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E S TAT U S N E W S 1 8 J U LY – S E P T E M B E R 2 0 1 3

Professional Respect

Introduction Best regards, Nelson L. Merchán B. The Vision Care InstituteTM Bogota Manager.

Frequent replacement a healthy culture

Hello friends of The Vision Care InstituteTM Bogotá, First Class:

for Lenses Replacement

Why shouldn’t we fit

or sell frequent replacement soft contact lenses without limitations in replacement time?

Face to face

With Dra.Yohana Collante Haad

Benefits In Box

We start the second semester of 2013 with the best spirit and faith.

There is excellent news in South America about the deployment of sports, teenagers and children categories in safe and proactive fitting of frequent replacement soft contact lenses. In different geographical scenarios, we have noticed how nowadays the culture of replacement is becoming a more frequent, healthy practice, which is recommended by the practitioners. Congratulations to those practitioners, who in an eager, honest and responsible way promote it.

For this reason, the principal article refers to the topic we will develop and include some frequently asked questions that can make us reflect about the civil and social responsibility of this replacement and the possible side effects of avoiding talking about the fitting process itself. The interview Face to Face has been developed with the participation of Doctor Yohana Collante Haad, a prominent optometrist. She has made herself known due to her conscious and responsible educational role in the field of soft contact lenses, her participation in the group of professors at La Salle University, and The Vision Care Institute de Johnson and Johnson of Colombia, in Bogotá.

Likewise, we are complementing this NEWS with a gallery of pictures of the groups who have visited us in the second quarter, and the index of articles published so far in the Panamerican Journal of Contact. Those articles can be found on the website: www.rpalc.com; and they can be downloaded for free and printed for autonomous learning, and in some cases to be shared with work teams and even with some patients who may be interested.

We hope that this new issue contributes to the strength of our profession and the personal and professional growth of all of us contact lenses fitters who are committed to the welfare of our patients.

Editorial

Professional Respect for Lenses Replacement

Dear colleagues,

Nelson L. Merchán B. Professional Issues Manager for Central and South America Johnson & Johnson Vision Care

Receive a warm greeting this second half of the year, full of the best wishes and success for this part of the year. This year has been very important for reflection and dialogue concerning the frequent replacement contact lenses users because in each country trendy topics nowadays, such as promoting and educational work and customized follow-up of use schedules, replacement and rechange of schemes should be immediately included and formalized in each office to make the professional fitter’s life easier. In this way, they will be able to focus only on their daily eye and visual health activities. However, we know we are just starting and our new and old users require training, even our supporting teams in stores, offices and optical sites require training.

The current market of frequent replacement is being analyzed from different points of view, supported by health practitioners and criticized in the commercial market by some analysts who argue that it is only a commercial strategy to increase sales. I ask you to judge if the factor of better visual, corneal, conjunctival and general health of the previous segment, along with the importance of efficient and healthy optics of the patient, are not enough reasons to promote visual health and frequent replacement aimed at better health and benefit for the users.

Part of the role of the current practitioner – the modern practitioner- is to educate the patient to promote an auto-hygiene culture and visual health by recognizing their own risks and barriers when using high- tech medical devices, such as contact lenses, and their rational for short term replacement. If they educate each new contact lenses user about attending check-ups, getting monitoring, and replacement of their optical device, prioritizing maintenance and care of visual health, each party will receive many mutual benefits in the future.

Regardless, the marketing proposals from the contact lenses companies, clinical and marketing research speaks for itself, supporting these new global proposals of use and rechange. You are the attentive practitioner, supervisor and guardian of visual health, and your judgment is the most important. The question is: Is it the best decision for the user’s health? And do you take responsibility of their visual health taking into account your decisions of proposed replacement of soft contact lenses?

Hugs,

Nelson L. Merchán

Why shouldn’t we fit or sell frequent replacement soft contact lenses without limitations in replacement time?

