GlobalCONTACT 1501

ISSN:1386 0194

21

2014 2015 (67) (69)

Company Profile • Lambda X

Fitting Background • Time for a change?

• Scleral lens induced conjunctival prolapse

Business + Marketing • The legacy lab

Technology • Diamond tool care and handling

Professional Services Research & Development Marketing Technical Expertise Networking Clinical Support Committed to support your business

www.contamac.co.uk Contamac_Titel.indd 1 01_01_Titel.indd 1

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Boston GP Materials. ®

Where innovation takes flight.

“Innovation” Through Education At Boston, our definition of “innovation” goes far beyond continuous improvements in GP technology, new lens materials and manufacturing advancements. We also offer a variety of educational materials, including publications and videos.

GUIDES:  A GUIDE TO SCLERAL LENS FITTING  GUIDE TO CORRECTION OF KERATOCONUS  CORRECTION OF PRESBYOPIA WITH GP CONTACT LENSES

Guides are available in many languages, including Spanish, French, Polish, Serbian and German, to name a few.

VIDEOS:  SCLERAL LENS FITTING TIPS VIDEO SERIES  SCLERAL LENS HANDLING VIDEO FOR PATIENTS  ORTHOK TRENDS BY MR. CRAIG NORMAN, FCLSA

Visit fit-boston.com for digital downloads of guides and videos. For printed guides, please contact your authorized Boston® laboratory.

Boston

®

Materials

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© Bausch & Lomb Incorporated. ®/TM are trademarks of Bausch & Lomb Incorporated or its affiliates. US/BNL/13/0008. RPL0305/01

1/29/15 9:37 AM 04.02.15 16:25

LETTER FROM THE PUBLISHER

What to do with weak employees?

The attempt to build up a superlative workforce often comes

The scientists devised the following experiment: those taking

to nothing. On television, casting shows are the hit: in ever

part were split up into different groups and had to solve a

differing variations, aspiring models, singers and actors give

particular calculation task in a given time. In different variations,

of their all to secure a breakthrough. In the end, however, of

the participants were informed to greater or lesser extent about

the thousands of candidates only one winner gets the job which

the scores of the other groups. Thereby they were either paid

all have been fighting for.

for each problem solved, or they had to concede the entire

But now the virus has spread to businesses. Not only do

winnings to the best problem solver.

applicants have to prove themselves for days on end in assessment

Irrespective of how the participants were paid: the knowledge

centers where their suitability is tested through role plays and

of the performance of the others had a negative effect on the

group discussions (so that in the end the wrong person is

productivity of the entire group. While in some people a certain

selected). Today employees already in the company, too, have

sporting competitiveness was aroused, in others the mistakes

to work under casting conditions: it is no longer enough just

they made increased significantly. In particular, rather than

to do ones job well. Many companies now measure precisely

feeling motivated, weaker employees were disconcerted by

how their employees perform against each other.

knowing they were behind in the scores, and their performance

The daily struggle culminates in performance-related

got progressively worse.

payment. Companies agree individual bonuses with each

The scientists had one piece of advice for all employers:

member of staff linked to individual targets. Only those

companies should avoid any thoughts of introducing public

who fully achieve their target at the end of the year can

feedback systems if they are at all interested in maintaining or

expect to have their bonus paid in full. As a survey by a

even increasing the performance of their weaker staff.

respected f irm of consultants showed recently, some

But it is precisely this which seems to be a thorn in the eye of

companies simply deduct the performance-based payment

many employers: in seminars on ‘What to do about low

from the employees previous fixed salary. In this way,

performers’, the focus tends to be mainly on how to get rid of

employers aim to get the maximum productivity out of their

poor performers, rather than pointing out ways how to get

workforce and from each individual employee.

more out of them. Companies prefer to put their trust in ‘super

Some companies take these performance-related measures to

employees’ – idolizing those who score the most goals. But they

such an extreme that they even publish in-house rankings in

seem to forget the fact that every striker needs the support of

which the achievements of all employees are made available to

an entire experienced team behind him in order to get the

the whole staff. That they are doing no one any favors by doing

results. Unfortunately it is team spirit which is the first casualty

this was shown by a recent study published by the Institute for

when the working climate becomes strained. 

the Future of Work in Bonn (Germany). According to this, such open competitiveness actually has an adverse effect on the quality of the work.

JÖRG SPANGEMACHER CEO and Publisher joergspa@global-cl.com

GlobalCONTACT 1-15

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CONTENT

ISSN:1386 0194

LETTER FROM THE PUBLISHER 3

21

What to do with weak employees?

Jörg Spangemacher

COMPANY PROFILE 6

2014 2015 (67) (69)

Company Profile

Lambda X - from space to ophthalmology

Silke Sage

• Lambda X

Fitting Background • Time for a change?

• Scleral lens induced conjunctival prolapse

TECHNOLOGY

Business + Marketing

10 Diamond tool care and handling

• The legacy lab

Dennis Keating

Technology • Diamond tool care and handling

Professional Services Research & Development

BUSINESS + MARKETING

Marketing Technical Expertise Networking

16 Delegating - and how to do it

Clinical Support Committed to support your business

Rolf Leicher

30 The legacy lab

www.contamac.co.uk Contamac_Titel.indd 1 01_01_Titel.indd 1

03.06.14 14:34 12.03.15 14:40

INDEX TO ADVERTISERS Title: Contamac, www.contamac.com Inside front cover: Bausch + Lomb Inc., www.bausch.com Page 4: Paragon Vision Sciences, www.paragonvision.com Page 13: Efclin, www.efclin.com Page 15: DAC International, Inc., www.dac-intl.com Page 17: Sterling Ultra Precision, www.sterlingint.com Page 19: Larsen Equipment Design Inc., www.larsenequipment.com Page 23: FOCUS CN, www.focus-cn.com.cn Page 25: Rotlex, www.rotlex.com Page 29: LAMBDA-X S.A., www.lambda-x.com Page 35: Benz R&D, www.benzrd.com Page 37: K & Y Diamond Ltd., www.kydiamond.ca Page 41: TRIOPTICS GmbH, www.trioptics.com Page 43: Optocraft, www.optocraft.com Page 45: Contour Fine Tooling, www.contour-diamonds.com and Technodiamant, www.technodiamant.com Page 47: Optimec Ltd., www.optimec.com Inside back cover: MediaWelt Outside back cover: Benz R&D, www.benzrd.com

NAMES TO NOTE

Aalbers, Wim 40 Baugh, Tom 34 Bennett, Ed 38 Caroline, Patrick 26 Keating, Dennis 10 Larsen, Erik 30 Leicher, Rolf 16 Martin, Will 32 Molkenboer, Vincent 20 Roth, Hans-Werner 36 Tovaglia, Marco 44 van der Worp, Eef 20, 42

GlobalCONTACT 1-15

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Erik Larsen

FITTING BACKGROUND 20 Time for a change?

Eef van der Worp and Vincent Molkenboer

26 Scleral lens induced conjunctival prolapse Patrick Caroline

44 A new era in RGP Marco Tovaglia

REPORT 32 Optometry Giving Sight Will Martin

34 Introducing the Ganzfeld contact lens Tom Baugh

38 The GP Lens Institute 2015 Ed Bennett

HISTORY 36 Thermoplastic molded scleral lenses Hans-Werner Roth

INTERNATIONAL NEWS 40 Column

Wim Aalbers

42 Column

Eef van der Worp

43 Conferences & Trade Fairs 46 Spotlights 48 Industry News 48 Yellow Pages 50 Masthead

5

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COMPANY PROFILE Lambda X

From space to ophthalmology Visit to Lambda X at Nivelles, Belgium In order to work with ophthalmic lenses, exact measurement data regarding the condition and the quality of optical surfaces is required. The Belgian company Lambda X developed a measuring technology using phase-shifting schlieren that within a few years has established itself as the standard measuring procedure used by many companies.

By Silke Sage Let's start with something simple: Have you ever watched

the measuring instruments produced by Lambda X. Naturally;

the projection of hot air onto a wall? This can be observed

imaging elements are not enough on their own to analyze optical

when the hot air above a candle or a toaster is projected onto

surfaces: they have to be converted into data that can be

a bright wall by sunlight. Grey schlieren or streaks encircle

reproduced and compared with other data. That is how precise

the projection area, whirling around like grey smoke above

statements about the optical properties and surface quality of

it: this is how one can illustrate the basic principle of phase-

ophthalmic lenses can be made.

shifting schlieren.

While when observing the shadow the shift in light beam can

INITIALLY A SPIN-OFF FROM THE UNIVERSITY OF BRUSSELS

be measured, it is also possible to measure the angular

By applying this principle, the founders and staff of Lambda X

displacement of the light bundle using the right aperture and

found out by accident that they were able to precisely measure

suitable lenses. It is precisely this method which is applied in

optical lenses and surfaces. In fact they did it so well that within

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Lambda X COMPANY PROFILE

a short time the company became the market leader in this field.

special phase-shifting schlieren method. In 2005, they finally

Initially, the company was aiming to break into an entirely

came up with an instrument for the inspection of ophthalmic

different field. When the present CEO, Olivier Dupont, founded

lenses such as contact lenses, intraocular lenses (IOLs) and

the company in 1996, as a spin-off from the University in

spectacle lenses for the first time with the catchy name of

Brussels, his aim was to analyze fluids and gases in zero gravity

“Nimo”. The name was the original working title used during

and to calculate their behavior. This was to be based, among

the development phase in French: “Nouvel Instrument de Mesure

other things on this imaging technique.

Optique” which translates as “New Instrument for Optical

In this way, over time, the company was able to send a variety

Measurement”. The basic optical system gives approx. 400

of instruments into space. Some are used to analyze specific

times more accurate results than a system based on

radiation, others help with the fine-positioning of satellites.

Shack-Hartmann.

Currently, the company has 30 instruments which are either

Another device was developed to analyze diffractive optics.

already in space or soon to go there. Lambda X is a long-term

The PMTF (optical power and modulation transfer function)

partner of the ESA and a major player in European space optics.

can precisely measure and characterize any kind of intraocular lenses in real-time.

TAKING THE PLUNGE INTO INDUSTRY

Today, the Belgian company in Nivelles has 25 members of

In 2002, the team around Olivier Dupont pitched their expertise

staff and a state-of-the-art building covering 1,200 m². Almost

to the industry for the first time. Before long they were working

all members of staff have a background in Physics, Engineering

on a device based on their own patented implementation of this

or Software Design; seven have PhDs.

