Off the Cuff: Are Our Solutions Becoming Problems?

No one would dispute that we’ve 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. It’s time the FDA makes this testing mandatory.

Arthur B. Epstein, OD, FAAO Chief Medical Editor artepstein@optometricphysician.com

Case in Point: Entropion

A 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 appeared normal.

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.

--Case study courtesy of Andrew S. Gurwood, OD, FAAO, Associate Professor, Pennsylvania College of Optometry, Elkins Park, PA.

This 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 cells.

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 2004;23(8):S82-S86.

The 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 2004;111(10):1847-52.

NEWS & NOTES

	FOUR-LENS 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, PolyVue’s 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.
	NEW CONTACT LENS PACKAGING EMPHASIZES "BREATHABILITY." CIBA Vision is introducing new packaging in North America for its Night & Day contact lenses, aimed at providing stronger support for the product’s 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.
	HEIDELBERG 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, Heidelberg’s laser imaging instrument for glaucoma. For more information, go to www.heidelbergengineering.de.

 

	It’s 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 materials.