GLG News by Darcy Ryan, OD

Implications: A recent study showed that children aged 8-12 were just as successful as teenagers aged 13-17 in the areas of physiological adjustment and contact lens care.  I find this is true in my practice as well.  Not only can prescribing to this younger demographic change a child's life, it can also increase an Eye Care Practitioner's bottom line.

Analysis: My personal philosophy on prescribing contact lenses for children is based on the child's maturity level, rather than age.  I've found that children have a very wide range of maturity levels, even though their ages may be the similar.  If I determine a child may be a good candidate for contact lenses based on their prescription and my assessment of their maturity level, I'll introduce the idea to both the child and the parent at that exam.  I'll actually take a trial lens out and put it in the child's hand and let them touch it so that they get a better understanding of the concept.  Depending on both their reactions, I assess if it is an option to pursue now, versus one that they can discuss on their own, and then I'll bring it up again at their next exam.
 
The first lens I consider for a child is a daily disposable lens.  There are less steps to follow for both parent and child when the child can just throw the lenses out at night.  No cleaning, no solutions, and no keeping track of when 2 weeks, or a month is up.  What 8 or 9 year old child has an accurate concept of time?  Also, I have several children who are on their school swim teams.  Once they are done their swim, they can just throw the contacts out after getting out of the pool.

The social impact at school for a child who is embarrassed about wearing glasses can be devastating.  Put contact lenses on that child and it can literally change their lives.  I have one patient in particular that stays with me.  He was a 10 year old with -5.00DS OU, and was very introverted and quiet at his first exam.  I convinced him to try contacts and he took to them like it was meant to be.  At his followup a couple weeks later, he was a different boy.  His Father reported a complete change in his personality; he was more outgoing, more social. and came out of his shell.  It sounds cliche, but contacts changed his life.

One more aspect that should be addressed when considering prescribing to younger patients, is the potential financial gain for the Eye Care Practitioner.  When you open up a service to a new demographic, you stand to make more money.  And who doesn't like that?  There may be slightly more chair time involved initially, but if you become effective at qualifying the child as a good contact lens patient, and delegate the training, everyone should be rewarded.

Implications: This survey gives strong evidence to support issues that Eye Care Professionals deal with every day.  Most Americans (73%) believe that vision correction would help their ability to drive at night, and yet only 27% of those drivers have sought help from an Eye Doctor.  Why is there a discrepancy?  Why doesn't everyone who has a vision problem get their eyes examined?  Fears and misconceptions.

Analysis: Of the hundreds of patients I see in a month, there are always a handful that swear up and down that their vision is 'fine', or that they are 'very safe' drivers.  Or, they admit to having difficulty driving at night, but either don't wear their glasses or are wearing a 5 year old pair of glasses.  Most, though not all, of these patients are elderly, and all of them, young and old, take some serious convincing from me to get them to first, test for glasses, then to wear them.  The survey showed that males over 50 years old were least likely to report having vision problems at night.  I agree.

I realize that elderly patients who drive, see driving as a source of independence, and sometimes think that there is a conspiracy (of which, the DMV and Eye Doctors are part) working against them to try to take away their drivers' licenses.  So, when they sit in my exam chair, they don't want to report that anything is wrong, so everything is 'fine'.  Even when I find a significant improvement that I can make in their vision with a change in prescription, or a new prescription, I often meet with resistance.  I actually had argument with one patient.  I'm happy to say though, that I am successful most of the time, in convincing them that getting their glasses updated is the right thing to do.  My argument goes something like this: "I know you think you see well, but your vision has changed since last year.  And, we all know that our reaction time slows as time goes on.  These new glasses will allow you to see further down the road so that you can react to changing conditions earlier, and be a safer driver."  Luckily, most people want to be safer drivers.

There are some younger patients who resist vision correction as well.  In my experience these tend to be mostly males, who may be the same ones who won't stop to ask for directions. or admit they're lost.  Many of these patients have resisted getting their vision corrected because of a common misconception that wearing glasses makes your eyes weaker, or creates a reliance on glasses.  I understand this thinking, but I make sure that they understand that this is not true.  I inform them that our eyes will change over time regardless of how we correct them, or if we correct them at all.  Glasses or contacts are only meant to make vision sharper and more comfortable.  They will do nothing to 'weaken' the eyes.

