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OPTOMETRIC OFFICE OCTOBER 2017

PRODUCTS AND TECHNOLOGY FOR YOUR PRACTICE

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MPS, multipurpose solution. *Compared to MPS in symptomatic users. References: 1. Gabriel M, Bartell, J, Walters R, et al. Biocidal efficacy of a new hydrogen peroxide contact lens care system against bacteria, fungi, and Acanthamoeba species. Optom Vis Sci. 2014;91:E-abstract 145192. 2. Alcon data on file, 2014. 3. Alcon data on file, 2015. © 2016 Novartis 04/16 US-CCS-16-E-1913

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OPTOMETRIC OFFICE PRODUCTS AND TECHNOLOGY FOR YOUR PRACTICE

OCTOBER 2017

CUSTOM SOFT CONTACT LENSES FOR SPECIAL FITS HOW TO KEEP YOUR PRESBYOPIC PATIENTS IN CONTACT LENSES WHY H202 IS ONE DOCTORâ€™S FIRST CHOICE

DRY EYE DIAGNOSIS MORE INSTRUMENTS AT YOUR DISPOSAL

SUPPLEMENT TO VCPN OCTOBER 2017

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TABLE OF CONTENTS 10

12 | One-to-One: Carol Alexander, Johnson & Johnson 26 | The Optometric Technician 28 | Daily Disposable Contact Lenses At-A-Glance

30 | New Product Gallery 32 | Docs Speak Out

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24 | Why Hydrogen Peroxide is My First Choice

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OPTOMETRIC OFFICE EDITORIAL STAFF VP, Editorial John Sailer | JS@VisionCareProducts.com Professional Editor Richard Clompus, OD | RC@OptometricOffice.com Editor-in-Chief Jeffrey Eisenberg | JE@VisionCareProducts.com Assistant Editor Cara Aidone Huzinec | CH@VisionCareProducts.com Vice President, Design Jane Kaplan | JK@VisionCareProducts.com Assistant Art Director Bruce Kenselaar | BK@VisionCareProducts.com Production and Web Manager Anthony Floreno | AF@VisionCareProducts.com Contributing Writers Roberta Beers, CPOT • Mario Contaldi, OD • Jackie Garlich, OD, FAAO Christopher W. Lievens, OD, FAAO, • Anar Maurya, OD • Leslie E. O’Dell, OD, FAAO Nancy Rausman • Jennifer L. Stewart, OD • Gina M. Wesley, OD, MS, FAAO

BUSINESS STAFF Executive Vice President/Publisher Shawn Mery | SM@VisionCareProducts.com President/Associate Publisher Frank Giammanco | FG@VisionCareProducts.com Director of Sales Janet Cunningham | JC@VisionCareProducts.com Vice President, Marketing Debby Corriveau | DC@VisionCareProducts.com Vice President, Operations Sharon O’Hanlon | SO@VisionCareProducts.com

EDITORIAL ADVISORY BOARD Jeffrey Anshel, OD • Sherry Bass, OD • Murray Fingeret, OD • Ed De Gennaro, MEd, ABOM Deepak Gupta, OD • Alan Homestead, OD • Nikki Iravani, OD • Bill Jones, OD Alan G. Kabat, OD • Kenneth A. Lebow, OD, FAAO • Jerome A. Legerton, OD, MBA Scot Morris, OD • John Schachet, OD • Eric Schmidt, OD • Leo Semes, OD Peter Shaw-McMinn, OD • Joseph Sowka, OD, FAAO Jennifer Stewart, OD • J. James Thimons, OD

INDUSTRY ADVISORY BOARD Dwight Akerman, OD, Alcon Laboratories, Inc., a Novartis Company Steve Baker, EyeFinity • Joseph Boorady,OD, TearScience, Inc. Sally M. Dillehay, OD, Visioneering Technologies, Inc. Dave Hansen, OD, Ophthalmic Consultant • Carla Mack, OD, Alcon Laboratories, Inc. Dave Sattler, Dave Sattler Consulting Michele Andrews, OD, CooperVision, Inc. • Ellen Troyer, Biosyntrx, Inc. Millicent Knight, OD, Johnson & Johnson Vision Care, Inc. Throughout this magazine, trademark names are used. Instead of placing a trademark or registration symbol at every occurrence, we are using the names editorially only with no intention of infringement of the trademark.

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ADVERTORIAL

YOU’VE DIAGNOSED DRY EYE DISEASE … NOW WHAT?

ith dry eye affecting more than 30 million individuals in the United States, you’ve no doubt seen many such patients in your practice, with symptoms ranging from mild to severe. In fact, it is one of the most frequent causes of patient visits to eyecare practitioners. The good news is that with more than three decades of research, including the recently released Dry Eye Workshop II, or DEWS II, report from the Tear Film and Ocular Surface Society, we now know that dry eye is a multifactorial disease1—and we have a wider range of treatment options than ever before. Meibomian gland dysfunction, or MGD, is the leading cause of evaporative dry eye, so treatments to remove obstruction from the ducts of the meibomian glands become necessary.2

BUNDLE NO MORE Researchers compared different methods of applying warm compresses and found that the bundle method worked best at increasing lid temperatures above the 40°C needed to achieve a therapeutic effect.3 However, because this method is the most labor intensive, compliance is poor. Consider: In the bundle method, the patient rolls five wet washcloths together and then warms them in the microwave.

The patient applies the outer wash cloth for two minutes, and then applies the next washcloth for two minutes, and so forth.

The Bruder Moist Heat Eye Compress, also known as the Bruder mask, offers the same benefits as bundling, minus the inconvenience. The mask features MediBeads, which absorb and store water molecules from the air. The patient heats it for 20 seconds in the microwave and then places it over his or her closed eyes for several minutes. The clean, natural moist heat goes to work immediately to provide soothing relief and slow tear evaporation. And, the new Bruder Hygienic Eyelid Sheet, which has been specially designed to work in conjunction with the Bruder mask, helps cleanse oil, debris and/or makeup from the eyelids and lashes, keeping them clean and healthy.

IN-OFFICE EXPRESSION

Another highly02017-06_Bruder effective procedure for reHalf Page_Vertical.pdf 1 5/12/2017 ducing symptoms and improving signs of MGD is meibomian gland expression. It should be considered as part of your regimen when diagnosing and treating this disease. Bruder offers a line of state-of-theart German stainless instruments that will help perform meibomian gland expression, including the popular Collin™ Expressor Forceps and the Karpecki Debrider.

WARM-UP Consider applying a warmed Bruder Moist Heat Compress for approximately 10 minutes prior to an expression. Heat helps to liquefy and soften meibum, improving the effectiveness of the expression. And, Bruder offers a full range of products for in-office and at-home treatment.

By providing relief from dry eye disease—and quickly—patients will credit you for providing treatment that really works.

1. Nelson JD, Craig JP, Akpek EK, et al. TFOS DEWS II Introduction. Ocul Surf 2017 Jul;15(3):269-275. 2. Jones L, Downie LE, Korb D, et al. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017 Jul;15(3):575-628. 3. Murakami DK, Blackie CA, Korb DR. All Warm Compresses Are Not Equally Efficacious. Optom Vis Sci. 2015 Sep;92(9):e327-33.

For convenience, all Bruder products are available through the Professional Ordering portal. Log on to Bruder.com to learn more.

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VIEWS

Richard Clompus SOCIAL MEDIA AND YOUR PRACTICE

There was a time when a website was an effective vehicle to market and promote your practice. By listing the services and any specialty care you provide, your webpages would educate patients and market your practice 24/7. The challenge has been to get potential patients to find your website and stay long enough to lead to a phone call to make an appointment. Times are changing. Now, social media has become an essential part of creating a community of followers for your practice. And the global community that uses social media continues to increase. TechCrunch reported in June that Facebook has two billion monthly users. That’s a lot of potential patients waiting to discover your office. Many of those users check Facebook multiple times a day.

TechCrunch reported in June that Facebook has two billion monthly users.

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The practitioner that sets the bar for recognizing the potential for social media and optometry is my friend, Alan Glazier, OD, of Shady Grove Eye & Vision Care in Rockville, MD. He literally wrote the book on engaging social media, Searchial Marketing: How Social Media Drives Search Optimization in Web 3.0 (Authorhouse, 2011), in which he teaches do-it-yourself methods of implementing a ‘’searchial’’ media campaign. Many know Glazier as the founder of ODs on Facebook. There are many forms of social media sites that may align with helping to promote your optometric practice. You might even place the icons for such sites as Google Plus, Facebook, Twitter and LinkedIn on your practice’s website. These, in turn, link to social media sites with your content to promote your practice. It’s all about building a community of followers who return to the site to view fresh content and refer their friends. Regardless of the size of your practice, using new tools to share your practice’s “vision” and services will help grow your office. And it’s never too late to start. Richard Clompus, OD, FAAO | Professional Editor | RC@OptometricOffice.com

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Partners

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The Marco TRS systems enabled us to see 4 more patients a day and rapidly paid for themselves in efficiency cost savings, additional exam revenue, and sales of multiple eyewear. These workflow and profitability enhancements compelled us to purchase 3 additional TRS systems for our clinic.

April Jasper, OD West Palm Beach, Florida

I truly appreciate the seamless EMR integration of the Marco system. More than 50 mouse clicks are eliminated by this seamless data transfer with the push of one button. The time saved in the exam room is priceless.

Scot Morris, OD Conifer, Colorado

Our favorite refractor is the Marco TRS-5100. Because it is quiet, fast, efﬁcient and comfortable, it also has earned the “cool” factor. Since patients can instantly compare their old and new Rx- and decide if they value the difference, satisfaction is greatly enhanced.

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Our revenue per patient has risen- in part because the TRS-5100 allows me to show people the changes in the Rx with a push of a button. They can quickly see for themselves how minor shifts can impact their overall vision.

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All-new!

