Article Date: 3/1/2007

News Spectrum

News Spectrum

GKC Educates Hundreds

The first Global Keratoconus Congress (GKC), which took place from Jan. 26 to 28 in Las Vegas, NV, drew more than 500 participants including 400 registrants from 30 countries, plus 100 sponsors and exhibitors representing 31 companies.

Contact Lens Spectrum and the Lippincott, Williams & Wilkins Health Care Conference Group hosted the two-and-one-half day meeting that focused on the latest diagnostic and treatment methods for keratoconus. GKC provided international insights and access to the most advanced products and methods used in treating keratoconus. The educational program provided information for vision care professionals in all disciplines with both surgical and non-surgical options, offering 17.5 hours of COPE, NCLE and JCAHPO continuing education credits.

Session Highlights

Fundamentals

The first day of the educational session focused on fundamentals of keratoconus. The program began with Jay Krachmer, MD, discussing how older patients may not continue to progress in keratoconus due to their cornea becoming more rigid.

Joe Barr, OD, MS, FAAO, next discussed keratoconus diagnosis and key symptoms, touching on data from the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) study. He shared his theory that keratoconus is probably genetic (13.5 percent of CLEK patients had family history) with eye rubbing as a contributing factor. Dr. Barr also discussed whether keratoconus is actually a non-inflammatory disease and that Fleischer's ring isn't really a ring - the iron deposition extends out to the periphery.

Tim McMahon, OD, FAAO, discussed topography analysis of keratoconus. In addition to explaining different types of topography maps, Dr. McMahon revealed that keratoconus cones develop in all shapes and locations, including 10 percent to 12 percent located above the horizontal meridian. Because of this, he echoed Dr. Barr's idea that the classical terms nipple, oval and globus may be obsolete.

Eef van der Worp, BSc Optom, from the Netherlands, moderated a session on keratoconus lens designs that included Alan P. Saks, MCOptom, FAAO, of New Zealand, Mark Andr�, FAAO, Pat Caroline, FAAO, Michael Wyss, dipl. Augenoptiker, FAAO, of Switzerland, and Michael Ward, MMSc, FAAO.

Dr. Saks reviewed corneal GP lens designs for keratoconus, suggesting that practitioners get to know a few keratoconus designs intimately and stressing that you order your diagnostic lenses from the same manufacturer that made your trial set.

Mark Andr� discussed the somewhat controversial topic of soft lens designs for keratoconus, indicating that although this isn't his first choice, it can be the only choice for some patients.

Pat Caroline explained how to fit hybrid lenses for keratoconus, stressing that hybrid lens fitting is counterintuitive. Specifically, the lenses must be fit steep to prevent lens tightening. He also explained that hybrids work best for central cones.

Michael Wyss discussed large diameter GP designs. He recommended that you avoid apical bearing, make sure that mini scleral lenses move a little to avoid total adherence and instruct patients use protein removers when caring for the lenses.

Michael Ward discussed fitting piggyback lens systems for keratoconus, even if used as an aid to GP adaptation. He stressed the importance of using the highest-Dk combination possible.

Hans Bleshoy, PhD, of Denmark, Richard Lindsay, BscOptom, of Australia and Mark Soper, FCLSA participated in a panel discussion about problem solving in fitting keratoconus patients.

Pat Caroline moderated a panel discussion among Paul Rose, OD, FNZCLS, of New Zealand, Frank Widmer, OD, of Germany, William Winegar, FCLSA, and Christine Sindt, OD, FAAO, on keratoconus video case histories. The panel members discussed fitting methods for early to severe keratoconus, how much apical touch is acceptable, how to avoid late-onset tightening with semiscleral designs and when to use piggyback or hybrid designs, among other fitting considerations. The panel also debated whether axial or tangential maps are best to use and whether it's valuable to map the patient in upgaze to center inferior cones. They furthermore discussed the use of quadrant specific lens designs, which are lenses that allow you to customize the design for each quadrant to better fit the cone and are currently fit mainly in Europe.