Whether young or old, if a patient would benefit from vision correction, and indeed be a safer driver, we, as Eye Care Professionals, have a responsibility to be as convincing as possible in our recommendation for glasses.  But, as the saying goes, you can lead a horse to water, but you can't make it drink.  Hopefully, these horses that don't drink drive away from our office about a half hour before I do.

Implications: Even though Bausch & Lomb appears to be getting back on its feet in the contact lens and solution market, their lawsuit woes continue to pile up.  At 573 and counting, these lawsuits are expected to cost them over $1 billion.

Analysis: With the recent buyout of Bausch & Lomb (B&L) by Warburg Pincus, it would seem that they are on the recovery trail.  But, this report definitely indicates that it will be quite some time, and will require quite a lot of money, before their ReNu MoisturLoc problems are resolved.

I found it interesting that the article stated that the CDC directly named the poor disinfecting properties of the MoisturLoc solution, and not the questionable contact lens hygiene habits of the users, as the cause of the Fusarium outbreak.  I've read reports from B&L stating that poor contact lens hygiene was just as responsible for the outbreak as the solution itself.  Also, I never realized also that the South Carolina plant that produced the MoisturLoc had been cited by the FDA for prior quality control problems.  Who knows, maybe the Fusarium outbreak could have been avoided if someone at B&L had fixed these quality control problems.

On a personal note, B&L continues to be my least prescribed company, as far as contact lenses and contact lens solutions go.  I've talked to our rep. a couple times trying to get some contact lens trial sets in my office, but he continue to insist they will only send sets to those who sell a large volume of their contacts.  My argument that, "If I don't have any trial lenses, how am I going to sell your lenses?" didn't convince him.  Somehow Vistakon and Coopervision both take this argument to heart, and send me as many trial sets as I ask for.  The B&L rep. also told me that he couldn't send me any contact lens solution (ReNu Multiplus) because they didn't have any to give me.  They were back-ordered because of the increased demand after AMO's Complete had been recalled.  This is their big chance to gain a big chunk of their lost market share, and they're dropping the ball.

So, 573 state and federal lawsuits to date, many years in court,  potentially over $1 billion, and at least one unsatisfied Optometrist... B&L has a tough road ahead.

Implications: The newest silicone hydrogel contact lenses introduced to the market use a siloxane-based material, and include the Ciba O2 Optix Custom, the Coopervision Biofinity, and now the Menicon PremiO.  I have yet to get my hands on and prescribe any of these lenses so I don't have any first accounts of their performance.  But I hope to try at least the Biofinity very soon.

Analysis: I still have yet to try any of these next generation silicone hydrogel lenses (O2 Optix Custom, Biofinity, PremiO) on my patients.  My only experience is with the Biofinity, and that has been word of mouth accounts through colleagues.  The overall sentiment is positive, but I want to try these for myself.

As far as I know, this is Menicon's first production of a soft contact lens.  I believe they are known more for their rigid gas permeable lenses.  It was smart of them to break into the soft contact lens market with a silicone hydrogel so that they could hit the ground running with the newest and best lens material.  If they really want to be successful, their next step should be to get some reps out there to knock on the doors of every eye doctor they can find, and give these doctors trial sets.  Then we'll see how it performs.  I hope to hear from a Menicon rep in the near future so that I can try out these new lenses, but I won't hold my breath.

I've been trying to contact CooperVision for a while now to obtain a trial set of Biofinity lenses.  The last time I talked to my rep, he said he'd send one as soon as it was available.  I found out recently that I have a new rep, who I haven't heard from, and I still have no trial set.  I recently went to a conference, at which CooperVision was a sponsor, and they indicated that trial sets were being shipped out.  Again, I'm a little skeptical, as I've heard this from CooperVision for the past 2 years.

I used to prescribe the original Ciba O2 Optix (first generation silicone hydrogel) at a former office where I worked, and had some success with it.  In my current office, we've never had very attentive representation from Ciba, so I don't expect to be trying the O2 Optix Custom any time soon.

It seems only Vistakon has figured out that when you give an eye doctor a trial set (or sets) for them to try on their patients in-office, that this eye doctor will fit and prescribe more of their lenses.  For this reason, 90% of the spherical soft lenses I prescribe are Vistakon (AV Oasys) lenses.  This seems like common sense to me, but apparently, it's not.  I'm sure this is why Vistakon has been the leader in the contact lens industry for so many years.