VIEWS

Jeffrey Eisenberg

A QUESTION OF CHOICE

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With my son’s teenage years getting closer in sight, my wife and I face the same dilemma as many other parents: We want to guarantee his physical and emotional well-being without becoming helicopter parents. And, we realize that we probably won’t agree with every decision he’ll make. What it inevitably comes down to is that we have to switch our focus, albeit gradually, from making decisions on his behalf to teaching him to make responsible choices of his own. Okay, I know this isn’t a parenting magazine. But here’s my point: We all hear the word “choice” constantly used in association with contact lens patients—namely where patients obtain their lenses. This question of choice led the Federal Trade Commission to adopt the Fairness to Contact Lens Consumers Act, requiring optometrists to provide every patient with a copy of his or her contact lens prescription, in 2003, and now has the FTC pondering whether to require that ODs obtain and keep for at least three years a signed document from each contact lens patient stating that he or she did indeed receive a copy of the Rx. Those in favor of this change will argue that it’s important to keep this choice in the hands of consumers. But, while they emphasize consumer choice, I wonder if they’re also considering the responsibilities that come with that choice. These include patient education, prescription verification, adherence to the recommended wear schedule and care regimen, and follow-up care. As you’ll read in this month’s issue, advances in contact lenses can benefit patients with highly irregular corneas, presbyopes and even patients with disfiguring ocular disorders. But, as optometrist Christopher Lievens reminds us, noncompliance with the recommended wear schedule or care regimen can result in serious ocular complications. Whether you prefer patients get their lenses from you or support their choice of going to an outside vendor, the responsibility rests with everyone—patients, legislators, third-party vendors and ODs.

Be sure to check out our new website redesign at OptometricOffice.com. Jeffrey Eisenberg | Editor-In-Chief | JE@VisionCareProducts.com © 2017 AMETEK, Inc. & Reichert, Inc. (9-2017) · Made in USA ClearChart is a registered trademark of Reichert, Inc. · www.reichert.com

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OCULUS Keratograph® 5M Please note: The availability of the products and features may differ in your country. Specifications and design are subject to change. Please contact your local distributor for details.

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GLANCE GIVING YOU A QUICK RUNDOWN ON THE TOP NEWS AND RESEARCH FROM THE PAST MONTH. CONSIDER THIS THE MOST PRODUCTIVE FIVE MINUTES OF YOUR DAY. READY?

Jackie Garlich

If you use LipiFlow ... Johnson & Johnson Vision now officially owns TearScience, maker of LipiView and LipiFlow. If you want to know the best hospital for eyecare ... Bascom Palmer ranks #1 on the list of best hospitals for ophthalmology by U.S. News & World Report. If you accept vision insurance ... Centerbridge Partners, L.P., owner of Superior Vision, has agreed to buy Davis Vision from Highmark for an undisclosed amount. The combo of these two vision plans is expected to make the third largest vision care plan behind EyeMed and VSP. If you love talking about the retina ... Luminate is getting some hype. It’s an intravitreal injection from Allegro Ophthalmics, LLC that treats vitreoretinal diseases by targeting integrin receptors. Although still in clinical trials, Luminate has two different mechanisms of action in which it both regresses and inhibits vascularization. The authors say that “this should be particularly useful for half of the current patient population that doesn’t respond adequately to repeated anti-VEGF treatments alone.”

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If you treat glaucoma ... A study published in the American Journal of Ophthalmology found a strong association between anxiety and depression and glaucoma. Given that anxiety and depression may affect the patient’s ability to follow treatment recommendations, the authors recommend depression and anxiety screening questionnaires for all glaucoma patients and encourage eyecare providers to collaborate with psychiatrists as needed. Lastly, with Halloween upon us, it might be worth remembering a 2015 study in Eye & Contact Lens that tested over-the-counter theatrical lenses and found chlorine and iron in several lenses, presumably from the colorants used to tint the contacts. Patient education is key! CONSIDER YOURSELF INFORMED. SEE YOU NEXT MONTH! Jackie Garlich, OD, FAAO | 20/20 Glance | 2020Glance.com

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THINK ABOUT YOUR EYES

Contact Lenses Continue to Evolve; Safety Measures Remain Important Given the strides in contact lens technology, it’s hard to believe that the first concept was illustrated by Leonardo da Vinci in the 16th century. Today, contact lenses hold enormous appeal for the many patients who want clear vision without the constraints of glasses, especially in our fashion-conscious society. Although contact lenses provide enhanced peripheral vision and clearer visual images, the key benefit for many patients is freedom from eyeglasses.

ADVANTAGES AND DISADAVANTAGES While contact lenses offer potential freedom from eyeglasses, they certainly have advantages and disadvantages. To receive a clearer, more precise image of the world while removing nearly all the prismatic effect of glasses, one must accept the higher risk

Basic hygiene is a key component of contact lens safety. of infection. Ocular dryness is another issue that needs ongoing attention for many patients. Before even considering how contact lenses feel in the eye, the patient must first master the mechanics of lens insertion and removal. Basic hygiene is a key component of contact lens safety. Patients may engage in risky behaviors such as reusing solution; wearing lenses past their recommended timeframe; rinsing them with water; and sleeping, swimming and showering in lenses. These behaviors are all too common, and it’s our job to continually educate our patients regarding their lens habits.

INNOVATIVE OPTION Contact lenses continue to be an innovative option for vision correction. The rise of the single-use contact lens modality gives enhanced comfort and safety. Additionally, the rebirth of scleral

Mario Contaldi

Mario Contaldi, OD, is a member of the Texas Optometric Association and among the 19,000 doctors listed on the Think About Your Eyes online locator. Think About Your Eyes is a nationwide public awareness initiative promoting the importance of an annual eye exam and overall vision health. First Vision Media Group supports Think About Your Eyes as a media partner.

lenses and the advancement of hybrid lenses have given rise to exciting new options for otherwise hard-to-fit patients. Contact lens patients are almost guaranteed to visit their eye doctors annually to update their prescriptions and order new lenses. However, many patients still need a reminder as to the importance of an annual eye exam for overall vision and full-body health. I’m proud to support Think About Your Eyes and its efforts to encourage the greater public to get an annual eye exam and prioritize vision health. As advocates for our patients’ vision health, we need to take advantage of every tool that promotes annual eye exam habits. O|O

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PRODUCT | BUZZ LAUNCHES, PROMOTIONS, MERCHANDISING, EVENTS AND OTHER THINGS TO KEEP YOU IN THE KNOW.

ANOTHER ACQUISITION FOR J&J Johnson & Johnson Vision has acquired Sightbox, Inc., an online, membership-based subscription service for contact lens wearers. Sightbox will operate as a separate business, providing contact lenses from all major manufacturers. Call 800.843.2020, or go to JNJVC.com or Sightbox.com.

eye strain with their ECPs. When asked to describe ocular signs and symptoms, individuals used descriptions such as tired (60%), dry (18%), blurry (17%) and strained (9%). In other news, CooperVision’s subsidiary, EyeCare Prime, announced that its LensFerry contact lens solution now integrates with electronic health record systems used by ECPs, allowing prescription and ordering information to automatically sync between systems to streamline ordering. Call 855.526.6737, or go to CooperVision.com or EyeCarePrime.com.

TALKING ABOUT DIGITAL EYE HEALTH Digital device screens pose vision challenges, but only a handful of eyecare practitioners talk about these issues with their patients, according to a new study commissioned by CooperVision, Inc. and conducted by YouGov. Of 1,129 adults surveyed, only 6% said that they had spoken with an ECP about the amount of time spent using their devices. That represents a missed opportunity, considering that 64% of contact lens wearers and 60% of spectacle wearers expressed interest in discussing how to reduce

AMD FEATURES IN DIFFERENT COLORS Heidelberg Engineering’s SPECTRALIS MultiColor, which uses confocal scanning laser technology to visualize the retina, had greater sensitivity than color fundus photography for detecting early features of age-related macular degeneration, according to a study in Northern Ireland. Researchers from the Centre for Public Health, Queen’s University in Belfast, evaluated 105 eyes and found that MultiColor imaging was able to identify soft drusen

Drusen, as seen by color fundus photography (left) and SPECTRALIS MultiColor, are an early feature of AMD.

in 85%, reticular drusen in 83%, and geographic atrophy and fibrosis in 100% of cases in which these abnormalities were seen on color fundus photography. Color fundus photography, however, identified 58% of soft drusen, 28% of reticular drusen, 83% of atrophy and 68% of fibrosis on MultiColor imaging. The study is available online and will appear in the November issue of Retina. Call 508.530.7900, or go to HeidelbergEngineering.com.

News

MacuHealth, L.P. and M&S Technologies have entered into a cooperative marketing agreement to educate and train ECPs on the direct relationship between enriching macular pigment with nutritional supplements and optimizing visual performance. Rev360 has acquired Unified Imaging, an image management software solution that delivers a cloud-based system for image display, review and comparisons, enabling the company to provide technology and support to RevolutionEHR users. Professional Eyecare Resource CoOperative (PERC) and Infinity Vision Alliance (IVA) have partnered with illuma Care Connections to engage identified diabetic patients and schedule appointments with PERC and IVA providers throughout the U.S. GSRx, Inc. has launched ProperOptics.com, an optical e-commerce site created to provide independent practices with an online presence to capture more optical sales.

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Ask Yourself This Question...

“Why Prescribe?”

OTC Savings Compared to Rx Costs Kills Bacteria on Contact -“0” Eye Irritation Stable 18 Months Opened or Unopened

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two-thirds of monthly wearers experience comfort-related issues, and 73% of those patients don’t plan to tell their eyecare providers because most think those issues are normal. ACUVUE VITA works with the tear film to maximize and maintain lens hydration. And, beginning this month, providers will be able to offer ACUVUE VITA to astigmatic monthly patients with the launch of ACUVUE VITA for ASTIGMATISM.

RC: Optometrists can prescribe ACUVUE Brand Contact Lenses with replacement cycles ranging from one to 30 days. With so many choices, how do you determine the best lens for your patients?

ONE-TO-ONE

Carol Alexander Carol Alexander, OD, FAAO, DNAP, joined Johnson & Johnson Vision (JJV) in 2007, bringing a rich history of leadership in organized optometry. She was selected as the American Optometric Association’s Young Optometrist of the Year in 1997 and as Ohio’s Optometrist of the Year in 2007. As director, professional communications, at JJV, Alexander champions the importance of preserving the doctor-patient relationship and advocates against initiatives that threaten patient health and safety.

