B&L will develop product formulations, conduct preclinical and clinical studies and bring the products to market.

■ The World Glaucoma Association and the World Glaucoma Patient Organization will hold the first annual World Glaucoma Day on March 6, 2008. The day will be marked by awareness and educational events organized by glaucoma institutions and local patient support groups worldwide. Visit www.wgday.net for more information.

Advanced Medical Optics, Inc. has entered into an agreement with Bausch & Lomb regarding AMO's U.S. Patent titled, "Fluid Management Systems with Vertex Chamber" (Patent No. 6,059,765) and its foreign counterparts, all of which relate to peristaltic pump fluidics used in phacoemulsification systems. B&L will pay AMO a royalty under the agreement.

■ A new Optometric Nutrition Society (ONS), led by Jeffrey Anshel, OD, has recently launched with a goal to make disease prevention, including lifestyle modification, attention to dietary intake and micronutrient supplementation, more of a focus of primary vision care. ONS will offer members a quarterly newsletter and will hold an annual meeting that will include COPE and Optometric Educational Institution approved continuing education with a nutrition focus. For more information on this non-profit organization, visit www.optometricnutritionsociety.org.

Bausch & Lomb has acquired Eyeonics, Inc., a privately held ophthalmic medical device company. Eyeonics, which manufactures the Crystalens intraocular lens, now operates as a wholly-owned subsidiary of B&L.

■ The American Optometric Association Paraoptometric Section now offers a Library of Education Modules. The Library consists of six education modules on practice management, anatomy and physiology, ophthalmic dispensing, special procedures, soft contact lens wear and care and optical dispensing. More information is available at www.aoa.org.

Fortune magazine has named Alcon, Inc. to its "100 best Companies to Work For" list for the 10th consecutive year. This year Alcon advanced five spots on the list to 60th place.

Prevent Blindness America held its third annual Eyes on Capitol Hill campaign in Washington, DC from Feb. 12 to 14. The delegates represented more than 20 states across the country. The program is designed to give constituents who have been affected by vision loss an opportunity to discuss vision issues with their respective government representatives. In addition, delegates also learn how to become effective advocates for vision health in their own state after returning home.

Barry J. Barresi, OD, PhD, has been appointed executive director of the American Optometric Association, effective July 1. Dr. Barresi is currently president of the New England Eye Institute and vice president of clinical affairs at the New England College of Optometry. He replaces Michael D. Jones, OD, who is retiring on June 30 after serving as the AOA's executive director for 10 years.

■ The Vision Council of America and the Sunglass Association of America announced that they were merging at the recent VCA Executive Summit. A new Sunglass and Reader Division will be created within VCA to provide the infrastructure, resources and support needed to grow this area of the industry, according to the VCA.

■ The American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel has created a new Category III CPT code for NeoVista, Inc.'s radiation therapy for the treatment of wet age-related macular degeneration. The new CPT code (0190T) will become effective July 1, 2008 and will be used in conjunction with the code for performing a basic posterior vitrectomy (67036).

Lifecore Biomedical, Inc. has renewed its manufacturing agreement with Alcon Pharmaceuticals, Ltd., a subsidiary of Alcon Inc. Lifecore supplies hyaluronan to Alcon for use in Viscoat ophthalmic viscoelastic solution, which doctors use in eye surgeries such as cataract extraction and intraocular lens implantation. The new agreement extends through December 31, 2013.

Wedgewood Pharmacy has announced that it will continue to provide Avastin (Bevacizumab) to retinal specialists and ophthalmologists who request it for their patients. The announcement is in response to Avastin's manufacturer, Genentech's decision to stop supplying Avastin directly to compounding pharmacies as of January 1.

B&L Names New Chairman/CEO

Bausch & Lomb has named Gerald M. Ostrov as chairman and chief executive officer, effective as of late January. Most recently, Mr. Ostrov served as company group chairman, Worldwide Vision Care for Johnson & Johnson, where he led the company's global Vision Care businesses from 1998 to 2006.

Current B&L Chairman and CEO Ronald L. Zarrella will retire this month and serve as chairman emeritus.

"It's been a privilege to serve as Bausch & Lomb's chairman and CEO since 2001," said Mr. Zarrella. "Jerry has extensive experience in ophthalmic businesses and consumer marketing, and is the ideal leader to take Bausch & Lomb into a new era of growth."

"It's an honor to lead Bausch & Lomb into a growth period, one that we believe will be marked by considerable success across the vision care, pharmaceutical and surgical businesses," said Mr. Ostrov. He continued, "Warburg Pincus' commitment to a longterm investment horizon, and the collaborative relationship it has quickly built with Bausch & Lomb, is empowering the company to grow."

Alcon's New Packaging Encourages Annual Exams
"See Your Doctor Yearly" now appears as a banner on all of Alcon's Opti-Free Replenish packaging, including starter kits, to remind patients of the importance of regular eye exams.
Both the American Academy of Ophthalmology (AAO) and American Optometric Association (AOA) recommend regular eye exams for everyone; the AOA specifically recommends that contact lens wearers receive more frequent exams. Alcon officials say that expanding the prevalence of this public education message on Opti-Free Replenish packaging and consumer communication vehicles is one way Alcon helps eyecare practitioners address this challenge.

Analysis Reports Stable ECP Soft Lens Margins

Arecent analysis by ABB♦Con-Cise indicates that independent eyecare practitioners continued to earn a 45 percent gross profit margin on sales of soft contact lenses during the fourth quarter 2007. This profit margin has remained virtually unchanged over the past eight quarters, according to the report.

The report also indicated that practitioners earn the identical profit margin from sales of silicone hydrogel lenses as they do from the sales of HEMA-based lenses. The highest profit margins are earned on sales of soft toric and multifocal lenses, while lower margins are earned on sales of daily disposables and colored lenses. Soft torics account for 19.3 percent of soft lens purchases, but 21.3 percent of practitioner retail sales and 23.7 percent of gross profits, according to the analysis.


Vistakon Unveils New Online Program

Eyecare practitioners will now have online access to their invoices and monthly statements from Vistakon with a new e-invoicing program. Under the new program, which was developed by Vistakon's Customer Development Group, practitioners can stop receiving daily paper invoices and weekly invoice summaries. The new program also provides doctors and staff an opportunity to reprint past invoices and monthly statements and to improve reconciling their account.
"Ofices have already seen improvements through more intuitive monthly statements," says Jack Rawle, senior director for Vistakon Customer Development. "We expect to make even more drastic reductions in paper waste later this year."


Contact Lens Spectrum, Issue: March 2008