to the PDF version of this publication



to the PDF version of this publication
SPrING 2011, Vol.13, Issue 2
Publication of the Contact Lens Society of America
In this issue:
The Daily Disposable
Contact Lens
Page 3
One Day at a Time
Page 20
A Good Starting Point
Boston XO2 –
designed to deliver
more oxygen.
Boston XO2 has a Dk of 141 to give your patients incredibly healthy GP lens wear
without compromising comfort or stability. One more reason why material matters.
To learn more, ask your authorized Boston laboratory or visit us at
* Boston XO2 delivers 40% more oxygen versus Boston XO.
© 2011 Bausch & Lomb Incorporated. ®/™ denote trademarks of Bausch & Lomb Incorporated. All other product/brand names are trademarks of their respective owners. PNG04107 GLOBAL 0928
From the President
CLSA Proud!
Vicky Sheppard, FCLSA,
here are many reasons to be proud in our lives. We are proud of our families,
friends, work, our country, and recently for me a new kind of proud, becoming
President of the Contact Lens Society of America. I have heard from manufacturers,
speakers and members alike, who attended the CLSA Annual Education Meeting recently
in Austin, how much they enjoyed the meeting. Carri Ferguson did a great job putting
it together!
CLSA is all about promoting education, mutual understanding and cooperation among
all persons interested in contact lens fitting. That is exactly who we are.
NCLE-AC, is the
Contact Lens Program
Manager for Vision
Benjamin Franklin once said something that I think is perfect for our society
“Tell me and I forget, teach me and I may remember, involve me and I learn.”
Essentials by Kaiser
Permanente, Southern
California. Her special
interests include Pediatric
Contact Lens Fitting and
Education. Vicky is NCLE
Advanced certified and
a Fellow of the CLSA.
I am encouraging you do something for yourself and CLSA. Sign up to take the NCLE
Advanced Exam if you haven’t already and then challenge yourself to take the next step by
sitting for the CLSA Fellow. Being a FCLSA is a distinction and accomplishment I share
with others that we are very proud of! Maybe you’ve thought about presenting a lecture
or submitting an article for the EyeWitness, now is the time to do it!
I truly believe without being involved in CLSA I would have missed great friendships.
I can refer my family and friends to people I trust knowing they will be well taken care of.
For example, last year, my brother-in-law David in Houston was having trouble with his
contacts. Mark Soper is working with him now to clear up his issue and we all know when
family is happy everyone is happy!
Thank you Immediate Past President Mike Gzik for your leadership, you did a great job!
Past President B.W. Phillips, Buddy Russell and Tim Koch, who went off the board, we
thank you for the many hours of work over the past years!
I am proud to be following in our Past President’s footsteps and excited to work
with our CLSA Board of Directors, members, Tina, and staff. Go CLSA!
c o n t ac t lens s o c i e t y o f ame r i ca | w w w . clsa . i nf o
The Daily Disposable Contact Lens
Jacob R. Lang, O.D., F.A.A.O., David L. Kading, O.D., F.A.A.O,
Mile Brujic, O.D and Ledonna Buckner, FCLSA
Ledonna Buckner, FCLSA
t seems that everywhere I turn today, I hear the
phrase “Go Green.” One of the first thing that comes
to mind when I hear this is recycle. Recycle, reuse,
repurpose! All great concepts, but then I think of my role
as an eyecare professional. One of the fastest growing
modalities in soft contact lenses is the one day disposable
lens. Open a package, insert a lens, throw away the packaging immediately, then at the end of the wearing time—
throw away the lens itself. This does not seem to match the
concept of “going green.” But wait a minute, is that wrong?
According to the website
go-greenfacts, the average American will dispose of 600
times their weight in garbage during their lifetime and
about 33% of a landfill is comprised of packaging material. While I find this fact a bit disturbing, I also understand that there are times that it is necessary to choose the
lesser of two evils. By this I mean, that in some situations,
the health benefits of putting a clean, fresh lens in daily far
outweigh the minimal contribution to the landfill waste.
What are the benefits to the patient? Most importantly,
a one day disposable lens offers a chance for the healthiest
wear with the least chance of infection to a patient. Assuming the patient washes their hands (and of course, you will
educate them as to how important it is for them to do so),
they will be removing a pristine, bacterial and fungal free
lens from a package and inserting it into their eye for a
one time use. They will wash their hands before removing
the lens (again, you will make sure they understand the
importance) and throw the lens away at the end of their
wearing time. Non-compliance with cleaning becomes a
non-issue because solutions are not necessary. Allergy suf-
ferers have a very good
chance to wear lenses
successfully with this modality and patients who seem to be
“klutzy” and frequently tear lenses
have immediate replacements.
So, who might you prescribe these
lenses to? You can prescribe them to anyone
that has a prescription compatible with the
available parameters, but patients who will
particularly benefit are as follows:
n Non-compliant patients
n Heavy depostitors
n Allergy sufferers
n Pediatric/teenage patients
n Occasional wearers
n Vacationers/campers
n Dry eye
Even though the one day disposable market is growing in
the United States, we still trail many other countries and
regions in prescribing this modality. I thought it might be
interesting to hear the viewpoint of some eyecare professionals in the U.S., so the following U.S. optometrists offer
their approach.
ledonna buckner, fclsa
Ledonna Buckner is a Virginia Licensed Dispensing Optician specializing in unusual contact lens fitting cases.
She is a Certified Ophthalmic Assistant, Fellow of the Contact Lens Society of America, Board of Director for the
CLSA and Editor-in-Chief for EyeWitness Magazine. She has extensive experience as a speaker on contact lens
subjects across the USA. Presently, Ledonna is the Senior Account Manager, Mid-Atlantic Region for Blanchard
Contact Lenses and is responsible for day to day account management, account education and training and
technical fitting consultation
E y e W i t n e s s s p r i n g 2 0 1 1 | c o n ta c t l e n s s o c i e t y o f a m e r i c a | w w w. c l s a . i n f o 3
Daily Disposable Contact Lenses; Here Today, Gone Tomorrow?
Jacob R. Lang, OD, FAAO
According to a recent publication by Efron, et al. prescribing habits of daily disposable contact lenses by country fall into two
distinct groups: high prescribing nations (Japan 32%, Norway 38% and the UK 32%) and low prescribing nations (Australia 11%,
Canada 8%, The Netherlands 5% and the US 5%). However, in this article the authors also describe that in all countries, but especially
in the lower prescribing nations, there appears to have been a sharp increase in the rate of prescribing daily disposable lenses.
Daily disposable contacts have been available in the United
States for more than 15 years. In that time we have seen
expanded parameters and powers, improved comfort and
now daily lenses are even available in cutting edge silicone
hydrogel materials. All major manufacturers have a daily
lens modality available, each with their own advantages. We
currently have daily disposable lenses that can correct the
great majority of our patients’ refractive errors with great
strides being made in the availability of astigmatic power
and axis, as well as overall power ranges. However, these
lenses are still not a mainstay in the prescribing
habits of many practitioners. According to a recent
publication by Efron, et al. prescribing habits of
daily disposable contact lenses by country fall
into two distinct groups: high prescribing nations (Japan 32%, Norway 38% and the UK
32%) and low prescribing nations (Australia
11%, Canada 8%, The Netherlands 5% and
the US 5%). However, in this article the authors also describe that in all countries, but
especially in the lower prescribing nations
there appears to have been a sharp increase
in the rate of prescribing daily disposable
lenses. Also interesting was that practitioners
prescribe this modality to males significantly
more often than they do to women. This was
especially true in Canada, where 41% of males
were fit with daily disposable lenses and 32% with
reusable lenses.
I found it surprising that only 8% of fits in Canada are into
daily lenses, but almost half of the men fit in lenses are into
a daily disposable lens. I believe these numbers are a sign
of things to come. In my opinion patients are more interested in these lenses than ever before and practitioners are
able to meet more and more of the visual and lifestyle demands of their contact lens patients with these lenses. This
combination of advancements position daily disposables
for an exponential increase in the upcoming years.
There is no such thing as a perfect contact lens. Every
lens has its own advantages, disadvantages, quirks and
niches. Everyone wants their patients to have
healthy eyes and great vision. Undoubtedly daily disposable contacts have proven
that they have a lot of advantages to offer.
Let’s explore these advantages first.
The Good
I think everyone can agree that a lens degrades with the continued handling, cleaning, environmental exposure, and general
wear regardless of the material, coatings
or other additives the lens may have. The
biggest advantage of any disposable
contact lens is that we are minimizing these degradative processes by
using a new lens at the prescribed
interval. The daily disposable
modality minimizes degradation
Jacob R. Lang, OD, FAAO
Dr. Lang currently practices at Associated Eye Care in Stillwater, Minnesota.
He received his Doctor of Optometry degree from The New England College of Optometry in Boston,
Massachusetts. Dr. Lang also completed a cornea and specialty contact lens residency in Boston, Massachusetts.
Dr. Lang is currently an adjunct clinical faculty member for both the The Ohio State University and The New
England College of Optometry. He is a Fellow of the American Academy of Optometry and is also involved in
clinical research and lecturing at meetings.
w w w. c l s a . i n f o | c o n ta c t l e n s s o c i e t y o f a m e r i c a | E y e W i t n e s s s p r i n g 2 0 1 1
and maximizes the quality of the lens by the fact that it is
replaced every day. This has allowed practitioners to treat
patients with pathology related to contact lens degradation. One such condition is giant papillary conjunctivitis
(GPC) and by prescribing daily disposable contact lenses
you eliminate the causal agent and allow these patients to
continue wearing contact lenses. The increased frequency
of replacement has also been shown to decrease other
biofilms on the lens such as allergens, making this a great
modality for allergy sufferers. Preservatives from cleaning
systems are also minimized reducing their toxic effects on
ocular tissues. Any bacterial biofilms are disposed of every
night and this, in theory should greatly reduce the risk of
any microbial consequences of contact lens wear.
Fahmy, et al. as well as others have shown clinically
that the implementation of a daily disposable modality can
improve comfort and other symptoms common to contact
lens wearers including tired eyes, blurred vision, redness,
irritated eyes, dryness, and discomfort as well as an improvement in biomicroscopy signs.
Many of our contact lens patients are part-time patients. By this I mean they don’t wear their lenses every
day. Many myopic presbyopes choose not to wear any
correction at their desk or in the office and glasses afford
them the ability to switch back and forth from near to far
tasks quickly and easily. Some patients just prefer glasses
and wear contact lenses only for certain activities such as
sports or exercising. Others enjoy the option of wearing
glasses for a different look, style or simply for convenience.
Daily disposable contacts fill the niche better than other
modalities for these part time patients. Daily disposables
allow these patients the benefits of contact lenses for the
times they need them (sports for example) while eliminating the possibility of contamination or poor care habits
that can occur from leaving the lenses in the case until
the next game, event or occasion. These patients may also
have a financial benefit to wear daily disposables. As they
use fewer lenses in between eye exams it may actually be
less expensive for them to buy or restock their shelves with
dailies as opposed to getting little use out of a supply of less
frequently replaced lenses.
With the ever-changing world of air travel as well as
other lifestyle needs contact lens solutions continue to be a
hindrance to many contact lens patients. By eliminating the
need for these solutions, daily disposable contacts allow
frequent flyers, travelers and even college students on a
road trip a more convenient way to travel.
The Bad
Daily disposable contacts cost more than other modality
lenses. This has been the biggest sticking point of these
lenses for years. However, as I stated earlier, if patients
don’t wear their lenses every day
it may actually be to the patient’s
financial advantage to wear dailies.