Richard Clompus, OD, FAAO: One of the most significant products introduced by Johnson & Johnson Vision is the monthly ACUVUE VITA lens. Senofilcon C is a new material with characteristics that balance hydration with lipid integration throughout the lens. Can you share some insights about this 30-day lens? Carol Alexander, OD: In studying the category, we’ve learned that most practices have a significant number of patients who wear monthly replacement lenses. These patients are very dedicated contact lens wearers who want affordable, reliable, hassle-free contact lens wear and seek to maximize the use of each pair of lenses for a full month. However, a survey of individuals in the U.S. and Europe who wear spherical contact lenses for 30 days found that more than

CA: Patients have unique needs, both in refractive status and lifestyle requirements, along with complex medical histories that must all be considered when determining the best lens to prescribe. We did not choose to enter the monthly market lightly. We firmly believe that a shorter wear schedule is best for a patient. But when there is an unmet need in the market, like there was with monthly wearers, we want to help patients have a better contact lens experience. That is really what it is all about—putting patient needs first—and that is exactly how I’d recommend determining the best lens to prescribe. Professional oversight in the selection process is paramount to ensure that patients receive the optimal lens to meet their unique combination of needs. Lastly, taking the time to explain why one prescribes a specific lens helps the patient understand that this medical device is far more than a commodity and that there is a reason he or she needs a doctor to prescribe contact lenses. RC: An aging population of baby boomers seems like a wonderful opportunity for practitioners to prescribe more multifocal contact lenses for full or part-time wear, yet I’ve seen many of our colleagues struggle to explain to patients how contact lens optics function. CA: When I approach the conversation with a patient, I rarely use the word “presbyopia” or “bifocal.” I just say: “Based on our conversation it’s no surprise that focusing difficulties you’re having can be beyond annoying. If I had a lens that could make focusing between distance and near tasks easier would you like to try it?” I usually follow that with a comment that helps set expectations, namely: “You know vision is complicated. While no lens ever created will be as good as your natural vision once was, I think you’ll love this new lens because it will allow you to do most visual tasks efficiently. You may still need some additional help with really fine print, but seeing your phone and accomplishing most focusing tasks should be much easier than you’re experiencing now.” O|O

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INSTRUMENTATION

Dry Eye Diagnosis: One Size Does Not Fit All By Gina M. Wesley OD, MS, FAAO Dry eye has various possible causes, which advanced testing can help determine. When the Tear Film & Ocular Surface Society released its Dry Eye Workshop II (DEWS II) report in May, it not only updated how we define dry eye but how we diagnose it. This process starts with questionnaires and, depending on the patient’s responses, may eventually warrant such tests as tear film osmolarity and interferometry. Although a single test might seem more desirable, dry eye has various causes and symptoms, so there is no “one-test-fitsall” solution. Here are some of the tools and instruments we may use in dry eye disease diagnoses and treatment.

SURVEYS AND QUESTIONNAIRES One of the most cost-effective ways to diagnose dry eye is to simply ask patients about their symptoms. With the confounding nature of dry eye, patients’ symptoms don’t always correlate to clinical findings. So, an assessment of a patient’s complaints and noted observations regarding their dry eye is valuable. Determining what course of treatment may be the best for a patient based on symptomology and likely adherence to the protocol is necessary. There are a variety of validated surveys available. For example, the Standardized Patient Evaluation of Eye Dryness (SPEED) Questionnaire asks about the

type, frequency and severity of symptoms. The Ocular Surface Disease Index (OSDI) asks about what symptoms the patient has experienced, if those symptoms have limited the patient’s ability to perform specific tasks, and in what conditions those symptoms occur.

CORNEAL TOPOGRAPHY Corneal topography, a tool readily available to many doctors, can tell a story regarding ocular surface health. For example, the OCULUS Keratograph 5M allows you to examine the meibomian glands and view morphological changes, evaluate the lipid layer, and measure tear film break-up time and tear meniscus height. On corneal topography, mires will show a “smudging” or merging together due to an irregular ocular surface. The severity of the mires irregularity is reflective of the surface irregularity. Additionally, when looking at an axial map, there can be false elevations due to patches of keratitis on the cornea. Missing or patchy areas on a topography map could also indicate reduced tear break-up time scores. Inferior steepening that could mimic kerataconus may also manifest and could be related to epithelial dehydration. Lagophthalmos and exposure are common culprits in this finding.

The RPS InflammaDry Detector is a single-use, disposable test that detects elevated levels of MMP-9, an inflammatory cytokine, in the tear film.

INFLAMMADRY Matrix metalloproteinase-9 (MMP-9), a cytokine produced by epithelial cells, is an indicator of inflammation in the ocular tissues and has been correlated with dry eye disease. The RPS InflammaDry Detector, which Quidel Corp. acquired from Rapid Pathogen Screening in May, detects elevated levels of MMP-9. The test is inexpensive and easy for you or your employees to use in the office. Simply touch the conjunctiva with the pad of the tester and then use the solution provided, which contains antibodies to MMP-9. As the solution interacts with potential MMP-9, the indicator shows a positive or negative result. Results are available within 10 minutes, and the company says InflammaDry has 85% sensitivity and 94% specificity. InflammaDry indicates possible late-stage, or long-term, inflammation associated with dry eye.

TEAR OSMOLARITY The DEWS II definition of dry eye includes hyperosmolarity , or higher salt content, as one of the components of dry eye disease.

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The TearLab Osmolarity System provides a different, yet valuable, data point for those with dry eye disease. Elevated levels of 300 or more milliosmoles/liter (mOsm/L) indicates a loss of homeostasis of the tear film. Inter-eye variability of more than 8mOsm/L indicates tear film instability. Meaningful test results with osmolarity may be seen even in mild-stage dry eye disease. Objective testing such as this can help identify, track and manage patients by marking changes in levels over time and with treatment.

LIPIVIEW II Most patients who have dry eye have evaporative dry eye from Meibomian gland dysfunction (MGD). And, patients who have aqueous-deficient dry eye (Sjögren’s and non-Sjögren’s) often have MGD. Thorough evaluation of the lids and related structures, such as Meibomian glands and lid margins, as well as lipid layer analysis, is important when it comes to dry eye management. Symptoms such as burning and fluctuations in vision can be related to reduced lipid layer thickness. Poor blinking habits are also linked to MGD and lipid irregularity.

The LipiView II from TearScience, which was recently acquired by Johnson & Johnson Vision, utilizes interferometry to quantify the lipid layer thickness of the tear film in real time. This technology can also detect incomplete blinking and performs high-resolution meibography to capture the structural integrity of the Meibomian glands. A comprehensive diagnosis and treatment plan for dry eye and MGD requires an assessment of both the function as well as the structure of the meibomian glands.

NO STANDALONES

These diagnostic technologies, although not inclusive of all testing available, summarize many of the advanced methods to help diagnose and treat our dry eye disease patients. Although there are no standalone tests for The TearLab Osmolarity Test measures the salt content of tears. A higher diagnosing dry eye, salt content is indicative of a loss of homeostasis of the tear film. the data we gather from several or all of them allow us to best manage and help our dry eye patients. Embracing the preventative model when it comes to dry eye is a novel concept, but with the technology outlined in this article, is

The LipiView II from TearScience can quantify the lipid layer thickness of the tear film in real time, detect incomplete blinking and perform high-resolution meibography.

absolutely possible. We owe our patients the opportunity to understand causative relationships and current disease state risk when it comes to conditions that can greatly affect one’s quality of life. Dry eye has the potential to impact millions of people. Instead of waiting to react to its aggravations, proactively test, treat and educate your patients for life. O|O Gina M. Wesley OD, MS, FAAO, is in private practice in Medina, MN. WHERE TO FIND IT: Oculus, Inc. 425.670.9977 | OculusUSA.com Quidel 800.874.1517 | Quidel.com TearLab 855. 832.7522 | TearLab.com TearScience 919.459.4880 | TearScience.com

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INSTRUMENTATION

Electronic Health Records and Dry Eye: What’s Available Compulink

Dry Eye Disease on the Record By Leslie E. O’Dell, OD, FAAO EMR software can keep our dry eye evaluation organized and identify at-risk patients. Dry eye disease (DED) is one of the most common reasons for a patient to present for a problem-focused eye exam. The recently released report from the Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II offers evidence-based criteria to help us properly diagnose this disease, while electronic medical record (EMR) software can help keep our dry eye evaluation organized, gathering the important data points and increasing efficiency of each exam.

TRIAGE TFOS DEWS II recommends starting with a series of triage questions to help narrow the diagnosis and rule out dry eye masqueraders, such as recurrent corneal erosion or epithelial basement membrane dystrophy. You can build these questions into the history of present illness (HPI) as screening questions: • How severe is the eye discomfort? • Do you have mouth dryness? • How long have your symptoms lasted, and was there any triggering event? • Are the symptoms or any redness much worse in one eye than the other? • Are the eyes itchy, swollen or crusty, or has there been any discharge? • Do you wear contact lenses? • Have you been diagnosed with any general health conditions (including recent respiratory infections)?

Your software can prompt you or your technician through the preset triage questions, and the answers could populate the HPI section of the patient chart.

800.456.4522 | CompulinkAdvantage.com Eyecare Advantage allows you to assess and document dry eye in the Workup tab, including documenting results from tear osmolarity testing. The company’s web registration feature also has questions to help assess dry eye.

Eyefinity 877.481.4455 | Eyefinity.com Eyefinity EHR lets you document all your dry eye findings in the Ocular Exam area and recently expanded its ability to document details of ocular surface disease, such as grading TBUT, Schirmer’s and more.

First Insight RISK FACTOR ANALYSIS The next step is to determine any medications, systemic diseases and even prior ocular surgeries that increase the risk for DED. This is presently part of EMR systems, and use of technology to generate an “at risk” patient or a dry eye suspect could prevent us from under-diagnosing. Evaluation of symptoms can be done with in-office questionnaires, such as the Dry Eye Questionnaire 5 or the Ocular Surface Disease Index. We can also build these surveys into an EMR so that the EMR rates the severity of DED or flags that patient as having an increased likelihood of DED. Evaluation of clinical signs should include one of the following for diagnosing DED: • Non-invasive tear break up time of less than 10 seconds. • Osmolarity of 308mOsm/L or an interocular difference of 8mOsm/L. • Ocular surface staining that shows more than five corneal spots, more than nine conjunctival spots, or a lid margin that’s 2mm or greater in length and 25% width.

IMPROVED OUTCOMES By customizing EMRs to allow better data

800.920.1940 | First-Insight.com MaximEyes EHR offers comprehensive data entry for all parts of the eye plus the ability to customize and build your own dry eye or other disease template. There’s also a customizable and build-your-own document system.

RevolutionEHR 877.738.3471 | RevolutionEHR.com RevolutionEHR lets you track patients’ progress and document treatments and other dry eye protocols, including tear meibography, anterior segment photos and other tests specific to dry eye management.

entry for a dry eye patient or dry eye suspects, we can improve patient outcomes. That’s because we’ll be able to identify atrisk groups and introduce treatments to restore homeostatsis. As the diagnosis and treatment of DED improves, we should let technology revolutionize the patient encounter. O|O Leslie E. O’Dell, OD, FAAO, is the director of the Dry Eye Center of PA at Wheatlyn Eye Care, Manchester, PA.

