I have been considering the issue of eyestrain recently and have come to the conclusion that many of our contact lens wearing patients commonly face this issue. If you think about it, our lens wearing patients encounter many situations that can lead to eyestrain and there are a variety of potentially contributing factors. Simple things such as fully correcting refractive error, and especially cylindrical correction, may lead to a reduction in strain on the visual system. I would urge you to keep this in mind for your toric lens wearing patients—optimizing their prescription could significantly reduce their visual demands and help optimize comfort of the visual system.
Valeant Pharmaceuticals International, Inc. completed its acquisition of Bausch + Lomb (B+L) on August 5, 2013. Bausch + Lomb will retain its name and become a division of Valeant. Valeant's existing ophthalmology businesses will be integrated into the B+L division, creating a global eye health platform with estimated pro forma 2013 net revenue of more than $3.5 billion. The united business has a vast eyecare product portfolio and an array of late stage over-the-counter, prescription and ophthalmic surgery products in the development pipeline.
In a separate release from Valeant on its second quarter results, the company noted that to finance the transaction and add to their liquidity, Valeant raised $9.6 billion by issuing 27.1 million common shares, $3.2 billion in senior unsecured notes and $4.1 billion in senior secured credit facilities. Valeant expects to realize significantly more than $800 million of cost synergies from the combined company, with a run rate north of $500 million by year-end 2013 and a run rate significantly more than $800 million by year-end 2014.
With the completion of the acquisition, Valeant also began to implement its previously announced plans to downsize the combined company global workforce by up to 15% (potentially almost 2,900 positions worldwide) by announcing the immediate layoff of 200 employees in the Rochester B+L facilities. According to information released by New York Gov. Andrew Cuomo's office, Valeant plans to cut an additional 200 B+L employees by early 2014. Valeant also plans to locate the new B+L division headquarters somewhere in New Jersey.
According to stories previously published in sources such as USA Today, the company does not plan to cut the B+L North American sales force or close any U.S. manufacturing sites.
Nearly 14,000 vision industry representatives and eyecare providers from countries around the world are expected to be in Las Vegas, October 2-5, for the 2013 International Vision Expo West. Co-owned by Reed Exhibitions and The Vision Council and held at the Sands Expo & Convention Center, the ophthalmic conference and expo includes more than 475 exhibitors, 5,000 brands and 375 hours of continuing education. Celebrating its 25th anniversary, International Vision Expo West will feature 190,000 sq. ft. of exhibits, which is an increase from 2012.
Vision Expo West has planned special activities and giveaways to mark its 25th anniversary as the largest annual meeting place and trade show for the vision industry. Highlights include: 25th Anniversary Toast on the show floor with 25th anniversary champagne glasses provided to each attendee to commemorate the show's silver anniversary; 25th Anniversary Opening Night Kickoff at TAO; 25th Anniversary Free Food with free snacks on Level 2 of the show floor on Thursday, Friday and Saturday, from 3:00 to 5:00 pm and Continuing Education participants will receive free lunch on the show floor on Friday between 12:00pm and 2:00 pm; and on Throwback Thursday Vision Expo will post photos from the past 25 years on its Facebook page, www.facebook.com/visionexpo.
To learn more about 25th anniversary celebrations and show specials, or to register for International Vision Expo West, please visit www.visionexpowest.com.
Plan now to attend the Optometric Management Symposium on Contemporary Eye Care, December 6-8, 2013 at Disney's Contemporary Resort in Lake Buena Vista, Florida. This popular annual symposium provides the perfect balance of timely, disease management courses and practice-building courses with plentiful networking and leisure time to enjoy all that Disney resorts and theme parks have to offer.
The educational program is presented by the Pennsylvania College of Optometry, Salus University. For agenda, more information and to register visit www.OMConference.com.
As of August 1st contact lens manufacturers, among other medical manufacturers, are required track information on payments and other transfers of value made to physicians and teaching hospitals for purposes of reporting such payments to CMS (U.S. Centers for Medicare and Medicaid Services). OPEN PAYMENTS (Physician Payments Sunshine Act) is intended to create greater transparency around the financial relationships of manufacturers, physicians, and teaching hospitals and accordingly prevent inappropriate influence on research, education, and clinical decision-making; avoid conflicts of interest that can compromise clinical integrity and patient care; and minimize risk of increased health care costs.
Aside from programs and information available from CMS to assist companies in collecting and providing the data necessary for successful program reporting, there is a mobile app for physicians (called OPEN PAYMENTS Mobile for Physicians) to use to help ensure accuracy of information reported about them by industry.
Here are some final comments received regarding the July 21 Editor's Commentary which discussed the importance of the fit of a standard soft contact lens in terms of the ultimate the success of a contact lens wearing patient relative to the fact that most mass produced soft lenses are designed so as to fit the vast majority of the population.
I had to comment on the observations of the contact lens fitters bemoaning the lack of mass produced contact lenses that include the less frequently encountered base curves. The major contact lens companies are in business to create a product that fits within a bell curve distribution. It no longer pays for them to perform the myriad testing necessary to carry multiple base curves and/or diameters as they did in the past. For that we have a variety of specialty contact lens companies, which offer more base curves in their standard lenses as well as custom lenses with customizable base curves and diameters.