General Sessions

Anthony Nesburn, MD, moderated the session What Do We Know about Keratoconus? that included M. Cristina Kenney, MD, PhD, Yaron Rabinowitz, MD, and Eberhard Spoerl, PhD, of Germany.

Dr. Kenney presented her research on corneal cells. She related that mitochondrial DNA of keratoconus patients has higher deletions and mutations than that of normal corneas. She theorized that keratoconic corneas undergo oxidative stress, which contributes to keratoconus pathogenesis. Her research also indicates that keratoconus does have a genetic component, with multiple genes involved in the common oxidative stress pathway.

Dr. Rabinowitz related his search for a molecular marker for keratoconus. He noted that the aquaporin 5 gene, which is a water transport gene related to wound healing, is suppressed in keratoconus patients. He said this is the first molecular defect ever identified in keratoconus

Dr. Spoerl explained the use of a combined riboflavin/ultraviolet A (UVA) treatment for keratoconus. The riboflavin absorbs the UV radiation to protect the endothelium, and the treatment increases crosslinking to make the cornea more rigid and stable. He noted that this treatment can only stop the progression of keratoconus.

Karla Zadnik, OD, PhD, discussed flat vs. steep fitting GP lenses in keratoconus, concluding that scarring is more related to disease severity than to fitting decisions and that you should base your fitting on vision, comfort, wearing time and what's happening to the cornea.

Dr. Barr discussed corneal scarring and vision in keratoconus. He reported that the CLEK study shows we can't conclude that flat fitting lenses cause more scarring, but lens wear is implicated as a causal pathway for corneal scarring. Scarring does impact visual acuity even if it's not located in the line of sight. Dr. Barr also reported on the use of reverse geometry lenses for keratoconus in that they can reduce coma and improve vision.

Tim Edrington, OD, MS, FAAO, discussed the benefits of using the first definite apical clearance lens (FDACL) to measure the cornea and serve as a fitting guide in keratoconus.

A number of presenters discussed the use of scleral lenses for keratoconus. Perry Rosenthal, MD, Rob Breece, OD, Henry Otten, Optometrist BSc, FAAO from the Netherlands and Ken Pullum, FCOptom, DipCLP from England offered fitting tips for corneo-limbal, mini scleral and scleral designs. Emphasis was placed on fluorescein analysis, given that topography data doesn't extend out far enough to fit sclerals, and on how to avoid lens adherence.

David Schanzlin, MD, discussed surgical approaches to keratoconus, including penetrating keratoplasty, lamellar keratoplasty and Intacs. He reminded attendees that the goal of surgery is to strengthen the cornea and restore the possibility of a good contact lens fit. Dr. Rabinowitz discussed different methods for inserting Intacs, and also stressed that patients need to be counseled about the purpose of the surgery.

Buddy Russell, FCLSA, offered suggestions for how to fit contact lenses following Intacs inserts, suggesting that piggyback fits may help with comfort.

Loretta Szczotka-Flynn, OD, MS, discussed contact lens fitting following penetrating keratoplasty and other surgical alternatives. She explained how different types of sutures may affect lens fitting and that you should be mindful of Dk when fitting such patients.

Carla Mack, OD, discussed coding and reimbursement issues for keratoconus. She emphasized that coding is the practitioner's responsibility and that all practitioners in a multi-doctor practice should code consistently.

Dr. Zadnik discussed the unique personality characteristics that are common among many keratoconus patients. She said practitioners should make it a goal to help such patients to not think about their keratoconus all the time.

Sponsor Seminars

Many of the GKC's sponsors held seminars to educate attendees about products and technology available in diagnosing and managing keratoconus. Sponsor presentations were given by Blanchard Contact Lens, Contamac, Bausch & Lomb, SynergEyes, Inc., X-Cel Contacts, Precision Technology Services, Ltd., Valley Contax, the Contact Lens Manufacturers Association and the National Keratoconus Foundation.

Information from the GKC meeting will appear in greater detail in future CLS articles. The second GKC will take place from Jan. 25th to 27th, 2008.