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A D V E RT O R I A L

OPEN YOUR EYES TO A FRESH START: EYE HEALTH OF PATIENTS WHO SLEEP IN THEIR CONTACT LENSES Reed Bro, OD Optometrist Eye Care Center of Colorado Springs Colorado Springs, CO Dr Reed Bro was compensated by Alcon for his participation in this advertorial.

Sleeping in contact lenses that aren’t approved for such use has been associated with discomfort, as well as with more serious eye health problems. Even so, a recent survey of contact lens wearers found that 64% of those who sleep in their lenses for at least a week at a time are not wearing extended/overnight use lenses. A separate study found that about one-third of contact lens patients report wearing their lenses to bed.

Unpredictable Work Schedules

Busy Professionals

Frequent Travelers

Moms with Young Kids

Need immediate vision waking up for shift

Eyes feel strained looking at my mobile devices

Travel too often to hassle with my lenses

Can’t see clearly getting up throughout the night

In our practice, many patients want extended-wear contact lenses because of lifestyle demands, such as new moms, shift workers and on-call physicians and nurses. One of my patients—a law student—spends endless hours studying in the school library and sleeps for a few hours at a time, taking naps when his schedule allows. He recently complained of lens discomfort and frequent redness, and his history revealed that he often wore 2-week replacement lenses continuously and overnight for a week at a time (for which his lenses were not approved). I explained that sleeping in lenses like his could cause the discomfort he was describing, and that it also increased his risk of ulcerative keratitis, a serious condition that can lead to loss of vision, which is usually caused by a microbial infection. I switched him to AIR OPTIX NIGH T & DAY AQUA contact lenses because, unlike some overnight lenses that are available, I find that AIR OPTIX NIGHT & DAY AQUA contact lenses provide continuous comfort, and are specifically designed for continuous wear, even while napping and sleeping. The lenses are FDA approved for daily wear and up to 30 nights of continuous wear.* ®

AIR OPTIX NIGHT & DAY AQUA contact lenses are made from lotrafilcon A, a lens material with an established safety profile including a low rate of microbial keratitis. In a study of more than 6,000 lotrafilcon A wearers, only 0.18% of patients were diagnosed with presumed microbial ®

My patients’ eye health is important to me and my practice, but I also want to make sure that overnight lens wearers remain comfor table throughout the full recommended wearing period. AIR OPTIX NIGHT & DAY AQUA contact lenses feature SmartShield Technology, a proprietary surface technology that protects against the inherent hydrophobic properties of silicone. SmartShield Technology acts as a protective barrier, limiting silicone’s expression on the surface of AIR OPTIX contact lenses, and thereby helping to maintain excellent surface wettability and deposit resistance. With this technology, my patients can experience clear vision and consistent comfort from the first day they put on their lenses, waking up to these benefits for up to 30 days thereafter. ®

keratitis, and less than 0.04% with presumed microbial keratitis and a loss of visual acuity.

4,5

Since the health of my patients is very important to me, I’m concerned that so many may be inappropriately wearing their contact lenses overnight. As their eye doctor, my job is to educate them and provide the best lenses to meet their needs. Thanks to the many benefits of AIR OPTIX NIGHT & DAY AQ UA contact lenses, I can provide comfort to my overnight lenswearing patients, ensuring that they see, look and feel their best. ®

Our passion is to help your patients see, look and feel their best. *Extended wear for up to 30 continuous nights, as prescribed by an eye care practitioner Important information for AIR OPTIX NIGHT & DAY AQUA (lotrafilcon A) contact lenses: Indicated for vision correction for daily wear (worn only while awake) or extended wear (worn while awake and asleep) for up to 30 nights. Relevant Warnings: A corneal ulcer may develop rapidly and cause eye pain, redness or blurry vision as it progresses. If left untreated, a scar, and in rare cases loss of vision, may result. The risk of serious problems is greater for extended wear vs. daily wear and smoking increases this risk. A 1-year postmarketing study found 0.18% (18 out of 10,000) of wearers developed a severe corneal infection, with 0.04% (4 out of 10,000) of wearers experiencing a permanent reduction in vision by two or more rows of letters on an eye chart. Relevant Precautions: Not everyone can wear for 30 nights. Approximately 80% of wearers can wear the lenses for extended wear. About two-thirds of wearers achieve the full 30 nights continuous wear. Side Effects: In clinical trials, approximately 3-5% of wearers experience at least one episode of infiltrative keratitis, a localized inflammation of the cornea which may be accompanied by mild to severe pain and may require the use of antibiotic eye drops for up to one week. Other less serious side effects were conjunctivitis, lid irritation or lens discomfort including dryness, mild burning or stinging. Contraindications: Contact lenses should not be worn if you have: eye infection or inflammation (redness and/ or swelling); eye disease, injury or dryness that interferes with contact lens wear; systemic disease that may be affected by or impact lens wear; certain allergic conditions or using certain medications (eg. some eye medications). Additional Information: Lenses should be replaced every month. If removed before then, lenses should be cleaned and disinfected before wearing again. Always follow the eye care professional’s recommended lens wear, care and replacement schedule. Consult package insert for complete information, available without charge by calling (800) 241-5999 or go to myalcon.com. ®

References 1. Alcon data on file, 2012. 2. In a survey of 2,115 daily and extended wear contact lens patients. Alcon data on file, 2012. 3. Schein OD, McNally JJ, Katz J, et al. The incidence of microbial keratitis among wearers of a 30-day silicone hydrogel extended-wear contact lens. Ophthalmology. 2005;112:2172-9. 4. Alcon data on file, 2012, 2013. 5. Epstein AB, et al. Surface and polymer chemistry: the quest for comfort. Rev Cornea Contact Lens. 2010;247:15-9.

See product instructions for complete wear, care and safety information.

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US-AND-16-E-1883(1)

Sponsored by

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CONTACT LENSES

Special Cases Require Specialized Fits By Anar Maurya, OD Custom soft lenses can correct irregular corneas and improve the appearance of disfigured eyes. A 43-year-old male with keratoconus presented to our clinic following a motor vehicle accident that left him with limited motility and limited dexterity of his extremities. The patient was unable to properly insert scleral lenses, which presented a challenge in correcting his irregular corneas. How would you correct this patient’s vision, keeping in mind the new limitations from the accident? As contact lens technology continues to evolve, we are better able to fit challenging patients. Consider: Scleral lenses allow us to vault an irregular cornea and allow us to treat such conditions as dry eye, post-trauma, keratoconus, keratoplasties, and neurotrophic keratitis. (To learn about a new scleral lens and expanded indications for an existing one, go to “New Product Gallery,” page 30.) Furthermore, hybrid lenses, such as UltraHealth, SynergEyes KC and ClearKone from SynergEyes, combine a highly oxygen-permeable rigid center with a soft peripheral skirt, with the central GP zone of the lens vaulting over the cone-shaped cornea for increased comfort. And, we now have a variety of custom soft contact lenses that have become available for individuals with keratoconus and to improve the appearance of individuals

with disfiguring ocular disorders. We’ll look at some of these custom soft lenses here.

NOVAKONE The patient above elected to switch from his existing scleral lenses to a soft contact lens in the hopes of reducing the insert and removal struggle. We obtained the NovaKone fitting set and fit the patient with equally good visual success. NovaKone from Alden Optical, a division of Bausch & Lomb, is an option for varying stages of keratoconus and is an alternative option for patients who cannot tolerate gas permeable, scleral or hybrid lenses. Online certification and an 18-lens diagnostic fit set are required to successfully fit this product. NovaKone is comprised of hioxifilcon D with a 54% water content and a Dk value of 21. The key novel features of the NovaKone include: Dual Elliptical Stabilization for rotational stability of the front-surface toric, variable center thickness (IT Factor) to help neutralize the irregular astigmatism, base curve parameters aligning with the steep central cornea, and an independent para-central fitting curve to help lens movement and stability. NovaKone comes in a standard diameter of 15.0mm but can be custom made to larger diameter designs. The sphere

The SpecialEyes Multifocal Simulator simulates the potential visual performance of the SpecialEyes 54 Multifocal custom contact lens.

power availability is from +30.00D to -30.00D in 0.25D steps. Cylinder power availability is up to -10.00D (0.25D steps), and axis powers are from 1° to 180°. Additionally, the lens features variable center thickness (index of thickness, or IT factors) to neutralize corneal irregularities.

KERASOFT IC KeraSoft IC is a lathe-cut silicone hydrogel soft lens design that can be customized for irregular corneas. Recommended fitting for this lens includes all stages of keratoconus, pellucid marginal degeneration, postrefractive surgery and post-LASIK ectasia. This lens originates from UltraVision in the U.K. and is manufactured and distributed in the U.S. by ABB Concise, Art Optical and Metro Optics. KeraSoft IC is made from efrofilcon A, a 74% water content material with a Dk value of 60, and it is recommended for quarterly replacement. The fit set for KeraSoft IC consists of an eight-lens diagnostic set with standard 14.5mm diameter lenses, plano power and a range of base curves from 7.8mm to 8.6mm. The standard base curves utilize a standard periphery, while the flatter base

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curves include flat and steep peripheries for special fitting circumstances. Spherical powers are available from +30.00D to -30.00D, cylinder power from -0.50D to -15.00D (0.25D steps) and axis of 1° to 180°. You must complete an online certification to fit KeraSoft IC and purchase the fit set. You cannot fit these lenses empirically, as there are numerous variables you must assess prior to ordering. The manufacturer recommends using the MoRoCCo VA technique to assess the lens behavior on eye: movement, rotation, centration, comfort and visual acuity. Treat all characteristics equally when assessing the fit on an irregular cornea. Live consultants are available for troubleshooting if you need assistance.

light. Hand-painted prosthetics are the best option for light colored eyes along with considering matching the healthy eye with the same color prosthetic. The Cantor Prosthetic and Nissel Naturals contact lenses are available in sphere power of -30.00D to +30.00D, cylinder Lenses from MedCorp International help improve the power of -0.75D to -6.00D, and appearance of eyes that have been disfigured. an axis of 1° degree to 180° degrees in 5° steps. Base curves range from SpecialEyes 49% with yearly replacement. 6.60mm to 10.40mm. Available diamSpecialEyes delivers the lenses to your eters are 11.00mm to 20.00mm (0.50mm office in two to four business days and ofsteps), and closed pupils are 2.5mm to fers a Guaranteed Fit Program. This pro5.0mm (0.50mm steps). The ability to gram will remake or exchange lenses at no custom-design the prosthetic lenses proadditional cost until optimal fit and vision vides practitioners with successful prodare obtained. If the trial is unsuccessful ucts for patient loyalty and retention. or the patient is unable to adapt to the

