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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


Advanced Studies in Contact Lens Care and Ocular Health


GOAL
To provide ophthalmologists and optometrists with up-to-date information on the advancements in contact lens care and how best to maintain good ocular health.

TARGET AUDIENCE
This activity is designed for ophthalmologists and optometrists. No prerequisites required.

LEARNING OBJECTIVES
At the conclusion of this activity, the participant should be able to:

  • Discuss the epidemiology and current patterns of contact lens wear and care.
  • Illustrate application of care options.
  • Assess treatment strategies to address complications from contact lens wear.

The Johns Hopkins University School of Medicine and University of Alabama at Birmingham School of Optometry take responsibility for the content, quality, and scientific integrity of this CE activity.

ACCREDITATION STATEMENT
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the University of Alabama at Birmingham School of Optometry and The Johns Hopkins University School of Medicine. The University of Alabama at Birmingham School of Optometry is accredited by the Accreditation Council on Optometric Education (ACOE).  The Johns Hopkins University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

COPE Approval granted for some or all parts of this program.
COPE Course ID: 22211-CL.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This activity has been reviewed and is acceptable for 1 hour of continuing education credit by the University of Alabama at Birmingham School of Optometry. UAB accreditation begins 05/31/08. The term of approval is for 1 year from this date.

The estimated time to complete this educational activity:  1 hour.

After reading this monograph, participants may receive credit by completing the CE test, evaluation, and receiving a score of 70% or higher.

Release date: May 31, 2008. Expiration date: May 31, 2009.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The Johns Hopkins University School of Medicine and University of Alabama at Birmingham School of Optometry names implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

This program is supported by an educational grant from Alcon Laboratories, Inc.

Full Disclosure Policy Affecting CE Activities:
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of The Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Course Directors and Participating Faculty reported the following:

COURSE DIRECTORS

Roy S. Chuck, MD, PhD
Tom Clancy Professor of   Ophthalmology
Director of Refractive Surgery
The Wilmer Eye Institute
The Johns Hopkins Medical Institutions
Baltimore, Maryland
Dr Chuck reports serving as a consultant for Advanced Medical Optics, Inc, Alcon Laboratories, Inc, Allergan, Inc, Ista, Vistakon, and WMR.

Elliott H. Myrowitz, OD, MPH
Assistant Professor of Ophthalmology
Chief of Optometric Services
The Wilmer Eye Institute at Green  Spring Station
The Johns Hopkins Medical Institutions
Lutherville, Maryland
Dr Myrowitz reports serving on the speakers' bureau for Alcon Laboratories, Inc.

PARTICIPATING FACULTY

Charlotte Joslin, OD, FAAO, PhD Candidate
Assistant Professor of Ophthalmology and Visual Sciences
PhD Candidate, Epidemiology
School of Public Health
University of Illinois at Chicago
Chicago, Illinois
Dr Joslin reports having no significant financial or advisory relationships with corporate organizations related to this activity.

Jason J. Nichols, OD, MPH, PhD
Assistant Professor
The Ohio State University College of Optometry
Columbus, Ohio
Dr Nichols reports serving as a consultant for Alcon Laboratories, Inc and Vistakon; receiving honoraria from Advanced Medical Optics, Inc, CIBA Vision, Inc, Inspire Pharmaceuticals, and Societa Industria Farmaceutica Italiana; and serving on the speakers' bureau for Allergan, Inc.

Ralph P. Stone, PhD
R.P. Stone Consulting
Fort Worth, Texas
Dr Stone reports serving as a consultant for Alcon Laboratories, Inc; and holding stock appreciation rights in Alcon Laboratories, Inc from previous employment (now retired).

Notice: All faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.

Johns Hopkins Advanced Studies in Ophthalmology provides disclosure information from contributing authors, lead presenters, and participating faculty. Johns Hopkins Advanced Studies in Ophthalmology does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Advanced Studies in Contact Lens Care and Ocular Health
Roy S. Chuck, MD, PhD,* and Elliott H. Myrowitz, OD, MPH 

This issue of Johns Hopkins Advanced Studies in Ophthalmology addresses several important aspects of contact lens wear and care with the eye care professional in mind. To meet the optometrist's need for current information and to underscore the important role of all eye care professionals in contact lens care and ocular health, this publication draws on the expertise of 3 optometrists, an ophthalmologist, and a chemist who is a consultant to the contact lens industry. This viewpoint is especially germane because, according to data from the American Optometric Association (AOA), optometrists provide more than 66% of primary eye care services in the United States1 and because more than 80% of the estimated 36 million Americans who wear contact lenses go to an optometrist for their eye care.1,2

