With any new products, there can sometimes be a few surprises.  If you read my post about Bausch and Lomb's new monthly Ultra contact lens, you know that I found it exceedingly comfortable and a very exciting new option on the market.  The overwhelming response to their launch of Ultra has been positive, with most patients reporting better initial comfort and less end of day dryness compared to other monthly lens options.  But as more doctors began fitting the lens around the country, a surprising finding began showing up in a minority of lens wearers: redness.

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Staining grid studies are a controversial topic, but can raise some interesting discussions as to what solutions we should really be recommending to patients for the contact lens brand that they wear.  We don't have information about Ultra yet, but perhaps it to requires a certain solution brand to perform at its best in a sensitive patient population.  via

With the official kick-off of summer vacations, if you haven't already pulled out your new pair of sunglasses for the season, now is most certainly the time.  With all of the Memorial Day sales going on this weekend, here are Eyedolatry's picks for the best new looks to bring to the beach, lake, or wherever your outdoor travels may lead.

White cat eye sunglasses pair great with the summer's bold floral prints.  via

Miu Miu patterned sunglasses via

You've done it!  You've made the decision to devote the rest of your life to eye balls and their care and keeping.  I know that may seem like an exaggeration, but when you become an optometrist, you really do think about eyes all day long.  When you aren't at work seeing patients, you are talking to your optometrist friends about eyes, talking to your family about their eye problems, talking to your outside of optometry friends about their eyes, talking to total strangers that ask what you do for a living about their eyes.  Just as a word of advice, when you are on vacation and don't want to talk about eyes for a few days, pretend that you have a different career.  White lies can't hurt in this case. There is nothing like hiking Yosemite and having to talk to a stranger about their uncle's cousin's cataract surgery complication all the way up the mountain.

States with current optometry schools -- more coming soon!  via

My Graduating Class

With the recent launch of Ciba's Daily Aqua Comfort Plus Multifocal, the world of daily multifocal lens options just got a second look.  Remember about a year ago when CooperVision first pioneered the option with their Proclear 1 Day Multifocal lens?  Within a few tries, I think most ODs sighed a long, low sigh of exasperation at the peculiar performance of the lens, and went back to fitting Biofinity Multifocal.   Well, I know I did at least.

But as with most products, what we really needed was a good fitting guide to cut down all the time spent trying and failing in the room.  CooperVision has recently published their recommended guide, and it is time to take a second look at fitting this lens!

Things to Know:

No, this lens is NOT designed like Proclear Multifocal (the monthly version) or the newer Biofinity Multifocal.  Unlike Ciba's daily product that uses their exact same Air Optix multifocal fitting strategy, you need a whole new method to fit the Proclear 1 Day multifocal.

Center Near design via

Even though this is a multifocal, you will definitely need to be maximizing vision by using the dominant eye.  Make sure you determine this before you get started.

This is a center-near optical design, and there are no add powers to select. CooperVision states the lens can accommodate up to +2.50 add despite this.  If you have detail oriented patients that like to question the power of their contact lenses compared to their glasses Rx, please tell them up front that this lens power will look NOTHING like their glasses Rx.  Set the stage that this is a whole different way of seeing, and the power of this lens on the box label does not mean the power they are getting out of the lens due to the center-near aspheric optics!

Fitting Guide:

1) Refract and determine eye dominance.  I like to use the +2.00 blur out method (the eye that cannot take the plus is your dominant eye).
2) Select your initial lens:  

Dominant Eye:  Select +0.50 over top of vertexed distance power
Non-Dominant Eye:  Selection depends on add
             +1.00                          Select +0.50 over top of vertexed distance power
             +1.25 to +1.75            Select +0.75 over top of vertexed distance power
             +2.00 to +2.50            Select +0.75 to +1.00 over top of vertexed distance power

3) Over-refract with +0.25/-0.25 in binocular conditions
For distance refinement refract over dominant eye
For near refinement add more plus to non-dominant eye

In Summary:

Since changing to this fitting guide method, I have saved a ton of chair time.  The lens takes A LOT of plus, so don't waste time by grabbing their distance Rx as a starting place.  Vision has all the complaints of normal multifocal lens wearers -- ghosting at near, poor performance in low lighting, etc.  Typically I can get 20/25 distance vision and around 20/30 near vision on most every patient.  These are my target goals for optimal performance (I set the expectation before we ever start the fitting process so the patient knows what to expect, and that for better vision than this they will likely need glasses).  If you were frustrated before by the large over refraction needed over their distance Rx, take a second look at the Proclear 1 Day Multifocal. In my experience the vision performance out of the Biofinity Multifocal tends to be better for most people, but for the comfort of a daily, you are still achieving usable vision with this lens approach!