MEDCORP INTERNATIONAL MedCorp International offers Cantor Prosthetic Lenses and Nissel Naturals to improve the appearance of eyes that were disfigured due to congenital abnormalities, traumatic injuries and scarring secondary to eye diseases. MedCorp International offers these patients lenses via computer-generated colors that are hand-painted for an exact match. You can order lenses that have an open or closed pupil of varying pupil size, a clear back surface or a black back surface to eliminate photophobia. Even severe forms of congenital coloboma, corneal scarring, strabismus, aniridia and traumatic iridoplegia are disguised with the remarkable hand-painted iris detail that MedCorp International can provide. The best way to obtain a successful color match is to digitally photograph the healthy eye in natural lighting. Lighter iris colors are generally more difficult to match than darker iris colors due to reflections of

SPECIALEYES SpecialEyes designs custom soft spherical, toric, bifocal and multifocal contact lenses for patients who have large amounts of astigmatism, hyperopia and/or myopia. The wide parameter ranges offer the ability to design a lens to the patient’s exact refractive error for precise visual acuity. These lenses are an alternative for those individuals who have difficulty adapting to scleral and gas permeable lenses and when an inoffice stock contact lens doesn’t work. Custom lenses can be made with the following parameters: spherical lenses from +25.00D to -25.00D and cylinder powers up to -8.00D (0.10D steps), with 1° axis increments. Multifocal products are available in toric or sphere parameters with add powers up to +4.00 diopters and completely customizable optics via the SpecialEyes Multifocal Simulator. Lens modalities include SpecialEyes 54% and 59% with quarterly replacement or

lenses, SpecialEyes will provide full credit for the trial lens cost. Live consultants are available to help fine-tune adjustments along with extensive online training. O|O Anar Maurya, OD, received her doctorate from UAB School of Optometry in 2004. She currently specializes in ocular disease, post surgical management and fitting specialty contact lenses at Woodhams Eye Clinic in Atlanta. WHERE TO FIND IT: Alden Optical, Inc. 800.253.3669 | AldenOptical.com Info@AldenOptical.com Art Optical Contact Lens, Inc. 800.253.9364 | ArtOptical.com Medcorp International 949.582.0313 | MedcorpInt.com SpecialEyes 866.404.1060 | SpecialEyesQC.com SynergEyes, Inc. 877.733.2012 | SynergEyes.com

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CONTACT LENSES

Grow Your Specialty Through Social Media By Nancy Rausman You can answer questions, give demonstrations and advise your audience—all online—to establish your expertise. For your specialty contact lens service to really take off, you need your community to perceive you as the local expert. This is what will bring patients knocking on your door when they are in the market for contact lenses or have special contact lens needs. Promotional materials, ads or webpages can give information and describe what you do, but if you really want to show that you are an expert, social media is the way to go.

WHY SOCIAL MEDIA? Social media creates a relationship with your audience that engenders a deeper, more lasting impression than an ad or webpage. The interactive nature of social media allows you to answer questions, give demonstrations, show off products and open up a discourse to advise your audience and demonstrate your expertise. In other words, you aren’t telling your audience that you’re an expert; you’re showing them. Further, it’s more personalized, especially with video. Your audience can get to know you beyond a picture. They can hear how you sound, see your body language and develop a sense of familiarity and trust that cannot be achieved in print. Here are some powerful ways you can use social media to engage your specialty contact lens audience.

EDUCATIONAL CAMPAIGNS Specialty contact lenses are something that most patients don’t know much about unless they have firsthand experience. Most aren’t aware of the therapeutic uses for contact lenses, such as using ortho-k to prevent the progression of myopia, unless a doctor suggests it to them. The same goes for scleral lenses, hybrid lenses or custom soft lenses. Many hard-to-fit patients give up on contact lenses without realizing that they have options. You can use social media to create this awareness and provide information that will grab your audience’s attention so that they will want to learn more—from you. The formula for engaging content on social media includes short bites of text, eye-catching images and, whenever possible, video. Also, be sure to make it dynamic. For example, one day you might link to a blog post on your website. Another day, you might ask a question to start a discussion. Post a pre-recorded video or host a Facebook Live information session. Create an infographic or post a series of facts over a few days. Use hashtags, such as #contactlenses, #contactlensspecialist or #orthok so that people who are searching for information will find you. The point of social media marketing is to capture your audience’s attention—all while building your

reputation, name recognition and trust.

PRODUCT DEMOS You can also use social media to profile products or conditions that require specialty lenses. Create a video to show a scleral lens next to a standard contact lens, and discuss which patients should consider them. Alternatively, present an ortho-k case study or display an array of lenses and discuss the conditions, such as dry eyes, keratoconus or astigmatism, for which they are most appropriate. You may want to consider paid ads such as a Facebook Ad campaign that you can target according to location, age, gender and more. If you’re on social media networks, you can use a social media management system such as Hootsuite, TweetDeck or Social-Engage to help you schedule and track your marketing efforts. Social media has a unique ability to help your practice build a trusted reputation and gain exposure about your contact lens specialty. It’s worthwhile for you to take the time to learn about it and incorporate it into your specialty marketing strategy. O|O Nancy Rausman is managing editor at EyeCarePro, which specializes in digital and traditional new patient acquisition strategies for optometry and ECPs.

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New! SynergEyes VS Scleral TM

Innovative Scleral Lens with a Distinctive Linear and Toric Periphery Linear scleral landing zone Toric periphery

Standard diameter: 16.0 mm Diameter range: 14.0 to 17.5mm

Introduction to the SynergEyes VS Scleral Lens TM

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PATIENT CARE

Keeping Presbyopes in Contact Lenses By Jennifer L. Stewart, OD To do so, educate your patient and take advantage of the materials available. Patients who are likely to give up contact lens wear represent one of the greatest opportunities in our practices. Contact lens usage drops off dramatically after age 45 due to comfort and vision issues, even though today’s contact lens technology means they do not have to sacrifice vision or comfort while wearing contact lenses. Also, many patients are unaware of the opportunities that exist for them. If we can successfully provide these patients with clear, crisp, comfortable vision that matches their changing needs, our practices will benefit greatly. Multifocal wearers have traditionally been thought of as time consuming patients who take a lot of chair time. I welcome these patients, however, and ask every presbyopic patient about contact lens wear. Many of these patients have never considered themselves a candidate for contact lenses and are thrilled with the option of even part time freedom from spectacle wear. One of the best ways to ensure success is proper patient selection and clear cut expectations. I often tell patients that “if I can get you happy 80% of the time, that is a 100% success in my book.” I also let them know that multifocal lenses may not work for them in every situation, but that does not mean they are a failure. Having the option for sports, social occasions and as an option for everyday use can be just as great.

We are very fortunate to have many different lenses available, all with different designs and materials.

ALCON

The 1-DAY ACUVUE MOIST Brand MULTIFOCAL from Johnson & Johnson Vision features a permanently embedded wetting agent.

file Design, which allows for clear vision at all distances, and a smooth transition from center near to intermediate and far. Like the DAILIES AquaComfort Plus Multifocal, this lens is available in powers of +6.00D to -10.00D low (to +1.25D), medium (+1.50D to +2.00D) and high (+2.25D to +2.50D) add powers.

The AIR OPTIX AQUA Multifocal lens provides patients with a monthly lens offering crisp vision, comfort and wettability, and high oxygen transmission. The Precison Profile Design gives clear vision at all disJOHNSON & JOHNSON tances, and the lens is available in powers The 1-DAY ACUVUE MOIST Brand of +6.00D to -10.00D and low (to +1.25D), MULTIFOCAL from Johnson & Johnmedium (+1.50D to +2.00D) and high son Vision features pupil optimization, (+2.25D to +2.50D) add powers. which closely matches the optical design DAILIES AquaComfort Plus Multifocal to the pupil size according to age and reOne-Day Contact Lenses, made of nefilcon fractive power for built-in precision and A, also feature Precision Profile Design. consistent performance, and LACREON A consistent add power also decreases fit Technology, which permanently embeds time and improves performance at all disa wetting agent in the lens material for tances. This lens is available from +6.00D improved comfort. They are available to -10.00D with The Bausch + Lomb ULTRA for Presbyopia combines Moisture Seal low (to +1.25D), Technology with a 3-Zone Progressive Design. medium(+1.50D to +2.00D) and high (+2.25D to +2.50D) add powers. The DAILIES TOTAL1 Multifocal is a water gradient contact lens for presbyopes. This lens features the Precision Pro-

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in powers of +6.00D to -9.00D (0.25D steps) and three ranges of add powers: low (+0.75D to +1.25D), medium (+1.50D to +1.75D) and high (+2.00D to +2.50D). The ACUVUE OASYS FOR PRESBYOPIA lens combines HYDRACLEAR PLUS technology, which balances increased oxygen transmissibity of the senofilcon A silicone hydrogel material with a higher volume of wetting agent, for greater lubricity, and the STEREO PRECISION TECHNOLOGY, which works with the eye’s natural function to provide balanced near, intermediate and distance vision across variable lighting conditions. With 98% of the oxygen available reaching the eye, and increased lubricity, patients wearing this lens find they have better comfort in challenging environments. The ACUVUE OASYS FOR PRESBYOPIA is available in three add powers from +6.00D to -9.00D (0.25D steps) with three add powers: low (+1.25D), medium (+1.75D) and high (+2.50D).

Proclear 1 day multifocal is an aspheric center near design that allows for vision at all distances.

at all distances. The Proclear material can help with dry eye discomfort, as the molecular chemistry of the lenses and PC Technology keep the lenses hydrated and clean all day. The single power profile keeps distance vision sharp, optimizes near and intermediate vision and maintains binocularity. This lens is available from +6.00D to -10.00D (0.25D steps, 0.50D steps after -6.00D), and can accommodate add powers to +2.50. The Biofinity multifocal is a lens that has a low modulus, high Dk value (128) and is naturally wettable. It is approved for daily and extended wear up to six nights/seven days. It is available from +6.00D to -8.00D and in add powers of +1.00D to +2.50D.