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COMPANY PROFILE Lambda X

Around 35% of the turnover is generated by the manufacture

The prototype of the Nimo Matrix could also be seen. This

of these inspection instruments for ophthalmic lenses. Besides

device can check 121 lenses fully automated either wet or

orders from the aerospace industry, they also receive orders

dry. It doesn’t matter whether the lenses have been sorted

from the military but they did not talk about these: of course,

or not. The spectrum can be mixed at will: single vision,

they are strictly confidential!

toric or multifocal lenses, it doesn’t matter. Everything is

They only moved into the new building in the north of Nivelles

measured and in just a few minutes the results are displayed

a few weeks before our visit. The rooms in the new building

– proving very quickly whether the strengths comply with

are large and bright and the cleanroom offers perfect working

the requirements or not.

conditions; reason enough on its own to move from the other

In the cleanroom next door, where mainly research is carried

end of town. The old premises had become too cramped and

out, there are even stricter entry regulations. Some things remain

no longer met the expectations of the company.

secret and are hidden from view. On two standardized heavy benches, typical for optoelectronics, different arrangements

VISITING THE PRODUCTION

were being set up with a mass of cables, lenses and computers.

Some preparation is necessary before one can enter the production.

In the room next door, where the space projects are carried out,

Protective clothing has to be worn. The production area is designed

there was an even stricter level of cleanliness. We could watch

to have a constant temperature and to be completely free of dust

the staff at work through a window.

as far as this is possible. On the day of our visit, there was not much to be seen because all devices from the last batch had

OUTLOOK

already been sold and sent out. "We produce to order and always

The right ideas and a motivated team are almost always the

in batches of 10," explained Laurent Malfaire, Chief Commercial

key to success. Moving into the new modern facilities is likely

Officer at Lambda X. However, preparations for the next

to have proved an additional source of motivation for the

production run were well under way. Rows of machine parts

whole team. There are further innovations in the pipeline,

were already waiting, individual components had been

too, but the company said it was too early to give us any details

preassembled and the covers were also awaiting the next stage.

yet. Lambda X looks set to continue developing innovative

Before being sent off, each device is checked personally by Luc

devices in the future. Think about it the next time you make

Joannes, the CTO of Lambda X. Nothing is left to chance!

a slice of toast.

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Lambda X COMPANY PROFILE

The measurement operation consists of applying the phase-shifting principle to obtain the mapping of the light beam deviation at as many points as available on the camera. The instrument resolution is therefore directly related to the number of pixels in the camera; this represents a significant increase in resolution by comparison to previous methods.

Both x and y components of the light beam deviation are measured which taken together fully characterize the lens power because they are the derivative of the wavefront on each point on the lens. As with all power mapping devices, the instrument then uses customized software to calculate many different aspects of the power-related dimensions of the lens. The paraxial power, sphere, cylinder and axis, is calculated in any zone. To do this, the calculated wavefront is fitted to a Zernike polynomial combination; the paraxial sphere power is deduced from the defocus coefficient while cylinder and axis are deduced from the astigmatism terms. For IOLs, the Modulation Transfer Function is calculated from the wavefront. In addition, power maps with a very high spatial resolution are calculated for each pixel within the optic zone of the lens. The instrument software also allows wavefront analysis via Zernike polynomial decomposition to be made at any aperture diameter of the lens being measured. (Luc Joannes, GlobalCONTACT 2010_03)

1

2 Fig. 1: Schematic layout of NIMO based on the PSS technique Fig. 2: Schematic representation of light ray travel in the Schlieren method when a positive power contact lens is placed in the instrument Fig. 3: Live image of a single vision IOL as produced by this instrument

3

4

Fig. 4: A single vision spherical soft contact lens observed in a wet cell

LAMBDA X BULLETPOINTS: • Metrology for controlling ophthalmic lenses (RGP and soft contact lenses, refractive + diffractive IOLs, spectacles) • Wet or dry measurement (sphere, cylinder, addition, axis, micro-four-thirds (MFT), through focus MTF, power maps, power profiles, wavefront)

• Full assessment of complex lenses (torics, multifocal or multifocal torics, freeform) • Automated + custom solution

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TECHNOLOGY Diamond tools

Diamond tool care and handling How to maximize your tooling cost Let’s start with the basics…“Diamonds are forever”: according to the jewelry industry, but not when you use them for manufacturing. Diamond may be the hardest material known to man, yet a diamond can be easily damaged if not handled or used properly.

By Dennis Keating 10

10_Keating.indd 10

GlobalCONTACT 1-15

12.03.15 12:45

Diamond tools TECHNOLOGY

Many factors come in to play which affect the tool cutting edge and can drive the tooling cost up so I will break them down in to an easy to follow format.

2. CUSTOMER IN-HOUSE QUALITY CONTROL Because single crystal diamond tools can be expensive, it behooves the customer to ensure there are adequate procedures in place to ensure tool quality is maintained through receiving

1. TOOL SHIPPING AND HANDLING Any reputable tool supplier will guarantee

and use on the machine. Anything less can result in higher tool cost.

the tool edge integrity allowing the

• As noted the tool supplier should guarantee the edge quality

cutting edge to be received by the

at time of shipping. If not it may be time to seek a new supplier.

customer chip free.

• The tool cutting edge is usually

• Any pre-inspection of the cutting edge can result in unintentional damage.

documented by visual inspection

• The tool should never be removed from the shipping container

under magnification of 500 to 800x power

and placed in a tool storage bin, as this can expose it to

and with Nomarski Filters that help illuminate the cutting edge.

• On a controlled tool the edge waviness is typically

potential damage.

• Anyone who must handle the tool should receive adequate training on the do’s and don’ts of tool handling.

documented with a peak to valley (P-V) measurement over

• The tool edge does not need to be cleaned or inspected

the full arc of the cutting edge. This is important as this

before it is put in the machine. That is the responsibility of

information can be used to optimize the machine set up.

the tool vendor.

• When the tool is ready to ship from the vendor it is placed in a crush proof shipping container that protects the cutting

• It would be best that a minimum number of people be allowed to handle the tool.

edge and also provides useful tool information to be used later by the operator during machine set up. If the packaging

3. MATERIALS TO BE TURNED

arrives damaged it should be reported, photo documented

Not all materials can be diamond turned. Ferrous material can

for the damage and sent back to the tool vendor for tool

have a reaction to the carbon in the diamond and cause premature

inspection. It is recommended that you do not remove the

wear of the cutting edge. With that said there is new technology

tool and inspect yourself. That is best done by the tool vendor.

becoming available with ultrasonic devices that allow steel parts

• When received by the customer it is highly recommended

to be turned with some success. Glass and ceramics are materials

the tool remain in the shipping container, untouched, until

typically not suitable for diamond turning, and certain polymers

it is needed at the machine. By doing this the customer can

can also react chemically to a diamond affecting the edge quality.

avoid unintentional damage to the cutting edge. It will also

Other materials such as silicon or materials that contain silicon

avoid any problem if the tool is accidently placed back in

can cause excessive wear to the tools edge. Some of the materials

a different container with incorrect tool height and radius.

coming to the market today such as silicon hydrogel’s can be

• The shipping container should remain at the machine as it

abrasive and result in excessive tool edge wear.

contains tool radius and height which the operator will need for machine set up.

• When the tool is ready for repair it should be placed back in the same shipping container to avoid any further damage and returned to the tool vendor for repair.

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TECHNOLOGY Diamond tools

To try turning a specific (new) material it might be best to;

• Contact your tool supplier for their experience and specific recommendations.

• Seek experience from other resources within the industry.

• Universities are a good place to start if they do diamond turning themselves.

• SETTING TOOL HEIGHT: There are different methods for setting tool height

• Optical tool set stations are the safest method to use when setting the tool height. These are non-contact and will not damage the tool cutting edge.

• Touch probe tool setting is another method used but this

• Try a lower cost non-waviness controlled tool or a tool that

has the potential to damage the tool cutting edge by the

is near its end of life to evaluate if the material can be

type probe used to set the tool radius. An air bearing

diamond turned or not.

LVDT (linear voltage displacement transducer) may be used and if the bearing is not maintained and cleaned

4. MACHINE SET-UP This is a time when the diamond can be damaged if certain rules

of contaminates the probe can stick and break the edge of the diamond due to additional force.

are not followed. The customer needs to make sure that whoever is of a job well done. If done properly the machine is set-up quickly

• SETTING TOOL LATERAL CENTER • Again an optical tool set station may be the best device

and production can begin with minimum delay. If not, there may

because it does not come in contact with the tool.

handing the tool is properly trained and understands the consequences

be significant lost time, damage to an expensive cutting tool, a scrapped work piece and delay completing a job on time.

• THE SHIPPING CONTAINER:

• TOOL SETTING WITH A FLAT PART A flat part may appear to be an easy and non destructive

important information for radius and height that the

way to set a tool but it has hidden problems.

recommended the container remains at the machine for quick access to this information and to put the worn tool

10_Keating.indd 12

the edge of the diamond due to excessive probe force.

The tool arrives in a protective shipping container with operator needs to set up the machine quickly. It is strongly

12

• Touch probes are used as well but they can actually damage

For instance;

• If the machine X and Z axes are set square then a flat can be turned with no problem.

back in the container for repair. Having the container

• Also if multiple passes are taken at the flat surface during

available at the machine can eliminate addition damage

set up a small facet may be worn in to the diamond radius

to the cutting edge that might result in lost tool life or

which could then appear on the surface of a sphere or

increased tool edge repair cost.

asphere when the tool is used.

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TECHNOLOGY Diamond tools

CORRECT

INCORRECT

Gentle wipe Never wipe up or down

around the edge

5. TOOL CLEANING

damaged. A C-axis that dithers can cause an upward work

The best way to ensure tool edge integrity is to not touch it. But

piece motion on the diamond which can chip the cutting

in the real world, a diamond may need cleaning to remove built

edge. Also a machine with poor vibration damping may

up materials from time to time. The best way to do that is;

cause very slight machine movements that could create micro

a. Use a clean lint free lens cloth each time the tool is wiped.

cracks within the diamond structure and cause premature

This will eliminate debris from damaging the tip by using

tool edge failure.

the cloth more than once.

Machine environment thermal control is very important as

b. Use a solution on the cloth like alcohol, mineral spirits, caustic soda to help dissolve the built up material. c. Allow the damp cloth to remain in contact with the built up for a few minutes then wipe around the tool radius. d. Then with a new clean cloth wipe from the front of the diamond

well. If a machine is allowed to drift thermally the tool may move vertically and the tool may then be turning above center. This can cause an upward force on the diamond tool which can cause internal damage to the diamond, and premature edge failure.

to the back. If wiped from the back to front debris can be pulled over the edge of the tool. The material then can be

7. COOLANT AND CHIP CONTROL

caught up in the turning process and damage the cutting edge.

With many single crystal diamond turning materials a

e. A very simple and inexpensive method is to use a roll of

light air/oil mist is used but in some cases flood coolant

toilet tissue. Make sure to buy the cheapest kind that does

may be used.

not include lotions or powder. Keep the roll handy near the machine and when needed take some tissue and roll

• AIR/OIL MIST

around the hand. The outside surface should roll inside

This type system is used to help provide some cooling of

around the hand. By doing this a surface that is clean of

the tool cutting edge and help with chip management.

any contaminates is ensured.