Implications: So how important is contact lens hygiene?  Extremely.  If you don't properly take care of your contact lenses, you risk vision loss. Would you change your bad habits if it were to cost you your professional career?  Most sane, competent people would emphatically say 'YES!'.  Unfortunately though, through ignorance or laziness, not everyone would.

Analysis: Contact lens hygiene has been a big news topic in the contact lens world recently.  Both heads of Bausch & Lomb (ReNu MoisturLoc) and AMO (Complete MoisturePlus) have blamed consumers' poor contact lens hygiene for their solutions' problems with infections.  There is some truth to their arguments.  It is a well-known fact that poor contact lens hygiene puts you at higher risk for developing an infection.  This boxer is an unfortunate, but appropriate, worst case scenario example of this fact.

This article is pretty vague about the details of this boxer's infection.  The author does not report what type of contact lenses he was wearing, the type of contact lens solution (if any) he was using, or the actually microbe involved.  The thing that strikes me as most significant is that he was expected to spend 7-10 days in the hospital until they figured out his prognosis.  It is pretty rare to spend that long in the hospital for an eye infection.  This must be one heck of an infection by one very nasty bug.

So, we all get the take home message from this article - if you've got to clean your contact lenses, use your dog's mouth, not yours.  Just kidding, of course.  I read that the boxer 'cleaned' his contacts with his mouth, and after cringing for a few moments thought, 'What the hell was he thinking?'  Fortunately, this type of improvised 'cleaning' is not very common, but definitely not unheard of.  These are the patients who should consider alternatives.  Obviously, People, if you can't handle the responsibility of cleaning, disinfecting, and caring for your contacts, consider refractive surgery, consider glasses.  But most importantly, consider the fact that if you don't stop abusing your contact lenses, you can lose both your vision, and your career.  I tell my patients who, against my recommendations, sleep in their lenses, "If you were to needlessly lose vision because you contracted a central corneal ulcer, because you slept in your lenses, after we told you not to, you'd kick your own butt for the rest of your life."  I usually see the light come on at this point.

Implications: Similar to Bausch & Lomb's reaction to last year's ReNu with MoistureLoc's recall, AMO's CEO has blamed their consumers' poor contact lens hygiene habits for Complete MoisturePlus' recent problems with Acanthamoebic Keratitis.  Is there any truth to this statement, or is he just deflecting blame away from himself?

Analysis: There is definitely truth to the statement that poor contact lens hygiene causes an increased risk of infection, no matter what contact lens solution you use.  This has been true for a long time, and it's something I tell my patients each time I see them.  However, the fact that AMO's CEO, James Mazzo, is blaming consumers for this new outbreak of Acanthamoebic keratitis, a very rare condition, seems ridiculous.  The tone of the article suggests that the author agrees with my assessment.

There is scientific evidence that proves that consumers who use Complete MoisturePlus are 7 times more likely to contract this potentially vision threatening disease, than any other contact lens solution.  So there has to be something in MoisturePlus' chemistry that is making the conditions favorable for Acanthamoeba to thrive.  Now, if AMO has not changed its formula recently, and to my knowledge they haven't, the big question is 'What conditions have changed in the past year or so that have caused these infections to happen?"

Is there something different in the water, where the Acanthamoeba live?  Possibly.  Has there been any contamination anywhere along the production process?  Not according to Mazzo.  Have contact lens patients being less hygienic with their contacts?  Doubtful.  If anything, I would say my patients are being more careful, thanks to the ReNu recall last year.  Hopefully, they'll be able to determine what actually caused these infections, so that they can prevent them from happening again.

Going back to my original question about Mazzo's laying the blame on consumers' poor hygiene vs. deflecting blame.  I don't think the poor hygiene argument holds any water.  In my opinion, it seems like a very petty attempt to deflect blame away from himself and his company.  And it will definitely make me think twice about dispensing any new solution they develop to replace MoisturePlus.

Implications: AMO issued their recall of their MoisturePlus solution in late May, but are some contact lens patients still unaware and still using this solution?  The answer is YES.

Analysis: Yes, I do think that there is cause for alarm.

I still have contact lens patients coming in for their annual contact lens exam using the Complete MoisturePlus, unaware of the worldwide recall, and unaware of their increased risk for contracting the Acanthamoeba infection.

Most patients are stunned when I tell them that the solution that I told them was safe to use last year (and that some have been using for many years) is now, potentially dangerous.  I know my patients trust me in my recommendations, but 2 solutions in 2 years that I've told patients were safe, are now gone from the market.  I hate that it has now come to me having to tell patients to use Optifree or ClearCare, because they are the only solutions that haven't been connected to a potentially blinding infection.