According to Efron, et al. “The
point at which the cost-per-wear
is virtually the same for all lens
replacement frequencies is five
days of lens wear per week.
A similar but upwardly
displaced (higher cost)
pattern is observed for
toric lenses, with the
cross-over point
occurring between
three and four days
of wear per week.”
As you can see the difference in cost is minimal and
as prescribing trends have shown
us patients don’t seem to be bothered
by the increased cost incurred with these lenses.
Yes, there may be slightly larger cost up front, and yes, this
may be a significant factor for some patients, but I would
argue that this is the exception, not the rule. Especially
if the improved ease of care and other benefits of a daily
disposable modality are included into the equation.
Some might say that oxygen permeability is the most
important factor in soft contact lens fitting. They might also
feel that because most daily disposables have less oxygen
permeability than some other lenses that daily disposables
are an unhealthy option for patients. I believe oxygen is an
obvious component to corneal health, and now with daily
disposable silicone hydrogels hitting the market this argument may be over. However, I also feel standard hydrogels
have a proven track record as a safe and effective option
for vision correction. As we move forward with the ever
expanding knowledge base and understanding of corneal
physiology I expect oxygen permeability and other factors
to continue to be incorporated into all forms of contact
lenses including daily disposables.
Whether daily disposables improve patient compliance
is debatable. People are interesting creatures and because
of this I believe there will always be the occasional patient
that sleeps in their lenses for three months straight or the
patient that comes back after not keeping several followups in a year’s time still wearing the trial lenses given to
them a year earlier. Moral of the story, and I know this may
take you by surprise, but patients don’t always do what we
ask them to do! A study by Dart et al. found that 30% of
daily disposable patients used their lenses for occasional or
regular overnight wear. This obviously puts these patients
at higher risk for complications. I do believe, however that
E y e W i t n e s s S p r i n g 2 0 1 1 | c o n ta c t l e n s s o c i e t y o f a m e r i c a | w w w. c l s a . i n f o 5
the daily lens modality makes it as simple as possible to
encourage borderline offenders to do the right thing the
majority of the time. Basically, this lens modality minimizes
the margin for error. This does, in my opinion, make more
of the patients wearing these lenses less likely to do the
things we don’t want them to do. Or at least hopefully they
won’t do these bad things as often.
The Ugly
A wise man once said “bad things happen to good people”
and contact lens wearers are no exception. Even with the
ease of care, improved compliance, increased cleanliness
and all the other advantages a daily disposable modality
has to offer to our patients we still have reports and see
cases of contact lens related complications in these lenses.
There are several reports in the literature describing cases
of microbial keratitis in daily lens wearers. For example,
Priti Batta, M.D., and Michael H. Goldstein, M.D. published
a case of a compliant and infrequent daily lens wearer with
a culture positive Pseudomonal ulcer. This patient wore
her lenses for only 5 to 6 hours per day, interchanging with
glasses wear. She reported replacing her contact lenses
daily and denied overnight use.
These sight threatening infections, however rare, are
currently still a possibility for any and all contact lens patients. Hopefully with the continued advancements we have
seen over the last fifteen years of daily disposable contacts
these improvements in technology, patient care and a better understanding of corneal physiology we will continue to
reduce these risk and give the patients the most convenient,
safest, most comfortable option for their visual correction.
Daily disposable contact lenses offer many advantages
to the vision and ocular health of our patients and are a
growing part of the contact lens landscape. Although no
such thing exists as a perfect or foolproof contact lens, the
advancements in contact lens science continues to improve
contacts making them a safe and convenient solution for
visual correction. As daily disposables continue to utilize
these advancing technologies I expect we will continue to
see improvements in patient comfort, safety and overall
satisfaction with their contacts.
The Indispensable Daily Disposable
David L. Kading, OD, FAAO, FCLSA, and Mile Brujic, OD
Many clinicians reserve single use lenses for problem solving situations. Although these lenses make great problems solvers,
there are many applications where single use lenses can be used.
Daily disposable contact lenses provide significant benefits
for a number of patients. Understanding the benefits along
with the options that are available will empower practitioners to optimally match each patient type with the lens
options available (see chart on pages 8–9).
Regardless of the lens or modality that is prescribed,
practitioners are always concerned about the rate of compliance that is exhibited by our patients. Manufacturers
have looked at the lens replacement compliance rate of
each modality type. It should be no surprise that single
use lenses demonstrate higher compliance rates than all
the other modalities. Depending on the source single use
lenses consistently maintain between 75-90% compliance
rate. (Ciba Vision Single Use Lens Data on file)
We have to consider the health affect on our patient’s
eyes when we discuss non-compliance. Clinically, we see
lenses that are worn longer than recommended and can
build up microscopic deposits. Additionally, we must con6
sider the long-term effect that non-compliance may have
to patient comfort. Daily disposable lenses will offer a high
level of compliance and often times are associated with
comfortable lens wear.
Single Use Patient Options
Many clinicians reserve single use lenses for problem
solving situations. Although these lenses make great problems solvers, there are many applications where single use
lenses can be used.
First Time Wearer—First time lens wearers have unique
challenges when it comes to wearing contact lenses. There
are a number of rules that many of us go over thoroughly
with patients that are new to lens wear. Many of these
instructions can be very challenging to a new patient who
is very focused on “putting their finger into their eye” for
the first time. Simplifying the process by utilizing a single
use lens may make the initial fitting process a less stressful experience. This is important to consider, particularly
when working with pediatric patients.
w w w. c l s a . i n f o | c o n ta c t l e n s s o c i e t y o f a m e r i c a | E y e W i t n e s s s p r i n g 2 0 1 1
Allergy Patients—Allergies affect 30% of the population and between 70-80% have ocular symptoms. (Clinical
Ophthalmology 2009:3 329-336). Although some patients
experience more significant symptoms than others, many
patients find that they have difficulty wearing their lenses
during their allergic exacerbations. Unfortunately, allergens
can accumulate on the surface of the contact lens and if
not completely removed by the cleaning cycle, may reexacerbate allergic signs and symptoms. A new lens placed
on the eye during allergy season in addition to proper
pharmaceutical treatment when indicated, will bring relief
to many allergy patients and will allow them to wear their
lenses when allergic symptoms arise.
Dry Eye Symptoms—Dry eye affects millions of Americans. Patients who have a decreased tear volume and
quality may have their problem exacerbated by wearing
lenses. An unclean contact lens surface can increase these
symptoms. Single use lenses can minimize this and in effect help those patients wear their lenses longer and with
greater comfort.
Contact lens solutions can also increase dry eye
symptoms. Fitting a patient with a single use contact lens
eliminates the need for cleaning and disinfection solutions.
Therefore, patients with dry eye symptoms can often wear
daily disposable lenses with a greater degree of comfort
than a lens that must be cleaned and disinfected and
reused in the eye.
david L. Kading, od, faao, fclsa
Dr. Kading graduated from Pacific
University College of Optometry. His
residency focused on teaching and
fitting irregular corneas at the Portland
VA hospital, Oregon Health Science
University and Pacific University. He
has two practices in the Seattle area
that emphasize Corneal Reshaping,
Presbyopic, High Cylinder, and Irregular
Cornea contact lens fitting. He actively takes part in contact lens
and solution research and lectures nationally on areas of contact
lens, solution, and anterior segment disease.
Piggyback Options—Patients who have a need for piggyback lenses are often frustrated with the complexity of their
lens wearing options. They must clean and disinfect their
rigid gas permeable (RGP) lenses with one solution and
then clean and disinfect their soft lenses with another solution. Utilizing a daily disposable simplifies the lens wearing
experience for patients requiring this type of specialized
fitting strategy.
Part Time Wearers—Single use lenses are ideal for
patients who desire to wear their lenses on a part time
basis. For patients wearing a two-week or monthly replacement contact lens a couple of times a week, they will often
overuse their lens because they easily lose track of the age
of their lenses. When presenting options to part time wearers, become familiar with what the cost to wear a single
use lens would be per day. This will effectively illustrate the
value to patients of the convenience of utilizing a single use
lens for part time wear.
Daily disposable contact lenses provide significant benefits
for a number of patients. A number of factors need to be
considered when selecting lenses and those discussed in
the article are all things that both practitioners and patients
desire when making a lens selection. As patients walk into
the office consider whether single use lenses might be an
option for them.
mile brujic, od
Mile Brujic, O.D. is a partner of a
successful five location group practice in
Northwest Ohio. He practices full scope
optometry with an emphasis in ocular
disease management of the anterior
segment and glaucoma. He contributes
to a monthly column in Review of Cornea
and Contact Lens and has been published
in Contact Lens Spectrum and Optometric
Management. He is active at all levels in organized optometry. Dr.
Brujic educates eye care practitioners at the local, state and national
level on contemporary topics in eye care.
A Time and a Place
There is definitely a time and a place for prescribing daily disposable contact lenses. As Dr. Lang, Dr. Brujic and Dr.
Kading have illustrated in this article, strong arguments exist for one day disposable lenses and there are certainly many
options for some very diverse prescription needs. As the eyecare professional, it is up to you to determine what is best for
your patient. Even though the U.S. is not the leader in prescribing daily disposables, it seems that with the health benefits
to the patient and the growing prescription options available, daily disposables will continue to be a growing modality.
E y e W i t n e s s S p r i n g 2 0 1 1 | c o n ta c t l e n s s o c i e t y o f a m e r i c a | w w w. c l s a . i n f o 7
Types of Daily Disposable Lenses
Spherical Lenses
Bausch & LombThe SofLens® daily disposable is made of hilafilcon B and is 59% water. It has a diameter of 14.2mm
and a radius of 8.6. It comes in a wide range of powers: from +6.50D to -6.50D in 0.25D steps and
from -6.50D to -9.00D in 0.50D steps. It is available in 90 packs and works well on a wide range of
patients who would benefit from a daily disposable modality.
CIBA VISION®CIBA VISION produces two types of daily disposable lenses: Focus® DAILIES® with Aqua Release (AR)
and Focus® DAILIES® Aqua Comfort Plus (ACP). Both contact lenses are made with nelfilcon A and
are 69% water. Each of the contact lenses are made in the same powers which is -0.50D to -6.00D in
0.25D steps, 0.50D steps from -6.00D to -10.00D and +0.50D to +6.00D in 0.25D steps. Additionally,
are convenient for patients in that they are available in both 30 packs and 90 packs.
The Original Focus DAILIES AR have a base curve of 8.6 and a diameter of 13.8mm while the Focus
DAILIES ACP have a base curve of 8.7 and diameter of 14.0mm. The Focus DAILIES ACP differ from
their predecessors in that they contain a unique “triple action moisture” formula which is composed
of hydroxypropylmethyl cellulose, polyethylene glycol, polyvinyl alcohol. For patients who benefit
from Focus DAILIES AR but may notice dryness towards the end of the day, Focus DAILIES ACP work
remarkably well to alleviate those symptoms in most patients.
CooperVisionClearSight™ 1 Day is made of Ocufilcon B and is 52% water. Its base curve is 8.7 and diameter is
14.2mm. Its power availability is: +5.00D to -6.00D in 0.25D steps, 0.50D steps from -6.00D to
-10.00D and from +5.00D to +6.00D. Its proven material makes this lens a successful option.
Additionally, CooperVision also produces the Proclear® 1 Day lens. It is produced by omafilcon A
which is 60% water and has a base curve of 8.7 and a diameter of 14.2mm. Omafilcon A is a unique
bioimmetic material that contains phosphorylcholine. A double-masked, randomized daily wear study
demonstrated that a contact lens made of omafilcon A provided better comfort, fewer symptoms,
less on-eye dehydration, and less fluorescein corneal staining than other soft daily wear contact lenses
in subjects with mild to moderate dry eye symptoms. Both the Clearsight 1 Day and the Proclear 1
Day are available in a 30 and 90 pack.