1.- Situation: The trend of prescribing frequent replacement contact lenses in Latin America is not mature and homogeneous yet among practitioners, where only a few of them determine the prescription in dioptric value during the visual test, and let the patient himself choose their brand and replacement time according to their “affordability” without training them or explaining to them the health arguments that justify this system (that is how it is perceived). It is common to find this phenomenon especially among those who still do not believe that it is an excellent visual and ocular idea; in fact, it represents a financial advantage for the business center that manages the lenses of the patient. If the practitioner owns the site, then it is much better to prescribe due to the advantages.

Nowadays it is both more common and more strange to find sites where they sell optical supplies and non-optical supplies, which sell frequent replacement contact lenses, without making any emphasis on their replacement. This is true, even though it is well known that the FDA requires and approves the schemes of use and replacement for each product that can be commercialized and fitted commercially, at least, the most popular brands.

This phenomenon can be analyzed from several points of view and has different explanations, clearly indicating that any of them justifies this action:

Recommendation: Visual and ocular health practitioners, regardless of their denomination and title, should respect the protocols of replacement of soft contact lenses of this type, daily replacement, two week replacement or extended use and weekly replacement, in most cases. This is done in order to control the health of the user’s cornea and respect clinical protocols of monitoring of the patient in this type of visual correction. Nobody can assure us that patients who buy their contact lenses in the market replace them every two weeks or every week; although each practitioner should do a follow-up in the medical center. If this is not possible, they should at least do it in the mid or long term based on their fixed and variable income.

2.- Situation: Lack of information of the practitioners, and the people who sell these kind of products about international quality regulations, protocols and storage, product safety, and as a result, civil and social responsibility on the patient’s health and their guarantees. This lack of information allows them to sell the lenses without pointing out replacement times approved by the maximum authority; the FDA, and local institutions of surveillance and control.

Recommendation: Each frequent replacement soft contact lenses is designed, manufactured and guaranteed to be used in specific times and under professional surveillance. For this reason people who recommend, adapt and monitor their use must manage and respect the same advice of the manufacturer to perform the fitting process under a safe and reliable framework, both for he who recommends and fits it and the user.

3.- Situation: The fact that health companies are not supervised by commercial and quality surveillance institutions –in some countriesallows for a lack of prosecution when the practitioner, who fits lenses, prescribes this type of high-tech medical device, and when they are sold over the counter without showing a prescription signed by a practitioner.

Recommendation: It is the responsibility of the practitioners, who are aware of the mistakes a third party is making, to denounce those people who are performing those actions against the market, the patient’s health and clinical regulations and protocols, approved for sale and use of those kind of products, which are classified as high-tech medical devices. When they are sold without previous approval of a professional fitter, they are classified in an inferior category; and the customers do not understand the consequences of lack of support for both their health and themselves. Professional ethics represent an important factor of health safety and prevention, in each case.

4.- Situation: Awareness and understanding of frequent replacement technology aims for providing better health conditions to the patient when they replace their contact lenses with a new pair in a shorter time than those lenses, also prescribed, called conventional. Coming back to the store to buy a new box of lenses in a month and a half or in three weeks, according to the scheduled prescription, will never be a reality or even a culture among the users who consume and find those lenses with no restrictions in time.

The situation of market demand is due to the obvious supply that affects the natural consumption of the product. It is not a prevention and promotion culture for health; it is only a consumption opportunity.

Recommendation: Every person trained to fit frequent replacement soft contact lenses must, due to ethics and civil responsibility with the patient, instruct both orally and in writing the recommendations of cleaning, use and replacement of this type of product.

They must also let the user know the implications of cost, health, and guarantees, if they do not buy their lenses in a legal place, and from practitioners legally competent for their fitting and disposal.

I am aware of the financial and social excuses the frequent replacement soft contact lenses’ users have in Latin America.

These include the different social classes in the region, even in each country and within the country. This reason does not justify the mistakes made when they sacrifice products, guarantees, health, happy patients, clinical monitoring and professional support to save pennies. At the end, users pay more when an incident occurs with their eyes.