It seems to me that AMO should make more of an effort to reach out to more people via T.V. and radio advertisements, like Bausch & Lomb did last year.  They should consider the amount of money it would take to advertise, thus potentially preventing several nasty infections, and compare that to the amount of money a lawsuit or several lawsuits would cost them.  I'm sure they would come out on the plus side with the advertising.  Besides the money aspect, isn't that just the responsible thing to do?

Implications: Contact lens patients are starting to wonder what contact lens solutions are safe anymore.  After last year's ReNu with MoisturLoc (Bausch & Lomb) worldwide recall due to a fungal infection; and now, Complete MoisturePlus (Advanced Medical Optics) has been recalled worldwide due to an increased risk of a parasitic infection.  What contact lens solutions are safe?  Are there contacts available that don't need to be soaked in a contact lens solution?

Analysis: It is very discouraging as an Eye Care Professional to have to discuss yet another contact lens solution recall with my patients.  Twice in the past year and a half, contact lens solutions that I've recommended, or actually given to my patients, have been recalled due to increased risk of serious infection by various organisms.  I know my patients trust my judgement, and even though this is in no way my fault, I can't help but think a few of my patients, maybe in some small way, have lost a little faith in me.  I'm sure I'm not the only Doctor that feels this way.

So, what is happening?  Are the organisms getting stronger?  Is there contamination somewhere along the manufacturing process?  Are contact lens wearers not following our instructions on proper contact lens hygiene? 

I have to look at these questions and ask which one(s) I might possibly influence.  Really, the only one is better educating my patients on proper contact lens hygiene.  Maybe we've all gotten a little lax in our instructions to every patient, not just the ones we know abuse their contacts.  We assume everyone is doing what we tell them and don't pry a little further to find out what their habits really are.  I have definitely been doing more prying since last year's ReNu with MoisturLoc recall. 
Currently, I still have patients coming in for their annual exams who hadn't heard about the Complete recall and are still using it.  Of course, I immediately have them stop using it, and tell them to throw out their current contacts and contact lens solution.  I'll usually give them Alcon's Optifree Replenish.  Optifree seems to be one of the only 'safe' solutions out there.  ClearCare, which uses a hydrogen peroxide-based cleaner, is another solution that I've been recommending.

I suppose all we can do is wait to see if they find any direct cause of the increased risk for developing Acanthamoeba keratitis.  Until then, I'll continue to recommend what I think is best for I patients... with all the information I have at this point in time.  And that may change tomorrow.

Implications: One company suing another in the eye industry is commonplace these days.  Fines are paid and life goes on.  Will this lawsuit affect the sales or market share of either of these companies now, or in the long-term?  Not significantly, on both accounts.

Analysis: Of course, everyone claims that their contact lenses (contact lens solutions, pharmaceuticals, or whatever) perform the best, and they always have studies to back it up. But, obviously, not everyone can be the 'best'.  This is impossible.  So where do the studies come from, and how reliable are they, and what has been made up for the sake of trying to grab market share?  From this lawsuit, Ciba "deliberately misrepresented consumer opinion".  I interpret this as Ciba allegedly lied about their O2Optix lens performing better than J&J's Acuvue lens. 

How does this verdict affect J&J and Ciba?  J&J won the case, but it was a very weak win.  They sued for $7.2 million in damages and received $150,000.  To me this says, yes, J&J is in the right, but let's not waste any more time and money on this case.  This case has been going on since December 2004!  For Ciba, it means they were caught allegedly lying, but got off with a slap on the wrist.  More importantly, their reputation has been damaged.  As an eye care professional, I know they've fallen a notch or two in my mind.   The amount that Ciba's reputation has been damaged really depends on how many Docs or patients read about this lawsuit.

Will this lawsuit make much of a long term impact on the market?  No, I don't think there will be a significant impact.  We live in a litigious society where lawsuits occur daily.  The more lawsuits we hear or read about, the less of an impact they have.  A lot of eye care professionals read articles like this and forget them pretty fast.  Only because I'm writing this analysis, did I pause to put more thought into the weight of the article.  Otherwise, it would have been on its way to being forgotten.  Optometrists are creatures of habit.  It would take a lot for them to change their routine.  I don't prescribe many Ciba lenses, and that's not going to change.  If another Doc was successfully prescribing the O2Optix, they would likely continue to do so without missing a beat.

