Article Date: 5/1/2006

Practice pulse
Tips, Trends, & News You Can Use

MANUFACTURER LAUNCHES LOBBYING CAMPAIGN
1-800 and CooperVision Clash over Contact Lens Legislation

1-800 Contacts and CooperVision are at odds over the Contact Lens Consumer Protection Act (S. 2480), a federal bill that would require contact lens manufacturers to make lenses "available in a commercially reasonable manner" to mail order and Internet retailers, pharmacies, buying clubs, department stores or mass-merchandise outlets. GP, keratoconus, ortho-k and custom lenses would be exempt. Manufacturers that don't comply would be subject to civil action or injunction.

"Exclusive lenses undermine the intent of the FCLCA (Fairness to Contact Lens Consumer Act of 2003) by restricting the right of the consumer to choose where she fills her prescription," says Kevin McCallum, senior vice president of marketing and sales for 1-800, a supporter of the bill. "Marketing lenses based on their restrictive distribution policies rather than the medical merits is a blatant attempt by the manufacturer to tempt doctors to compromise their professional judgment," he says. He also says an investigation by the State Attorneys General concluded, "easier access to, and lower prices for, replacement lenses should encourage consumers to wear and use the lenses properly, thereby increasing patient safety."

CooperVision has launched a lobbying campaign against the bill. The manufacturer argues that current distribution policies do benefit the consumer and that the proposed legislation could force manufacturers to sell lenses to any business entity, including those such as gas stations. "There is no indication that (with the FCLCA) Congress intended to force manufacturers to sell their contact lenses without discrimination to all potential distributors," says Jeff McClean, president of CooperVision. "In an analysis presented to the Appropriation Sub-committee on Agriculture, Rural Development, FDA, and related Agencies (Oct. 2005), two former FTC officials concluded that the proposed amendment put forth by 1-800 would likely reduce competition among sellers of contact lenses and ultimately harm consumers."

A vote on the legislation had not yet been scheduled at press time.

MOST IMPAIRMENT CAN BE PREVENTED
New studies show women are at greater risk for eye-related conditions

Women are at greater risk of vision impairment than men — the result of their longer life expectancy and the fact that nearly all ocular diseases and conditions grow more prevalent with age, says a report from the National Women's Health Resource Center (NWHRC).

Two thirds of the 3.4 million Americans with a visual impairment are women, and two thirds of the one million blind Americans are women. A recent study by the Society for Women's Health Research shows 84% of menopausal women with dry eye symptoms don't know the conditions are related.

The good news is that 75% of vision impairment can be prevented or corrected with lifestyle changes, according to Ilene Gipson, Ph.D., a senior scientist at the Schepens Eye Research Institute, which collaborated in the NWHRC study. The report, "Women and Healthy Vision," offers a "Top 10" list of suggestions such as taking fish oil supplements and wearing UV-protection.

Pamela Miller, O.D., F.A.A.O., J.D., of Highland, Calif. recommends proactively addressing the issue of menopausal dry eye. "To me, it is in the same category as asking a patient if he or she has had a prostate exam, mammogram, bone density test, etc."

Ann Hoscheit, O.D., of Gastonia, N.C., says her practice targets marketing to women in the 35 to 55 years-of-age range. They established a Dry Eye Center to test saliva for estrogen, progesterone, DHEA, etc., to better determine hormones' effect on tear film. "This information can be used in conjunction with the patient's primary care provider to discuss hormone therapy," she says.

View the report at www.healthwomen.org/resources/nwhrcpublications.

NEW BUSINESS TOOLS FOR OPTOMETRISTS
Essilor Announces PM Programs and Lens Enhancements

Essilor of America (ELOA) recently introduced programs to help O.D.s improve practice operations and patient care. The ELOA Practice Builder combines incentives, staff training and business tools to maximize profitability. The program consists of strategic planning sessions, incentive programs, monthly progress reports and training.

Next month, Essilor will introduce Stimuleye Basic Optics, a new online staff development program, which includes courses on interpreting the Rx, physiological considerations for progressive lenses, benefits of AR lenses and others.

The company has planned several ABO-certified training programs to help O.D.s across the country understand and promote the Varliux Physio and Physio 360 lenses. Topics include: the effects of higher-order aberrations, molding technologies and design limitations, and understanding how distance correction affects a patient's perception of the PAL design. (Contact your Essilor sales representative for details.)