Contact Lens Conference Honors Pioneers

The 33rd Annual Invitational Bronstein Contact Lens Seminar honored two pioneers in the contact lens field.

Charles H. May, OD and Robert B, Mandell, OD, PhD, were honored at this year's event held Jan. 26 to 28 in Scottsdale, AZ.

Dr. May was honored for his work in lens design associated with orthokeratology, or corneal molding. Dr. Mandell was recognized for his research in corneal topography, pachymetry and corneal response to contact lens wear.

The conference is named after its founder, contact lens pioneer Leonard Bronstein, OD. It's one of the largest contact lens-only meetings in the country, if not the world, according to conference chair John Rinehart, OD.

For the Record

In the January issue, on p. 9 in the news article CLMA Recognizes Labs, Practitioners, Blanchard Contact Lens, Inc. and Tru-Form Optics, Inc. (TX) - 2 locations were omitted from the list of laboratories awarded the CLMA's Certificate of Manufacturing Excellence for the years 2007 and 2008. Both companies received the recognition concurrently with all other companies.

Also in the January issue, on p. 26 of the article Contact Lenses 2006, the text should have said, At the manufacturer level, the worldwide contact lens market is about $4.56 billion with about $3.3 billion in spherical lens sales and $1.26 billion in specialty lens sales.

Contact Lens Spectrum regrets the errors.

Allergan Launches Next-Generation Artificial Tear

Allergan, Inc. has launched Optive Lubricant Eye Drops, an artificial tear with an advanced dual action formula that works on both the ocular surface and at the cellular level to provide long-lasting relief from dry eye symptoms, according to Allergan.

Optive offers a new technology platform for the treatment of dry eye symptoms, said Joe Vehige, OD, Allergan Senior Director, Consumer Eye Care Research and Development. While most artificial tears typically provide moisture to the tear film, Optive Lubricant Eye Drops is optimally formulated to provide both lubrication to the tear film and penetration below the surface of the eye for osmoprotection against hypertonic stress.

Industry Briefs

* Vistakon recently announced the national launch of its Click-to-be-Contacted complimentary online service. Patients can visit www.acuvue.com to find a list of participating doctors in their area who fit Acuvue lenses. When they click on the Click-to-be-Contacted icon, they can request to to have a practitioner contact them by phone or e-mail to schedule an appointment.

* William Bill Baldwin, OD, has written a biography of Irvin Borish, OD, called Borish. The work explores the private and professional life of Dr. Borish, who is and has served as a clinician, researcher, inventor, educator and philanthropist. Obtain a copy with Dr. Borish's signature and a greeting by visiting http://www.opt.indiana.edu/bcor/borishbook/index.htm . Proceeds go to support the Borish Center for Ophthalmic Research.

* The Contact Lens Society of America's 52nd annual meeting will take place April 18 to 31 in Phoenix, AZ. Visit www.clsa.info for registration information.

* The Orthokeratology Academy of America will hold its 2007 Education Meeting from April 20 to 22 at the University of Houston College of Optometry. To register visit www.okglobal.org .

* This year's National Inventors Hall of Fame inductees will include soft contact lens inventor Otto Wicterle. Each year the National Inventors Hall of Fame honors individuals whose work has changed society and improved the way we live.

* Eyemaginations, Inc. has signed a graphics licensing agreement with the American Optometric Association to provide its state-of-the-art eyecare images and animations for the AOA's various educational and marketing materials through print and electronic media.

* The FDA recently granted approval of Alcon's AcrySof ReStor apodized diffractive aspheric intraocular lens for the visual correction of aphakia following cataract surgery in adult patients, with or without presbyopia. The company plans a phased commercial launch after necessary consignment quantities are established, with full distribution expected by mid-year.

* Johnson & Johnson voluntarily disclosed to the U.S. Department of Justice and the U.S. Securities and Exchange Commission that subsidiaries outside of the United States are believed to have made improper payments in connection with the sale of medical devices in two small-market countries. As a result, Michael J. Dormer, Worldwide Chairman, Medical Devices & Diagnostics, has retired from the corporation. His successor is Nicholas J. Valeriani, a company executive with nearly 30 years experience, who will add Mr. Dormer's former responsibilities to his own.