We have to have a protective heart and soul for our patient’s health to understand it. The shorter the replacement time of a lens in the eye, the better heath for the user.

This is an open invitation to behave in favor of the civil responsibility of the practitioners in Latin America, and fit and dispense frequent replacement soft contact lenses under suggested times as approved by the FDA, as applicable.

Legal Note: The text above is my personal opinion as a practitioner, author of the article of the topic developed: Fitting and sale of soft contact lenses without limitations in replacement time, aiming to highlight proactive principles of safe contact lenses fitting under legal regulations, taking into account health and the social responsibility of the fitter. I would like to clarify that this opinion is not sponsored by Johnson & Johnson Colombia S.A., that Johnson & Johnson Colombia S.A., has not promised any amount of money or any other benefit for the writing of this article, and that the personal and professional opinion of the author is not necessarily the opinion Johnson & Johnson Colombia S.A., and it does not compromise Johnson & Johnson S.A. in any sense.

Face to Face

2. ¿To what extent is it the responsibility of the practitioner to assure replacement times for the users, and first time users? Many times it is an issue that has been regarded as rechange for convenience and a decision of the user himself.

The role the fitter plays is highly important. We are the ones who give instructions for the use and replacement of lenses.

In the same way we need to show the importance of checkup appointments. We have heard about incidents involving questions or comments the following days after fittings. This is the reason why we should implement strategies for fitting, calls, and sms messaging at different hours during the day to confirm comfort, establish early appointments, and reminders. I insist on pointing out that what we look for is not only a delivery of lenses but the creation of a new hygiene and visual health culture in the new or old contact lens user.

The views expressed in the articles reflect only the view of the authors and do not necessarily reflect the position and policies of The Vision Care InstituteTM.

Why not issue a list of use information to the patient the first day? In that list they can find the lenses brand, the solution to use, the schedule to follow the first week, general instructions and the next appointment date. This could avoid misinterpretations.

5. ¿Why isn’t there a universal protocol for use and replacement of frequent replacement soft contact lenses followed around the world? If it exists, why isn’t it promoted and known?

A universal protocol of use and replacement for soft contact lenses fittings does exist. In my opinion people know about it, but unfortunately the purchasing power in Latin America compared to Europe or North America does not allow us to speak the same language regarding use and replacement.

Commercial interests cause practitioners to adopt different strategies and modes of advising.

With Dra. Yohana Collante Haad

4. ¿Why do you constantly mention the importance of frequent replacement in your dissertations? Do you think it is a cultural problem of the fitter rather than a problem of the user?

Yes! Unfortunately it is a cultural problem of both parties.

Users look for economy, and they forget the guidelines given by the practitioner. They change the rules of the game with simplicity or ingenuity; and in most cases we do not realized it.

The fitter, triggered by their commercial interest give incorrect information and negotiate replacement times from patient to patient, which shows flexibility that may be misunderstood by the patient.

Replacement of Soft Contact Lenses

1. ¿It has been argued in several scenarios that suggesting frequent replacement for contact lenses has been seen more as a commercial advantage for the practitioners who prescribe and fit lenses than a health factor for users. What do you think?

Not at all. It has been proved that the investment made by a patient fitted with lenses with replacement schedule is the same as the investment made for conventional lenses. It is necessary to explain to the patient in detail and with clinical arguments that there are other variables that intervene. These are different from financial variables, and include risks of infections, oxygen transmissibility, comfort, and stable visual acuteness, among other things. Nowadays, time plays an important role, as does practicality. Lenses with replacement schedule afford the possibility of having an easier life, spending less time involved with maintenance, higher hygiene requirements and more comfort..

3. ¿What significant risks can a first time patient be exposed to if his or her soft contact lenses replacement times are not controlled or monitored?

A first time user is creating new habits on their use of lenses.