Implications: So Bausch and Lomb is involved in yet another recall.  At least Bausch and Lomb learned a lesson from the big MoisturLoc® mess.  Pulling the affected solution lots quickly and voluntarily was the smartest thing they could have done.  But I have to ask, 'Where is the quality control?'

Analysis: So, what's up with Bausch & Lomb (B&L)?  They held a firm grip on the contact lens market share for many years, and in about a year's time, they've had 2 significant recalls.  The first was the MoisturLoc® disaster that caused vision loss, corneal transplants, and lawsuits that I'm sure B&L will be paying off for many years to come.  And now, just as they are starting to dig themselves out of the financial and legal hole left by MoisturLoc®, they screw up again and have to recall another lot of solutions.  At least they acted quickly this time before any major problems occurred.  There were reports that B&L allegedly knew about the problems with MoisturLoc® months before it was reported to the CDC and subsequently pulled from shelves worldwide.  And we know how that worked out for them.

I think the two major effects of this recall on B&L are further damage to their currently hurting reputation, and a further decline in consumer confidence.  For the most part, these go hand in hand.  Those who know about this latest recall, patients and Doctors alike, are likely to avoid B&L's solutions again.  Sound familiar?  If this story had made the evening news, there would be a whole different level of avoidance.  Luckily, for B&L, this story was kept fairly quiet.  So, those who haven't heard about the recall will continue to use the solution and go on their merry way.

The obvious question to ask is, 'So where the heck is B&L's quality control?!'  You would think after MoisturLoc®, they would have cleaned house, fired everyone vaguely involved with allowing the solution to be produced, and then hired a crack team of super inspectors.  Apparently, not.  Optifree® and Complete®, get ready to take over more of the market share. 

Implications: As the number of presbyopic patients, so does the demand for multifocal vision correction for these patients.  Currently, the two main 'non-spectacle' options are multifocal contact lenses and accommodative IOL's.  With the accommodative IOL industry growing, will it make a significant impact on the multifocal industry? 
Not any time in the near future.

Analysis: So far, I haven't seen a significant impact on the multifocal contact lens industry as more accommodative IOLs are approved.  There are a few reasons for this.

By far, most patients choosing to implant accommodative IOLs are those with mature cataracts, usually in their 60's or older, and who don't currently wear contact lenses.  Those who are wearing the bifocal contact lenses are usually younger, in their 40's and 50's, and who don't have visually significant cataracts.  So, these two demographics aren't affecting each other.

Another factor to consider is insurance.  Whether the patient has significant cataracts or not determines if their insurance will pay for all (or most) of the cataract surgery.  If a patient doesn't have significant cataracts, they will have to pay out of pocket for the surgery.  At a cost of about $5,000 to $6,000 for both eyes, this may deter the patient from having it done.  Alternatively, they can pay about $300/year for contact lenses.

As well, I don't think that the technology with accommodative IOLs is to the point where it is 'perfected' yet.  I think it will take a few more years of experience and fine tuning before patients who don't have cataracts elect to have it done as a better option than wearing glasses or contact lenses.

Give it 5-10 years, and I think the accommodative IOL industry will start to affect the multifocal industry, but for now, I see any significant effect.

Implications: Studies come out every day about contact lenses, spectacle lenses, eye medications, etc.  Most of these studies though must be ingested with a grain of salt.  The bifocal RGP study that this article discusses is one of those.  For many reasons, I don't think that it will have any affect at all on the soft bifocal contact lens industry.

Analysis: The short answer to the topic of this analysis is, 'no'.  I don't think that this one study will cause a decrease in the number of patients wearing soft bifocal contact lenses.  I have a few reasons for saying this:

1.  The study itself seems questionable.  They only used a study size of 16 people.  As far as determining accurate, reliable results, this is an extremely small number of people.  The smaller the sample size, the less reliable the results.  As well, I'm guessing that since the study was done in Japan, only Japanese patients were used.  As most Eye Care Professionals know, Asian eyes have a much different anatomy than other races.  Their lids are generally tighter, and the opening of their eyes is smaller.  This can change the way that a lens fits, how it moves, and how it performs.  So, the specific RGP lenses that they used may work differently than if they were worn by a caucasian, for example.