The attempt is to develop a continuous string for the chip if possible (dependant of the part shape and material

6. TYPE OF MACHINE AND THE SHOP ENVIRONMENT

14

10_Keating.indd 14

being turned) and in conjunction with a vacuum chip

Is the machine being used appropriate for a single crystal

extractor help to remove the chip from the cutting area.

diamond tool?

Excessive accumulation of chip in the cutting zone can

Machine design for servo control, loop stiffness and vibration

not only scratch a turned surface but may also cause

are all important in order that the diamond tool edge is not

damage to the tool edge.

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Diamond tools TECHNOLOGY

• FLOOD COOLANTS This is used primarily for spectacle lens manufacturing. It is a good method to help cool the tool cutting edge under very aggressive machining conditions and remove large volumes of cutting chips. However if not controlled properly those chips can come back to the diamond tool via the coolant delivery system and act like a sand blaster on the tool.

To do this you will need to know;

• The time it takes and the cost to set up a tool based on current shop rates.

• The cost of a roughing tool compared to the cost of a controlled waviness finishing tool.

• The number of re-laps that are possible when a finish tool is used for its intended purpose (not roughing).

• The number of re-laps that are lost due to excessive diamond • CUTTING CHIP BIRD NESTING

wear on a finish tool when it is used for roughing.

Improper chip management can cause the material to ball

With this information the bottom line cost can be calculated

up around the tip of the tool, resembling a bird’s nest. If

when using an expensive controlled waviness finishing tool

this happens, the chips can cause pressure from the bottom

for roughing. n

side of the diamond and result in chipping of cutting edge or micro-fracture within the stone.

Dennis Keating

8. ROUGHING WITH A CONTROLLED WAVINESS TOOL Some companies feel that a finishing tool that is already set up on the machine can be maximized by using it as a roughing tool once it is worn. This may save time but is it really cost effective?

A time study cost analysis should really be done to determine the real cost.

Dennis Keating, VP Sales & Marketing Contour Fine Tooling for the American Market. His career started with high production machines for automotive component manufacturing. He worked ten years as Asian Sales Manager for Precitech, Ultra-precision machines for optics manufacturing and the past 7.5 years for Contour.

Advertisement

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BUSINESS + MARKETING Management

Delegating – and how to do it There are various approaches to the topic of "delegating". Some say, "Why should I do everything myself, I have staff and they are paid to work here!" Other bosses have a different attitude: "Before I delegated something to someone else, I could have done it three times myself." Or: "Anyway I can do it better, I’m the boss!"

By Rolf Leicher

16

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Those who try to do everything themselves soon become bogged

Anyone who only delegates minor tasks or particularly urgent

down and their own staff becomes less independent. Delegating

ones to their staff is unlikely to boost their motivation. Well

presupposes you trust your staff and you only need to check up

qualified staff want to take on demanding tasks. For regular

on them during their initial training. However, staff must also

tasks, there are clearly defined responsibilities and everybody

have the appropriate qualifications to take on the delegated task.

knows what to do. In case of illness, delegation areas have to

Tasks can also be delegated on a temporary basis, e.g. while a

be reallocated spontaneously which requires a great amount

colleague is away on holiday. A long time ago your team should

of flexibility.

already have acquired the skills necessary for dealing with

Changes in delegation are only defined in emergencies if the

special tasks when they suddenly arise.

tasks are urgent and there is no time to discuss who should do GlobalCONTACT 1-15

12.03.15 16:34

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what. It is to be expected that staff members do not limit themselves to their own area with statements like, "I am not responsible for this". Delegation is not a rigid process. And incidentally: tasks related to the core competencies of a staff member are particularly well suited for delegation.

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intervene in exceptional cases.

Nevertheless managerial tasks and functions involving a lot of responsibility cannot be delegated, for example if an important customer has some special demands. Initially when starting to delegate, a certain lead time is necessary. This gives employees time GlobalCONTACT 1-15

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13.02.14 13:15 12.03.15 16:34

BUSINESS + MARKETING Management

Personal instruction of the member of staff by the boss himself is the best solution. The boss can then easily ascertain whether the employee is suitably qualified and understands how he wants the job to be done. For this reason, one should not rely on an employee being instructed by another member of staff.

However, in practice this basic rule is often broken.

1 Choosing the staff

2 Roughly describing the task

4

3 Describing the details

Showing them and let them do it themselves

REQUIREMENTS When delegating the work, the boss can also find out if an employee tends to over- or under-estimate himself. The skill of the employee alone is not enough, he also needs to be motivated to do the new task.

Another basic rule is to resist the desire to take the delegated

to grow into their delegated areas, gain the confidence that is

work back again if the employee makes a mistake. If the right

needed and acquire the skills necessary to complete the tasks

instructions were given, this shouldn’t happen. If checks are

without making mistakes. The boss must understand that initially

made at regular intervals, mistakes can be spotted early and

employees will need much more time to complete the task.

any serious setbacks avoided. Taking back the delegated task and assigning it to another colleague is sure to result in a poor

PROBLEMS WHEN DELEGATING WORK

working climate.

The delegation of a new task is often rejected by staff. Anyone who already feels overworked is reluctant to take on any more work: "How am I supposed to do all this?" However the issue of feeling "overworked" is sometimes exaggerated. In order not to overburden an employee, it may be necessary to relieve him of other tasks. What worries employees above all is having to take on responsibility for the delegated area.

Similarly, the boss handing over the responsibility also first has to get used to the new situation. Such concerns when transferring responsibility are often the biggest obstacle when delegating work.

Does one have to fear a loss of authority and influence when delegating work? What will customers think when they find out?

DELEGATION RULES FOR THE BOSS • Be sure to give your comprehensive instructions personally • Transfer responsibility to the person concerned • Do not check up constantly on the work you have delegated • Only offer help if problems arise • Praise the employee’s achievements promptly without delay • Delegate tasks according to an employee’s skills • Delegate tasks as early as possible • Do not make too heavy demands on the person concerned • Challenge and encourage ambitious employees • Assign tasks fairly

And if it comes to a claim for damages, who will be responsible?

For these reasons, the management tool “delegation” is often

WHAT TASKS CAN BE DELEGATED?

the subject of controversy. Nevertheless, the advantages of

Consider what tasks you have previously delegated and what

delegating far outweigh the disadvantages. And those in favor

other tasks you would still like to delegate. Make a list of all

of Management by Delegation have a lot of good arguments

the tasks that you currently do yourself. Keywords are sufficient

on their side. Those who remain worried about losing control

but every task should be listed, including checkups. Decide

if they delegate work, and regard themselves indispensable, do

which tasks could be done equally well by others. As a rule,

not place much emphasis on “delegation”.

you should not intervene in tasks you have already delegated, only taking an interest in the finished results. However, all

PROBLEMS OF DELEGATION FROM AN EMPLOYEE’S PERSPECTIVE

members of staff should know that if any problems arise they can always come to you. n

• Lack of clear instructions • Unclear assignment of tasks • Lack of trust on the part of the boss • Unwillingness of the boss to take responsibility for the necessary risks

• Worries that completion deadlines can’t be met • Anxiety on the part of the employee that he can’t do the job • The boss intervening in the delegated task • The boss’s expectations being too high • Uncertainty about separation of tasks 18

16_Leicher.indd 18

Dipl.-Betriebswirt Rolf Leicher is a marketing expert from Heidelberg and is well-known in companies for his seminars and as a communications trainer. He also works as author for several publications. His expertise is based on lectures and seminars he has given at well-known institutes and academies.

GlobalCONTACT 1-15

12.03.15 16:34

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Larsen equipments are robust, reliable, straightforward, easy maintenance and have good cost-benefit ratio. Fine tooling options together with right equipment made our life easier and have increased production and productivity in our lab.

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LAB MANAGER: ALEXANDRE LOPES

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It comes to attend an old demand to ensure the centralization

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can surpass pitch polishing for optical quality. I use to agree

autoblocker for contact lens production, it had also a very

with that in the past, since we manufacture contact lenses

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since 1975. At that time, we had to master pitch polishing

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having another Larsen Autoblocker for IOL production.

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GlobalCONTACT 1-15

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19

11.03.15 14:11

FITTING BACKGROUND Corneal Topography

Time for a change?

Corneal changes as a result of suboptimal soft lens fittings are not as uncommon as many may think. If practitioners would remove soft lenses at every follow-up visit and perform corneal topography, they would be surprised by the amount of unwanted changes that can take place beneath a soft lens.(1)

By Eef van der Worp and Vincent Molkenboer

20

20_Eef.indd 20

In refractive surgery clinics it has become clear that it is

outcomes: some subjects take significantly longer compared

critically important to cease soft lens wear for a substantial

to the average eye to reach stability.

period of time to let the cornea return to baseline before laser

But what is the best way to observe and/or to quantify topographical

surgery can take place. According to a study by Ng et al(2), it

changes in soft lens wear? To better understand this we

takes on average 10.7 ± 10.4 days before a stable refractive

retrospectively looked at the topographical changes after lens fit

state is reached based on corneal topography after cessation

in a group of normal, successful soft lens wearers in a large

of soft lens wear. From a clinical perspective in contact lens

contact lens practice in the Netherlands with a variety of lens

practice, it is interesting to note the large spread within these

types and brands – but all made of silicone hydrogel materials.

GlobalCONTACT 1-15

12.03.15 12:59

Corneal Topography   FITTING BACKGROUND

CLINICAL OBSERVATION

The tangential power map was used as this is considered the best

In our experiment, in 101 eyes of 52 subjects who had been

map for visualizing differences in shape. Topography changes

fitted successfully with contact lenses in the last year were

in optics and vision are best analyzed by looking at axial or

observed. The pre-soft lens fitting corneal topography

refractive power change within the pupil (e.g. sphere/cylinder/

(Medmont E300 Corneal Topographer, Nunawading,

and Zernike polynomials). If you want to know where the changes

Australia) was compared to the post-soft lens fitting

occur and to visualize them – then tangential maps seem to most

topography map at several follow-up visits. A difference

likely be the best tool.(3) To the best of our knowledge, power

map was generated, in the same fashion as a difference map

maps (in diopters of change) best represent this change, rather

between pre and post fitting is created in orthokeratology,

than millimeters and radii of curvature, to quantify the soft

to see whether a consistent pattern was present in the potential

lens-induced changes that may occur on the ocular surface.

changes that are occurring d u r i n g s of t l e n s we a r.

Medmont generated a custom concentric ring topography difference map tool that allowed us to analyze where on the cornea, and in what magnitude, the changes took place. The difference maps were generated in arbitrarily set 0-3 mm, 3-5 mm, 5-7 mm and 7-9 mm concentric rings.

The intervals of the map displays were set to very small (sensitive) steps of 0.1D increments to best visualize the potential pattern in the tangential power maps used in this experiment.

