A weekly e-journal
edited by Arthur B. Epstein, OD, FAAO
4, Number 44
November 1, 2004
here for the current issue of Review
the Cuff: Are Our Solutions Becoming Problems?
No one would dispute
that weve come a long way since the first
commercial contact lens care products were introduced.
Early solutions were difficult to use and suffered
from high rates of sensitivity and limited compatibility.
In fact, lens material and care product incompatibility
was a key reason for the creation of the lens
material groupings that remain in use today.
Despite 30 years of progress, lens material-care
product incompatibility remains an issue--with
new advanced lens materials, perhaps an even
bigger one. Some newly introduced lenses reportedly
do not work well with existing care products
and newer care products have apparently been
causing problems with existing lenses.
To add to the solution confusion, lens manufacturers
have warned against using specific products
with their lenses, while at the same time lens
care companies are introducing new or replacement
products. CIBA Vision has recalled SOLO-care
PLUS and will be replacing it with their new
AQuify 5 Minute Multi-Purpose Solution, and
B&L introduced ReNu Moisture-Loc, which
contains alexidine, a new never-before-used
(in lens care) biguanide disinfectant.
Until the FDA wakes up and realizes that new,
more complex materials like silicon hydrogels
increase the potential for lens-solution interactions
and complications, every contact lens fitter
should make sure that the care products and
lenses they prescribe are compatible. Some solution
manufacturers have voluntarily tested their
products for compatibility with newer materials,
but not everyone has. Its time the FDA
makes this testing mandatory.
in Point: Entropion
57-year-old white woman presented with complaints
of tearing and irritation in her left eye. She
reported no significant ocular history, and her
systemic history was positive only for hypertension,
controlled with medication.
Examination revealed corrected acuities of 20/25
OD and 20/40 OS. Pupils, motilities and confrontation
fields tested normal OU. Biomicroscopy demonstrated
an unusual appearance to the lower eyelid (see
photo), with associated conjunctival hyperemia
OS. The cornea OS displayed pronounced epithelial
disruption, especially inferiorly. Goldmann applanation
pressures measured 16 mmHg OU. The ocular fundi
This patient displays a classic senile, or involutional,
entropion. In this condition, the eyelid margin
and lashes are misdirected inwardly against the
globe. Ocular irritation, foreign body sensation,
epiphora, conjunctival hyperemia and punctate
keratopathy are common findings. In severe or
untreated cases, corneal ulceration can result.
Senile entropion is associated with aging. It
results from multiple factors, including increased
horizontal lid laxity, an overriding preseptal
orbicularis, disinserted or atrophied lid retractors
and involutional enophthalmos. In younger patients,
congenital, cicatricial, or spastic etiologies
tend to predominate.
Treatment of entropion includes both palliative
and reparative measures. Copious lubrication combined
with prophylactic antibiosis help to diminish
symptoms and restore a compromised epithelium.
Attempts to redirect the eyelid can be attempted
with taping, thermal cautery or a Quickert procedure
(nylon suture placed into the eyelid 2 to 3 mm
below and perpendicular to the lid margin) performed
in-office. Should these techniques fail to alleviate
the condition, more complex surgical techniques
may be employed at the discretion of the oculoplastic
surgeon. Botulinum toxin injection may offer an
effective alternative to lid taping for temporary
eyelid repositioning in patients awaiting surgery.
study courtesy of Andrew S. Gurwood, OD, FAAO,
Associate Professor, Pennsylvania College of Optometry,
Elkins Park, PA.
Retinopathy as a Complication of Colonoscopy
A 44-year-old man
presented to the Long Island College Hospital
in Brooklyn, NY, with complaints of a central
scotoma and blurred vision in the right eye,
which occurred while he was undergoing routine
colonoscopy. The patient reported experiencing
pain during the procedure.
The funduscopic examination revealed a dumb-bell
shaped hemorrhage overlying the fovea of the
right eye. A diagnosis of valsalva retinopathy
was made based on history and funduscopic examination.
The hemorrhage resolved within a month without
any sequelae. This is the first report of valsalva
retinopathy associated with routine colonoscopy.
SOURCE: Oboh AM, Weilke
F, Sheindlin J. Valsalva retinopathy as a complication
of colonoscopy. J Clin Gastroenterol 2004;38(9):793-4.
Orthokeratology and Corneal Endothelium
study evaluated the influence of overnight orthokeratology
on the corneal endothelium. Fifty-two eyes of
31 patients undergoing overnight orthokeratology
for myopia were examined. Subjects wore the
lens every night and were followed up for at
least one year. The corneal endothelium was
examined using specular microscopy to calculate
mean endothelial cell density, coefficient of
variation of cell area and percentage of hexagonal
Orthokeratology significantly reduced the manifest
refraction and improved uncorrected visual acuity.
The endothelial cell density did not change
significantly (2879 +/- 231 cells/mm before
and 2864 +/- 260 cells/mm after treatment).
The percentage of hexagonal cells was 72.8 +/-
10.2 percent pretreatment and 72.5 +/- 10.9
percent posttreatment. Overnight orthokeratology
for one year did not influence the density or
morphology of the corneal endothelial cells.