SafigelSafigel is the newest addition to the daily disposable family of lenses. It consists of methafilcon A
and is 55% water. Its diameter is 14.1mm and its base curve is 8.6. It is available in a wide range of
powers: from -0.50D to -6.00D in 0.25D steps, and from -6.50D to -8.00D in 0.50D steps. It is also
available in plus powers from +0.50D to +2.00D in 0.25D steps and from +2.50D to +4.00D in 0.50D
steps. The interesting component that is unique to this lens is that sodium hyaluronate is incorporated
into the lens.
UnilensThe C-Vue 1 Day ASV is made of methafilcon A and is 55% water. Its base curve is 8.5 and diameter
is 14.2mm. Its power availability is from +4.00D to -6.00D in 0.25D steps and from -6.00D to -8.00D
in 0.50D steps. It is available in both a 30 and 90 pack.
w w w. c l s a . i n f o | c o n ta c t l e n s s o c i e t y o f a m e r i c a | E y e W i t n e s s s p r i n g 2 0 1 1
1-Day ACUVUE® and 1-Day ACUVUE® MOIST® are both made of etafilcon A which is 58% water.
They are both 14.2mm in diameter and are available in two base curves: 8.5 and 9.0 which makes
it suitable for a wide range of corneas. The 1-Day ACUVUE MOIST differs from its predecessor, the
1-Day ACUVUE in that it contains Lacreon technology which embeds polyvinyl pyrrolidone (PVP), a
wetting agent. into the contact lens. This produces a surface that is more hydrophilic with the 1-Day
VISTAKON is the first company to introduce a silicone hydrogel daily disposable lens, the 1-Day ACUVUE® TruEye™. This lens delivers both the benefits of high oxygen permeability of silicone hydrogels
along with the convenience daily disposables. This lens is made of narafilcon B and is 46% water. It
has a diameter of 14.2mm and a base curve of 8.5. It has a high power range of availability: from
+6.00D to +0.50D in 0.25D steps, from -0.50D to -6.00D in 0.25D steps and from -6.50D to -12.00D
in 0.50D steps.
Toric Lenses
CIBA VISIONFocus® DAILIES® Toric with AquaRelease are made of nelfilcon A and are 69% water. They have a
diameter of 14.2mm and a base curve of 8.6. Its sphere power availability is: +4.00D to -8.00D in
0.25D steps and 0.50D steps between -6.00D and -8.00D. The cylinder power and axis availability
are: -0.75D and -1.50D at axis 20, 70, 90, 110, 160 and 180. It has toric markings at 3 and 9 o’clock.
The range of power and axis availability make this lens suitable for most toric wearers and is available
in both 30 and 90 packs.
CooperVisionClearSight™ 1 Day Toric is made of ocufilcon D and is 55% water. Its diameter is 14.5mm and base
curve is 8.7. Its sphere power availability is: -6.00D in 0.25D steps and 0.50D steps from -6.00D to
-7.00D. It’s cylinder power availability is: -0.75D and -1.25D, which are available at the following axis:
20, 90, 160 and 180. It is available as a 30 pack and has a toric marking at the 6 o’clock position. For
those patients with low amounts of astigmatism and would benefit from a daily disposable design,
this lens works well for satisfying their visual needs.
CIBA VISIONFocus® DAILIES® Progressives are made of nelfilcon A which is 69% water. It has a base curve of 8.6
and diameter of 13.8mm. It’s spherical power ranges from +5.00D to -6.00D in 0.25D steps. It has
up to +3.00D of add power. This lens is unique in that it is the only daily disposable multifocal lens. In
order to calculate the effective power in the lens, the patients vertexed distance prescription is added
to their near add to come up with the effective power in the lens.
Colored Contact Lenses
CIBA VISIONFreshLook® One-Day Colors contact lenses are the only daily disposable color contact lens available.
It is made of nelfilcon A. Its power availability is plano to -6.00D in 0.25D steps. It is available in blue,
green, grey and pure hazel. It is a great option for patients who are looking to wear opaque contact
lenses in addition to their regular clear lenses.
E y e W i t n e s s S p r i n g 2 0 1 1 | c o n ta c t l e n s s o c i e t y o f a m e r i c a | w w w. c l s a . i n f o 9
The Daily Disposable Contact Lens
Successfully Complete These Questions to the Article on Pages 3–9 to Receive NCLE Credit.
Phone (with area code)__________________________________________________
To expedite the process, c.e. credits will be returned via email to those providing email addresses.
Credit Card: ❑ American Express ❑ Discover ❑ MasterCard ❑ Visa
Card Number__________________________________________________________
Signature_ ______________________________________ Exp. Date______________
1. Which of these countries prescribes the highest
percent of daily disposable contact lenses?
a. United States
2. Which is the only manufacturer with a single use
silicone hydrogel?
a. Bausch & Lomb
3. Which material has removed concerns about the
DK/t of daily disposable?
b.Silicone Hydrogel
c.Silicone Acrylates
4. At what day of wear does the cost of spherical dailies
equal other modalities?
a. 3
c. 5
5. What percentage of daily lens wearers sleep
in their lenses?
a. 20%
c. 50%
6.This country had the lowest prescribing rate
of daily lenses.
a. United States
7. How would you calculate the power needed
for DAILIES Progressives?
a. Use the spherical equivalent and choose the proper add
b.Add vertexed distance to the ADD power to get
equivalent power
c. Use half the add power combined with the vertexed
d.Use all of the add power added to the non-vertexed
This article has been submitted for one continuing education
credit unit with the National Contact Lens Examiners (NCLE).
All technical articles that appear in EyeWitness for c.e. credit can
also be found at the CLSA University at
Online, CLSA members can complete these courses for FREE,
and nonmembers pay just $18 per course. Completed c.e. tests
that are faxed or mailed-in to CLSA at 441 Carlisle Drive, Herndon, VA
20170, Fax (703) 437-0727, will carry a $10 processing fee for CLSA
members, and a $25 fee for nonmembers.
8. Canada Daily disposable lens prescription rates are:
c.Staying the same
d.Increasing in women only
9.Pritta Batta, MD and Michael Goldstein, MD reported
which condition in a perfectly compliant daily
disposable patient?
a.Microbial Keratitis
c. GPC
10.Which of these symptoms showed improvement when
switching to daily lenses?
c. Pain after removal
d.Visual acuity
11.How many years have daily disposables been available
in the US?
a. 5 years
b.10 years
c. 15 years
d.20 years
12.Which manufacturer produces the only multifocal
and colored single use lens?
d.Bausch & Lomb
13.The compliance rate of patients wearing single use
lenses is:
a. 100%
c. 40-50%
14.What percentage of the population is affected
by allergies?
a. 20%
c. 50%
15.To eliminate the need of two different solutions,
1 days can be prescribed for:
a. Dry eye patients
b.Piggyback patients
c.Allergy patients
d.First time wearers
Please Record
Answers Below
by filling in
appropriate circle
w w w. c l s a . i n f o | c o n ta c t l e n s s o c i e t y o f a m e r i c a | E y e W i t n e s s s p r i n g 2 0 1 1
Applications are now being accepted for Fellow status in CLSA. A
Fellow member is a Regular Member who successfully passes the
pre-requisite written, practical and oral exams as monitored by the
Fellow Committee. To be eligible to sit for the practical and oral
exam sections, candidates must first sit for and pass the written
exam. Doctors of Optometry or Ophthalmology may waive the written exam portion of the Fellow Examination by providing documentation of completion of a prior one year residency in contact lenses.
You still have time to register for the upcoming exams in April.
Simply contact the CLSA office at (800) 296-9776 to receive your
packet of information.
It’s Time to Soar...
Become a Fellow Member Today!
E y e W i t n e s s S p r i n g 2 0 1 1 | c o n ta c t l e n s s o c i e t y o f a m e r i c a | w w w. c l s a . i n f o 11
Kids’ Korner
In the Beginning: Embryonic Eye Development
By Linda Conlin, ABOC, NCLEC
its formation and separates from
ou may fit contact lenses for
the ectoderm. Meanwhile, neural
infants and very young chilcrest cells have separated from the
dren. But do you know how
neural plate and migrate to form
the eye and the cornea, in particuother neuronal and nonneuronal
lar, develop? That background can
cells. Once separated, they move
help you anticipate the challenges
into the area between the lens and
and outcomes for these tiniest of
the corneal epithelium forming the
patients. The ability to see is an
corneal endothelium and stromal
amazing journey from fertilization
keratocytes, the primary cells of
to after birth. Any interruption or
the stroma. To all that activity, add
misstep along the way will result in
the formation of the orbits and exeye and vision problems.
traocular muscles at 4 weeks gesThe human eye begins to
tation. Depending on eye growth
develop during the 17th day of
after birth, however, the orbits may
gestation. Mesoderm cells, the
not mature until adolescence.
middle layer of the embryo, and
The lacrimal glands begin
ectoderm cells, the outer layer of
during the 6th week, but
the embryo, form the eye fields
Figure 1. Cross section of embryonic mouse eye.
there are no tears in the glands
in the neural area of the embryo.
(7 weeks comparable human development.) Orange
area is the developing cornea, blue is the lens cavity
until the 3rd month. At 8 weeks,
Optic vesicles develop in the eye
and green is the posterior lens fibers.
the eyelids start to form and fuse
fields, and in five days, infold to
together to protect the other develform the optic cup. At this point,
oping eye structures. (Figure 3) The eyelids begin to sepathe retina and crystalline lens begin to develop. In the
rate in the 5th month, but it takes 2 months to complete
mean time, surface ectoderm cells are becoming thicker.
The lens forms from these thickened cells. By the 32nd day, the process. While the eyelids are fused, the corneal epithelium decreases back to 2 cells in thickness and enlarges
you can actually identify the lens, and during the next 3 to
3-1/2 weeks the lens will grow to the size it will be at birth. and matures. The maturing, highly hydrated cornea does
not become transparent until the 7th month when the eye
(Figure 1)
becomes functional. Bowman’s membrane develops durThe critical connection between the developing eye
ing month 5 as the cornea becomes inervated. Descemet’s
and the brain occurs at 36 days when the optic stalk, the
membrane matures just prior to the eyelids opening.
precursor to the optic nerve, connects to the forebrain.
At 7 weeks the sclera develops from embryonic tissue,
Between 30 and 35 days, you can see the start of the iris.
which allows the formation of blood vessels. The cornea
In 2 more weeks, it is fully developed.
connects to the sclera which is nourished by blood. Then
Eye development during the first trimester of pregwhy are there no blood vessels in the cornea? The answer
nancy is like watching the Grand Finale of Fourth of July
is that the cornea develops from ectoderm rather than
fireworks. Cells and tissue develop quickly, and simultaembryonic tissue. This critical difference not only provides
neously form various eye structures. For example, as the
a clear medium for light, but the lack of blood minimizes
lens is developing, the cornea forms from ectoderm cells
covering the lens. At about 5 weeks of pregnancy this tissue tissue rejection in corneal transplants.