BAUSCH + LOMB COOPERVISION CooperVision’s clariti 1 day multifocal lens combines exceptional vision for early to late presbyopes, the ease of a daily disposable lens and the comfort and breathability of a silicone hydrogel lens. I’ve found that fitting this lens only requires an extra five minutes vs. the clariti 1 day. This lens also features WetLoc Technology to keep the surface continuously moist, UVA and UVB protection, and 100% corneal oxygen consumption. The clariti 1 day multifocal is available from +5.00D to -6.00D (0.25D) steps and two ranges of powers: low (up to +2.25D) and high (+2.50D to +3.00D). Proclear 1 day multifocal is an aspheric, center near design that allows for vision

The Bausch + Lomb ULTRA for Presbyopia combines Moisture Seal Technology with a 3-Zone Progressive Design. The combination of these technologies provides patients exceptional comfort and clear vision at near, far, and in-between. Bausch + Lomb ULTRA for Presbyopia also provides consistent add power across the powers for an easy, predictable fit. This lens is available in powers of +6.00D to -10.00D (0.25D steps) and with low (+0.75D to +1.50D) and high (+1.75D to +2.50D) add powers. Biotrue ONEday for Presbyopia contact lenses combine the bio-inspired Surface Active Technology with Bausch + Lomb’s 3-Zone Progressive design. The lenses have an extremely high water

content and maintain 98% of their moisture for a full 16 hours. The multifocal design offers patients comfortable vision across all distances and is available in powers of +6.00D to -9.00D (0.25D steps), including plano, and with low (+0.75D to +1.50D) and high (+1.75D to +2.50D) add powers.

MORE CHOICES There are more choices then ever for our presbyopic contact lens wearers. We have the option of daily disposable lenses, traditional two-week lenses, and monthly replacement lenses that are approved for extended wear. The newer designs and detailed fitting guides decrease chair time and improve fitting success, making it easier than ever for eyecare practitioners to add multifocal contact lenses into their practice. O|O Jennifer L. Stewart, OD, is a partner at Norwalk Eye Care, in Norwalk, CT. She is also the co-founder and chief optometric officer at Performance 20/20, a sports and performance vision clinic, in Stamford, CT. WHERE TO FIND IT: Alcon Laboratories 800.451.3937 | Alcon.com Bausch + Lomb 800.828.9030 | Bausch.com CooperVision, Inc. 800.341.2020 | CooperVision.com Johnson & Johnson Vision Care, Inc. 800.843.2020 | ACUVUEProfessional.com

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PHARMACEUTICAL

Why Hydrogen Peroxide is My First Choice By Christopher W. Lievens, OD, FAAO H2O2 solutions can help avoid noncompliance issues that lead to contact lens complications. Keeping patients in contact lenses without complication is the goal of many practices. Unfortunately, however, patients do not always adhere to our recommendations for safe wear and care. Hydrogen peroxide (H2O2) contact lens solutions afford practitioners ease of mind when it comes to safety and offer patients visual feedback and ease-of-use benefits. The H2O2 products on the market today are as ideal as it gets and our go-to system for patients. H2O2 contact lens disinfection is now my number one choice when it comes to reusable contact lenses.

COMPLICATING FACTORS Contact lens fitting success has historically been jeopardized by the occurrence of complications. Improper cleaning and disinfection, reuse of solutions, not replacing lens cases and contact lens overwear have been proposed as causes of complications. A 2011 study found that only 2% of individuals demonstrated good compliance, with only 0.4% fully compliant. The remaining 98% engaged in risky practices, including tap water exposure, sleeping in lenses not approved by overnight wear, wearing lenses beyond the manufacturer’s recommended replacement frequency, failing to wash hands, failing to replace

the lens case and solution misuse. We can address many of these issues by properly educating patients and by encouraging them to use H2O2 disinfection.

AROUND FOR LONG H2O2 disinfection of contact lenses has been around for quite some time, and it is oftentimes what other methods are compared against. H2O2 disinfection consists of 3% peroxide per case with a neutralizing agent. Very low levels of peroxide remain after neutralization, with a goal of less than 100 parts per million to avoid ocular detection. Modern systems include surfactants, buffering and wetting agents to increase lens wettability and lens comfort during the wearing cycle. We now have a system that is historically well known for its disinfection properties and has additives that increase wearability and comfort. Additionally, H2O2 may simplify patients’ care regimen—a significant advantage for a patient base known to be non-compliant. (Remind patients to use the special case that comes with the solution, not to rinse contact lenses with the solutions and keep the solutions out of their eyes.) Here are the steps required in the H2O2 care process: Wash hands, place lenses into the baskets and rinse for five

CLEAR CARE PLUS combines 3% hydrogen peroxide with HydraGlyde Moisture Matrix technology for sustained moisture.

seconds, and fill the case, tighten the cap and soak for at least six hours. For comparison, here are the steps required in a common multipurpose solution: Place at least three drops on each side of the contact lens, rub the lens for 20 seconds, rinse each side of the contact lens for five seconds, and fill the case, insert the lenses and tighten the cap.

ALL-IN-ONE Multipurpose solutions (MPS) first came to market in 1995. Patients can use these agents as an all-in-one product to clean, disinfect and store contact lenses. After 1997, MPS became the predominant disinfection method used by contact lens wearers. However, the convenience of requiring only one solution to perform a multitude of tasks has resulted in noncompliance with labeling instructions in more than 79% of users. MPS require rubbing and rinsing of the lenses (per the package inserts), yet as many as 75 to 77% of patients fail to do so, despite the increased

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Abbott Medical Optics 800.347.5005 | Surgical.JNJVision.com Oxysept Disinfecting Solution/ Neutralizer Ultracare Formula Description: Sterile 3% hydrogen peroxide solution for lens disinfection. Oxysept Neutralizing Tablets are a delayed-release neutralizing tablet that is added at the beginning of the disinfection cycle and colors the solution pink to show that the tablet has been added. This tablet allows disinfection to occur before neutralizing the solution all in one easy step. Oxysept Cup is a specially designed lens cup that must be used with this system.

Alcon Laboratories 800.451.3937 | Alcon.com, ClearCareSolution.com CLEAR CARE Cleaning & Disinfecting Solution Description: Preservative-free sterile solution containing micro-filtered hydrogen peroxide 3%. Comes with PLATINUM DISK, which activates bubbles to clean your lenses by neutralizing the hydrogen peroxide and lens baskets to hold contact lenses in place. CASE fill line helps you use just the right amount of solution for your lenses. CLEAR CARE Plus Cleaning and Disinfecting Solution with HydraGlyde Description: System consists of preservative-free CLEAR CARE Plus Cleaning & Disinfecting Solution, a 3% hydrogen peroxide solution. Features HydraGlyde Moisture Matrix technology for sustained lens moisture. Also comes with CLEAR CARE* PLUS lens case consisting of a transparent cup and a connected unit of screw cap, lens holders (baskets) and the neutralizer catalyst disc.

CooperVision, Inc. 800.341.2020 | CooperVision.com Refine One Step Description: Preservative-free, onestep, 3% hydrogen peroxide solution. Consists of Refine One Step hydrogen peroxide solution, platinum disc neutralizer and barrel lens case.

risk of biofilm formation and increased bioburden of pathogens. H2O2 does not require lens rubbing, and the frequency of all contact lens-related adverse events is reduced through the usage of H2O2 disinfection. Another challenge: One study found that 22% of subjects reported topping off MPS instead of using fresh solution. This is particularly worrisome, as this behavior was implicated as a key factor in the outbreak of contact lens-related fungal keratitis. The design of the H2O2 system counteracts this disinfection misuse. Patients get visual feedback with peroxide disinfection (the bubbles). They are discouraged from topping off H2O2 because there would be no bubbles.

CONTACT LENS WORKSHOP The FDA sponsored a two-day Contact Lens Care Product Workshop in January 2009, several years after the outbreaks of contact lens-related fungal and Acanthamoeba keratitis. A comprehensive research plan tested contact lenses and their lens care products in experiments meant to mimic real-world challenges that face patients. The results were published in 2012. In 2006, researchers found that biocides and MPS preservatives can be taken up into contact lenses, leaving what remained in the case questionably ineffective. Any loss of efficacy of a solution from preservative uptake, combined with MPS misuse by patients (topping off, for example), could have a marked effect of disinfection and safety. The FDA experiments also attempted to determine preservative depletion and the resultant efficacy of the remaining preservative in solution. Because uptake into the lens is a potential problem, the subsequent release of the biocide is also problematic.

The FDA found that MPS can lose its bactericidal efficacy when a contact lens is introduced and can have less microbiocidal action against common eye pathogens. H2O2 does not have similar challenges. Peroxide can enter and exit a lens with ease and is nearly completely neutralized after the disinfection process. The bactericidal efficacy of H2O2 is consistent in the presence of contact lenses.

DEDICATED PATIENTS Many patients today have challenges with contact lenses. These challenges can result in eventual contact lens dropouts. In one study of patients with lid papillae, my colleagues and I found H2O2 to outperform MPS in the following areas: lens cleanliness, clarity of vision, and lenses feeling clean and like new (after disinfection). The individuals also reported reduced irritation, grittiness/ scratchiness, burning/stinging, itchiness, dryness and blurred vision. Patients who use H2O2 are oftentimes very dedicated to the product. I have found that patients are well aware of the category of peroxide disinfection and the brand that they use (and they are correct!). Modern advances now afford additional benefits to this process in terms of improving lens comfort and wear. H2O2 is easy to use, and patients are less likely to misuse it. It offers visual cues to our patients. Thatâ€™s why these solutions are my first-line recommendation for reusable contact lenses. O|O Christopher W. Lievens, OD, FAAO, is chief of staff at The Eye Center at Southern College of Optometry, where he also is a professor. He has received compensation for consulting and/or speaking for Alcon.

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THE | OPTOMETRIC TECHNICIAN BY ROBERTA BEERS, CPOT GIANT PAPILLARY CONJUNCTIVITIS, A REACTION TO CHRONIC IRRITATION, MAY CALL FOR A CHANGE IN CONTACT LENS WEAR OR CARE. Giant papillary conjunctivitis, commonly referred to as GPC, is a condition in which the palpebral conjunctiva becomes inflamed and papillae develop. These small bumps often form in response to some type of chronic irritation, such as wearing contact lenses. In GPC, the bumps grow and combine, forming very large bumps that sometimes resemble a cobblestone appearance. Symptoms of GPC include itchy eyes, increased production of mucus, a desire to remove contact lenses earlier in the day, and a gritty, foreign-body sensation upon removal of contact lenses. Patients may also notice that their contact lenses tend to move around or don’t fit as perfectly as they used to.