One thing is always true about fashion: we love to recycle the past.  Glasses styles are definitely no exception, and this spring no vintage look is having a bigger moment than horn-rimmed specs.  It is popping up everywhere from Ray Ban's classic Clubmaster shades being relaunched in every spectrum of the rainbow, to ophthalmics embracing a new take on the geek-chic look that has become played out in the oversized trends of years past.

With the patent set to expire for Restasis this month, the dry eye world is poised to have a new option on the block with Shire's lifitegrast molecule that is just reporting Phase 3 clinical trial data.  When Restasis first hit the market in 2002, it was the first prescription available for dry eye, showing increased tear production for patients and an anti-inflammatory effect.  For over a decade Restasis has been your doctor's only prescription choice for a drop to help produce more tear film, but due to the varied issues that cause dry eye, it has not been a cure-all for every type of dry eye sufferer.  Here is what we know about the potential new kid on the block:

Lifitegrast is an anti-inflammatory molecule, working to reduce T-cell activation and cytokine release.  Anti-inflammatories like Restasis and lifitegrast theoretically combat dry eye by breaking the inflammatory cycle.  When your eye gets dry, redness and irritation result from increased inflammation on the eye's surface.  This inflammation appears to reduce normal tear film function, causing more dryness and more inflammation.  It is a never-ending circle of dryness, redness, and discomfort.  Both Restasis and lifitegrast are T-cell modulators, but it is theorized that lifitegrast will be faster-acting than the Restasis molecule. Restasis typically requires around 3 months (the lifespan of a T-cell) to begin effectively breaking the dry eye cycle, whereas early data suggests lifitegrast will begin having effects in as early as 2 weeks.  There are at this time no head-to-head studies that compare the two drugs.  Potentially they could even be used in combination for a greater effect!

Lifitegrast is completing Phase 3 FDA trials, and so far results have been mixed.  All trials so far compare lifitegrast to placebo (the vehicle in the drug).

SPK or corneal staining is a clinical sign of moderate to severe dryness. Unfortunately lifitegrast performed no better than its placebo at improving SPK on the surface of the eye in the OPUS-2 study.  Patients did however report improvement of their dry eye symptoms in the blind study.  via

In the OPUS-2 study, paitients reported a  statistically significant relief from dryness symptoms with lifitegrast versus placebo.  Unfortunately the clinical signs of dryness measured in the study (inferior corneal staining) was not statistically significantly improved with the use of the drug.  Thus continues the infuriating issue with dry eye -- symptoms and signs of dryness tend not to coincide.  So while patients felt better, the clinical findings of dryness and damage on the surface of the eye (corneal staining in this study) had not improved.

In the SONATA safety study, there were no reported dangerous side effects with lifitegrast use. The most common side effect was bad after-taste (16.2% of users) and irritation after installation (7.8%).  Burning with installation is also a common complaint with Restasis use.

While there is no way to accurately predict when or if lifitegrast will come to market as a true alternative or additive therapy to Restasis treatment, it can be several years before a drug with successful phase 3 trials actually makes it to market.  I will continue to keep you updated as we learn more!

Why is it so important to have an eye exam at 6 months of age?  There are so few people taking advantage of the great InfantSEE program that offers free eye exams for children age 6 months to 12 months, but the conditions that can be found during this exam can influence a lifetime.  During the exam your optometrist will be able to find life and vision threatening tumors, large prescriptions or eye muscle anomalies that could result in severe eye turns or vision loss, and congenital conditions that can result in permanent blindness and be associated with serious systemic health issues.  Yes, all that is what is taking place at your eye examination. It is so much more than "which is better, 1 or 2."