During this time the retina is still evolving. It
is 2 cells thick. What occurs over the next 2 weeks is amaztakes 6 months for the retinal layers to grow from
ing. The 2 cells will nearly double, creating the corneal
epithelium. (Figure 2) At this point, the lens has completed the neural ectoderm. The macula needs 4 or 5
w w w. c l s a . i n f o | c o n ta c t l e n s s o c i e t y o f a m e r i c a | E y e W i t n e s s s p r i n g 2 0 1 1
Babes in contact lenses
Congenital cataracts occur in 1.7 of
10,000 births and can be bilateral or
unilateral. Causes include genetics,
metabolic disorders, birth trauma,
and maternal infection during
pregnancy. Unlike in adults, use of
intraocular lens implants in infants to
replace the crystalline lens is controversial. Because the first year of
life is critical to visual development,
Figure 3. Eyelid formation in human embryo at
8 weeks gestation
contact lenses are fit 7 to 10 days
after surgery, with soft lenses as the
most common solution to restoring
aphakic vision. Keeping in mind that a new baby’s world is
close up, add 2D to 3D to the final prescription to enhance
Figure 2. Cross section of embryonic human eye at 8 weeks gestation.
Pink area is the corneal epithelium, and blue is the inner layers.
near vision. Avoid tight fitting lenses because the child will
spend a great deal of time sleeping with them.
Fitting infants with contact lenses for any vision probmonths just to begin, and it will mature 6 months after
lem presents some logistical challenges. Infants cannot
birth. As the retina and lens develop, the vitreous forms
be told to sit still or look at a target. They do, however,
between them. In the mean time, the neural connections
respond to voice recognition, touch and smell. Try to
between the eye and brain have been developing, taking
spend some time holding and speaking softly to the baby
5 months to complete.
before beginning procedures. Instead of a slit lamp, use a
pen light and magnifier or a lighted magnifier to evaluate
From birth to beyond
the lens. Work quickly when inserting and removing the
Even after 9 months of simultaneous, rapid fire tissue
lens to help keep the child calm. Remember that this is
formation, the eye is not completely mature at birth. In adan emotional time for parents who may overreact to the
dition to growth of the orbit, changes to the crystalline lens
baby’s cries.
and final maturation of the macula, pigmentation of the iris
Generally, follow-up visits are scheduled for 24 hours
may not be complete for a year. Corneal curvature changes
after the initial lens insertion, then every 1 to 2 weeks afterafter birth, too. Average keratometry readings in infants are
ward for lens removal, cleaning and disinfection. Parents
about 54D on the first day of life and flatten to about 48D
should apply lens lubricant every morning and night.
at 1 year of age. What’s more, the brain’s accurate interpreAfter about 4 to 6 weeks, instruct the parents in lens
tation of visually transmitted images seems to take a little
care, insertion and removal. Advise parents to look for
redness, discharge and the infant rubbing or reaching for
It is normal to find low levels of hyperopia in infants.
his eyes. Show parents how to identify a de-centered lens,
Hyperopia greater than 3D occurs in 25 percent of newand the methods to re-center it. Provide them with written
borns. Refraction of 4D is found in 9 percent of infants at
information on key points and a 24-hour phone number
6 months. By 7 to 9 months it falls to 5 percent and confor assistance. Whenever possible, provide parents with a
tinues to decline to 3.6 percent at 1 year of age. As can be
spare pair of lenses. Subsequent follow up visits depend on
expected with corneal curvature changes, the incidence of
the specific medical issues, but keep in mind that the
astigmatism, usually with the rule, is higher in the first year
corneal curvature changes quickly during the first year.
of life. The incidence decreases from 1-1/2 to 3 years of
Considering the intricate processes of human eye
age as the cornea flattens.
development and the many chances for error along the
Instances of anisometropia are common at birth but
way, vision is the most amazing of our senses. As eye care
decrease quickly with age. If all the components of the eye
professionals we have the rewarding work of picking up
grow proportionally, any refractive error decreases. Myowhere nature may have left off.
pia, however, seems to rebound. As is the case with hyperopia, infants born myopic will become less so. However, the
tendency is for myopia to increase into the higher ranges
once the child begins school.
E y e W i t n e s s S p r i n g 2 0 1 1 | c o n ta c t l e n s s o c i e t y o f a m e r i c a | w w w. c l s a . i n f o 13
The Student Class of 2011
Rex Spiller
An outstanding program fostered by CLSA is the Scholarship-Mentor program. This year
20 students from accredited schools around the nation were able to participate in Austin
as recipients of this scholarship. An experienced mentor from the ranks of CLSA is assigned
to each student to ensure that the students maximize their learning experience.
he 56th Annual Educational Meeting
of the Contact Lens Society of America
(CLSA) was held in Austin, Texas April
6th through 10th. Over 240 members were
present. A host of members and staff did
a masterful job of putting together a spectacular event. Promoting our profession
and assisting members in staying current
in this dynamic and vital field is critically
important to the thousands of patients that
will be depending on skilled eye care professionals.
I attended the CLSA Annual Education
Meeting along with 19 other students from
opticianry schools across the country on
scholarship. Scholarships were provided
through an educational grant from the
American Board of Opticianry and the
National Contact Lens Examiners. Students
were selected by their program directors
and instructors based on academic achievement and passion for the profession.
When I arrived in Austin, I attended
an orientation session and met my mentor,
Sherry Vanore, a long-time veteran CLSA
member. Throughout the week Sherry was
available to answer my questions and guide
me toward classes that would most benefit
my interests.
The CLSA Meeting met my goal of
increasing my technical sophistication of
the field of contact lens care. The contribution of these remarkable people that make
up CLSA cannot be overstated. An old Chinese proverb reads “it is better to light one
candle than complain about the dark”. This
conference through the extreme efforts of
all those who made it possible has kindled
not just a small flame but a bonfire of passion, vision and inspiration. On behalf of
those of us who received this scholarship,
thank you CLSA.
About Rex Spiller
Rex is a student at Seattle
Central Community College
in the school of opticianry.
He has published several
articles on learning practice
and theory and holds a PhD
in Instructional Psychology.
He became interested in
the vision care field after a
debilitating accident that left
him with a mild brain injury.
As a result, Rex’s reading
ability was reduced to a fifth
grade level. The loss of his
visual acuity had a profound
impact on him and he
developed a new awareness
of the importance of
eyesight. Gradually his vision
improved and he decided to
commit the rest of his life to
helping others improve their
A Big Thank You!
to the
for the
Scholarship-Mentor Program
From the
Student Class of 2011
at the CLSA Annual Education Meeting
w w w. c l s a . i n f o | c o n ta c t l e n s s o c i e t y o f a m e r i c a | E y e W i t n e s s s p r i n g 2 0 1 1
Replace Ad with correct size
A Meeting With Passion.
Vision. Inspiration.
Mike Gzik presents
outgoing Secy/Treas
Mike DiNapoli with
a plaque of appreciation
Jean Ann Vickery leads a hands-on
mini clinical course
Vicky Sheppard received the oath of office
from long-time friend and mentor Tim Koch
Incoming President
Vicky Sheppard is all smiles
with President Mike Gzik
New Exhibitor Optical Distributor Group
Education Chair Carri Ferguson gets advice
from Past President John Deering
w w w. c l s a . i n f o | c o n ta c t l e n s s o c i e t y o f a m e r i c a | E y e W i t n e s s s p r i n g 2 0 1 1
A busy exhibit hall in Austin
Carri Ferguson receives Member of the Year
from incoming President Vicky Sheppard
Vicky Sheppard
and Mike Gzik
cut the ribbon to open
the exhibit hall
Oculus exhibits in Austin
Buddy Russell discusses
Infant Aphakia
Treatment Study
Welcome back Metro Optics!
E y e W i t n e s s S p r i n g 2 0 1 1 | c o n ta c t l e n s s o c i e t y o f a m e r i c a | w w w. c l s a . i n f o
The CLSA Annual Golf Tournament at River Place Country Club
Directors Vickie Portis and Jane Beeman
support the CLSA Booth in Austin
A packed general
session room in Austin
Past President Keith Harrison
and Executive Director
Tina Schott
share a moment
Past President B.W. Phillips
talks about mentoring students
for the scholarship program
Nine generations of Past Presidents
arrive in Austin: (L-R) Keith Harrison,
Bruce Springer, Joseph Thoma,
John Deering, Jean Ann Vickery,
Marcus Soper, B.W. Phillips,
Stanley Harper and Michael Gzik
New exhibitor Smile Reminder!
Thanks for coming!
New board members Tom Shone, Jane Beeman,
Lee Hewitt and Carri Ferguson start their terms
w w w. c l s a . i n f o | c o n ta c t l e n s s o c i e t y o f a m e r i c a | E y e W i t n e s s s p r i n g 2 0 1 1
Past President Stan Harper (1973–75)
shows off his original membership
certificate in CLSA
Exhibitor Abbot Medical Optics
Keith Harrison leads a panel of experts (current and past presidents)
in the Practical in Practice Session
Featured speaker
Mark Andre
Exhibitor AccuLens (owner Bill Masler shown on right)
Rachel Behdania wins an all-expense
paid trip to the 2012 CLSA Annual
Meeting in Newport Beach, California
Photos by Dewey Nelson
Special Eyes gives away a Wii system. The lucky
winner: Jeanne Purnick
See you in
Newport Beach.
E y e W i t n e s s S p r i n g 2 0 1 1 | c o n ta c t l e n s s o c i e t y o f a m e r i c a | w w w. c l s a . i n f o 19
One Day at a Time
Addressing Patient Compliance Through the Use
of Daily Disposable Contact Lenses
By Carrie Wilson, ABOC, NCLE-AC
Patient Compliance
As early as 200 B.C.E., Hippocrates
warned physicians of the dangers noncompliance can pose to the patient and
courses of treatment. Over 2000 years
later, times have not changed. Noncompliance has been and always will be a factor
in the way the contact lens professional
fits and recommends different contact lens
modalities to the patient. In fact, compliance issues are an even larger factor today
due to all the conflicting information that
patients receive from the internet, marketing, as well as friends and family.
A Common Scenario
Contact Lens X has been prescribed for
a patient, Mr. Jones. The Mr. Jones is
informed that the contact is a disposable
lens that must be taken out daily, cleaned
with a specific multipurpose solution and
replaced every two weeks. The professional has determined this through years
of experience, the physiology of the
patient’s ocular surface, the general health
of the eye as well as the patient’s lifestyle.
This expertise should be enough for the
patient and Mr. Jones will adhere strictly
to what the contact lens fitter says, right?
Of course not. The patient is of course
going to listen to what the fitter says but,
in most cases, is going to follow his own
course of treatment.
Let’s say that Contact X was worn by
the Mr. Jones’ best friend and he or she
tells the patient that the contacts can be
worn overnight on a regular basis with
no problems. Or that Mr. Jones has researched the contact on the internet and
sees that the contact has been FDA
approved for monthly wear. The patient
may feel that all solutions are the same
and therefore go with a less expensive
generic brand or a saline solution instead.
All of this information may cause Mr. Jones
About the Author
Carrie Wilson has been in
the optical field for over ten
years. She has held numerous
training and management
positions in which she
has developed training
to change his course of treatment causing
noncompliance that may lead to various
health issues with the patient.
It has been believed that 1/3 of
patients follow all of the contact lens
fitter’s instructions, 1/3 follows some
instruction, and 1/3 doesn’t follow any
instructions. This means approximately
2/3 of all contact lens patients are
noncompliant in some form or other.
How to Break the Rules,
Let us Count the Ways
Handling the Situation
Good hygiene is imperative when it comes
to lens care. Lens handling and contact
lens case care are the most likely sources
of contact lens contamination. According
to a recent study, hand washing creates an
80% reduction in the amount of bacteria
in a lens. A research team of scientists
analyzed contact lenses after they were
handled by patients who washed their
hands and those handled by patients who
did not. Those handled without hand
washing contained an average of 10,000
colony forming units of bacteria, whereas
those who washed their hands had contacts that exhibited an average of only
2140 colony forming units of bacteria.