CAUSES OF GPC GPC is most likely an allergic reaction to deposits that form on the surface of a contact lens rather than the lens itself. Since the lens itself is made from a type

of plastic, it is probably not the lens that is the source of the allergy, but rather the proteins and lipids that deposit on the lens. The upper lid is in almost constant contact with the lens, and most of the abnormal changes occur on the inside surface of the upper lid. The large papillae under the eyelids act as little fingers grabbing the lens and causing upward movement. Papillae are more common in contact lens wearers who do not follow proper cleaning and disinfection routines or who over-wear their contact lenses. The eye interprets the contact lens as a foreign body, and a mild type of mechanical trauma occurs. At some point, the eye’s inflammatory processes kick in, resulting is GPC. Patients who have asthma, chronic allergies or hay fever tend to be more prone to developing GPC. It can also be caused by constantly blinking when

In giant papillary conjunctivitis, the palpebral conjunctiva becomes inflamed and papillae develop. Papillae are more common in contact lens wearers who do not follow proper cleaning and disinfection routines or who over-wear their contact lenses.

Photo: Andrew S. Gurwood, OD

wearing contact lenses. It also may occur when a patient wears an ocular prosthesis, or in an eye irritated by a suture from prior eye surgery. Because GPC is caused by exposure of the conjunctiva to allergens in the contact lenses rather than viral or bacterial infection, it is not contagious.

FOUR STAGES There are four stages of GPC: • Preclinical GPC, the earliest stage of this disorder in which certain spots of the eyelid turn red and rough. • Mild GPC, in which small bumps arise on the eyelid, causing minor difficulties in clear vision. • Moderate GPC, in which the bumps grow larger than 1 mm in this stage, leading to blurred vision. Patients often find their lenses moving upward as they blink. • Severe GPC, the acute stage in which vision becomes blurred, and the patient suffers from eyesight problems. This is the result of abnormal movement of contact lens. To aid in the diagnosis, be sure to take a careful medical history and listen to the patient’s complaints. Each office will have its own patient record form or EHR program. There are several basic areas that should be covered in any history. The patient’s chief complaint is an important part of the history. With GPC, patients may say their eyes are itchy or red, and/or report a burning sensation. Another complaint: eye pain and inflammation of the eyelids or of their eyes feeling gritty, discharge of watery mucus or blurred vision. Ask for more information. Determine how long the complaint has existed, how severe it is, and whether

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GPC is most likely an allergic reaction to deposits that form on the surface of a contact lens rather than the lens itself. Since the lens itself is made from a type of plastic, it is probably not the lens that is the source of the allergy, but rather the proteins and lipids that deposit on the lens. it is better, worse or the same? Can the patient associate the complaint to a time of day or task? Measure the patient’s visual acuity, observe the contact lens using the slit lamp and document what you observe. This description will aid the doctor in his or her diagnosis. The doctor will flip the upper eyelid outward so that the conjunctiva, the inner lining of the eyelid, can be easily seen. The doctor may also use a yellow dye to temporarily stain the surface eye tissue to aid in making a diagnosis.

TREATMENT OF GIANT PAPILLARY CONJUNCTIVITIS There are several possible treatments for GPC. The doctor might tell the patient to: • Discontinue wearing contact lenses, at least temporarily, to get clear the irritation. While contact lens wearers are generally not very happy to hear this, it does speed healing. It may only take a few weeks or as much as six to eight months of not wearing contact lenses for the condition to completely resolve. At the very minimum, it may be important to reduce the wear time to only a few hours per day. • Switch to a more effective disinfecting and cleaning solution. Peroxide-based cleaning solutions are slightly more complicated to use but are very effective at killing bacteria and viruses and removing any debris that can cause irritation.

• Try a different kind of contact lens. Changing from conventional or monthly disposable contact lenses to daily disposables often helps considerably. When patients wear daily disposable lenses, there is less of a chance to build up proteins that the patient might be allergic to. (For a listing of daily disposable contact lenses, see “At-AGlance,” page 28.) • Use cold compresses. Cold compresses can help to relieve itchiness and soreness of GPC. Instruct the patient to soak a clean washcloth in a container of water filled with ice. Remove the water from the washcloth and apply it against the affected eyelid, repeating this process for five to 10 minutes • Use prescription eye medications. The doctor may prescribe steroid eye drops to lessen the inflammation. Steroids work very well for most patients. If the doctor prescribes topical steroid drops it is important the patient follows the instructions, as steroids used in the wrong way can be harmful. A combination mast cell stabilizer/antihistamine eye drop can often help considerably and is safe for most patients to use every day. Most patients with GPC can still wear contact lenses. However, they need to be instructed in the proper contact lens hygiene and wearing habits that will lower the risk of developing GMC.

MORE QUESTIONS TO ASK WHEN YOU SUSPECT GPC Giant papillary conjunctivitis is most likely to occur with current contact lens wearers or with previous contact lens wearers. Here are some recommended questions to ask when obtaining a patient history: • How long have you been wearing contact lenses? • What is your average daily wearing time? • Do you sleep in your lenses? • How often do you replace your lenses? • Are you using a cleaning or disinfectant system? • Are you using any eye drops with or without contact lenses? • Have you ever been treated for lid irritation (GPC) during previous contact lens wear? Was the treatment successful?

GIANT PAPILLARY CONJUNCTIVITIS PROGNOSIS Depending on its severity, GPC typically resolves in one to six weeks—provided the patient does not wear contact lenses during that time. If the patient has chronic GPC, the condition will flare up once the patient resumes contact lens wear. This is why the doctor would suggest wearing daily contact lenses at that time rather than put the patient at risk of developing GPC again from over-wear of lenses. O|O Roberta Beers, CPOT, is an optometric assistant in Erie, PA.

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AT-A- GLANCE

DAILY DISPOSABLES BRAND

BC/DM

H20/DK

MATERIAL

RANGES

BENEFITS

Alcon Laboratories | 800.451.3937 | Alcon.com DAILIES AquaComfort Plus

8.7/14.0

69%/ dk 26

nelfilcon A

-0.50 to -6.00D (0.25D steps) +6.50 to +8.00 -6.50 to -15.00D (0.50D steps)

•B link-Activated Moisture for added refreshment with every blink • G reat for those with allergies or who use digital devices

DAILIES AquaComfort Plus Multifocal

8.7/14.0

69%/ dk 26 @ -3.00D

nelfilcon A

Plano to -10.00D +0.50D to +6.00D (in 0.25D steps)

•L ow, medium and high add powers

DAILIES AquaComfort Plus Toric

8.8/14.4

69%/ dk 26 @ -3.00D

nelfilcon A

Plano to -6.00D +0.25D to +4.00D (in 0.25D steps) -6.50D to -8.00D (in 0.50D steps) Cylinder powers: -0.75D, -1.25D, -1.75D Axes: 10°, 20°, 70°, 80°, 90°, 100°, 110°, 160°, 170°, 180°

DAILIES TOTAL1

8.5/14.1

33% core, >80% surface / dk 156 @ -3.00D

delefilcon A

+6.00D to -12.00D

FOCUS DAILIES

8.6/13.8

69%/26 @ -3.00D

nelfilcon A

-0.50D to -6.00D (in 0.25D steps) -6.50D to –10.00D (in 0.50D steps) +0.50 to +6.00D (in 0.25D steps)

• Water Gradient contact lens •A pproaches 100% water at the outer surface so all that touches the eye is a cushion of moisture •N ine out of 10 wearers say the lens feels like nothing

Bausch + Lomb | 800.828.9030 | Bausch.com Biotrue ONEday

8.6/14.2

78%/ dk 42

nesofilcon A

Plano to -6.00D (in 0.25D steps) • S urface Active Technology material— -6.50D to -9.00D (in 0.50D steps) maintains 98% of its moisture for up +0.25D to +6.00D (in 0.25D steps) to 16 hours • Features UVA/UVB protection • Aspheric optics

Biotrue ONEday for Presbyopia

8.6/14.2

78%/ dk 42

nesofilcon A

+6.00D to -9.00D (in 0.25D steps) • S urface Active Technology material— including plano maintains 98% of its moisture for up Add power: to 16 hours Low: +0.75D to +1.50D • 3-Zone Progressive Design spectacle add •P rovides clear vision across near, inHigh: +1.75D to +2.50D termediate and distance vision spectacle add

Biotrue ONEday for Astigmatism

8.4/14.5

78%/ dk 42

nesofilcon A

Plano to -4.25D (in 0.25D steps); Cylinder powers: -0.75D, -1.25D, -1.75D; Axes: 10°, 20°, 70°, 80°, 90°, 100°, 110°, 160°, 170°, 180° +0.25D to +4.00D (in 0.25D steps); Cylinder powers: -.075D, -1.25D, -1.75D; Axes: 20°, 70°, 90°, 110°, 160°, 180°

•S urface Active Technology—maintains 98% of its moisture for up to 16 hours •E volved, blink-inspired peri-ballast lens designed for comfort and stability •P rovides consistently clear vision all day • Features UVA/UVB protection

SofLens Daily Disposables

8.6/14.2

59%/ dk 22

hilafilcon B

+6.50D to -9.00D

• ComfortMoist Technology • Aspheric optics

SofLens Daily Disposables for Astigmatism

8.6/14.2

59%/ dk 22

hilafilcon B

Plano to -9.00 (-6.50D to -9.00D in 0.50D steps) Cylinder powers: -0.75D, -1.25D, -1.75D; Axes: 20°, 90°, 160°, 180°

• ComfortMoist Technology • Aspheric optics

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BRAND

BC/DM

H20/DK

MATERIAL

RANGES

BENEFITS

hioxifilcon A

+6.00D to -10.00D

•A quagrip Technology enables lens to retain water content •S pin Cast Technology reproduces accurate lens prisms •G reen manufacturing technology uses 70% less water and plastic •E xcellent for dry eye and allergy patients

Clearlab | 888.777.7147 | ClearLabUSA.com Eyedia Fresh Daily Disposables

8.6 or 8.7 58%/ dk 25.3 (for +4.00 to +6.00)/14.0

CooperVision | 800.341.2020 | CooperVision.com clariti 1 day

8.6/14.1

56%/ dk 60

somofilcon A

+8.00D to -10.00D

• Silicone hydrogel material • Available in toric and multifocal • UVA/UVB protection • Aspheric optics