As the practitioner, we must explain the need for a custom, and most likely, more expensive lens to our patient. This may be done quite easily utilizing a topography of the patient's cornea and showing how their curvature extends outside the range of the median. I then explain that it is like a seven foot individual trying to buy clothes "off the rack", and how they most likely need custom clothing. Yes, it is more time consuming, more difficult to fit, and probably more expensive, but in the end will outperform anything the patient has ever worn before.
Cracked Scleral Lens By Boris Severinsky, MOptom, Jerusalem, Israel
This image shows a full thickness crack inside the optics of scleral contact lens with corneal graft edema.
We thank Boris Severinsky for sending this image and welcome photo submissions from our 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.
RESEARCH REVIEW Loretta B. Szczotka-Flynn, OD, PhD, MS, FAAO
Epidemiology of Microbial Keratitis with Orthokeratology
With orthokeratology evolving as a more common treatment for myopia progression in children, the risks of corneal infection in this group of patients during overnight wear of corneal reshaping lenses is a concern.
A recent study of overnight corneal reshaping contact lens use evaluated 1317 patients; 640 adults and 677 children representing 2599 patient-years of wear. Eight events of corneal infiltrates associated with a painful red eye were reported (six in children and two in adults), of which two were classified as microbial keratitis which both occurred in children.
These rates provided an overall estimated incidence of microbial keratitis in children of 13.9 per 10,000 patient-years (95% CI = 1.7 to 50.4) and an estimated incidence of microbial keratitis in adults of 0 per 10,000 patient-years (95% CI = 0 to 31.7). As these confidence intervals overlap, the study was not able to find a difference between the groups, because it was beyond the study's power of detection.
The authors concluded that the overall risk of microbial keratitis during overnight corneal reshaping contact lens use (7.7 per 10,000 years of wear) in this study was about the same overall as in traditional extended lens wear, yet the risk in children may be higher, thus this group of patients should be closely monitored.
Bullimore MA, Sinnott LT, Jones-Jordan LA. The Risk of Microbial Keratitis with Overnight Corneal Reshaping Lenses. Optom Vis Sci. 2013 Jul 25. [Epub ahead of print]
Contact lenses are widely used as bandages for many conditions, including corneal abrasions and recurrent corneal erosions. But they are contraindicated for infectious conditions such as Herpes keratitis and bacterial ulcers. A new Class II medical device called Prokera (Bio-Tissue) is a therapeutic device that reduces inflammation and promotes healing of the ocular surface. Prokera is composed of amniotic membrane held within a thermoplastic ring. One component of amniotic membrane called heavy chain hyaluronic acid helps reduce inflammation and reduce scar formation by accelerating the apoptosis of neutrophils, promoting the formation of phagocytic macrophages, and reducing the activation of lymphocytes.
Because of its unique restorative properties, Prokera can be used in cases where bandage contact lenses are contraindicated, such as infectious keratitis. It is also used for neurotrophic ulcers, severe dry eye syndrome, recurrent erosions, post-DSEK bullous keratopathy, and post-PRK haze. The 16 mm diameter device is very similar to a bandage contact lens and can be inserted in office. The amniotic tissue is cloudy and the retention ring can be uncomfortable. But the amniotic tissue dissolves in about a week, and the retention ring is then removed. It is a useful new tool that appears to have greater healing properties for a number of corneal conditions.
Analysis of the Effect of Orthokeratology on Childhood Myopic Refractive Stability
These researchers wanted to determine whether overnight orthokeratology (OK) influences the progression rate of the manifest refractive prescription in myopic children, when compared with an age- and refraction-matched spectacle-wearing control group, over a period up to 8 years.
The right eyes of control (n=30) and OK (n=26) children were compared. Treatment groups were matched for baseline age and refractive error. At baseline, children were younger than 16 years and showed manifest spherical refractive error more than -0.50 diopters. The minimum period of evaluation for each child was 2 years. Changes to manifest refractive prescription were compared between the groups in 2 yearly intervals up to 8 years.
On the whole, OK eyes showed a significantly (P<0.05) more stable myopic refractive prescription than control eyes over all of the 2-year treatment intervals. A subpopulation (n=18; 64%) of OK eyes demonstrated an apparent total arrest of manifest myopic refractive change. Symmetry in the vertical meridian of baseline corneal topography was associated with a greater degree of refractive stability in OK eyes.
The authors concluded that this retrospective study provides evidence that OK can reduce the rate of progression of childhood myopia over the long term. In addition, these findings offer some early insight into a potential indicator that may help predict the extent of refractive stability in individual eyes undergoing OK.
Downie LE, Lowe R. Corneal Reshaping Influences Myopic Prescription Stability (CRIMPS): An Analysis of the Effect of Orthokeratology on Childhood Myopic Refractive Stability. Eye Contact Lens. 2013 Jul;39(4):303-10.