This philosophy also pertains to contact
lens case care. Although contact lens case
care used to involve running the case
under the hot tap water and then allowing
E y e W i t n e s s s p r i n g 2 0 1 1 | c o n ta c t l e n s s o c i e t y o f a m e r i c a | w w w. c l s a . i n f o plans to increase sales and
development management
skills. Her educational
background includes and
AA in Sociology/Psychology
from Dalton State College
and a BS in Organizational
Management from Covenant
College. She has recently
become an ABO Level III
approved speaker and an
NCLE approved Speaker; as
well as an NCLE examination
item writer. In addition,
she is a contributing writer
to EyeCare Professional
it to dry, it has been shown to be more beneficial to rinse
the case with solution and then let it air dry.
Unfortunately, these basics of contact lens hygiene are
frequently overlooked by the patient. Every contact lens
professional has seen patients who remove or insert their
contacts without washing their hands or the contact lens
case that is so filthy that words cannot begin to describe it.
Finding the Solution
Contact lens solutions are confusing. Take a trip down any
contact lens solution aisle and the array of products and
disinfection types can leave anyone in a state of uncertainty.
Even though the patients are told which solutions are the
best for them and their contact lenses, many patients forget
which solution they use. Then, when inundated with all the
choices, many patients choose either the wrong product
type or the cheapest option. Both of which can cause problems with the contact lens treatment course determined by
the contact lens fitter. It is not uncommon for patients to
purchase products that are detrimental to the integrity of
the contacts. Typical examples are saline solutions instead
of cleaner, improper disinfection types and oil containing
rewetting drops. Even when the proper products are
purchased, improper use can be an issue.
n Topping off—The reusing of solution creates an
ineffective disinfection process. It is similar to reusing
bathwater every day to get clean.
n Not maintaining a sterile bottle tip—Some patients
will touch the tip of the bottle to the contact lens itself,
the surface of the contact lens case, or insert the tip into
the solution already present in the lens case.
n Not following the manufacturer’s instructions—
Although cleaning and disinfection solutions may have a
variation in the way in which they are used, they typically
follow the same pattern
1. Remove lens from eye and place in palm of hand,
rubbing the lens with a few drops of solution. This is
true even of “no-rub” products.
2. Rinse lens with a steady stream of solution for the
manufacturer’s recommended amount of time.
This helps remove debris from the contact.
3. Place lens in a clean, dry case and fill with fresh
4. Rinse lens again before placing in eye.
Some individuals also use tap water to store and/or clean
their contact lenses instead of using manufacturer formulated solutions. This is probably the biggest no-no of all.
Luckily this is not as prevalent as it once was a couple of
decades ago, when it was common to put salt tablets into
tap water to create homemade saline.
Losing Track of Time
“I thought I was supposed to wear them a month.” “I didn’t
realize I had them in three weeks.” “I forgot.” “I wear
them until they are uncomfortable, then I take them out.”
All contact lens fitters have heard the reasons why patients
wear contacts longer than they are supposed to. However,
the confusion is understandable. We have disposables
which are thrown away after two weeks or less, frequent
replacements which are replaced monthly or quarterly, and
traditional replacement schedules which are 6 months or
longer. On top of that, the patient has to be aware of wearing schedules. Are these daily wear contacts that are taken
out every night, or are these extended wear lenses that can
be slept in? It is easy to see why the patient can over wear
his or her contact lenses even with the best of intentions.
Paying the Price
Patients who do not exhibit proper adherence to contact
lens care can develop serious infections that may create
a need for corneal transplants or lead to blindness if not
treated early. The three major and severe forms of infections
are bacterial keratitis, fungal keratitis and Acanthamoeba.
Bacterial keratitis is the most common of these infections
and often occurs after the cornea is damaged from contact
with a foreign body. The foreign body can be the contact
itself or tiny dirt particles trapped under the contact lens.
Then bacteria, especially from an improperly cleaned lens,
enter the broken surfaces of the cornea resulting in infection. Antibiotic treatment can eliminate the infection but if
not treated early enough severe infections can result in the
need for a corneal transplant.
Fungal keratitis is the rarest form of keratitis in the United
States. The Fusarium form of keratitis is more common in
the warmer more tropical areas of the U.S., such as Florida,
than in colder, drier climates. In those areas of the U.S.,
the Aspergillus and Candida forms are the most common.
Fusarium is the most recognizable of the fungal infections
because of the outbreak in 2006 in individuals who used
some Baush and Lomb solutions which have since been
pulled off the market. Although fungus can enter the cornea
through the same process as bacterial keratitis, and is therefore a risk factor for contact lens wearers, the risk is minimal compared to the incidences of the other two infections
types. Laboratory testing is necessary to determine what
type of fungal infection; howeve,r clinical features that are
specific to fungal keratitis include an infiltrate with feathery
margins, elevated edges, rough texture, a gray-brown pigmentation, satellite lesions, and endothelial plaque. If treated early, fungal keratitis is treated with antifungal drops.
Acanthamoeba keratitis (AK) is a condition that is almost
exclusive to contact lens wearers when contracted within
w w w. c l s a . i n f o | c o n ta c t l e n s s o c i e t y o f a m e r i c a | E y e W i t n e s s s p r i n g 2 0 1 1
the United States. Acanthamoeba are small, single celled
organisms that live in most water sources. When patients
use this water on contact lens, the risk of contracting AK
escalates. Common instances of contraction are through
the use of homemade solutions or water to clean or store
contacts, not allowing the contact lens case to air dry after
cleaning it with tap water, wearing contact lenses while in a
hot tub or swimming, and showering while wearing lenses.
Dirty or improperly cleaned lenses can also increase the
risk of AK because the acanthamoeba are easily removed
from the lens surface when the lenses are rubbed during
the cleaning process. AK is very difficult to treat and usually
results in a corneal transplant.
Common symptoms of all forms of keratitis are:
n inflammation
n photophobia
n severe pain
n blurry vision
n redness
n foreign body sensation
n discharge
n swollen eyelids
Keep it Simple…
Rectifying the Compliance Issue
The best way to ensure compliance is to remove ways in
which the patient can be noncompliant. So which contact
lens modality reduces handling of the lens, makes contact
lens cleaning and storage a non-factor, and makes it
easy to remember when to replace them. One day daily
Already the leading contact lens category in Europe
and Asia, daily disposable’s popularity is growing in the
United States. There is no need for any lens cleaning or disinfection so the confusion from all lens solution products
is removed from the equation. The result reduced solution
noncompliance and a decrease in solution incompatibility.
A clean, fresh lens every day has many benefits.
n The lack of a contact lens case eliminates the need
for case care.
n Proper lens cleaning, disinfection, and rinsing
techniques are no longer a factor.
Silicone Hydrogel
1day Acuvue Tru Eye
Patients who are heavy depositors and are unable to get
their contacts clean enough for repeat wear, are able to
see clearly and comfortably
n A reduced allergic response for allergy sufferers when
able to wear a lens free from allergen deposits left from
poorly cleaned lenses
It is also impossible to lose track of time when the contact
is only worn one day. When a contact is inserted in the
morning and then thrown away each night, incidences of
sleeping in the lenses and over wearing of the lenses is
significantly reduced.
Children, teenagers, athletes, socially active individuals;
all can benefit from the convenience of daily disposable
contacts. Not having to clean and disinfect lenses on a daily
basis can make contact lens wear easier for children and
teens, as well as provide peace of mind for their parents.
Travelers, campers and athletes, who do not always have
ready access to contact lens solutions and cleaners, enjoy
the no-mess ease of daily disposables. The occasional
wearer, i.e. vacationers, party goers, attendees of a formal
event, enjoy contacts that do not have to be maintained and
stored properly.
Daily Disposable Lenses Today
One of the fastest growing lens modalities, daily disposable contacts are now available in new materials and a
wider range of specialty corrections. The newest lenses are
exceptional for end of day comfort; provide clear, crisp
vision for all patients including presbyopic and astigmatic
patients; exhibit large amount oxygen permeability.
Daily disposable provide the best in patient care for most
patients. They are convenient, easy to care for, and are
available in a wide variety of corrections. By enabling even
the most noncompliant patient to maintain ocular health,
daily disposable contacts should be one of the most utilized
tools in the contact lens fitters’ tool box.
Ciba vision
CooperVisionBausch and Lomb
ToricFocus Dailies Toric
MultifocalFocus Dailies Multifocal
Dry Eye Relief
1day Acuvue Moist
Dailies Aqua
1day Acuvue Tru Eye Comfort Plus
Aspheric Design
Proclear 1 Day
Proclear 1 DaySoflens Daily Disposable
E y e W i t n e s s S p r i n g 2 0 1 1 | c o n ta c t l e n s s o c i e t y o f a m e r i c a | w w w. c l s a . i n f o 23
One Day at a Time
Successfully Complete These Questions to the Article on Pages 21–23 to Receive NCLE Credit.
Phone (with area code)__________________________________________________
To expedite the process, c.e. credits will be returned via email to those providing email addresses.
Credit Card: ❑ American Express ❑ Discover ❑ MasterCard ❑ Visa
Card Number__________________________________________________________
Signature_ ______________________________________ Exp. Date______________
1. Which is the most common infection associated with
contact lens wear?
b.Bacterial keratitis
c.Fungal keratitis
2. Which patient would be least likely to benefit from a
one day disposable?
a.The avid camper
b.The business traveler
c.The pediatric aphake
d.The busy mom who loses track of time
3. Contact lens cases:
a. should never be reused
b.should be rinsed with a multi-purpose solution and
allowed to air dry
c. should be topped off daily
d.are rarely the cause of eye infections
4. Fusarium is:
a.A form of fungal keratitis
b.A multi-purpose solution
c.A form of bacterial keratitis
d.A form of allergic conjunctivitis
5. What percentage of your patients can you expect to be
a.None of them
b.1/3 of them
c. 2/3 of them
d.All of them
6. A patient having trouble keeping track of time would
best be suited to:
a.Conventional soft lenses
b.2 week disposables
c.One month disposables
d.One day disposables
7. An inflammation with feathery margins, gray-brown
pigmentation and satellite lesions is most likely due to:
a. Bacterial infection
b.Dendritic ulcer
c.Fungal keratitis
d.Foreign body trauma
8. Which of the following Rx’s would be the least likely
to succeed in one day disposable lenses?
a. -0.25-1.25 @ 060 Add +1.50
b.+1.25+0.25 @ 080
c. -2.00-0.50 @ 045 Add +1.00
d.-4.00-1.25 @ 178
This article has been submitted for one continuing education
credit unit with the National Contact Lens Examiners (NCLE).
All technical articles that appear in EyeWitness for c.e. credit can
also be found at the CLSA University at
Online, CLSA members can complete these courses for FREE,
and nonmembers pay just $18 per course. Completed c.e. tests
that are faxed or mailed-in to CLSA at 441 Carlisle Drive, Herndon, VA
20170, Fax (703) 437-0727, will carry a $10 processing fee for CLSA
members, and a $25 fee for nonmembers.