GlobalCONTACT 1-15

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Fig. 1 21

12.03.15 12:59

FITTING BACKGROUND Corneal Topography

Lenses worn by the subjects were in the 2- or 4-weekly

diminished (as more than one follow-up visit was not available

replacement range, from different manufacturers and all were

to date in many cases).

made of silicone hydrogel materials. Subjects included in the

In the toric lens group (n=20), results were comparable to those in the myopic group (figure 2). Average

”IT SEEMS TO CONFIRM EARLIER FINDINGS THAT CORNEAL TOPOGRAPHY CHANGES OCCUR UNDERNEATH SOFT SILICONE HYDROGEL LENSES IN CLINICAL PRACTICE.”

ametropia in this group was -1.79D ± 3.23 spherical power (ranging from +6.50D to -6.50D) with a mean cylindrical power of -1.31D ± 0.62. The results were also very consistent again for consequent visits. A very limited subject count was available for 4th and 5th visits in this group.

The multifocal/hyperopic group (figure 3) was isolated to either spherical hyperopic or hyperopic-multifocal lenses (n=32). The mean amount of ametropia was +2.18D ± 1.88.

study were neophyte lens wearers (defined in this study as ”no

Again, similar results were seen for this group compared to the

previous contact lens experience” or ”at least one year of lens

other groups, and for consequent visits. A minimal subject count

cessation prior to lens fit”). The group was subdivided into

was available for the 3rd-5th visits in this group.

”spherical myopic” subjects, “toric myopic” subjects and

As minimal differences were seen between these sequential

“multifocal/hyperopic” subjects - to analyze potential inter-lens

subgroups, all data was added together (n=101) and averaged for

differences in topographical changes.

all visits (figure 4). This shows that the mean change in the central ring ranging from 0-3 mm was 0.57D ± 0.26, and this was 0.59D

OUTCOME

± 0.25 in the second ring ranging from 3-5 mm. From there going

Average time between the lens fit and the first visit was 8.3

peripherally, the difference gradually increased to 1.00D ± 0.57

months. Consequently, if applicable, this was 18.4 months from

in the 5-7 mm ring and 1.83D ± 0.74 in the outer ring (7-9 mm).

start to the second visit, 24.9 months to the third visit, 30.2

The standard deviation increases as well in these latter cases,

months to the fourth visit and 34.2 months to the fifth visit.

indicating a less predictable outcome.

In the myopic group, 49 eyes were analyzed. The mean amount of ametropia of the subjects was -2.51D ± SD 1.56. The

DISCUSSION

maximum tangential dioptric difference within each region

This data of our clinical observations from a large contact practice

is displayed, as shown in figure 1. The results were very

in the Netherlands seems to show a few things. First of all, it

consistent in consequent visits (figure 1). The number of

seems to confirm earlier findings that corneal topography changes

subjects for the 2nd, 3rd, 4th and 5th follow-up data gradually

occur underneath soft silicone hydrogel lenses in clinical practice.

If similar difference maps are used on normal eyes not wearing lenses, minimal differences are seen. Tear film instability may give rise to some irregularity in normal eyes not wearing lenses, but this is typically limited to within 0.25D within the 0-5 mm zone.

What may be of interest is that the differences that were found i n lens wea rers i n t h is experiment appear to be minimal between groups (myopic, hyperopic/multifocal or toric, respectively). They all share a similar pattern of

Fig. 2 22

20_Eef.indd 22

moderate change in the 0-5 mm GlobalCONTACT 1-15

12.03.15 12:59

YOUR GATEWAY TO SUCCESS IN CHINA... ... use the contacts and the trade journal FOCUS China The trade journal for the Chinese ophthalmic optics industry and labs, optometrists and ophthalmologists, managed by Europeans Founded in 2010 in Beijing and Xi‘An Well established and recognized in Chinese ophthalmic industry, labs, trade and associations Editorial content brought from MAFO, GlobalCONTACT and the german FOCUS Translations are done by professional Chinese interpreters and trade experts from universities and ophthalmic industry More than 9,000 stable contacts to Chinese industry, ophthalmologists, optometrists in clinics and big chain shops Content: Lens Technology - 镜片知识 Labs & Industry - 加工和制造 Optometry - 视光学 Ophthalmic Training - 眼视光和眼科培训 Contact Lenses + IOL - 隐形眼镜和人工晶体 Frames & Fashion - 镜架和时尚

Contact: MediaWelt GmbH Jörg Spangemacher Fon: +49 2104 958883, Cell: +49 172 6685550 Skype: joergspa1, QQ: 1417012494 E-Mail: joergspa@mafo-optics.com

FOCUS-China.indd 1

Contact: Beijing FOCUS Optical Culture Communication LTD. Jian Wang Fon: +86 (29) 89380269, Cell: +86 (139) 10771318 Skype: jennywang611, QQ: jenny E-Mail: jennywang_focus@126.com

20.02.15 14:51

FITTING BACKGROUND Corneal Topography

topography with Placido disk systems. However, as this was a ret rosp e ct ive st udy per for med in a real-life commercial setting, this disadvantage could not be overcome. To keep this effect to a m inimum, selected t o p og r a p hy m a p s we r e screened by an experienced ECP and excluded from the study if any signs of surface irregularity were detected (by looking at the raw Placido ring picture, and by taking four measurements of each eye and excluding any outliers). In Fig. 3

defence of the study methods: all contact lens specialists in zone – on average, in the 0.50D-0.75D range. Only very minor

their practices would to a large degree face the same limitations

differences in between follow-up visits seem to occur. Oftentimes,

in analyzing topographical changes beneath soft lenses. Also,

but not always, a ring pattern was seen as presented in figure 1-3.

the outcome of the study did not show large variations, even

Apparently, the dedicated change induced by the lens seems to be

between consequent follow-up visits. This gives us confidence

relatively stable. In clinical practice, eye care practitioners should

that the data was not largely diluted or distorted by the topographical

take into account that in some cases significant higher values can

analysis limitations.

arise, looking at the standard deviation (see figure 1-3).

Outside of the 5 mm zone, the differences seem to increase up

FINAL REMARKS

to roughly 1.00D-1.25D in magnitude in the 5-7 mm ring and to

This retrospective observation with a variety of lens types

more than 1.75D-2.00D in magnitude in the 7-9 mm ring. It

appears to imply that whether we like it or not, in daily contact

should be taken into account that the data towards the periphery

lens practice we induce unwanted changes to the cornea – even

may not be as reliable as the central 5 mm zone data. Also this

when fitting soft lenses. If the traditional ”<0.5D” criterion is

would most probably fall mostly outside of the pupil zone diameter.

applied, then this actually affects a very large proportion of

A disadvantage of analyzing a topographical change difference

our lens wearers. But more than “the numbers” this observation

is that in the pre-soft lens fitting topography map, a pristine,

seems to point in the direction of where the changes occur,

undisturbed pre-ocular tear film is present. In the post-soft lens

rather than necessarily quantifying them. Follow-up studies

fitting, a topography map taken shortly after lens removal (typically

hopefully can help us further investigate the phenomenon and

by the lens wearer, on occasion by the ECP), as we did in this

better understand why this is happening.

study, can result in tear film disturbances that can influence the

The effect found could in theory be the result of the “peripheral strain” induced by soft lenses on the ocular

THE PURPOSE OF THIS ARTICLE IS TO SHARE THE OBSERVATIONS DONE IN CLINICAL PRACTICE, WHICH MAY BE SEEN AS “FOOD FOR THOUGHT” FOR FURTHER DISCUSSION AND HOPEFULLY FOR FURTHER STUDIES ON THE SUBJECT. 24

20_Eef.indd 24

surface, as proposed by Graeme Young recently in Optometry & Vision Science.(4) This mathematical model shows that “lens edge strain” in a normal eye, with a typical (8.6 - 14.2 mm) lens could be as much as 2.7% - but for the same lens on a flat cornea and/or ocular surface this would result in a tight fit showing 8.5% strain. Hence – a mechanical component of a soft lens to the eye seems plausible.

Hopef ully new inst r uments, such as extrapolation with standard topography with Placido disc or Scheimpflug technology, or newer techniques such as optical coherence GlobalCONTACT 1-15

12.03.15 12:59

!AZ.ind

Corneal Topography FITTING BACKGROUND

tomography (OCT) or eye surface profilometry (ESP), will help

the soft lens geometries that are used today: are we following

us better understand the ocular shape – typically and specifically

and respecting the ocular surface enough with the current lens

beyond the corneal borders.

designs? Or can we do better?

The purpose of this article is to share the observations done in clinical practice, which may be seen as ”food for thought” for

ACKNOWLEDGEMENTS

further discussion and hopefully for further studies on the

The authors want to thank Randy Kojima FAAO, FSLS, FIAO

subject. It is not our intention to judge or to point toward any

from Pacific University (Oregon, USA) and the Medmont team

lens type or modality in particular.

in Australia for their help, support and contribution in generating

In our view, the changes in corneal topography we observed

the custom concentric ring topography difference maps. n

may indicate that it is time for a change going forward: a change in the way we assess ocular surface shape, and potentially in the way we fit and evaluate soft lenses on-eye. But work needs to be done – especially on the methods of how to best analyze ocular surface changes. Also we can, and should maybe, revisit Eef van der Worp, BOptom, PhD, FAAO, FIACLE, FBCLA, FSLS is an educator and researcher. He received his optometry degree from the Hogeschool

BIBLIOGRAPHIC REFERENCES 1 Schornack M. Hydrogel contact lens-induced corneal warpage.

Cont Lens Ant Eye 2003;26:153-9.

2 Ng LT, Lee EM, Nguyen AL. Preoperative assessment of corneal and refractive stability in soft contact lens wearing photorefractive candidates. Optom Vis Sci. 2007 May;84(5):401-9.

3 Michael Collins, Queensland University of Technology, Brisbane, Australia – personal communication.

4 Graeme Young. Mathematical model for evaluating soft contact lens fit. Optom Vis Sci. 2014 Jul;91(7):p. 810

van Utrecht in the Netherlands (NL) and has served as a head of the contact lens department at the school for over eight years. He received his PhD

Vincent Molkenboer is private practitioner and

from the University of Maastricht (NL) in 2008.

owner of a large contact lens practice in the

He is a fellow of the AAO, IACLE, BCLA and the

Netherlands. He received his optometry degree

SLS. He is currently affiliated with the University

from the Hogeschool van Utrecht (NL) in 2003. He

of Maastricht as an associate researcher, a visiting

is a contact lenses enthusiast in many aspects,

scientist at Manchester University (Manchester

especially when it comes to fitting the presbyopic

UK) and adjunct Professor at the University of Montreal University College of

eye. Vincent is the chairman of the scientific section

Optometry (CA) and adjunct assistant Professor at Pacific University College of

of the Dutch Contactlens Association (ANVC) since

Optometry (Oregon, USA). He is lecturing extensively worldwide and is a guest

2012 and is columnist for the Dutch contact lens

lecturer at a number of Universities in the US and Europe.

magazine “Contactlens Inside”.