2. The article itself was very limited in scope.  There seems to be a lot missing in the report of the study.  This is very important because most people will only read this report, and not the actual study.  What specific brands and designs of RGP bifocals were used?  Were these patients new or established contact lens wearers?  What specific brands and designs of soft Multifocal contact lenses were used as a comparison?  Were the patients, in fact, all Japanese?  Every question I have to ask makes this article and study less compelling.
 
3.  Was the physical comfort of the lenses evaluated?  Not every patient can wear RGP lenses.  They must be fit correctly and there is a 1-2 month window of getting used to the fit for a new wearer.  Most people don't have the time or energy to do this.  Most soft lenses go in easily, are very easy to fit, and the patient can walk out of the office wearing them comfortably.  If their vision is even close to what it would be with an RGP, most patients would prefer soft lenses.

I can count on one hand, the number of my patients in bifocal RGP lenses.  I have about 75 patients in soft multifocal contacts.  I don't see that ratio changing significantly at any time in the near future.  Soft multifocals contacts are easy to fit (we have many trials lenses in our office to make power changes on the spot - RGPs must be sent to a lab for any power or parameter change), they're very comfortable, they cost about the same, and they give comparable vision to RGPs.  Unless many more studies are performed, with much higher sample sizes, and more diverse sample sizes, soft multifocals will continue to rule the bifocal contact lens market for many years to come.

Implications: Cooper continues to lag behind the competition in the silicone hydrogel market.  They still haven't had a large scale launch of its Biofinity lens and there's no date set.

Cooper's lenses have been a staple in my office since I started practicing, but as I transition my patients in the healthier silicone hydrogel lens, less and less of my patients are wearing their lenses.

They better get it together quickly.  Their reputation is on the line.

Analysis: I still have yet to see a fitting set in my office.  I've read Cooper has been having money issues and manufacturing problems with their new silicone hydrogel lens.  Share prices are dropping, and their rating is decreasing in the stock market.  I also read that there were rumors of a buy-out.  I haven't heard who was supposed to buy them out, but apparently, with recent events, a buy-out is unlikely now.

It is unfortunate that such a great company is going through these hard times.  They missed the boat on getting into the silicone hydrogel market early, and I thought if they were able to put out a great lens of their own, sooner, rather than later, that they would recapture a good part of that market.  But the longer they have problems getting the lens out there, the more catching up they'll have to do.

So how much confidence do I have in Cooper to fully launch their silicone hydrogel lens soon?  Not a lot.  In the long term though, I think they'll eventually rebound and take back some of that market.  They have developed a lot of great lenses over the years that have helped earn them their great reputation, and I will continue to use these lenses.  However, until they fix this mess with the Biofinity launch, their reputation will slowly tarnish.  I really hope that that won't take very long.

Implications: Months after the worldwide recall of Bausch & Lomb's ReNu with MoisturLoc, this solution still holds a 2% market share (according to a recent survey by AC Nielsen Market Data).

How is this possible?  Is Bausch & Lomb not doing enough to inform doctors, retailers, and patients?  No...but, are they only ones at fault?

Analysis: This report really surprised me.  Months after this potentially blinding solution was recalled worldwide, there are still retailers selling it, and patients buying and using it. There could be several weak links in the communication chain which are causing this to happen. 

First, let's start in the exam room.  I make sure that every contact lens patient that comes in my door knows about the MoisturLoc recall and knows to avoid this solution in the future.  I'll give them Optifree or Complete to take with them so that they have new solution and a new contact lens case in hand to use when they get home.  Perhaps eye doctors aren't doing enough to warn patients about the solution in the exam room.  As a Doctor, you would have to be living in a cave to not have heard about the MoisturLoc recall, and if you aren't discussing it with every contact lens patient, you are potentially putting them at risk.

Next in line are the retailers. I'm sure most of the big retail chains like Walmart, Target, Rite-Aid, etc. will have pulled the solution from their shelves, but perhaps the smaller mom & pop drugstores may not have heard, or they may not be taking the recall seriously.  I suppose they would rather make a profit selling the solution than pulling it from the shelves, but I hope they know they are doing it at the risk of harming their customers.

Next in line are the patients.  For the most part, my patients are very well-informed, and often times will ask me about the MoisturLoc solution before I even mention it.  These are the patients that follow the instructions for healthy contact lens wear we give them in the exam room, and they have very few problems.  There are, however, a significant number of patients who are careless when it comes to taking care of their contact lenses.  These are the ones that come in with problems related to contact lens abuse i.e. overwearing their contacts, using old solution, not cleaning their contact lens case, etc.  These are the ones that are at higher risk for contracting the fungal keratitis associated with the MoisturLoc solution.