9.If should your contact lens patient presents with severe pain and a ring ulcer, you should suspect:
a.That he slept in his lenses
b.He inadvertently inserted his lenses with peroxide
c. He is having an allergic response
d.He has worn his contact lenses around a water source
10.“Topping off” is a term that refers to:
a.Refilling the contact lens case without disposing of the
previous solution
b.Putting a one day lens over a rigid lens to play sports
c.Adding a rewet drop to the wear regimen
d.Wearing reading glasses over top of distance only
11.Which regions worldwide are the leaders in fitting the
one day lens modality?
a. United States and Canada
b.Europe and Asia
c.Australia and New Zealand
d.South America and the Carribean
12.Fungal infections that would be common in colder,
drier climates are:
a.Fusarium and Candida
b.Aspergillus and Acanthamoeba
c.Aspergillus and Candida
d.Candida and Pseudomonas
13.What would be the least likely reason for fitting a
patient in a one day lens?
14.One day lens wear removes the worry of bacterial
exposure from:
a.The lens case
b.Improper hand washing
c.Showereing in contact lenses
d.Sleeping in lenses
15.A contact lens wearer who swims in contact lenses is
at risk for?
a.Fungal keratitis
b.Ancanthamoeba keratitis
Please Record
Answers Below
by filling in
appropriate circle
w w w. c l s a . i n f o | c o n ta c t l e n s s o c i e t y o f a m e r i c a | E y e W i t n e s s s p r i n g 2 0 1 1
E y e W i t n e s s S p r i n g 2 0 1 1 | c o n ta c t l e n s s o c i e t y o f a m e r i c a | w w w. c l s a . i n f o 25
A Good Starting Point
Jennifer Chancellor, COA, NCLE-AC
ith everything you do, you should have a good
starting point. I love to hike. It is one of my favorite pastimes. I especially enjoy hiking with my
husband. While my ability to endure a long hike is, in his
words “admirable,” having a hiking partner that is always
prepared is extremely beneficial. My husband will map the
terrain, gauge the distance, check the weather, and pack
the bags. A good starting point is crucial to a long hike in
a remote area. If you do not start correctly, the hike will be
more difficult and the task of getting to the end will take
longer than necessary.
We can use this analogy when fitting patients with contact lenses. At the beginning of a contact lens fit, vertexing
the refraction back to the corneal plane can help provide a
better starting point and help us determine the contact lens
Rx much more efficiently. But what exactly does it mean by
“vertexing a lens” and why is it necessary? The term vertex is
often used in geometry, to define one type of point. It is used
to explain the corners of geometrical shapes (Figure 1).
Figure 1
A better description of vertex in relation to the optical field
is to define vertex as the point where the axis of the lens
intersects with the surface (either front or back) of the
lens. The actual vertex distance is an indication of how far
the ocular (again, either the front or back) side of the lens
is from the front of the cornea. Moving a lens closer to or
further away from the eye has the effect of changing the total power of the optical system without changing the power
of the lens. When fitting a patient with contact lenses, we
typically start with a refractive correction that is determined
for spectacle vertex distance, and then select a diagnostic
lens based on the vertexed contact lens prescription.
To expand on the explanation of vertexing, it is important to understand how moving a lens affects the power of
the optical system. If the distance between the back of the
lens and the eye changes, the effective power of the lens
will also change. A better way of understanding the effective power is to refer to it as the actual power the wearer is
seeing (or perceiving). The effective power at the corneal
Figure 2
plane will always increase in plus power relative to the
spectacle plane. The perceived power of the lens varies
when the lens is moved toward or away from the eye. For
instance, if a plus lens is moved away from the eye and the
light rays are no longer focused on the retina, the perceived power is stronger than needed and the actual power
of the lens will need to be decreased. If the same plus lens
is moved toward the eye, the perceived power will seem
weaker, necessitating a lens that is stronger in plus to get
the same effective power. The exact opposite will occur
with a minus lens (Figure 2).
With spectacles, it is often understood the glasses will
have the same amount of distance in between the cornea
and lens as the refraction. Since contact lenses rest on a
tear film on the cornea, the distance in between the cornea
and the lens will not be the same as it was in the phoropter
during the refraction. To achieve the same power at the
contact lens plane as the spectacle plane, plus power has
to be incorporated into the contact lens Rx. Assuming a
standard 12mm vertex for the contact lens prescription,
both minus and plus contact lenses will always require less
minus (more plus) than the spectacle plane. While assuming a 12mm vertex distance will suffice in many cases, you
may want to know the actual vertex distance when stronger
powers are involved. For instance, if the refraction was
performed at a 15mm distance, a greater compensation
may be needed for higher powers (over – 15.00 or +11.00
w w w. c l s a . i n f o | c o n ta c t l e n s s o c i e t y o f a m e r i c a | E y e W i t n e s s s p r i n g 2 0 1 1
@ 90
F (in meters)
+5.00D = 1 x 1000 = 200mm
(Multiply x 1000
–6.50 @ 180
to convert to mm)
200mm – 12mm = 188mm
Figure 4
@ 90
188 = 0.188m
(Divide by 1000
to convert back to m)
+5.25 @ 180
1 = +5.32D
Figure 5
Figure 3
diopters). There are several online resources that will
calculate vertex distance based on your inputs, and most
contact lens manufacturers provide vertex correction tables
within their fitting guides.
The process of vertexing the spectacle or manifest
refraction into a contact lens prescription is not complicated. For spherical powered soft contact lenses above a
power of ±4.00D, simply using a conversion table can help
to determine the correct power. If a conversion table is not
available, a rule of thumb that can be used is to square the
spectacle plane power and divide by 100 to give a good approximate amount to vertex. For example, a 5D lens needs
a 0.25D correction (52/100). A 10 diopter lens needs
1.00D of correction. This rule of thumb works well for
moderate minus and plus powers, but may underestimate
the amount of vertex correction needed for plus powers
above +10.00D. Another way to calculate the vertex prescription would be to use the focal length (Figure 3). The
focal length of a lens is the inverse of the diopter power
and specifies the distance from its optical center to the
point where the rays of light being imaged come into focus.
Taking the straight inverse of the diopter power will give
the focal length in meters. For instance, on a +5.00D lens,
we know the focal length is 1/5.00 or 0.2 meters. Typically,
focal lengths are specified in centimeters or millimeters,
so this would be 20cm or 200mm. Vertexing a +5.00D
spectacle plane power at a 12mm distance means the corrected vertex distance is 200mm – 12mm which is equal
to 188mm or .188M. The new focal length would now be
1/.188 or in diopters, +5.32. For a – 5.00D lens, consider-
ing the same conversion, the new focal length would be
.212M, or in diopters, – 4.72 lens.
One aspect of vertex correction that is often overlooked is in the calculation of sphero-cylindrical, or toric
contact lens prescriptions. In order to vertex a toric spectacle prescription, the two principal meridians, the meridian of the shortest and the longest radii of the lens, will
need to be vertexed. You can best understand the concept
of vertexing both meridians by using the optical cross. The
optical cross is a graphic method for specifying the powers
in each meridian. For example, if there is a contact lens
prescription with compound astigmatism, the prescription
should be placed onto an optical cross to determine how
much power in each of the meridians needs to be vertexed.
To illustrate, if a patient presents to you with a compound
myopic astigmatic prescription of –5.00 –2.00 x 180, the
spherical power will vertex to a –4.75 but the total combined power in the vertical meridian (–5.00 (+) –2.00
= –7.00) will vertex to a –6.50 (Figure 4). The refractive
power will need to be decreased resulting in a contact lens
prescription of –4.75 –1.75 x 180. (Note: the cylinder
power is now –1.75 rather than –2.00 because the amount
of change in power from one meridian to the next is 1.75.
The travel of –4.75D to –6.50D is 1.75D) If a patient presents with a compound hyperopic astigmatic prescription
of +7.00 –2.00 x 090, the spherical power will vertex to
+7.62 but the total power (+5.00) will vertex to +5.25
(Figure 5). The refractive power will need to be increased
resulting in a contact lens prescription of +7.62 –2.37 x
90. (As noted previously, the cylinder power changes be-
E y e W i t n e s s S p r i n g 2 0 1 1 | c o n ta c t l e n s s o c i e t y o f a m e r i c a | w w w. c l s a . i n f o 27
cause the travel in power from one meridian to the next.
The change from +7.62 D to +5.25 is 2.37D) The optical
cross should always be utilized for bitoric and front toric
gas permeable lenses as well as for all soft toric contact
The calculation of the vertex distance is an important
step when choosing the correct contact lens; however, it
may not always represent the final power needed by the
patient. This is especially relevant when fitting aphakic
patients or determining the final power needed for refractive surgery. For many aphakic patients, the elimination of
the space between a spectacle lens and the cornea through
the use of contact lenses is important and may be necessary
to reduce or eliminate distortion. In higher refractions, the
amount of correction for vertex distance will be greater in
plus powers (for example, a +19.00 will vertex up over 5
diopters to a +24.75 while a –19.00 will vertex down over
3 diopters to a –15.50).
The greater the spectacle lens power, the more important it becomes to know the actual vertex distance of the
refraction in order to make an accurate vertex adjustment
for a contact lens. Because of this, some fitters of aphakic
lenses will not even consider vertex distance and prefer
aspheric front surface
brings all light rays
to a precise focal point
spherical aberration
Figure 6
to use a diagnostic lens of known power and then over
refract, largely eliminating the need for vertex correction.
It is also very important to note that if the over refraction is
greater than ±4.00D, then the over-refraction itself will
need to be vertexed before a new diagnostic contact lens is
If a contact lens is placed onto the eye and yields poor
vision, a number of factors may be involved. These factors
may include but may not be limited to: optical clarity, fit,
or a problem with the optical system. Some soft contact
lenses may be labeled such that correcting for vertex will
not result in the correct power. Spherical and aspheric
lenses provide a good example. While an aspheric lens may
provide a fairly consistent power across the optical surface,
a spherical design may actually provide more or less power
than labeled as you progress from the center of the lens
across the optical surface (Figure 6). For instance, if a lens
is labeled –7.00 but is really more like a –7.50, you may
question your vertex correction if an over-refraction yields
a resultant of +0.50. Sometimes if a toric prescription is
not fully vertexed and results in the patient being over-corrected, an over refraction may result in a higher cylindrical
over-refraction which can confuse the fitter and complicate
the fitting process. Most fitters agree the best results come
from placing a lens on the eye and over-refracting; however, accurately vertexing a prescription in the beginning
should always provide a good starting point and help you
come to a final Rx more quickly and efficiently. As the contact lens industry continues to introduce new materials and
designs, the options for choosing a lens will only continue
to improve. Remembering to vertex the contact lens prescription will improve efficiency in the practice and provide
greater success for the contact lens fitter.
w w w. c l s a . i n f o | c o n ta c t l e n s s o c i e t y o f a m e r i c a | E y e W i t n e s s s p r i n g 2 0 1 1
Change their life without changing their lifestyle.
Tangent Streak® NO LINE™
Multifocal Contact Lens
Tangent Streak® Segmented
Bifocal Contact Lens
Tangent Streak® Segmented
Trifocal Contact Lens
“I like contacts.
Reader and bifocal glasses aren’t
for me. They’re for older people.”
Your patients want precise, comfortable vision correction for
near, intermediate and distance in a contact lens.
You want happier patients and an easier fit.
Tangent Streak® are the gas permeable (GP) multifocal lenses that
deliver happier patients, an easier fit and profits to your practice.
• Sharp, clear vision
• Bi, tri- and no-line options
• All-day wearing comfort • Easy fit
• Available in a back surface toric, bitoric and front toric.