It depends on us whether they follow the initial instructions they were given. The way to verify it is by seeing the patient during the check-up appointment. That appointment must be scheduled by the fitter rather than the patient. In a new fitting under-corrections or hypercorrections might occur, as well as ocular appearances due to over use, and hyper sensibility to solutions. All of these are discovered in the posterior assessment.

Myth or Reality

We have taken this opportunity to interveiw Dr. Yohana Collante Haad, a Colombian optometrist, graduate from La Salle University, Specialist in College Teaching, Master in Teaching. In her presentations at The Vision Care Institute Bogotá or at international conferences and seminars, she has expressed her concern regarding the educational roles of the soft contact lenses fitter regarding frequent replacement. No one else could answer some questions about this important factor of culture of safety and health better than she does:

Our Visitors

local and international

Chilean group: April 8th and 9th

Argentinian group: April 11th and 12th

Colombian group: April 15th and 16th

Venezuelan group: April 22th and 23th

Argentinian group: May 20th and 21th

Chilean group: May 27th and 28th

Venezuelan group: June 4th and 5th

Advisors June 17th

Colombian group: June 14th and 15th

Uruguayan group: June 20th and 21st

AMERICAN JOURNAL OF CONTACT LENSES EDICIÓN

2009 - Vol. 1, nº 1

EDITORIAL

Pan-American Journal of Contact Lenses: Just on time! Ricardo Pintor

ARTÍCULO ORIGINALES

AUTORE(S)

Brief History and Evolution of Soft Contact Lenses Part 1: Materials, Lifestyles and Contact Lenses:

José FernHando Pérez Mogollón, Abner Augusto Lobão Neto

Understanding the Needs of your Patients

Ricardo Pintor, Elihú Mexía

“Shorter is better” – A Visual Health Culture

Nelson L. Merchán B., Myriam T. Mayorga C., Augusto Rossé T

Main Measurements in Epidemiology Applicable in Optometry and Contactology

Ruben Velázquez Gerrero

Letter to the Editor

Yohana Collante Haad

Comfort with Contact Lenses: A Multidimensional Factor

2009 - Vol. 1, nº 2

2009 - Vol 1 - nº 3

2009 - Vol. 1, nº 4

Times of Change: How, when and why to take your patients to the next level in comfort and health. Ricardo Pintorr

The Visual Care Professional: Key person in recommending, adjusting and making follow up of contact lenses Ricardo Pintor

Celebrating our First Year!

Ricardo Pintor

Designs of Stabilization of Soft Lenses for Astigmatism: Where are we going?

Ricardo Pintor, Elihú Mexía, Yosani López Valle Rolando P. Rojas Bernuy, Nelson L. Merchán Bautista

Impact of the base curve on the performance and comfort in a refitting of HEMA at SiHy

Noemi Dominguez

Visual Rehabilitation after surgery with intrastomal rings

Edgar Dávila

UV Radiation: What’s new; eye risks and strategies for a more efficient protection

Jorge Giovanni Vargas Velasco

Challenges of a Real Contact Lenses Fitting for Children and Young People

Henry Hernán Martínez M.

Papillary response Induced by Contact Lenses: What have we learnt?

Guillermo Carrillo Orihuela

Contact lenses and sporting activities: The perfect partnership

Elihú Mexía, Isaac Rosas G

Useful Advice to organize your contact lenses “business

Nelson L. Merchán B.

Variation of the higher- order corneal optical aberrations using Acuvue® Oasys® Brand contact lenses for astigmatism Effects of the elasticity module in fitting hydrogel of silicone contact lenses

Myriam Teresa Mayorga C.

Fernando Ballesteros

Satisfaction Survey for Acuvue® Oasys™ Brand contact lenses for Astigmatism among visual and eye care professionals from Argentina and Chile

2010 - Vol. 2, nº 1

2010 - Vol. 2, nº 2

2010 - Vol. 2, nº 3

Research Among Visual Health Professionals in Latin America: Wish and Reality Ricardo Pintorr

The best option for my contact lenses patients Ricardo Pintor

The Professionals’ Decision Ricardo Pintor

Useful Advice to organize your contact lenses “business”

Nelson L. Merchán B.

