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Featured Articles

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A War on Two Fronts: Combat Dry Eye and Allergy in Contact Lens Wearers 5/15/2017

As optometrists, we spend a great deal of our time trying to keep our contact lens wearers happy and comfortable. No matter how much effort we put into this, preventing dropout is often a struggle. While there are many reasons for dropout, two of the most common are dry eye and allergic eye disease. When both are present, it creates a significant clinical challenge.
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Contact Lenses and Comfort: It’s a Material World 5/15/2017

Influenced by clinical feedback that discomfort is the number one cause of dropout, the latest contact lenses have evolved significantly to improve ocular comfort. Researchers have been trying to improve comfort by increasing water content, decreasing the modulus, lowering contact angle hysteresis and adding surface coatings and plasma treatments. They are also unsure if lubricity is the only variable that correlates well with in vivo contact lens comfort. So while new, more comfortable materials emerge (though older materials are not eliminated), patients are benefiting from newer, more comfortable silicone hydrogel contact lens materials. With wider parameters and replacement modalities, more patients than ever are finding successful contact lens designs that fit their daily needs. This article discusses the latest silicone hydrogel contact lens materials and how they affect patient comfort. 


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Five Ways to Connect Lens Care with Comfort 5/15/2017

Whether you’re working with a first-time contact lens patient or an existing wearer who is having difficulties, you need to play every card you hold if you want to win them over to long-term lens wear. During the contact lens fitting process, the influence of case systems on comfort is often sidelined for a proper fit and correction, and with a 24% contact lens dropout rate directly due to discomfort, it can feel like a no-win scenario. However, choosing the right lens care system can help minimize discomfort. Here are some of the most important things to keep in mind when recommending an effective and comfortable lens care system for your patients. 
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Highlights from ARVO 2017: Abstract Review 5/15/2017

It’s a fast-paced world, for sure. Health care is advancing daily, and we—and our patients—continue to enjoy the fruits of researchers’ labors. Recently, investigators presented a full year’s worth of findings at the Association for Research in Vision and Ophthalmology’s (ARVO) meeting, held in Baltimore. Don’t you wish you could sit down, stop the clock and take the time to devour all the new research presented there, boosting your knowledge and clinical skills? To give you a taste, we selected what we consider important research and reviewed abstracts for you. Take a look to see what investigators have uncovered so far.


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It's All About the Tear Film 5/15/2017

We love our contact lenses. They improve our vision and looks while also helping us win on the athletic field. But we also hate our contact lenses, especially when they cause ocular irritation. Successful contact lens wear is multifactorial, and one of the leading factors is lens wettability. Research shows a dysfunctional tear film is associated with complaints of ocular discomfort and dryness in contact lens patients, which in turn leads to reduced wear time, increased chair time and, ultimately, contact lens discontinuation. When these symptoms arise, often our first move is to immediately switch a patient’s contact lens modality or change contact lens solutions; however, addressing the ocular surface and unstable tear film first may improve contact lens retention and overall comfort. Let’s take a closer look at the tear film, how contact lenses affect it and how to keep our contact lens patients comfortable in their lenses. 


Departments

The GP Experts

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Deterring Discomfort Dropouts 5/15/2017

Eye care professionals battle contact lens discomfort (CLD) management on a daily basis. According to one survey about discontinuation of contact lens wear, 45% of those surveyed dropped out of wear within the first year, and 47% cited discomfort as the primary reason for dropping out. Studies show that nearly 15% to 30% of contact lens wearers drop out each year. One of the most significant factors in CLD is dry eye, as approximately 50% of contact lens wearers report experiencing dry eye symptoms at least occasionally. This issue occurs with both soft and gas permeable lenses alike. Due to its multifactorial nature, we have no cure-all for CLD, and even with today’s technological advancements, CLD remains a leading cause of dropout in contact lens wearers. Ultimately, if CLD is not diagnosed and managed early, a patient may drop out of contact lenses permanently. 


The Big Picture

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Too Much of a Good Thing 5/15/2017

A 74-year-old female with a >20-year history of Sj√∂gren’s syndrome, epithelial basement membrane dystrophy and repeated episodes of recurrent erosions of the left cornea presented with a three-month history of decreased vision, foreign body sensation with discomfort, irritation and photophobia OS.


Practice Progress

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A One-Two Punch to Beat Dry Eye 5/15/2017

The ocular surface is a remarkable system. When it functions properly, an adequate quantity and quality of tears help the eye remain unnoticed by the person as the lids spread the tears across the surface, allowing light to enter the eye through a smooth refractive surface. And on this normal functioning ocular surface, contact lenses provide a remarkable option for vision correction. But, disrupting this delicate balance can cause increased awareness of the eyes, poor vision, desensitization of the cornea and anatomical alterations such as staining. Even with early stages of ocular surface disease (OSD), a contact lens can potentially compromise the comfort and visual performance the lens was designed to provide. Although mild OSD can be treated immediately and rarely requires any discontinuation of lens wear, patients often do so on their own due to discomfort. This is where the clinician steps in to treat the ocular surface appropriately and get patients back to their contact lenses.

Pharma Science & Practice

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Allergy and CLs: The Seasonal Battle 5/15/2017

Spring always comes with the good—warm weather and outdoor activities—and the bad—ocular allergies. Our offices see a noticeable uptick in complaints of itchy, watery, red eyes and an inability to wear contact lenses comfortably, if at all.

News

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News 5/15/2017

Here is a snapshot of what is happening in the industry.

My Perspective

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Passive Verification Doesn’t Work 5/15/2017

It’s been over a decade since the Federal Trade Commission mandated the Contact Lens Rule. Its intent is to allow patients the right to purchase contact lenses from the seller of their choice, whether a health care provider or other source, including online. The intentions are worthy. However, most of us would agree that it just doesn’t work in its current form. Most likely, you can easily cite abuses that have resulted from the Contact Lens Rule. At best, the current system of verification is onerous. Eye care providers must verify the patient’s prescription through a “passive” process—and within eight regular business hours after a seller requests it. Should the prescriber’s office not respond in time, the seller can (and will) consider the prescription verified (even though it has not been) and sell the patient lenses. 


Fitting Challenges

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Building a Better Bandage Lens 5/15/2017

After a Boston keratoprosthesis (KPro) implantation, many patients are prescribed extended-wear soft contact lenses to protect the cornea and minimize complications such as infections, epithelial defects and stromal melt. However, these lenses are usually standard for every patient, and clinicians do not evaluate the fit. One study found that merely five out of 16 patients actually fit the standardized bandage lens size (9.6mm/16.0mm diameter) typically used for patients following surgery. We at UCLA use traditional silicone hydrogel contact lenses to minimize hypoxia for patients who need bandage lenses. But sometimes, we need a customized lens to achieve the best fit.


Corneal Consult

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Don’t Let HSK Heterogeneity Fool You 5/15/2017

Although it’s estimated that roughly 20% of patients with herpes simplex virus (HSV) keratitis will develop herpes stromal keratitis (HSK), I’d estimate 50% of HSV patients referred to our cornea clinic from ODs have HSK. This suggests we are more comfortable identifying and treating dendritic keratitis than we are with HSK. And it’s not surprising, given just how repeatable the presentation of the dendrite is, compared with the extremely variable nature of HSK. Let’s take a look at HSK and discuss the diagnostic clues different cases offer us. 
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