[email protected]
Fitting Tool
with your next
E y e W i t n e s s S p r i n g 2 0 1 1 | c o n ta c t l e n s s o c i e t y o f a m e r i c a | w w w. c l s a . i n f o 29
COnsultant’s Perspective
Virtual Fitting Assistance
Using Today’s Technology
James W. Slightom, FCLSA, ABOM, NCLE-AC
About the Author
Mr. Slightom is a Fellow
in the Contact Lens
Society of America,
and a Master Optician
certified by the
American Board of
Opticianry. Jim has been
an optician and contact
lens technician for over
34 years, owned his
own optical business for
the first 18 years, was
the Contact Lens Clinical
Director at the University
of Missouri Kansas
City Ophthalmology
Department for 8
years, and is currently a
Contact Lens Consultant
at ABB Concise.
Whether you are new to
contact lens fitting or a
seasoned veteran,
an industry consultant
can be a useful tool.
My goal with this
column is to share my
experiences with all
types of contact lens
fitting while often
putting the focus on the
most challenging types
of fits. This is YOUR
magazine and YOUR
organization, please be
a part of the excitement!
I am happy to hear your
suggestions for material
content at any time.
he Chinese coined the phrase a long time ago when
they said: “A picture is worth a thousand words.”
Sometimes a thousand words are not enough when
the contact lens practitioner is trying to describe the fit to
the contact lens consultant when seeking assistance in a
very challenging gas permeable(GP) fit.
What if the practitioner fitting an irregular cornea in a GP
lens was able to email the topography showing the corneal
shape, take still pictures of the GP fit, and maybe even send a
video of the fit, all by just using a cell phone that had a camera? This
way the consultant could review the picture…then the consultant and
practitioner could view the images together, and then they could discuss
the fit with a much better chance of getting a proper fit completed with less
patient visits and fewer reorders needed.
The technology and fit assistance is here
and is ready to be used when facing the
challenging fits that expert fitters face every
week. One of the first things I bring up as a
consultant is the fact that cell phones today
with their great picture resolution can be
a very inexpensive yet valuable tool when
fitting irregular corneas.
Shown is a topographical map of a patient’s
right and left eye. When the practitioner
says my topographer isn’t hooked up to the
internet, or I don’t know how to save and
attach the picture to send it, then it might be
as easy as printing the topography and taking a picture of the map with a cell phone.
The pictures in this article were
all taken with the use of cell phone
cameras. As can be seen, the
resolution to most of these fits can
more easily be determined when
viewing the actual fit of the lenses.
—Al Vaske
w w w. c l s a . i n f o | c o n ta c t l e n s s o c i e t y o f a m e r i c a | E y e W i t n e s s s p r i n g 2 0 1 1
When the practitioner says there is a bubble
present, it would be best if the consultant could
see the bubble. In this case the lens isn’t too
steep, but it is fixing itself onto the steep portion of the cornea that has pellucid marginal
degeneration, and the lens is tilted causing
what is known as “Z” axis tilt, thus an air bubble forms. The photo was taken through the slit
lamp oculars.
If the practitioner
taking the pictures
isn’t quite comfortable taking the pictures through the slit
lamp, then there is
nothing wrong with
using the cell phone
camera outside the
slit lamp to take the
picture. This will
still give valuable
fitting hints based
on what is seen.
Then the practitioner asks the consultant
if a change may be needed on a GP fit on
this corneal graft that has a 10 diopter
variance from the flattest point to the
steepest point in the grafted portion of the
cornea. The photo shows a reverse geometry design in a large diameter GP Lens
on the grafted eye. What do you think….
leave it as is or adjust it?
Sometimes using the tools we already have is the answer.
The quality of the pictures and what has taken place with
the cell phone technology of today is right at our fingertips.
Videos and still pictures are much better than words used
for describing GP lens fits. Use what is already available for
much better results!
E y e W i t n e s s S p r i n g 2 0 1 1 | c o n ta c t l e n s s o c i e t y o f a m e r i c a | w w w. c l s a . i n f o Maybe the practitioner
tells the consultant the
lens seems a little on
the loose side, so just
steepen the fit a little bit.
How much is “a little
loose”? The amount of
fit change can better
be determined looking
at the picture sent as
shown here. This is a
reverse geometry lens
on an irregular cornea
that should be steepened no less than 1.00D
and the PC’s steepened
as well.
We’re in this fit together.
Fitting irregular corneas with specialty GP lenses is good for your patients, good for
your business. Getting started is the tough part. Look for a custom lab that will go the
distance with you.
Industry-leading, no risk warranty.
Chair Time
No Risk
Ease of fit minimizes chair time.
Experience, resources and flexibility to
ensure success with your patient.
Fitting Issues
Look to Lens Dynamics and get more for your specialty lens fits.
Dyna Cone Plus® Elite
Dyna Intra-Limbal® Elite
post penetrating keratoplasty
pellucid marginal degeneration
tilted grafts
inferior apexed keratoconus
highly asymmetric corneas
compromised corneas
steep nipple keratoconus
It’s your lab
that makes the
See the difference here:
Dyna Cone Plus Elite and Dyna Intra-Limbal Elite contact lenses are all made
exclusively in Boston® XO material with its excellent wetting characteristics and
outstanding oxygen delivery.
The Bottom Line
By Michael DiNapoli, FCLSA, NCLE-AC
A Return to Normalcy
s the contact lens industry permanently breaking
through into the therapy market? How many years
have we been waiting for a true myopic reversal
lens (orthoK), melting vision lens (collagen), drugdelivery system lens and/or a dry eye therapy? We
might be there.
The next question, how much is it worth to
“cure” someone’s myopia, glaucoma, or dry eye?
Certainly more than a cosmetic treatment for some
form of ametropia, if you think about what a contact
lens specialist is managing, it’s more than just vision
correction. I think we can call it “Lifestyle Alignment.” How many patients are now able to function
in everyday life thanks to our efforts. Let me present
three recent examples in my practice.
P.B., a 51 year old male, who came in two
months ago with no prescription because no one
could refract him. At 11 years post LASIK, he hasn’t
seen print or objects without shadows or double
vision since before his surgery. Two different fitters
in the last five years have been unable to “cure” his
visual handicap. What did I have that the fitters before
me didn’t have? Scleral lenses that would become
therapeutic vision devices. He lived over 90 minutes
from our practice but our local cornea specialist
referred him to me because he knew I had the therapeutic lenses that could help him.
I successfully fit him with the scleral lenses and
even accidentally ended up with a bifocal on one eye,
eliminating the need for reading glasses for most
tasks. He went back to his teaching job without headaches or double vision. He was thrilled.
The next patient is D.B., a 35 year old female
kidney dialysis patient, again with no prescription
because no one could refract her. She did have corneal maps from her specialist that indicated large
gas perm lenses. She had only one major hindrance;
microscopic corneas with a narrow tight fissure.
She had been previously fit with gas perm lenses that
always fell out. Her k- reading in the right eye was
90D and the left was 83D. Her left eye was centrally
scarred and I was expecting very little. I diagnostically fit her with my steepest, smallest eccentric
keratoconus lens and it appeared about 5–10D too
flat. Could I really fit her or was I fooling myself? I
decided to create my own fitting system. The diagnostic fit indicated she needed an 8.7mm lens to satisfy
her fissure and lower lid position. When I called my
custom GP lab, my first question was, “What’s the
steepest lens I can get with an 8.7mm diameter?”
The lab response was about 4.80mm base curve.
We co-developed the lens design based on diameter,
then base curve, then edge and peripheral curve
design. We created our own therapeutic design and it
Her outcome: Vision OD 20/50, OS 20/70, OU
20/40; 8–10 hours of comfortable wear. It was good
enough for her to get a drivers license. Not bad for
someone walking around with finger-count vision
for the last several years. “Normal life” restored to
a patient through my therapeutic creation. She was
beyond thrilled!
D.G., a 63 year old male, status post graft OU
came into our practice in the winter of 2009–2010.
He was unsuccessfully fit in contact lenses in New
York and Florida. Both eyes were dry, allergic and
watered profusely. After a GP evaluation, I told him
that I could fit his right eye with a large diameter
irregular cornea lens design of 11.0mm. When I
informed him his left eye could only have a scleral
lens his answer was simple, “NO.” At this point he let
me know that a previous fitter had tried a scleral lens
on him and it made him physically ill. I proceeded
to fit his right eye only with an irregular corneal lens
design that was much better than his simple corneal
lens. He was happy, but insisted that I fit his left eye
with a similar corneal design. This time, my answer
was simple, “NO.” I actually refused to fit his left eye
because I couldn’t improve his profuse tearing and
poor vision with a corneal design. Upon his return
for his final check-up for his right eye, he broke
down and said, “Why don’t you stick one of those
huge lenses in my left eye just to see how I feel?” I
selected the best diagnostic lens I had and inserted
it. He immediately had two reactions: He hardly felt
it and he could see everything blacker and clearer
than ever. The rest is history. When he returned from
Florida in the spring he begged me to refit his right
E y e W i t n e s s s p r i n g 2 0 1 1 | c o n ta c t l e n s s o c i e t y o f a m e r i c a | w w w. c l s a . i n f o Mike DiNapoli is
part of a thriving
New York State
Optical Company,
DiNapoli Opticians,
which has served
the Capital District
of New York for the
past 60 years.
He believes strongly
in the concept of
providing good
customer service in
a professional and
efficient manner.
A successful contact
lens practice
requires not only
the skills of technically proficient
contact lens fitters,
but also the ability
to practice in a cost
efficient manner.
The ability to
generate revenue
while saving time
and reducing
expenses, combined
with highly trained
staff, will ensure
a healthy
bottom line!
A Return to Normalcy
Continued from page 13
eye out of the corneal lens and into the scleral. That lens
was equally successful. At every visit, he reminds me he can
now drive at night again and see clearer than his girlfriend
without any excessive tearing. Another example of an individual with a therapeutic life enhancing success.
The commonality of these three cases is obvious. In
a nutshell, the patients got their lives back primarily and
their vision back secondarily! Think about that. Each one
came in for vision and went out with enhanced lifestyles,
more than they paid for! What’s that worth? We’ve all
heard our patients say “I went to Dr. Miracle Worker and
he cured the pain...” I live with some form of pain almost
daily, but I would be challenged to live an active life without
clear vision.
So, let’s go back to the big question: What is this level
of fitting worth? In my world, the value added experience
of getting more than what you paid for is what distinguishes
you from your competitors and creates strong referrals.
My recommendation is that you price specialty services and
products in terms of difficulty. Each market has variations
in competition, insurance, and its economic environment
allowing flexibility of pricing and you should consider this
when developing your pricing structure.
It’s a great time to move into specialty gas perm lenses.
Who wouldn’t want to be involved in enhancing someone’s
life or their return to normalcy? As far as value goes, I always
think about the MasterCard ad that says, “Priceless...” and
that’s the bottom line!