Advertisement

!AZ.indd 12 25 20_Eef.indd

25.02.15 12:59 22:15 12.03.15

FITTING BACKGROUNDâ&#x20AC;&#x2026;Scleral Lens

Scleral lens induced conjunctival prolapse ... What we know in 2015 For eye care practitioners conjunctival prolapse is a new complication, never seen before in rigid, soft or hybrid contact lens wearers. Therefore it is appropriate that we review our current understanding of the condition from the perspective of its identification, etiology and management.

By Patrick Caroline

Conjunctival prolapse is a scleral lens complication that occurs when the conjunctival tissue migrates over the limbus and onto the peripheral cornea (figure 1).

HOW OFTEN DOES THIS CONDITION OCCUR IN SCLERAL LENSES PATIENTS? I n ou r exper ience conjunctiva l prolapse occu rs in approximately 20-30% of scleral lens wearers and has been noted in patients with a wide range of corneal and/or ocular surface disease pathologies (figure 2). It occurs most often at the inferior corneal-scleral junction from 4:00 to 7:00 oâ&#x20AC;&#x2122;clock however, in rare cases we have seen it occur superiorly (figure 3).

26

26_Contamac.indd 26

1 Fig. 1: Conjunctival prolapse GlobalCONTACT 1-15

11.03.15 15:53

Scleral Lens FITTING BACKGROUND

2 Fig. 2: Conjunctiva prolapsed in a wide range of ocular conditions

HOW AND WHY DOES CONJUNCTIVAL PROLAPSE OCCUR? This question is best answered by first understanding why scleral lenses rarely center on the eye but, typically position more inferiorly and temporally.

3

INFERIOR DECENTRATION OF SCLERAL LENSES

Fig. 3: Superior positioned conjunctival prolapse

While the exact mechanisms for inferior decentration are unclear, we believe that it is multifactorial, involving 1, gravitational forces secondary to the weight of the lenses and the fact that the lenses are designed to completely clear the cornea and the limbus. 2, the “watermelon seed” effect of the upper lid pushing the lens down as it passes across the anterior surface of the lens. And, perhaps most importantly, 3, OCT observations at Pacific University have shown that the superior sclera is higher than the inferior sclera therefore, when the lens is placed onto the eye, it lands first at the point of greatest elevation (superiorly) which forces the lens towards the area of lesser resistance in the opposite direction inferiorly.

TEMPORAL DECENTRATION OF SCLERAL LENSES

4

We have a slightly greater understanding as to why scleral

Fig. 4: Temporal positioning of a scleral lens secondary to the nasal

lenses decenter temporally. We have observed that the nasal

scleral shape

sclera is significantly higher than the temporal sclera and that this finding appears to be greater in right eyes than in left eyes

flat (higher) nasal angle creates a horizontal asymmetry that

(figure 4). This height differential is related to the presence of

accounts for the temporal decentration of scleral lenses. It is

a “notch” on the nasal side of the sclera, at a chord of

no surprise that when the inferior and temporal decentration

approximately 13.0 mm (figure 5). The “notch” appears to be

forces are present that we see a quadrant of fluorescein thinning

related to the fact that as the nasal sclera approaches the

commonly located in the superior, nasal portion of the peripheral

peripheral cornea, it does so with a relatively flat angle. The

cornea (figure 6).

GlobalCONTACT 1-15

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27

11.03.15 15:53

FITTING BACKGROUND Scleral Lens

TOPOGRAPHICAL INFLUENCE IN CONJUNCTIVAL PROLAPSE

accurate assessment of the actual shape of the cornea (how

In assessing corneal topography two primary maps are used,

high or how low it is at any given point) is best seen with the

the axial display map and the elevation display map. The axial

elevation map.

map actually has little to do with the shape of the eye but instead,

The anterior corneal shape can influence the location of the

describes the dioptric power of the corneal surface. A more

prolapse. Figure 7 shows an eye with advanced keratoconus.

The blue areas of the elevation maps represent the areas of greatest depression, thus the greatest tear layer depth. It is in these depressed areas that the conjunctiva is most susceptible, as the tear layer depth attempts to equalize its pressure. Just as epithelium is drawn towards the reverse curve of an orthokeratology lens, with conjunctival prolapsed the tissue is pulled (via negative pressure forces) into the area of greatest clearance.

This can again be seen in a patient with advanced pellucid marginal degeneration in which conjunctival prolapse has occurred at both 4:00 and 8:00 (figure 8). Here, the axial display map shows the greatest dioptric curvature at 4:00 and 8:00 however, the elevation display map shows the corneal

5

surface highest from 10:00 to 2:00 and the lowest at 4:00 and

Fig. 5: The “nasal notch” (at approximately 13.0 mm appears

8:00. As with the previous patient, the conjunctival prolapse

to be related to the fact that as the nasal sclera approaches the

occurred exactly where the lens clearance was at its greatest.

peripheral cornea, it does so with a relatively flat angle)

It appears that in certain susceptible patients, the conjunctiva

The world benefits in motorized

will be “sucked” into any area in which significant lens clearance

exists. This environment is most often present inferiorly due to: 1. the slightly low positioning of scleral lenses and 2. the lower corneal height (inferior depression) commonly seen in pathologic

eyes like those with keratoconus or pellucid marginal degeneration.

WHAT ARE THE PRESSURE FORCES TAKING PLACE BENEATH SCLERAL CONTACT LENSES? The atmospheric pressure is greater than the pressure beneath a scleral contact lens, therefore a negative pressure system (suction force) is created, which “pushes” the lens onto the eye.

The maximum pressure beneath a contact lens is provided by:

6

● Up to 121 D is lens diameter, and h is maximum tear layer depth. ● Flexible M The formula is complicated by the variation in tear layer depth ●lensOne time beneath a scleral lens. The tear film behind the scleral exerts a “squeeze film pressure” force, similar to that which takes place beneath an orthokeratology lens, in order to equalize tear ● theDry or W layer depth. In susceptible patients, the malleability of the conjunctiva makes it vulnerable to these forces, and ● it is “pulled” Non-mov onto the peripheral surface of the cornea, resulting in the prolapse. water mana ARE THERE ANY LONG TERM COMPLICATIONS Ppeak = 4.5(μVD2/h 03)

Fig. 6: The inferior/temporal positioning of scleral lenses results in the classic thinning of fluorescein noted in the superior/nasal quadrant

Where μ is tear viscosity, V is velocity of lens toward eye, 0

TO CONJUNCTIVAL PROLAPSE? Historically, we have always considered conjunctival prolapse

7

to be a relatively benign phenomena, however, recent observations

Fig. 7: The axial and elevation display maps of a patient with

of long-term prolapse have shown adherence of the prolapsed

advanced keratoconus with a subsequent scleral lens induced,

conjunctiva to the corneal surface. It appears that in some

patients, the prolapsed conjunctiva forms synechia that cannot Lambda-X s.a. • Av. Robert Schuman 102 • B-1400 Nivelle Lamb La Tel. : +32 (0) 67 79 40 80 • Fax. : +32 (0)GlobalCONTACT 67 551-1527 91 • inf Tel.Te:

conjunctival prolapsed at 8:00 28

26_Contamac.indd 28

11.03.15 15:53

!AZ.ind

Scleral Lens FITTING BACKGROUND

8

9

Fig. 8: The axial and elevation display maps of a patient with

Fig. 9: In some patients, the prolapsed conjunctiva forms synechia

advanced pellucid marginal degeneration with a subsequent

that cannot be easily broken by manual manipulation

scleral lens induced, conjunctival prolapsed at 4:00 and 8:00 be easily broken by manual manipulation (figure 9). Synechia

Prof. Patrick J. Caroline, Clinical Consultant in

are most commonly associated with internal adhesions of the

the areas of Contact Lens Research and New

iris to the cornea or to the crystalline lens however, external

Product Development for Contamac.

adhesions can be seen in conditions such as psudo pterygia and

He serves as an Associate Professor at Pacific University College of Optometry and Assistant

world famous NIMO technology and efits in a brand new ALL IN ONE orized instrument now... in some cases of conjunctival prolapse. This brings into

Professor of Ophthalmology at the Oregon

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Health & Sciences University in Portland, Oregon.

on the peripheral cornea, limbus and conjunctival tissues?

He team teaches the contact lens curriculum.

He is a Fellow member and Diplomat of the

Further long term studies on this condition are clearly indicated.

Cornea and Contac t Lens Sec tion of the

Despite this finding, we continue to consider conjunctival prolapse

American Academy of Optometry. He is a Council member of the International

to be a relatively benign complication. We believe that as we learn

Society for Contact Lens Research as well as a member of the International Association of Contact Lens Educators and the American Association of

more about the complication, we will be better able to manage

Optometric Educators. For the past fifteen years Prof. Caroline has served

the condition. This will most likely take place in the form of

as a contributing editor for the Contact Lens Spectrum and is on the editorial

asymmetrical scleral lens designs in which corneal/limbal clearance

board for Contact Lens and Anterior Eye Journal. He is an internationally recognized lecturer and researcher on contact lenses.

can be better controlled 360 degrees around the eye. n

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La Te

04.02.15 15:53 16:40 11.03.15

BUSINESS + MARKETINGâ&#x20AC;&#x2026;Manufacturing

The legacy lab First, what is a legacy lab? I define it as a lens producing facility that uses processes that are centered on machinery and tooling that has been superseded by equipment and procedures in use in the last decade.

By Erik Larsen A short list of the legacy tools includes: manual lathes, three-

5. Tapered or screw-on blocking tools: These tools have poor

axis air-bearing CNC lathes, lens blanks in collets, tapered

security on the lathe spindle and internal debris affects prism

or screw-on blocking tools, spin blocking, pitch polishing,

control. Used with a collet blocker, this system can be prone

manual inspection and manual order-entry and tracking. Some

to poor centration.

of these items are still in use even in productive labs; producing

6. Spin blocking: This procedure is dependent on the skill and

spheres and aspheres. Here are the effects of each of the above

attention of the operator, and greatly limits the precision of

mentioned items:

the blocking process.

7. Pitch polishing: This procedure has many operator influences

1. Manual lathes: These lathes are limited in the lens designs that they can produce. The poor surface quality requires

8. Manual inspection: This process can be dependent on the operator.

pitch polishing.

9. Manual order entry and tracking: The potential for lathe set

2. Three-axis CNC lathe: These lathes are limited to corneal and mini-scleral designs.

30

30_Larsen.indd 30

and is useful only for spheres.

up and date entry errors should not be underestimated.

The continued use of these older items and practices can be a

4. Lens blanks in collets: This practice can result in poor

major source of reject lenses or may require substantial rework

centration control, distortion leading to poor optics and

of the lens at final inspection. The rejects can range from prism,

possible tilt leading to edge thickness variation problems

surface defects, and wettability problems, poor optics, radius/

especially with scleral lenses.

power errors, and data entry errors, among others.