Clearsight 1Day

8.7/14.2

52%/ dk 16

ocufilcon B

+6.00D to -10.00D

• UVA/UVB Protection •T hinner design reduces lid interaction •L enticulated design promotes easy handling

MyDay Daily Disposables

8.4/14.2

54%/ dk 80

stenfilcon A

+8.00D to -12.00D

• UVA/UVB Protection •S ilicone hydrogel •S mart Silicone chemistry creates soft, naturally wettable lens • Aspheric optics

Proclear 1 Day

8.7/14.2

60%/ dk 25

omafilcon A

+8.00D to -12.00D

•P C Technology that causes water molecules to actually become a part of the lens, creating a natural resistance to dryness • Available in multifocal

Johnson & Johnson Vision Care, Inc. | 800.843.2020 | ACUVUEProfessional.com 1-DAY ACUVUE MOIST

8.5 or 9.0/14.2

58%/ dk 28

etafilcon A

–0.50D to –6.00D (0.25D steps) • Lacreon Technology –6.50D to –12.00D (0.50D steps) • O ne of the highest UV blocking lenses +0.50D to +6.00D (0.25D steps) available in daily disposable • May help allergy sufferers •M OIST brand family is also available in multifocal and for astigmatism

1-Day ACUVUE TruEye

8.5 or 9.0/14.2

46%/ dk 118

narafilcon A

–0.50D to –6.00D (0.25D steps) • HYDRACLEAR 1 Technology –6.50D to –12.00D (0.50D steps) • Super-breathable design • Highest UV protection

ACUVUE OASYS 1-Day

8.5 or 9.0/14.3

38%/ dk 121

senofilcon A

+6.00D to -12.00D

• Hydraluxe Technology •T ear-like molecules that integrate with patient’s own tear film to decrease dryness • Highest UV protection

1-DAY ACUVUE DEFINE

8.5/14.2

58%/ dk 28

etafilcon A

-0.25D to - 6.00D (0.25 steps), -6.50D to – 9.00D (0.50 steps) +0.50D and +1.00D

• LACREON Technology • Beauty Wrapped in Comfort Technology •O ne of the highest UV blocking lenses available in daily disposable • May help allergy sufferers •A vailable in multifocal and toric

Menicon America | 800.MENICON | MeniconAmerica.com Miru 1Day

8.4 or 8.6/14.2

57%/ dk 25.38

hioxifilcon A

+0.50D to +4.00D -0.50D to -10.00D

•C ENTRAFORM Technology results in a smooth edge profile for reduced friction when blinking •O uter surface of lens is always facing up in package eliminating confusion in lens orientation and minimizing risk of touching inner surface of lens

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NEW PRODUCT | GALLERY NEW MONTHLY LENS FOR ASTIGMATISM Johnson & Johnson Vision has launched ACUVUE VITA Brand Contact Lenses for ASTIGMATISM, daily wear monthly replacement contact lenses. This latest addition to the ACUVUE VITA family of products combines HydraMax Technology, to maximize and maintain hydration throughout the month, and BLINK-STABILIZED Design, which works naturally with the eyelid to keep the lens in the correct position. ACUVUE VITA for ASTIGMATISM also provides Class I ultraviolet protection, blocking 93% of UVA and 99% of UVB rays. Call 800.874.5278, or go to ACUVUEProfessional.com.

NEW SCLERAL LENS FROM SYNERGEYES SynergEyes, known for its hybrid contact lenses, has launched its its SynergEyes VS, a scleral lens with distinctive linear landing zones and a toric periphery. The lens design completely vaults the cornea and limbus and lands on the sclera. This non-rotationally symmetrical lens design incorporates linear landing zones to follow the linear shape of the sclera and landing zones with bitangential toricity to provide consistent stabilization and allow for front-surface cylinder. The lens comes in diameters of 14.0mm to 17.5mm (0.5mm steps) and base curves of 7.4mm to 9.2mm (0.2mm steps). It is available in sphere powers of -25.00D to +25.00D (0.25D steps) cylinder powers of -0.75D to -3.00D (0.25D steps) and axis powers 0° to 180° (1° steps). The SynergEyes VS scleral lens may be prescribed using a 16-lens diagnostic set in which all lenses have a toric periphery. Call 877.733.2012, or go to SynergEyes.com/Professional.

ULTRA-WIDEFIELD IMAGING FROM ZEISS ZEISS Medical Technology launched CLARUS 500, a high-definition, ultrawidefield fundus imaging system that combines true color and high-resolution clarity down to 7 microns and lets you view the fundus from the macula to the periphery. True color, which resembles the coloration seen through direct observation, enables you to evaluate focal change in rim tissue, nerve pallor, dry age-related macular degeneration, changes in the retinal pigment epithelium and drusen. With a single capture, ZEISS CLARUS 500 produces a 133° high-definition image, then automatically merges images to achieve a 200° field of view. The technology lets you review and compare images captured during a single exam and provides annotation and caliper measurement tools for in-depth analysis of eye health. Call 800.341.6968, or go to Zeiss.com/US/CLARUS.

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ALL IN ONE TAB Compulink Business Systems, Inc. enhances its Eyecare Advantage system with OneTab—a single tab exam layout that allows providers to easily view and document an exam from one screen. Compulink’s all-in-one system supports the entire practice workflow (clinical, business and dispensary) to maximize efficiencies and increase profitability. Features include electronic health records, practice management, optical point of sale and inventory management, patient engagement tools, telehealth and revenue cycle management services. The system also supports Merit-Based Incentive Payment System, or MIPS, analytics and real-time reporting of performance to help ECPs maximize their MIPS scores. Call 800.456.4522, or go to CompulinkAdvantage.com.

SCLERAL LENS FOR OSD The Ampleye scleral lens from Art Optical has received 510(k) clearance from the U.S. Food and Drug Administration for the therapeutic management of ocular surface disease. The specific therapeutic indications for Ampleye include ocular pemphigoid, Stevens-Johnson syndrome, symblepharon formation, graft vs. host disease, persistent epithelial defect, exposure keratitis, neurotrophic keratopathy, Sjögren’s syndrome, filamentary keratitis, limbal stem cell deficiency, atopy and ectodermal dysplasia. The indication covers Ampleye lenses manufactured in roflufocon D, roflufocon E, hexafocon A and paflufocon D. Call 800.253.9364, or go to ArtOptical.com/Ampleye.

HIGH-RESOLUTION IMAGING Optovue has debuted its AngioVueEssential with optical coherence tomography angiography (OCTA) capability. AngioVue Essential provides high-resolution, non-invasive imaging of retinal vasculature to help you visualize ocular disease. AngioVue Essential generates a single-page report displaying individual layers of retinal vasculature and structural OCT B-scans. Optovue also added its Wellness scan into its comprehensive widefield OCT imaging platform, the Avanti System. Avanti Wellness gives optometrists a report that displays retinal and ganglion cell complex thickness with normative comparisons to identify the signs of retinal and nerve fiber disease and recommend additional scans and appropriate treatment options. Call 866.344.8948, or go to Optovue.com/products/AngioVue.

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DOCS | SPEAK OUT SPECIALTY SOFT CONTACT LENSES Contact lens care is an important part of most optometric practices. Prescribing custom soft contact lenses with complex designs has significantly improved thanks to labs using digital lathing technology. This issue’s Docs Speak Out survey explores managing patients with specialty soft contact lens designs.

During the past two years, how has the number of patients you care for with specialty soft contact lenses changed?

Do you actively market your practice as a provider of specialty contact lens care?

What are the most important factors in choosing a specialty soft contact lens lab? (Check all that apply.)

40 30 20 10

18% 52% 22% 7%

ly ant ific d is gn rease inc

YES 57%

NO 43%

ge tly dly d dly ed mil crease o chan mil creas ifican d n in de is gn rease dec

40 30 20 10

57% 4% 55% 3% 21%

s n y ost y to der ne atio ring nt r rte factu warra y abilit pt or ically low c pho nsult o h e c s i u e n co rvic accectron pol ma e se el tim

WHAT STEPS DO YOU PLAN TO TAKE TO INCREASE THE NUMBER OF CUSTOM SOFT LENSES YOU PRESCRIBE IN YOUR PRACTICE? “Continue to advertise the office as such.” “I get referrals from other doctors, including ODs and corneal specialists.” “Present options in specialty contact lenses to candidates that need them.”

“Continue to strive to please each patient, who then refers friends, family and co-workers to our office.” “I would like to become more familiar with the custom soft lenses that are available.”

“Educate patients about options to improve their vision”

“Practice is limited to contact lens fitting. Referrals are the main source of patients.”

“Constantly offer the best possible products to patients and their families.”

“Most come by word of mouth, so don`t expect to do anything additionally.”

“Improve website and presence on social media.”

“Work with regional ophthalmologist to increase referrals.”

“None. I am changing the focus of my practice, going to rehabilitation. Will probably not fit contacts in the future, only follow the patients I currently have in care.” “Talk with my colleagues and let them know about any new lenses that I am fitting.” “It is all about training the staff and the public. Once my staff knows more about the lenses, they are more apt to talk about them with patients. And once the patients know that we carry these lenses and what they can do, they order more!”

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YO U R PAT I E N T S ’ E Y E S TA K E I N A L O T. Sometimes it’s not all good. SYSTANE ® BALANCE Lubricant Eye Drops are scientifically formulated to work on all 3 layers of the tear film, protecting the ocular surface with ingredients that increase lipid layer thickness by 40%.*,1 Recommend SYSTANE ® BALANCE to your patients for the temporary relief of dry eye symptoms, and see how science leads to real relief. *Prospective, randomized, double-masked, single-dose, contralateral eye study, N=40. Lipid layer thickness was measured in nanometers, and baseline measurement was 63.38. 1. Korb D, et al. Evaluation of extended tear stability by two emulsion based artifi cial tears. Poster presented at: 6th International Conference on the Tear Film and Ocular Surface: Basic Science and Clinical Relevance; September 22-25, 2010; Florence, Italy.

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For work play and a

special day Patients want multiple pairs of eyewear to enhance the way they live. Help make them easier to purchase from your practice with promotional financing options* available through the CareCredit credit card. Or call for more information and enroll at no cost today^.

866.853.8432

www.carecredit.com

visioninfo@carecredit.com

* Subject to credit approval. Minimum monthly payments required. See carecredit.com for details. OO1017OA ^ Subject to change.

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