SOURCE: Hiraoka T, Furuya
A, Matsumoto Y, et al. Influence of overnight
orthokeratology on corneal endothelium. Cornea
Iris Reconstruction Lens
safety and efficacy of the Ophtec model 311
iris reconstruction lens for the treatment of
visual disturbances related to partial or total
aniridia was evaluated in this study. Iris reconstruction
lenses were placed in nine patients who had
lost all or part of their iris from trauma and
in one patient who lacked iris pigmentation
due to congenital albinism. Patients were examined
preoperatively, intraoperatively and postoperatively
at one day, one week and months 1, 3, 6 and
12. Efficacy measures evaluated were uncorrected
visual acuity, glare, starbursts and photophobia.
Safety measures were best-corrected visual acuity,
surgical complications and adverse events.
Uncorrected visual acuity improved in all eyes
after implantation of the iris reconstruction
lens, but best-corrected visual acuity did not
change significantly. Postoperative photophobia
was reduced in all nine eyes that experienced
moderate to severe preoperative photophobia.
Likewise, postoperative glare was reduced in
all six eyes with moderate to severe preoperative
glare. There were no surgical complications.
Adverse events included two cases of iritis
and one case of macular edema.
Preliminary results suggest that the Ophtec
model 311 iris reconstruction lens can improve
uncorrected visual acuity and reduce glare and
photophobia in patients with partial or total
absence of the iris or iris pigmentation.
SOURCE: Price MO, Price
FW Jr, Chang DF, et al. Ophtec iris reconstruction
lens United States clinical trial Phase I. Ophthalmol
SYSTEM INTRODUCED FOR PRESBYOPIA
MANAGEMENT. PolyVue Distribution,
Inc., has introduced its Presbyopic
System, which incorporates PolyVue
High Definition soft contact lens
technology into a four-product system
for matching specific performance
characteristics with changing vision
needs of presbyopes. The system
includes PolyVue High Definition,
PolyVue High Definition Toric, PolyVue
High Definition Progressive and
PolyVue High Definition Toric Progressive
lenses; the toric progressive lens
is the only fully molded toric progressive
lens on the market and is specifically
engineered to address presbyopes
who also need astigmatic correction.
By masking up to 1 diopter of refractive
astigmatism, PolyVues High
Definition Toric Progressive lens
reduces the number of cylinder powers
needed and simplifies fitting. All
four products are uniformly priced
at $24.00 per lens or $72.00 for
a three-lens multi-pack for quarterly
replacement, plus one free lens
designed to replenish the dispensing
inventory. The PolyVue Presbyopic
System is sold through select distributors,
and the company is offering a 396-lens
consignment inventory to qualified
eyecare practitioners. For more
information, go to www.polyvue.com.
CONTACT LENS PACKAGING EMPHASIZES
Vision is introducing new packaging
in North America for its Night &
Day contact lenses, aimed at providing
stronger support for the products
hyper-oxygen transmissibility (175
Dk/t @ -3.00D). The company is dropping
the word "Focus" on the
package and adding the phrase "breathable
contact lenses." Lenses in
the new packaging will be shipping
during the fourth quarter of 2004.
No changes have been made to the
Night & Day contact lens, which
is FDA-approved for daily wear and
extended wear for up to 30 continuous
nights and days.
RECEIVES FDA CLEARANCE FOR CORNEA
LASER MICROSCOPE. Heidelberg
Engineering recently announced that
it has received FDA clearance for
the Rostock Cornea Module, the key
component for its confocal laser
microscope. The new product can
image and measure corneal structures
and diseases that were previously
difficult or impossible to see.
The Rostock Cornea Module is the
first FDA-cleared microscope using
laser scanning technology for directly
imaging a patient's cornea. It displays
magnified images of the internal
structures of the cornea, enabling
the clinician to directly view the
cell layers and individual cells
in real-time. This may prove especially
important for recognizing parasitic
infections which are affecting long
term contact lens wearers in increasing
numbers. The cornea module connects
directly with the HRT II, Heidelbergs
laser imaging instrument for glaucoma.
For more information, go to www.heidelbergengineering.de.
only been up and running a
few short weeks. Yet, it’s
already clear that the Check
Yearly. See Clearly.(SM) marketing
campaign is opening consumers’
eyes to the benefits of regular
eye exams. Call the Vision
Council of America at 800-424-8422
today or visit checkyearly.com
for your free promotional
Chief Medical Editor
Arthur B. Epstein, OD, FAAO
Gretchyn M. Bailey, NCLC, FAAO
Shannon Steinhäuser, OD, FAAO
• Alan G. Kabat, OD, FAAO
• Joseph Sowka, OD, FAAO
• Andrew Gurwood, OD, FAAO
• Murray Fingeret, OD, FAAO
• William Jones, OD, FAAO
• Paul Karpecki, OD, FAAO
• Ron Melton, OD, FAAO
• Bruce Onofrey, RPh, OD, FAAO
• John Schachet, OD, FIOS
• Joseph Shovlin, OD, FAAO
• Randall Thomas, OD, MPH, FAAO
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