GlobalCONTACT 1-15

12.03.15 22:29

Manufacturingâ&#x20AC;&#x2026; BUSINESS + MARKETING

This is not to say that the legacy lab doesn't invest in new

both soft lens and RGP corneal designs. At some point in the

equipment. I have seen labs that buy a new lathe, blocker, and

future, they may produce scleral lenses, so it would be good to

polishers to an amount of a few hundred thousand dollars and

have an easy transition to that process. Their advantage, as I

then continue to use their old blocking tooling. The cost of new

see it, is the unbiased and "no baggage" approach to the

blocking tooling for a lab that is producing 100 corneal lenses

manufacturing process.

per day would be less than $1000. New precision tooling gives

We would recommend the machines and tooling and process

the lab manager a repeatable process that can be validated.

to produce these lenses. The benefit to the start-up is that we

This will give the production manager control over the system

will work with the production manager and staff to be trained

comprised of the lathe collet, blocking tool, and blocking

in contemporary CL manufacturing practices; keeping in mind

machine. By measuring radial run-out and making the indicated

that in five to ten years new processes and/or machinery will

adjustment, precision control of prism will be realized.

dictate production changes in the lab. This means the lab owner can be assured of having a state of the art facility that can

Here is an example of legacy blocking tools. There has been a

concentrate on the front office and sales, growing the company

notion to use oversize blocking tools (see GlobalCONTACT

rather than managing the minutia of lens manufacturing. It is

2014_03). The reason for this approach was to provide a firm

easier to leave that to the lab manager/support group partnership.

clamping force on the blocking tool while being able to place

By that, I am referring to the relationship the production manager

a lens blank in the same collet without needing to adjust the

has with the machinery/tooling/consumables vendors.

collet clamping force to provide a delicate force on the blank.

The procedure does allow the use of one collet for both front

Now, let's look at the start-up from the veteran lab owner's

curve and base curve production. The problem with this

perspective. The concept of a start-up is foreign to most seasoned

procedure is the over-stressing of the collet and the lens blank.

lab owners. If he/she were to consider the four points listed

In the case of the collet, the oversize tools may permanently

above, they might decide not to get into the business. But let's

damage the collet. In the case of the lens blank, clamping the

assume that they want to stay in. They may be considering a

lens blank can yield poor optics.

new location or a secondary production facility possibly in a different country. This could be an opportunity to train new

There is a secondary effect that the legacy lab has had on our

people in contemporary lab practices as if it was truly a start-up.

industry around the world. This effect has happened many

This would require that the lab owner accept the contemporary

times in technology transfers to developing markets. I have

practices and hire a production manager who will promote

visited many labs where the owner partnered with a US or

them. This must be difficult, because I don't see that happening

European lab to start a lab in their country. Visiting such a lab

very often.

is like going back in time. Yes, they may have invested in new

There is a side benefit to adopting the contemporary process;

equipment, as I mentioned above, but they use the tooling design

if the implementation is successful, the lab owner can install

and the old processes, including pitch polishing from the parent

it in the original lab.

lab. As with the example about the collet above, the "daughter" lab adopted the same collet/lens blank procedure. Even with

The start-up culture is one of forward thinking process planning.

new equipment, they were still having random prism problems

It is a culture of improvement. I know of a few labs that maintain

due to the mismatch of the blocking tools and the lathe and

the startup culture. The goal is to improve the production level

blocker collets. I have found the resistance to improvement/

and or lens quality every year. Everyone in the company is

change is greater in the daughter labs than in the parent lab.

engaged in the goal. One could say, with reason, that this is an unrealistic goal after several years. But the culture that is

NOW LET'S COMPARE THE LEGACY LAB TO A NEW START-UP LAB

developed can stay in place and continue to generate a successful enterprise. One thing is for sure, this lab stays current. n

I'm going to make some assumptions about the new (ideal) lab owner.

She/he is: 1. Well-funded.

Erik Larsen graduated from the University of Washington with a Mechanical Engineering degree in 1981 and started Larsen Equipment Design later

2. Understands the market.

that year. Erik Larsen has industry awards from

3. Understands the regulatory environment in the market.

CLMA and EFCLIN.

4. Understands the need for a trainable production manager.

In the case of a new lab owner; going into the start-up process, this owner is looking into machinery and the process to produce GlobalCONTACT 1-15

30_Larsen.indd 31

31

12.03.15 22:29

REPORTâ&#x20AC;&#x2026;Prevention of Blindness

Optometry Giving Sight Ten year anniversary statement For the past ten years, Optometry Giving Sight has been the only global fundraising initiative to specifically target the prevention of blindness and impaired vision due to uncorrected refractive errors (URE). Our efforts generate the support needed to provide sustainable access to criticallyneeded vision care and eye wear.

32

32_Optometry.indd 32

Optometry Giving Sight and its project partners have made

their goal of eliminating blindness and impaired vision due

a significant impact on the lives of hundreds of thousands of

to uncorrected refractive error.

families and communities over the past decade, and w dedicated

Our yearly fundraising event coincides with World Sight Day

to having an even greater impact in the years ahead. Only

and is a global event where the optometry community comes

Optometry Giving Sight seeks to mobilize support from the

together to raise funds for our many eye care initiatives. In

vision care profession and optometric and optical industry to

2014 we had the enthusiastic participation of optometry

support high impact optometry education, training and

students from the Fielmann Akademie in Hamburg and the

advocacy projects from a broad range of partners, united in

Aalen University. n

The photo of the elderly woman from Africa: 72-year-old

The photo of the boys writing: As part of its outreach activities

Berenice had her eyes examined at the Vision Plus Eye Clinic

to celebrate World Sight Day, the India Vision Institute organised

in Cap Haitien and was given her very first pair of glasses.

comprehensive eye examinations for over 200 school children

"My view is much clearer now! I love my glasses," she said.

with support from Optometry Giving Sight and Alcon Foundation.

Optometry Giving Sight was pleased to fun the equipment

Students from government schools in Chennai were presented

for the Bobby and Jayne Christensen Refraction and Training

with free spectacles on World Sight Day. The students pictured are

Room at the clinic. (Photo courtesy from our Project Partners -

writing to express their thanks and sincere appreciation now that

Vision for the Poor, International Eye Foundation.)

they can see clearly. (Photo courtesy India Vision Institute.)

GlobalCONTACT 1-15

13.03.15 11:58

Dear Mr Spangemacher, the whole GlobalCONTACT-Team congratulates to your 70th birthday

GC_JubilaĚ&#x2C6;um.indd 3

12.03.15 15:52

REPORT Opaque contact lenses

Introducing the Ganzfeld contact lens Contact lenses are widely used for refractive correction of vision all over the world and are a great success. Our field has room to grow and expand into new markets that are not refractive. In this article, we will explore a non-refractive contact lens that has more uses than you think.

By Tom Baugh

“Ganzfeld” is a term coined in 1930 by the famed German

or multicolored. While the lens comfort and feel would be very

Psychologist Wolfgang Metzger to describe a uniform,

important, a soft lens of disposable nature would be ideal with

featureless, full field of view often called an "empty field".

low solution expense and sterility assured in one time lens use.

Examples include the inside of clouds or fog, unlit cave interiors,

New cast mold lens reproduction may be ideal for a rapid, varied

and the view with the eyes blocked. Recently a device to create

SKU inventory. Our current lens production machinery can all

a Ganzfeld using tennis balls cut in two was published to the

be used with minor adaptation.

internet (in 2008) and had over two million views that year.

Strap on featureless goggles are also made that create an

I have carefully thought about wearing and using the Ganzfeld

adequate Ganzfeld field of view. Could an opaque contact lens

lenses for several years. So has the US patent office where I

create a much better field to experience the effect now called

have a file pending. The US patent examiner has indicated that

the Ganzfeld Phenomena? A lot of things can occur in the use

Ganzfeld lenses can change everything about contact lens use.

of these lenses. Examples include meditation, lucid dreaming,

That is why I'm telling readers of GlobalCONTACT magazine

altered states of consciousness, hypnogogic and hypnotic effects,

now. Only USA sales would be subject to any patent expense.

music and auditory enhancement, extra sensory perception, “psi” phenomena, remote viewing, heightened sensory effects,

Many more Ganzfeld lens phenomena have just begun to be

including therapeutic massage, sexual touch experience, and

explored in this undiscovered land within our visual system.

as a tool in biological and psychological research.

Production of safely worn Ganzfeld soft contact lenses would offer a new opportunity for contact lens fitting and knowledge.

HERE IS A PROPOSED GANZFELD LENS:

Please contact me if I can help. n

A well-made, fully opaque soft contact lens could improve upon present goggles or mask devices in providing less compromise in the Ganzfeld visual field. Some contact lens measurements would be different. The lens might be larger, like 15 mm, to give good coverage of the cornea and occlude

D r. To m B a u g h (D e n i s o n , Te x a s) i s a n optometrist, contact lens inventor and writer for GlobalCONTAC T. Your comments are welcome at tkbaugh@hotmail.com

light. No lens Rx would be needed. Few base curves, either.

Opaque tint color could include white to black and all colors in between, extending as far as lens edge to edge. Colors used affect the Ganzfeld. The lens material itself could be opaque 34

34_TomBaugh.indd 34

GlobalCONTACT 1-15

12.03.15 16:22

The Future of Hydrophilic IOL Manufacturing Efficient, Precise & Productive

For samples of this new product contact Lorrie Pomroy at lpomroy@benzrd.com Benz Quality. Benz Innovation. benzrd.com

!AZ.indd 11

25.02.15 15:59

HISTORY Vision and Eyecare

Only after it became possible to replace glass – which was fragile and difficult to machine – by the plastic polymethylmethacrylate (PMMA) was the way opened up for modern contact lenses. The new material known as Plexiglas, once heated, could be formed easily so that lenses could now be molded directly to fit the eye. And this was badly needed: the high number of eye injuries as a result of World War II called for new therapeutic approaches. Posttraumatic irregular corneal astigmatism could now be corrected by a contact lens. Their now historical shape as scleral lens or shell played a vital role here.

Thermoplastic molded scleral lenses Series on the Roth Collection In the middle of the last century, irregular corneal astigmatism was the most important indication for contact lenses. This was due to wounds sustained on the battlefield or injuries caused by bomb attacks. The best way to deal with the corneal scars which resulted was through optical contact lenses. But high myopia or aphakia, too, which could only be corrected with difficulty using glasses, soon became additional areas of application of early contact lenses.

By Hans-Walter Roth

However the process of lens manufacture during the war and

turn was then used as a mold to create a thin plastic disc made

postwar years was complicated and expensive. First, a cast had

of Plexiglas pressed together under heat and high pressure.

to be made of the eyeball. For this, after administering a few

After cooling, the inner contour was an exact replica of the

drops of a cocaine solution to the eye, the cast of the front part

cornea and conjunctiva of the patient. As with implants the

of the eye was made, initially out of plaster and later with

plastic used initially came from the cockpits of aircraft which

hydrogels used in dentistry. This was certainly not without the

had been shot down.

added complication of tears, because the corneal epithelium had a tendency to stick to the cast material.