This summer, the company plans to launch iSite, a personalized web site for practitioners, which will include such services as ordering/tracking, prescription analysis, account history and a message board.

In the material world, Varilux Ipseo will offer Wavefront Advanced Vision Enhancement (W.A.V.E.). technology, which minimizes distortions caused by higher-order aberrations. Also, Essilor's Clear Guard, the company's anti-reflective lens coating, is now available nationwide on a variety of lenses.

CIBA Vision has introduced www.specialty-lenses.com for its line of specialty lenses. Designed for eyecare professionals, the site includes areas for product information, fitting assistance, consultation and ordering. It also allows users to download materials useful for the specialty lens fitting process. The CIBA line of specialty lenses includes the CIBASOFT Progressive Toric and DuraSoft 3 prosthetic lenses.

NEW LENSES ARE INDIVIDUALLY CUSTOMIZED
Ophthonix Introduces Wavefront-Guided PAL

Following the launch of its iZon single vision lens, Ophthonix has introduced a wavefront-guided customized progressive addition lens (PAL).

As with the single-vision lens, the PALs are programmed to include the patient's unique optical map, which the eyecare professional acquires through the Ophthonix Z-View Aberrometer.

The iZon lenses are compatible with any frame — the minimum fitting height is 13mm. The power ranges include: sphere from -6.00D to +4.00D in 0.01D steps, cylinder to -4.00D in 0.01D steps, and add from +0.75D to 3.50D in 0.25D steps.

The 1.6 high index base lenses include hard coating, super hydrophobic AR coating, and finishing.

Ophthonix offered the progressive lenses to its resellers in April and will make them available to other U.S. practices in July.

SUN EXPOSURE NOT WIDELY UNDERSTOOD
Survey Shows Consumers Need Education for UV and Eyes

Most consumers (82%) know that extended exposure to the sun can cause skin cancer, yet only 9% understand that it can harm the eyes, according to new research sponsored by Transitions Optical. In addition, 30% of the respondents who wore prescription eyeglasses said it was "very unlikely" that they would purchase UV blocking lenses.

The research also found that parents were half as likely to "always" choose UV blocking lenses for their children as adults would be for themselves. In addition, one third of parents were "very unlikely" to get UV blocking lenses for their children and 11% said it would depend on how much time they thought the glasses would be worn outdoors.

In 2002, a similar survey showed that only 6% of consumers knew of the harmful effects of the sun on the eyes. "A 3% increase in four years may not seem like a lot, but it represents more than six million consumers," says Carole Bratteig, manager education and training, Transitions.

SOURCE OF INFECTION YET TO BE FOUND
Cases of Fungal Keratitis Alarm ECPs in U.S. and Asia

Eyecare professionals in the United States and portions of Asia recently expressed alarm over a high incidence of fungal corneal infections in contact lens wearers.

At press time, the Centers for Disease Control and Prevention (CDC) reported that it was investigating the suspected infection in a total of 182 patients in 17 states, including states in the Mid Atlantic and Midwest regions. (Most species of Fusarium are more common in tropical and subtropical areas).

Authorities completed interviews with 30 patients, 28 of whom wore soft contact lenses. Of those, 26 reported using a ReNu (Bausch & Lomb) brand contact lens solution or a generic brand manufactured by B&L. Five patients reported using other solutions in addition to ReNu, including some made by Advanced Medical Optics and Alcon. Nine patients reported over-night wear; eight required corneal transplantation.

In April, B&L suspended shipments of ReNu with MoistureLoc from its Greenville, S.C., facility. B&L also asked retailers to take the product off shelves until the investigation concludes. The company suspended sales of solutions to Singa- pore and Hong Kong in March in response to reports of Fusarium keratitis in those locations.

The investigation — by the CDC, the FDA and state and local health departments — has not determined any association between the fungal infections and any product.

B&L Chairman and CEO Ronald L. Zarrella called the CDC data "both troubling and perplexing," noting that while there is an "apparent disproportionate representation of U.S.-manufactured ReNu with MoistureLoc" among the cases, "the available scientific evidence does not establish any type of ReNu solution as the cause."