Lastly, what is Bausch & Lomb doing to educate everyone.  I can tell you from first hand experience that they were diligent about informing all eye doctors on their email list about the latest updates in the studies.  I felt well-informed at the time.  Now, I've read different reports saying that B&L actually knew about the potential dangers of MoisturLoc months before the recall. This is disturbing. The only reports to the public I've seen have been news reports and articles on the internet.  Some of these articles I had to do some deep searching to find.  And what are they doing to inform the retailers?  Obviously, not enough.  Why is this solution still on the shelves?

Overall, I think Bausch & Lomb holds the biggest responsibility in informing everyone about the recall and potential dangers of its MoisturLoc solution.  Hopefully this report will be a wake up call for them to do more to inform everyone.  If they don't, they're just asking for more problems, lawsuits, etc. than they already have.  Can they really afford that?

Implications: 1-800 Contacts, through its wholly-owned Clearlab subsidiary, based in Singapore, have come up with a new packaging design.  They are also looking to manufacture its own lenses, called AquaSoft Singles, to be contained in this new packaging, for sale in the U.S. within the next 2 years.

The new packaging and lenses are meant to improve "the experience of wearing contact lenses."

Are these a flash-in-the-pan gimmick, or will we all be healthier and happier because of them?

Analysis: 1-800 Contacts/ClearLab is trying to get into the manufacturing side of contact lens sales, and they've found a nice packaging gimmick to promote and introduce their new lenses to the market.  Why stop at just selling other companys' contact lenses, when you can make and sell your own, and make even bigger profits?

Before I comment, I must explain that most eye doctors (myself included) don't think very highly of 1-800 Contacts.  Since they came about several years ago, they've managed to complicate the relatively simple process of prescribing and dispensing contact lenses, and the already difficult management of contact lens patients.  They have a documented reputation for selling and dispensing lenses to patients using prescriptions that are expired or just plain incorrect (without concern for the problems that will occur).  These patients undoubtedly return to our office with complaints of poor vision and/or discomfort with their contacts, and WE take care of them, not 1-800 Contacts.  There are many other reasons for our discontent, but we'll leave it at that for now. 

That being said, I will try to be objective while commenting on their new contact lens/packaging system.

1-800/ClearLab claims that their new AquaSoft Singles will have the following benefits (my comments are asterisked below each item):

1) The packaging is 8 times thinner than current contact lens packaging.
***Okay, but how small do you want the packaging to get?  Current packaging allows storing and traveling in just about any bag or case one would want.  And when does smaller get to be too small.  Smaller packaging may mean that it may be more difficult to open or handle, or that it may be more delicate.

2) There will be no contact lens solutions so there will be no sensitivity problems, less hassles, and easier traveling.
***This is true, but single-use/daily-use lenses have been around for many years.  This is nothing new.

3) It reduces steps required to put the lenses in.
***I would love to see how the lenses 'pop' up out of the package.  Since no one has seen them, the written description leaves some room for interpretation.  Well, if a step or two is eliminated, and your insertion time is reduced from 15 seconds to 10 seconds, then I suppose you'll get to work a little earlier.

4) It eliminates the need to touch the inside of the lens, reducing the chances of infection.
***I do see this as the one unique benefit of this packaging.  We tell our patients to thoroughly wash their hands before handling the contacts.  Realistically though, I'm sure most don't clean them enough, then get whatever is on their hands on the inside of their lenses, and in turn, in the eyes.

5) Cost will be about the same as other single-use lenses on the market - about $365/year.
***If single-use lenses are appropriate for you, then you'll pay the same as the other brands.  No advantage there.  If cost is an issue, then you can pay $200-$250 for a two-week silicone hydrogel lens. 

I noticed one glaring omission in this article.  They failed to discuss the actual contact lens, i.e., its properties, the lens material, its parameters, etc.  Even if the packaging is the best thing since the internet, if the lens does not perform, then all you have is a crappy lens in a pretty package.  They did mention that they may just license the packaging technology instead of producing a lens in conjunction.

Until I see this packaging in action, and until I actually put these lenses in my patients' eyes, I can only speculate at what, if any, benefit these will have over current lens systems.  I can tell you with some certainty though, that you will have quite a few stubborn eye doctors who will not be bring anything from 1-800 Contacts into their office any time soon.