As it was already known at the time that a plane-parallel fitted scleral lens worn on the eye quickly led to the

36

36_Roth.indd 36

After being allowed to dry and cure, the plaster mold thus

degeneration of the corneal metabolism, everything had to

created was filled with metal to create a positive form. This in

be rethought. Thus flattened surfaces, channels and holes GlobalCONTACT 1-15

11.03.15 15:57

!AZ.ind

Vision and Eyecare HISTORY

were tried in order to improve tear circulation. The edges

Such old scleral shells or lenses can be found occasionally at

of the lens were also deburred and rounded. After smoothing

flea markets or auctions on the Internet. Not many will have

and polishing the optical zone in the middle of the lens was

been preserved; the few remaining ones are likely to be in the

ground. These lenses were still not very comfortable and

showcases of collectors of old optical equipment. The undamaged

thus the wearing time was limited. Nevertheless such scleral

specimen shown here is from a kind patient with high myopia

lenses or shells remained available as a last resort, particularly

who donated this item to the collection. The lens, she assured

for compensating irregular corneal astigmatism or correcting

me, was once worn by her grandfather who presumably suffered

high refractive errors. Little is known about the comfort of

from the same condition. Today she herself is the satisfied

such lenses but it is likely they could only be tolerated by

wearer of two highly gas permeable corneal lenses from the

the eye for a few hours at a time.

same manufacturer. n

The power of the scleral lens shown here is -12.25D, the diameter of the optical zone 9.1 mm and the overall diameter 24.1 mm.

The value of the central inner curve is from 7.2 to 7.9 mm. The peak height is 8.2 mm and the central thickness 0.4 mm. The surviving original box, made of Bakelite, reveals the name of the manufacturer to be Müller-Welt who produced such lenses by hand in Stuttgart until 1952. This one has the number 704 marked on the edge. Since the Müller-Welt archive was lost during a bombing raid, the total period of production can only be guessed.

Dr. Hans-Walter Roth The ophthalmologist Dr. Hans-Walter Roth from Ulm is the long-time Chairman of the Editorial Advisory Board of DER AUGENSPIEGEL and author of numerous articles on ophthalmology and contact lenses. He is planning to set up a technical museum, among other things to display his own extensive collection on the “history of the eye and seeing”. Already in the past, exhibits have been shown from time to time at exhibitions, such as on the occasion of the jubilee celebrations of the Ulm University and at the ECLSO Congress in Ulm. He is Director of the Institut für wissenschaftliche Kontaktoptik in Ulm, Germany.

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36_Roth.indd 37 !AZ.indd 9

11.03.15 13.02.15 15:57 12:21

REPORT Education

The GP Lens Institute 2015 The GP Lens Institute (GPLI) is the educational division of the Contact Lens Manufacturers Association (CLMA). The GPLI is dedicated to providing practitioners and students with a comprehensive array of resources and programs – most of which are online at www.gpli.info – to enable them to become more knowledgeable and proficient with the fitting and follow-up care of both GP and custom specialty soft contact lenses.

By Dr. Ed Bennett

The GPLI was founded in 1985 when a small, independent

who regularly provide input – and often contribute content

group of practitioners and industry representatives met to

– to GPLI programs and resources.

discuss the need for GP lens education. From a modest beginning the GPLI has grown to become a focal point for worldwide specialty contact lens education. The GPLI-team

Most of the GPLI resources are available online under

includes Dr. Ed Bennett, who has served as Executive Director

“Education: Lens Types”. A large number of different resources,

since 1988, Jan Svochak, President of the CLMA, the CLMA

including archived webinars, are provided under each of the

Board of Directors, Daren Nygren, Chair of the CLMA GP

following seven topics:

Committee, Pam Witham, Administrative Director of the

• spherical GP lenses • bitoric/high astigmatism • corneal reshaping • scleral lenses • keratoconus/post-surgical • presbyopia/multifocals • soft specialty senses

CLMA, webmaster Ron Walker of Access Media Group and Publisher of allaboutvision.com, and Wink Productions (i.e., Sue Connelly Schnell and Ursula Lotzkat), who are responsible for producing many of the GPLI educational programs. In addition, the lifeblood of the GPLI is the GPLI Advisory Board, a group of 74 outstanding contact lens specialists 38

38_GPLI.indd 38

GPLI PROGRAMS AND RESOURCES

GlobalCONTACT 1-15

11.03.15 15:58

Education REPORT

For example, for more basic tools,

HOW ABOUT THE CONSUMER?

there are several resources in the

There are several resources for the consumer as well. The

“Spherical GP Lenses” category.

“Building Your Practice with GP Bifocals & Multifocals”

“Click N’ Fit” is an interactive

module has a downloadable brochure as well as a reading

empir ical GP f luorescein

card available to consumers. In addition, the consumer

evaluation program with an 18

partner to www.gpli.info, www.contactlenses.org, has a large

lens diagnostic set. Changes in

number of articles, FAQs, and videos – with a GP emphasis

lens design can be viewed, the

– to benefit consumers.

impact of these changes on the fit can be viewed, and information

NEW AND UPCOMING PROGRAMS AND RESOURCES

pertaining to how to optimize the

The GPLI has recently introduced a “Laboratory Consultants

fit will be provided. A 52 case

Q & A” module, which consists of over 20 common questions

Grand Rounds Troubleshooting

asked to laboratory consultants and multiple responses to each

Guide provides unique concise

question. As no one knows a given design/material better than

cases in all areas of GP lenses (i.e.,

those who manufacture it and troubleshoot cases for a living,

spher ica l, tor ic, mu lt i fo ca l,

this is an important resource. The new “Coding and Billing”

keratoconus, post-surgical, and

module, under the direction of Dr. Clarke Newman, is a

c o r n e a l r e sh a pi ng). Seve r a l

valuable resource for those responsible for obtaining

ca lculators a re ava i lable for

reimbursement for specialty lenses. A new webinar, serving

determining empirical lens design

as a primer for anyone interested in GP spherical, corneal

parameters for both spherical

reshapi ng, bitor ic, a nd mult i foca l lens f it t i ng a nd

designs (i.e., the “GPLI Toric and

troubleshooting, has recently been introduced. Entitled: “GP

Spherical Lens Calculator”) and

Contact Lens Case Grand Rounds”, it includes cases pertaining

tor ic lens desig ns ( b ot h t he

to each of these areas and their management.

Mandell-Moore Guide and the

The GP Lens Institute, although based in the United States,

GPLI Toric and Spherical Lens Calculator). In addition, a

has made efforts, via having some resources translated, others

video program, entitled: “GP Fitting, Evaluation, and

made available to the World Council of Optometry, and via

Troubleshooting” provides videos on how to evaluate GP

support of Optometry Giving Sight, to be a valuable

lenses as well as common problems and their resolution.

international resource for GP and custom soft lens education.

The presbyopia/multifocals category includes a 17 component

Ideas for new programs and resources are always welcome

module entitled: “Building Your Practice with GP Bifocals &

and can be emailed to me at ebennett@umsl.edu. n

Multifocals”. This includes powerpoints and video programs that provide valuable information for practitioners on patient selection, communicating the options, lens design and fitting, and a dynamic fee calculator, which can be used for other contact lens designs as well. In addition, for staff there is a handling patient telephone inquiries, scripts to answer patient questions, a presenting options card, a glossary of terminology, and GP lens application and removal videos.

WEBINARS The GPLI hosts a monthly educational webinar provided by a renowned expert in the topic to be presented. Popular seminars have pertained to scleral lenses, multifocal fitting and evaluation, specialty soft lenses, corneal reshaping, toric GP lenses, and specialty lens care. Numerous opportunities are provided throughout the webinar for attendees to ask questions. If the time is not convenient to view the webinar all webinars are archived on the website to allowing viewing at one’s convenience. In fact over 35 webinars have been archived with numerous presentations pertaining to topics of most interest to practitioners.

GlobalCONTACT 1-15

38_GPLI.indd 39

Edward S. Bennett, O.D., M.S.Ed. received his Doctor of Optometry (O.D.) degree from the Indiana University School of Optometry and his M.S.Ed. degree in Educational Psychology from the Indiana University School of Education.

Dr. Bennett is currently Professor and Assistant Dean for Student Services and Alumni Relations at the University of Missouri-St. Louis College of Optometry. Dr. Bennett is currently Executive Director of the Gas Permeable (GP) Lens Institute, the educational division of the Contact Lens Manufacturers Association (CLMA) and is past Chair of the Association of Optometric Contact Lens Educators (AOCLE). He currently serves as Secretary of the Contact Lens and Cornea Section Council of the American Optometric Association(AOA). He is also the past President of the MD-OD Contact Lens Foundation of St. Louis. He is a Diplomate and is a past Chair for the Cornea, Contact Lens and Refractive Technologies Section of the American Academy of Optometry and is also a Fellow in the Scleral Lens Education Society.

39

11.03.15 15:58

COLUMN

Fig. 1

How we communicate with figures Communication with words is not always easy. And when figures become a part of it, it might even be more complicated.

By Wim Aalbers A few years ago, a very rich lady decided to build a house in

in Seattle told me it was 1,332 miles to Denver to meet

Palm Beach in the US. House is maybe not the correct description

Al Vaske, it turned out to be way over two thousand kilometers

for the palace she had in mind. Anyway, she hired a local

and not two…

constructor who was used to sometimes the strange wishes of

To make it all more confusing, there is a third way the “.” is

his Palm Beach clientele. She also hired a fashionable modern

used. In scientific circles “9.615” would be 9 times 615 = 5535

French architect who exactly understood the special requirements

(in the US 5.535, in Europe 5,535).

of rich ladies in Palm Beach.

But even that is not all…

The drawing came and the lady was very enthusiastic and accepted

In the UK there is a third notation system. Instead of the US

the final design from the French architect. The constructor started

notation 9.615, they still sometimes use “·”, a dot, placed a bit

building expeditiously and all went prosperous. Until they started

higher than the regular dot. Mathematicians all over the world

building the front door. The parameters of that door, according

might be tricked and read 9·615 as 5535. (I left out the “.” or “,”

to the drawing, had to be 25 feet high and 16 feet wide… The

to avoid any further confusion, if that is not the case already…).

French architect indeed clearly defined the door size as: 300 X 192. But he forgot to communicate about what standard to be used: centimeters or inches. Disturbed communication by different standards (figure 1).

SOME RESEARCH MADE IT CLEAR WHERE ALL THIS CONFUSION COMES FROM We learn that several scientists in the past have been working on a system that could be used universally. Simon Stevin was

BUT EVEN ONLY NUMBERS CAN CAUSE DRAMATIC MISCOMMUNICATION

40

40_Wim.indd 40

one of the first in 1585. I will not explain his system because it was even more complicated than all the three systems together

When a European tells an American that he easily can do 100

we have now. (It had to do with circles around the figures,

meters in 9.615 seconds, the American might be very impressed

indication tenths, hundreds and so on).

because in his perception only Yohan Blake, Tyson Gay and

In his book Rabdology (figure 2), John Napier introduced in

Usain Bolt were faster at that distance.