* A congressional briefing and press conference held on Capitol Hill brought vision advocates together in an effort to raise awareness for H.R. 507, the Vision Care for Kids Act of 2007. More than 60 participants educated attendees about the need to improve vision care for children and encouraged their support for the bill.

* The Contact Lens Association of Ophthalmologists Education and Research Foundation has announced the availability of Scientific Research Grants to be awarded July 1. Research proposals, which are due by March 30, should focus on contact lens science and/or ocular anterior segment science. Visit www.clao.org for a grant application.

* The American Academy of Ophthalmology and Lippincott Williams & Wilkins, part of Wolters Kluwer Health, will collaborate to create an online educational resource center for ophthalmologists. The Ophthalmic News and Education Network is scheduled to launch in late 2007.

* The Centers for Medicare and Medicaid Services has established a product specific J-Code for Bausch & Lomb's Retisert. The new J-Code, J7311 Fluocinolone acetonide intravitreal implant, replaces the Medicare hospital outpatient code C9225.

* The Centers for Medicare and Medicaid Services has published Ruling No. CMS-1536-R allowing beneficiaries to choose implantation of an intraocular lens that corrects pre-existing astigmatism at the time of cataract surgery.

* Eschenbach will offer the seminar Low Vision Care � What's It All About? as an introductory, hands-on workshop and lecture that's approved for 3 CE credits by ABO, JCAHPO and ACVREP. To register for the April sessions in California, Wyoming and Ohio visit www.eschenbach.com .

* Richard W. Phillips, OD, former officer of SECO International and a past president of the Tennessee Optometric Association, has been selected to serve as the sixth president of Southern College of Optometry. He will succeed William E. Cochran, OD, SCO's longest-serving president.

* Dr. Eric Papas has been named the new Director of Postgraduate Studies for the Vision CRC, Institute for Eye Research and International Centre for Eyecare Education. Dr. Papas takes up the position from associate professor Fiona Stapleton, who is now the Head of School for the School of Optometry and Vision Science of the University of New South Wales. She is the first female head of an optometry school in Australia.

* March is Age-related Macular Degeneration Awareness Month. The American Academy of Ophthalmology reminds patients that early detection and treatment is key to saving sight.

1-800 Contacts Announces Agreements

Now that 1-800 Contacts has made agreements with its largest contact lens suppliers, the company's chief executive officer says the company will no longer seek to amend the Fairness to Contact Lens Consumers Act.

In its most recent session, to ensure that consumers could fill their prescriptions from the business of their choice, Congress considered legislation regarding contact lens distribution practices. We supported that legislation. However, we believe the market solution embodied in these recent supply agreements is adequate to ensure a competitive market - making legislation unnecessary at this time, said Jonathan Coon, the company's CEO.

1-800 Contacts announced in late January it had signed long-term supply agreements with CIBA Vision, CooperVision and Vistakon. The company has purchased directly from Bausch & Lomb, its fourth largest supplier, without a written agreement since 2001 and doesn't expect this relationship to change.

Under the terms of CooperVision's new agreement with 1-800 Contacts, purchases must now be made directly from CooperVision only, which ends the risk of distributing counterfeit CooperVision lenses. The agreement also removes previous channel distribution restrictions for the Biomedics and Proclear brands and brings CooperVision's new trade policy parallel with the AOA's position on patient access.

Consumer Reports Focuses on Contact Lenses

▪ The March issue of Consumer Reports emphasizes that proper care of contact lenses can help consumers experience healthier, more comfortable lens wear.

The article details for readers the importance of finding a qualified eyecare practitioner, choosing the right lens and solution and following the proper cleaning regimen. It also stresses the importance of scheduling regular eyecare check-ups.

A section of the article also looks at the Fusarium outbreak last year and its possible causes.

 



Contact Lens Spectrum, Issue: March 2007