Visual Tiredness Syndrome Resulting from Using the Computer

Elizabeth Casillas Casillas, Sergio Ramírez González

Comparative Study of Visual Field: From Spectacles to Contact Lenses

María Concepción González del Rosario

Generations of Disposable Soft Contact Lenses of Hydrogel of Silicone: Marketing or Real Clinical Relevance

Myriam Teresa Mayorga, Fernando Ballesteros Beltrán, Nelson L. Merchán B.

Regarding Refraction and Visual Acuity for Soft Toric Contact Lenses Wearers

Jonathan Soto Cabello, Augusto Rossé.

Variables and Interaction LensEye in Fitting Soft Toric Lenses of Hydrogel of Silicone

José María Plata Luque

Soft Contact Lenses in Keratoconus – A Review. PART 1

Sergio M. García R.

Reference Brands in Contac Lenses for Astigmatism: What is the Correct Position?

Iosef Podlubne

Therapeutical Contact Lenses, Theoretical Bases Daily disposable lenses: “healthy eyes, comfortable patients, wearers who do not quit” Importance of Frequent Replacement for Contact Lenses

2010 - Vol. 2, nº 4

Contact lenses as an alternative for visual therapy Ricardo Pintor

Jorge Nicolás Ayala, Patricio Alberto Quezada Navarro, Abner A. Lobão-Neto, Liane Touma-Falci

Adaptación de lentes de Fitting with Contact Lenses of Hydrogel of Silicone in Teenagers ¿Cómo buscar información académica de lentes de contacto en la web?

Soft Contact Lenses in Keratoconus – A Review.

PART 2 Letter to the Editor

Myriam Teresa Mayorga C.

Édgar Dávila-García, Augusto Rossé Toledo Ricardo Pintor

Olga Yaneth Sandoval Tovar

Yohana Collante Haad, Jonatan Collante Haad Sergio M. García R

2011 - Vol. 3, nº 1

The Importance of an integral visual and ocular test pre and post fitting with contact lenses: Safety and trust Nelson L. Merchán B.

Clinical Applications of Contact Lenses with Low Vision Patients

Gabriel E. Cabaleiro

Importance of Contact Lenses in Functional Visual Rehabilitation of Children

Stewar Saucedo Salcedo

Importance of Oculomotor Assessment for Refractive Correction with Contact Lenses Clinic Case: Atypical Corneal Ectasia El uso correcto de los lentes de contacto. Diagnóstico

2011 - Vol. 3, nº 2

2011 - Vol. 3, nº 3

2011 - Vol. 3, n° 4

The Multifunctional Educative Role of the Contact Lenses Fitter in Latin America Nelson L. Merchán B

Scientific Production Applied to Practice. Nelson L. Merchán B.

Working in Networks: Differential of visibility and recognition.

Nelson L. Merchán B.

Visual acuity from the analytical lenses Corneal Curves, Their Vital Importance in Fitting with Soft Contact Lenses

Marcela Camacho Montoya

Hector Hugo Paez Villa

Nayeli Cerón

Jorge Giovanni Vargas Velasco

Ingrid Pedraza

Some Fittings with Contact Lenses After Intrastomal Ring Implant

Ernesto Ortega Pacific

Visual Acuity Reduced in Contact Lenses

Augusto Rossé

“ Hygiene Crisis” – Daily Disposal Contact Lenses: The Best Alternative

Yohana Collante Haad

Classification and Design of Gas Permeable Contact Lenses

Ricardo Pintor

The real use of diagnostic lenses as a tool of safety in the test for pre-fitting with toric disposable contact lenses.

Nelson L. Merchán B.

Is there a lack of information regarding contact lenses?

Reasons that hinder their use in the community

Juan Isaac Rosas Gutiérrez.