Until recently, fungal keratitis reports were rare in contact lens wearers. In the first three months of 2006, Bascom Palmer Eye Institute's Miami facility identified 21 cases, 12 of whom wore contact lenses. The average number of fusarium keratitis cases between 2000 and 2005 was 21 per year. Usually, less than 2% have been in contact lens users.

Clinicians Must Rethink Patient Management
J. James Thimons, O.D.

In light of recent reports of Fusarium keratitis, clinicians must rethink the management of patients who wear contact lenses and present with an active keratitis.

While clinicians typically directed therapy toward bacterial disease, especially outside the extreme southern United States, the FDA now recommends that "if a patient presents with a microbial keratitis, consider that a fungal infection may be involved."

The appropriate protocol is to scrape the tissue for fungal analysis with a stain such as Gomori-Methenamine Silver (Fusarium can be identified by cellular analysis in minutes vs. culturing, which may take weeks) and send the material out for laboratory analysis.

If you suspect or identify a case of fungal keratitis in a contact lens wearer, report the event to the FDA at 1-800-FDA-1088 (phone), 1-800-FDA-0178 (fax) or at http://www.fda.gov/medwatch/report.htm.

The need for laboratory analysis is critical because in the initial presentation, clinicians cannot differentiate between bacterial disease and most fungal keratitis.

Some clinicians recommend dual initial therapy of fourth-generation fluoroquinolones and topical anti-fungals (Amphoteracin B) until the cellular analysis is available.

Most important, do not initiate steroid treatment until the condition has been identified. Fungal disease " feeds" on the immuno-suppression produced by steroids.

For further information, visit www.CDC.gov or to the above listed Web site for the FDA.

AOA's 6 Recommendations for Safe Wear

At AOA.org, the American Optometric Association lists the following six steps for clear and safe contact lens wear.

1.  Always wash your hands before handling contact lenses.

2.  Carefully and regularly clean contact lenses.

3.  Store lenses in a clean and proper case. Replace the case every three months.

4.  Use only cleaning products recommended by your optometrist.

5.  Never re-use old solution.

6.  Replace contact lenses as prescribed by your doctor.

O.D. NOTEBOOK

The American Optometric Association has urged optometrists to write their senators to oppose bill S1955, the "Health Insurance Marketplace Modernization and Affordability Act." The bill would allow the federal government to restrict consumer access to eye and vision services by pre-empting all state-mandated benefit legislation. Approved in committee, the bill is due to advance to the Senate floor for a vote. See www.aoa.org for details.

A recent study reports high levels of satisfaction among patients who wear two-week, silicone hydrogel lenses (O2Optix, CIBA Vision). When compared with their previous lenses, 99% of the survey participants the new lenses felt more natural. Additionally, patients' eyes were less irritated (93%) and they were able to wear lenses longer during the day (92%). Finally, 95% said they would recommend the lenses. The study was conducted by an independent research firm in January 2006.

The Vision Council of America launched a new interactive job board, the Optical Career Center, http://careers.visionsite.org. The center offers online employment connections for manufacturers, distributors, laboratories, sales, retail and eyecare professionals. The site is open to all members of the vision industry and is available at no charge to job seekers.

Advanced Medical Optics has won the NorthFace ScoreBoard Award, presented by the Omega Management Group to companies who, as rated by their own customers, achieved excellence in customer satisfaction. This is the sixth consecutive year that AMO (formerly as VISX) has earned this honor.

Art Optical is celebrating 75 years of service to the ophthalmic industry. Founded in 1931 by Charles J. Anastor as a spectacle lens maker, the now exclusive GP manufacturer, whose strength lies in custom lens designs, remains privately held by his son, Thomas E. Anastor.

Vision Council of America added 10 new members: ClearVision Optical, Revolution Eyewear, 1-800-Clip-Ons, Precision Tool Technologies, VersaSuite, Carskadden Optical Company, Collard Rose Optical Lab, McLeod Optical Company and New South Laboratory.

Internet portal Eyefinity has announced an alliance with Marchon, the manufacturer and distributor of eyewear and sunwear. The company's collection will be available at www.eyefinity.com later this year.

Will presbyopes use computers to improve their vision? Singapore-based NeuroVision (www.neuro-vision.com) believes so. The company says its NewVision computer program is clinically proven to improve vision for patients with presbyopia, low myopia, amblyopia and post-LASIK vision enhancement. NewVision is awaiting FDA approval.



Optometric Management, Issue: May 2006