A good starting point is to review the demographics of contact lens wear in the United States and the different types of contact lenses that are approved for use. Data from the AOA indicate that approximately 87% of Americans who wear contact lenses wear soft hydrogel lenses; the remaining 13% wear rigid lenses with varying degrees of oxygen permeability.1 AOA statistics also indicate that most contact lens wearers are nearsighted, approximately 66% are female, 10% are aged 18 or younger, and 65% are between the ages of 18 and 44.2 Approximately 80% wear daily wear soft lenses, over 50% wear 1- to 2-week disposable lenses, and 15% wear extended-wear (up to 30 days) soft lenses.2

All contact lenses are medical devices that are regulated by the US Food and Drug Administration (FDA), and solutions used to clean and disinfect contact lenses are subject to US FDA regulation as well.3 The materials used to manufacture traditional soft hydrogel lenses are classified by the US FDA into 4 groups on the basis of their water content and whether they are ionic.1 Although the hydrogel materials are believed to exhibit the same chemical behavior, the oxygen permeability of traditional hydrogel materials across all groups increases with the water content.1

Specifically, hydrogel materials in group I have a low water content and are nonionic; those in group II are also nonionic, but have a high water content. Materials in groups III and IV are ionic, with those in group III having a low water content and those in group IV having a high water content.
Silicone hydrogel lenses, which are made of silicone to enhance oxygen permeability and traditional hydrogel materials to enhance comfort, represent a newer class of hydrogel lenses.1,3 These lenses can be worn on a daily basis and some continuously for up to 30 days.3 They account for nearly 50% of all new lens fittings, particularly for overnight and extended wear,3,4 and are  an alternative to laser surgery to correct refractive errors.3

In addition, some contact lens manufacturers have introduced a second generation of silicone hydrogel lenses offering enhanced comfort in dry environments, such as airplane cabins and air-conditioned offices.3

With the increasing use of soft and silicone hydrogel lenses in mind, Jason J. Nichols, OD, MPH, PhD, reviews the key functions of lens care solutions and explains how these functions are interrelated. He discusses the importance of lens comfort, the role of the tear film in protein and lipid deposition, and the efficacy of multipurpose and hydrogen peroxide solutions in cleaning and disinfection. He also addresses the importance of compliance with lens care regimens.

In contrast, Charlotte Joslin, OD, FAAO, PhD Candidate, focuses on microbial keratitis, the lens-related complication of greatest concern to patients and eye care professionals. She explains the role of a stable tear film and the corneal epithelium as a barrier against infection, identifies risk factors for corneal staining, and reviews findings from reports of microbial keratitis outbreaks that were associated with 2 specific lens care solutions that have since been taken off the market. She also addresses the critical role of compliance with lens care regimens in preventing infection.

An expert question and answer session devoted to contact lens-related issues that eye care professionals  frequently encounter in clinical practice provides some additional insights on lens care and ocular health.

The material presented in this issue of Johns Hopkins Advanced Studies in Ophthalmology provides ophthalmologists and optometrists with a deeper understanding of contact lenses and lens care solutions, in addition to strategies to prevent infection and other complications associated with contact lenses. This information, when integrated into patient counseling directed at enhancing compliance with lens care regimens, should result in increased patient comfort and fewer lens-related complications.

REFERENCES

1. Optometric Clinical Practice Guideline. American Optometric Association. 2nd ed. 2006. Available at: http://aoa.org. Accessed March 26, 2008.
2. Facts and Stats. American Optometric Association Web site. Available at: http://aoa.org/x5231.xml. Accessed March 9, 2008.
3. Contact Lens Council Web site. Available at: http://www. mycontactlenses.org. Accessed March 15, 2008.
4. Key JE. Development of contact lenses and their worldwide use. Eye Contact Lens. 2007;33:343-345.

*Tom Clancy Professor of Ophthalmology, Director of Refractive Surgery, The Wilmer Eye Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
 Assistant Professor of Ophthalmology, Chief of Optometric Services, The Wilmer Eye Institute at Green Spring Station, The Johns Hopkins Medical Institutions, Lutherville, Maryland.
Address correspondence to: Elliott H. Myrowitz, OD, MPH, Assistant Professor of Ophthalmology, Chief of Optometric Services, The Wilmer Eye Institute at Green Spring Station, The Johns Hopkins Medical Institutions, 10753 Falls Road, Suite 455, Lutherville, MD 21093.
E-mail: emyrowitz@jhmi.edu.


The content in this monograph was developed with the assistance of a staff medical writer. Each author had final approval of his/her article and all its contents.

 





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