Visual Rehabilitation with hybrid lens in patients with irregular cornea

Gonzalo Carracedo Rodríguez

2012 - Vol. 4, n°1

The responsibility of the fitter in the lacrimal assessment for the new potential user . Nelson L. Merchán B.

Interaction of the Tear Film in Contact Lenses Wearers (First Part)

Yosani López, Elihu Mexia

Sjögren Symdrome and its important diagnosis when fitting contact lenses

Melania Madrigal Coto

Combined Treatment of visual stimulation and contact lens in adult patient with amblyopia due to anisometropia and squinting Letter to the Editor

2012 - Vol. 4, n° 2

2012 - Vol. 4, n° 3

2012 - Vol. 4, n° 4

High Technology in eye testing: Ally or Enemy?

Nelson L. Merchán B.

Planned Clinic test Vs. Performed test.

Nelson L. Merchán B.

Power of words and attitudes Nelson L. Merchán B.

Hypermetropia in patients without presbyopia: Ideal candidate for fitting with contact lenses?

Jairo Madriz Rodríguez

Jorge Bustos Moya Gabriel Cabaleiro

“Why to use toric contact lenses”

Jorge Giovanni Vargas V.

Visual Rehabilitation of a postLasik surgery patient with contact lenses.

Édgar Dávila

Eye side effects of Isotretinoin in patients who wear contact lenses: Case Report

Johana Collante H

Meniscus tear test: a good alternative to assess tear volume

Myriam T Mayorga

Astigmatism Correction and use of spherical equivalent

Catalina Baquero Meza

Letter to the Editor

Ana Lydia Cury

Motivation in fitting contact lenses of hydrogel of silicone

Gabriel Cordone

Back to basic in Astigmatism

Enzo Ghiliasa

Case Report

Evelyn espinoza Gallardo

2013 - Vol. 5, n° 1

2013 - Vol. 5, n° 2

Health, sports, vision and comfort Nelson L. Merchán B.

The importance of discipline in continuous professional academic updating.

Nelson L. Merchán B.

Ana Cecilia Maza

Binocular Alterations and their impact in visual quality

Contact Lenses and Sports

Fabio Mora

CL Fitting Rose K2 NC in nipple shaped keratoconus Changes in adjustments and convergences with spectacles and contact lenses in myopic astigmatism

Patricia Flores, Miguel Romero

Luis Fernando Barba Gallardo, Elizabeth Casillas Casillas

Letter to the Editor: Why do we recommend more the use of contact lenses for children?

Enrique Tilli

In Box

I am back and rested from my trip to Bogota. I would like to thank you for the kind invitation to the Phase 5 of the Excellence in Contact Lenses Course.

I have felt privileged for having had the opportunity to take part of these sessions again. The sessions always let us broaden our knowledge and experiences of our practice.

It is all done with a high level of hospitality, thanks to the great host team of Johnson & Johnson.

Thank you for giving me the opportunity of being part of the red T-Shirt group. I feel very honored and thankful because of that acknowledgement.

I hope to see you soon here in Valparaíso.

Esteban Bonilla Optometrist Costa Rica

Good afternoon. I am back in my country and my clinic. Thank you again for granting me the privilege of being part of the group “First Class” and for inviting me to the 5th Phase of the Vision Care Institute TM. Ongoing training is very important for our practice and the growth of the region in the field of Optometry and contact lenses fitting. It is very important that Johnson & Johnson provides that training because it is the leading company on this topic. They provide us topics that help us develop a better practice with our patients on a daily basis. Additionally, they make us analyze the weak issues in our practice.

I would rate it a 10 based on my experience in Phase 5 because of the comfortable facilities, transport, food, support team, and the professional team, and last, but not least, the treatment given to us that made us feel like a real First Class Group!

Greeting from Costa Rica, I send you a hug and thanks again.

Material de The Vision Care InstituteTM y Johnson & Johnson 2013

Enrique Koch Optician Contact lenses professional Chile