I’ve been doing this gig for a long time now, and frankly, it can get a little stale. As one of the early acolytes of the Short Attention Span Theater, I can get bored really easily. The only thing that keeps me interested in what I do is that occasionally (read: frequently), I actually learn something new.

My Shiny Objects du Jour

Demodex I don’t know about you, but Demodex seems to have taken over my patient population. In my neck of the woods, we seem to not have winters anymore, and that seems to coincide with this increase. Coincidence does not always mean causation, but I have my suspicions.

Thankfully, these critters have a kryptonite—tea tree oil. You can make your own solution to treat this infestation, or you can use one of the prepared systems. And, some of you may not know that this infestation has its own ICD-10 code. The code that the guidance suggests works with Demodex is B88.0—Other acariasis; this code is more accurate compared to the blepharitis codes.

Lid Wiper Epitheliopathy (LWE) Second, according to Korb et al (2002), 80% of contact lens patients who exhibit symptoms of discomfort have some level of LWE. This condition is characterized by cellular metaplasia along the mucocutaneous junction, or the line of Marx.

When a patient has LWE, the lid wiper injury stains with lissamine green or sodium fluorescein. The treatment of this condition is fairly straightforward—oil-based tear supplements and a one-month course of an ester steroid.

Ask yourself whether this condition is one of the first things you think about when a patient complains of lens discomfort. Just knowing that a lot of soft contact lens patients who have symptoms of lens discomfort may be helped more by identifying this condition than by trying to change lenses is a real game changer for many prescribers.

Scleral Multifocals Third, I’ll bet you didn’t know that scleral lenses make for great multifocals. Because scleral lenses center so well, don’t move much, and have large optic zones, they lend themselves well to great simultaneous vision multifocal optics.

PEG Coating Next, I’ll bet you don’t know how much of a game changer a 90% water polyethylene glycol (PEG)-based polymer coating surface treatment is. This proprietary method for applying a coating of PEG to a lens really helps improve the wettability. In my opinion, it is a step up from a plasma treatment.

Irregular Pupils I’ll bet you didn’t know that the VSP Necessary Contact Lens Benefit now covers irregular pupil as a diagnosis. That is pretty cool, huh?

DEWS II I’ll bet you didn’t know that the Tear Film & Ocular Surface Society’s International Dry Eye Workshop II (DEWS II) has now been published. This very comprehensive revisiting of the conundrum of dry eye disease has advanced the standardization of the diagnosis and management of the most common disease that we see in clinical practice.

Multifocal Torics Did you know that there are very good multifocal toric lenses out there? You should learn how to prescribe them because they can make you look like a hero. When patients have been seen by other prescribers and you are the one who, at long last, solves their problem, what is that worth to your practice? I’ll bet you know. CLS

For references, please visit and click on document #265.