New Members
Marisa Acuff
Joanne Alexakis
Guadalupe Arredondo
Davyne Asato
Laurie Atchisson
Kelly D. Auton
Lisa Bailen
Noel Balkema
Bernice Barnard
Linda Bason
Linda Bauman
Paul Becker
Karen Jill Bennett
Cassie Bernal
Barbara Bigdoski
Staci Blackwell
Kathy L. Bodine
Patricia Bolanos
Mary Briggs
Brandy Brinegar
Jessica Brooks
Emilie Bucasas
Katherine Campbell
Stacy Campbell
Connie Carter
Kim Cataldo
Kenneth Chee
Steve Chang Cho
Danielle Chretien
Kimberly B. Chun
Angela Clark
Jennifer Cleary
Lynn Coffman
Elizabeth Coon
Stephen Corlett
Annette M. Coulter
Dana Cowart
Amanda Craig
Amanda Crosby
Robert Curtis
Carolyn Daigle
Sean J. Daly
Lien-Thu V. Dao
Esmeralda DeLaTorre
Donna DeVito Gregory
Lavon Drake
Mark DuBois
Kristine Duke
Amy Easterlin
Linda Edgell
Ashley Edwards
Nora Elizalde
John Emanuele
Sue Ethridge
Martha Fabila-Ramirez
Zohreh Farhang
Rebecca Farnbach
James Farrington
Tyler Fitzpatrick
Megan Flatt
Ken Freshman
Jennifer Gaetz
Sandra Gallo
Kimberly Garrett-Lembke
Cristofer Garza
Jennifer Glass
Rebecca Goff
Nancy Gomez
Shukla Goomar
Karin Grant
Sharon Gross
Carol Hall
Beth Hamlett
Maria Hassinger
Holly Hassler
Scott Helkaa
F. Carter Helm
Rebecca Hewett
James Heymann
Edward Hillsman
Kim Hoch
Kathleen Hoopai
Jamie Howell
Melissa Hunemuller
Mary Johnson
Peter Kaspar
Lea Keown
Jennie Khalfan
Paul Kiefer
Meltem Kilinch
Edward Kimble
Carmen Kirouac
Judy Knitter
Lora Kralik
Kimberly A. Krall
Sarah Krause
Indu Kumari
Rebecca Lambert
Julie Lammi
Tawnie Lavallee
Sharon Lee
Jessica Leonhardt
Nancy Leung
Barbara Lightfoot
Julie LiPari
Daniel Liporto
David Lopez
Derek Louie
Osmond Mack
Katherine B. Manna
Deb Maynard
Martha McGaugh
Kevin P. McHugh
Laura McKenney
Sherri McMahan
Mauricio Mendes
Florencia Merino
Gary Metoyer
Yvonne Metten
Adrienne Micuda
Raymond Mirzabegian
Jennifer Mitchell
Kathy Moffat
Peter Morse
Sheri Moser
Kerrie Mountan
Ann Mullins
Abel Navarro
Barinder Nijjar
David Novack
LeAnn Olson
Lisa Oppenlander
Crystal Orange
Kimberley O’Rawe
Jan Parker
Kaaryn Pederson
Bethany Peebles
Sabrina Petee
Mandy Pfeil
Hannelore Plank
Wilfred Pogachnik
Garla Porter
Mary Powers
Juan Prado
Don Price
Kristi L. Purtteman
Shelaine Quan
Sangeetha Raghupaty
Rekha Rangarajan
Amy D. Reidel
Debra Reviere
Carmen Rivera
Roy G. Rodriguez
Melissa Rodriguez
Laura Susan Rogers
Victoria Rossetti
Kyle Rush-Katz
B J “Rust, Jr”
Brianne Ryan
Taherah Sadi
CLSA is pleased to welcome a new Associate Member: Oculus, Inc.
Josue Santos
Gresia Serrano
Maria Serrano
Thais Shepard
Terry Shortt
Maggie Slomka
Kimberly Soto
Amanda Speeckaert
Richard Spinn
Shari Struck
Valerie Tadday
Kimberly Thompson
Christine Throngard
Michelle Titzkowski
Paula Tribuzio
Betty Tumlinson
Tiffany Umbenhower
Aida Valencia
Duanne Vancamp
April Vancheri
Deborah Vasquez
Nicole Velazquez
Diana Villanueva
Michael Vitale
Anne West-Ellmers
Carol Williams
Kim Wisniewsk
Barbara Wohlk
Lisa Wolff
Suzanne Wopatz
Marie Wraight
Alina Xiong
Tiffany Yang
w w w. c l s a . i n f o | c o n ta c t l e n s s o c i e t y o f a m e r i c a | E y e W i t n e s s s p r i n g 2 0 1 1
And the Winner is…
There’s more than one reason to attend the CLSA
Annual Meeting—there’s competitions to enter and
prizes to be won.
This year, CLSA introduced the Contact Lens Skills
Challenge for all levels of attendees. This skill challenge
includes questions on superior limbic keratitis, keratoconus, PMD, segmented bifocal, and many others. The
competition involved answering questions in a given time
period as displayed in a powerpoint slide presentation
showing a pathology slide with questions.
Winners were selected in three categories to be fair to
attendees of all levels attending the meeting. Winners in
each category received a $100 American Express Gift Card.
First Place—Fellow Member Category
Wendy Ford, FCLSA
Manassas, Virginia
First Place—Non-Fellow Category
Randall Baughman
Greenville, South Carolina
First Place—Student Category
Amanda Hopke
J. Sargeant Reynolds College
Richmond, Virginia
Prizes were sponsored by
CLSA Associate Member Alden Optical
Here’s an example of questions…do you know
the answers? Send your answers to EyeWitness
Challenge Question, c/o email: [email protected]
1. What slit lamp illumination is used in
this image?
2. Name three clinical signs in this image.
3. What two corneal diagnoses could one
make with this image?
E y e W i t n e s s S p r i n g 2 0 1 1 | c o n ta c t l e n s s o c i e t y o f a m e r i c a | w w w. c l s a . i n f o 35
Associate Members
CLSA is proud to list the names and addresses of the following
suppliers who support the Society as Associate Members.
ABBA Optical, Inc.
2230 Centre Park Court
Stone Mountain, GA 30087
(800) 331-2015
ABB/Con-Cise Optical Group
12301 N.W. 39th Street
Coral Springs, FL 33065
(954) 733-2300
Abbott Medical Optics, Inc.
1700 East St. Andrew Place
P.O. Box 25162
Santa Ana, CA 92799-5162
(866) 427-8477
CIBA VISION Corporation,
A Novartis Company
11460 Johns Creek Parkway
Duluth, GA 30097-1556
(800) 241-5999
Conforma Contact Lenses
4705 Colley Avenue
Norfolk, VA 23508
(800) 426-1700
Contamac US Inc.
806 Kimball Avenue
Grand Junction, CO 81501
(970) 242-3669
Firestone Optics, Inc.
P.O. Box 219142
Kansas City, MO 64121
(800) 373-2020
Fused Kontacts, Inc.
P.O. Box 219142
Kansas City, MO 64121
(800) 621-1159
Hydrogel Vision Corp.
7575 Commerce Court
Sarasota, FL 34243
(877) 336-2482
Soflex Contact Lenses
Barlev Industrial Park
Misgav, Israel
Special Eyes
P.O. Box 21417
Bradenton, FL 34204
(866) 404-1060
SynergEyes, Inc.
2232 Rutherford Road
Carlsbad, CA 92008
(877) 733-2012
The Lagado Corporation
2890 South Tejon Street
Englewood, CO 80110
(800) 574-2581
TruForm Optics, Inc.
400 South Industrial Boulevard,
Suite 100
Euless, TX 76040
(800) 792-1095
Accu Lens Inc.
5353 West Colfax Avenue
Denver, CO 80214
(800) 525-2470
CooperVision, Inc.
370 Wood Cliff, Suite 200
Fairport, NY 14450
(800) 538-7824
Alcon Laboratories, Inc.
6201 South Freeway (TA5-7)
Ft. Worth, TX 76134
(800) 451-3937
Corneal Design
18709 Mooney Drive
Gaithersburg, MD 20879
(800) 634-0785
9860 North 19th Drive
Phoenix, AZ 85021
(800) 528-1175
Unilens Corp. USA
10431 72nd Street, North
Largo, FL 33777
(800) 446-2020
Cynacon OCuSOFT
P.O. Box 429
Richmond, TX 77406-0429
(800) 233-5469
Lens Dynamics, Inc.
3901 NE 33rd Terrace. Suite E
Kansas City, MO 64117
(800) 228-2690
Diversified Ophthalmics, Inc.
250 McCullough Street
Cincinnati, OH 45226
(800) 537-5711
Lobob Laboratories, Inc.
1440 Atteberry Lane
San Jose, CA 95131-1410
(800) 835-6262
Universal Contact Lenses
of Florida, Inc.
3840-3 Williamsburg Park Blvd.
Jacksonville, FL 32257
(800) 874-4884
[email protected]
Essilor Contact Lens Division
13515 North Stemmons Freeway
Dallas, TX 75234
(800) 366-3933
Luzerne Optical Laboratories, Ltd.
180 North Wilkes-Barre Boulevard
Wilkes-Barre, PA 18702-5341
(800) 233-9637
Euclid Systems Corp.
2810 Towerview Road
Herndon, VA 20171
(703) 471-7145
Marietta Vision
397 Sessions Street
Marietta, GA 30060
(866) 300-6257
Alden Optical Laboratories
13295 Broadway
Alden, NY 14004
(800) 253-3669
Art Optical Contact Lens, Inc.
P.O. Box 1848
Grand Rapids, MI 49501-1848
(800) 253-9364
Bausch & Lomb, North American
Vision Care
1400 North Goodman Street
Rochester, NY 14609
(800) 828-9030
Blanchard Contact Lens, Inc.
8025 South Willow Street
Building #2, Unit 211–212
Manchester, NH 03103
(800) 367-4009
Menicon America, Inc.
1840 Gateway Drive, 2nd Floor
San Mateo, CA 94404
(650) 378-1425
Advertisers’ Index
ABO/NCLE National Education Conference................................... 25
Alcon Laboratories...............................................Inside back cover
Art Optical Contact Lens.................................................Back cover
Bausch & Lomb....................................................Inside front cover
Blanchard Contact Lens, Inc........................................................ 15
CLSA 57th Annual Education Meeting.......................................... 32
CLSA Fellow Membership............................................................ 11
Corneal Design............................................................................ 28
Fused Kontacts, Inc..................................................................... 29
Lens Dynamics, Inc..................................................................... 32
Metro Optics
P.O. Box 81189
Austin, TX 78708
(512) 251-2382
2125 196th Street SW, Suite 112
Lynnwood, WA 98036
(425) 670-9977
Paragon Vision Sciences, Inc.
947 East Impala Avenue
Mesa, AZ 85204
(800) 528-8279
Valley Contax, Inc.
200 S. Mill Street
Springfield, OR 97477
(800) 547-8815
Viscon Contact Lens
Manufacturing, Ltd.
#B101, 12225-105 Avenue
Edmonton, Alberta T5N 0Y3
(800) 661-6530
Visionary Optics
1325 Progress Drive
Front Royal, VA 22630
(877) 533-1509
VISTAKON, Johnson & Johnson
Vision Care, Inc.
7500 Centurion Parkway
Jacksonville, FL 32256
(800) 876-6644
Westcon Contact Lens
Company, Inc.
611 Eisenhauer Street
Grand Junction, CO 81505
(800) 346-4303
X-Cel Contacts,
A Walman Company
2775 Premiere Parkway,
Suite 600
Duluth, GA 30097
(800) 241-9312
w w w. c l s a . i n f o | c o n ta c t l e n s s o c i e t y o f a m e r i c a | E y e W i t n e s s s p r i n g 2 0 1 1
TearGlyde® Reconditioning System keeps lenses
moist for up to 14 hours for enhanced comfort.1, 2, 3
References: 1. Data on file. Alcon Laboratories, Inc.; Fort Worth, TX. 2. Schachet J, Zigler L, Wakabayashi D, Cohen S. Clinical
assessment of a new multi-purpose disinfecting solution in asymptomatic and symptomatic patients. Poster presented at: AAO;
December 2006; Denver, CO. 3. Meadows D, Ketelson H, Napier L, Christensen M, Mathis J. Clinical ex vivo wettability of
traditional and silicone hydrogel soft contact lenses. Poster presented at: BCLA; May 2006; Birmingham, UK.
©2010 Alcon, Inc.