1617 the dot to indicate that after that dot decimal figures were

What the European joker actually is saying that he did the

expected. In the same book however, he used the comma as

100 meters in 1 hour, 20 minutes and 15 seconds. That is

well, so confusion about the subject was born.

what 9.615 means in Europe: nine thousand, six hundred

In the 18th century, Gottfried Leibnitz proposed to use the

and fifteen seconds.

higher place dot (“·”) as multiplication sign. Then all over

The 9.615 in America would be noted as 9,615 in Europe.

Europe it was decided that the comma was used in decimal

When running in Europe seems to be easier, distances in the

figures. Except in Britain (of course…). They decided to use

US are much longer than Europeans expect. When Erik Larsen

the “X” in multiplication and the “·” in decimal figures.

O

I

•

•

•

GlobalCONTACT 1-15

12.03.15 16:28

!AZ.ind Tri_Anz

COLUMN

Fig. 2: Page of the book Rabdology by John Napier

Fig. 3: Wine party, but where?

For unknown reasons the Americans chose for the comma

CONCLUSION • If there is a party, go to Europe. Preferably to Rome where

instead of the European decimal dot.

And to make things worse, at a certain point in time, the English decided to replace the “X” for “.”.

you will lose track of how much you have been drinking after the first two liters anyway.

I will give you an example how all this could cause tremendous

• Athletics in Europe is more relaxed than in the US since

misunderstandings. Let’s analyze the volume of the wine served

you can take a few hours to reach the same result as Usain

at that party as our example (figure 3). In a press release it was

Bolt when he run his record.

mentioned that at this party 4.546 liters of wine were served.

Europeans get the impression that far over four thousand liters of wine were consumed. Americans however believe

• The distance from Seattle to Denver is much longer than Europeans expect.

• And the English… well, the English… n

only a bit over four and a half liter was used, which is 1,2 US gallon (in the US notation). The British however are convinced that 2184 liters were used, which is exactly one Imperial Gallon.

Wim Aalbers was Executive Director of EFCLIN until 2011.

He wrote the columns "Something Else" since 1992. Active in the industry since 1972. He wrote for GlobalCONTACT since it was founded in 1992.

And finally the Romans, they used MMMMDXLVI liters at the same party...

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Prof. Patrick J. Caroline, Clinical Consultant in the areas of Contact Lens Research and New

OptiSpheric IOL PRO 2 ®

IOL Testing Fast and Automated

Product Development.for Contamac.

He serves as an Associate Professor at Pacific University College of Optometry and Assistant Professor of Ophthalmology at the Oregon Health & Sciences University in Portland, Oregon.

He team teaches the contact lens curriculum.

He is a Fellow member and Diplomat of the

• Production instrument for simple and fast testing of IOL batches • IOL measurement in air or in situ according to ISO 11979 standard • Measurement of all types of IOLs: including multifocal, diffractive, trifocal and toric lenses

40_Wim.indd !AZ.indd 7 41 Tri_Anzeige_OptiSpheric_210x99_RZ.indd 1

Cornea and Contac t Lens Sec tion of the • Measurement parameters: Academy of Optometry. He is a Council member of the International power, add power,American cylinder, Society for Contact Lens Research as well as a member of the International MTF, toric marks, radius of Association of Contact Lens Educators and the American Association of curvature, throughOptometric focus Educators. For the past fifteen years Prof. Caroline has served as a contributing editor for the Contact Lens Spectrum and is on the editorial scans, energy distribution board for Contact Lens and Anterior Eye Journal. He is an internationally recognized lecturer and researcher on contact lenses.

www.trioptics.com

12.03.15 11.02.15 16:28 12:35 05.02.15 16:25

COLUMN

Alcohol, Sewer, Statistics – Presbyopes: do I have your attention?

By Eef van der Worp

Statistics: a fantastic subject. If you like it, that is. It can also

a given population. Back to our first example: the age at which

be pretty frustrating and confusing. Let me share some statistics

most people died in 1860 wasn’t 37, but 73 years of age. The

with you from my hometown and country. In 1860, the mean

difference can be explained by the high rate of infant mortality

life expectancy in the Netherlands was extremely low at 37

at the time. Today, the average life expectancy in the Netherlands

years. Not because the Dutch drink so much alcohol. Well, that

is 78 years of age, while the age at which there’s the highest

too actually (remember, the Dutch invented gin!). But there is

frequency of becoming deceased is 85 years of age.

another explanation. In today’s thinking, 37 years of age is extremely young. Maybe not for a 16-year-old, but to me it is,

Another example of the essence of good statistics is the

and also for the optical profession as a whole: where were the

Amsterdam sewer system. Up and well into the 1900s, faeces

presbyopes in 1860? It would be quite a drain for the optical

in Amsterdam were dumped into our famous canals. The smell

industry today if all presbyopes would vanish.

in the city was horrible. Epidemics occurred frequently because of this. With the introduction of statistics, one was able to prove

We love “mean”, or the equivalent “average”. But that is not

a correlation between the hygienic circumstances and the death

always the best statistic. Especially if there are outliers, then

rates in these years. In the second half of the 1900s, technical

mean or average is not always a good measure. For many statistical

and scientific developments helped improve the situation

instruments, the rule is that there has to be a “bell curve”

dramatically, with a huge impact on the general health of the

distribution. That means a normal distribution, with a peak in

citizens of the city.

the middle and increasing flatting at either side of the peak in frequency. The median, on the other hand, is the numerical value

Even if you don’t like statistics: this evidence solves the mystery

separating the higher half of a data sample from the lower half.

of the “missing” presbyope in the late 1800s. Surely, there are

In other words, 50% of the values are below the median and 50%

enough of them around today. All we need is some good

of the values are above the median. If we don’t see the “bell

multifocal contact lenses for them, as many of them would like

curve” distribution (or maybe a beer-belly curve in the Dutch

to see without reading glasses. Oh wait, we already have them:

case), then the “median” may be a better metric: here 50% of the

RGP multifocal lenses! Simply offering and trying them would

distribution is under this value, and 50% above that. A good

do. But let’s not forget the importance of lens care, and to wash

example is income: typically the average income is higher than

our hands. The relationship between hygiene and infections is

the median income value. A few super-rich “spoil” the data here.

– indeed – statistically significantly proven. n

Back to the presbyope: here the median is not all that helpful either, actually. In this case, the “mode” may be the statistic of choice. This is the distribution that is seen most frequently in 42

42_EefColumn.indd 42

www.basisinkomen.nl www.wikipedia.nl www.onsamsterdam.nl GlobalCONTACT 1-15

11.03.15 16:02

CONFERENCES & TRADE FAIRS 2015

CLSS

March 14 - 15 2015

Billund, Denmark

World Cornea Congress

April 15 - 17 2015

San Diego, USA

AOMC

April 16 - 19 2015

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EFCLIN Meeting

May 7 - 9 2015

Venice, Italy

EAOO

May 14 - 17 2015

Budapest, Hungary

Freiburger KL Tage

May 16 - 17 2015

Freiburg, Germany

IACLE

May 24 - 28 2015

Manchester, United Kingdom

BCLA

May 29 - 31 2015

Liverpool, United Kingdom

EurOK

July 10 -12 2015

Budapest, Hungary

ISCLS

Aug 29 - Sep 3 2015

St. Gallen, Switzerland

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13.03.15 11.02.15 14:14 13:07

FITTING BACKGROUND Contact Lens Design

A new era in RGP When a revolutionary RGP geometry fits like a soft contat lens When we talk about RGP contact lenses, often many contact lens opticians consider them to be an obsolete fitting solution, due to a recurring issue: discomfort. Discomfort is a specific feeling that occurs when two elements are not well balanced: a good fitting relationship between the contact lens and the cornea, due to an inadequate geometry and an excessive interference between edge and eyelids.

By Marco Tovaglia

44

44_TSLAC.indd 44

A new concept design, that has become a different fitting

The “E-value” is a parameter determined through topography;

philosophy for TSLAC, is “3L” a multi-conical profile that allows

knowing this value, allows using total diameters larger than

obtaining a bio-mechanical respect for the cornea and maximizing

traditional RGP geometries, following the corneal shape in

comfort. Slit lamp observations, in fluoroscopic checks and

both the peripheral and central area, consequently obtaining

topographical analysis at removal, have convinced TSLAC that

an important quality: comfort. Fitting a contact lens design

the revolutionary 3L design could create a new era in the RGP

that covers about 90% of the total corneal surface, reduces

fitting approach. Design and verification are the two main stages

interactions with the eyelids while blinking and gives the

of the practical process that thrill eye care specialists and enhance

overall comfort.

the work of the manufacturer. For this reason, the new RGP 3L

Another successful factor is the particular front surface

design by TSLAC came under research and development. An

shape that minimizes transition areas between the front

optimal adjustment underlines the fact that the new 3L development

optical zone and peripheral curves. This makes blinking

enhances the quality of TSLAC production, making it one of the

effortless and comfortable. The 3L fluoresceinic pattern

leading products of its category (figure 1 + figure 2). The innovation

highlights a mimetic link with the topographical shape, this

introduced with 3L is based on multiple aspects that influence

permits maximum fitting-relationship between the contact

comfort and adjustment; the most important of which is the

lens and the shape of the cornea; for the entire inner surface

multi-aspheric design that ensures compliance with the corneal

the lens and the cornea are perfectly aligned, especially in

profile through an intimate morphologic adaptation.

the landing zone, where e-value changes due to eye GlobalCONTACT 1-15

12.03.15 22:37

!AZ.ind

Contact Lens Design FITTING BACKGROUND

1

2

Fig. 1, Fig. 2: Design and verification are the two main stages of the practical process that thrill eye care specialists and enhance the work of the manufacturer. morphology. The peripheral bevel raises the limbal ring

easier, even to those who stopped using soft contact lenses. In

profile and maintains a suitable proportion with the edge of

fact a 3L experience is so challenging it could become the first

the lens; this allows a high degree of subjective comfort.

choice in a new fitting approach for practitioners and could

Another key aspect to the 3L design is the implementation

re-evaluate RGP lenses as an important opportunity to obtain

of the epithelium and eye thelium and eye health (figure 3).

an excellent visual acuity with maximum comfort and corneal

Clinical trials, conducted by the TSLAC Professional Service

health results. n

during design development, confirmed 3L as a very efficient design and is now considered the company’s main answer to

Marco Tovaglia FBCLA, Professional Service

the needs of contact lens specialist and wearers alike, in the

Manager of TSLAC Italy. Also he has worked for

early stages of the contact lens fitting process. 3L is mainly for regular corneas, but it is also deduced to early keratoconus, with a high comfort success rate. This revolutionary geometry may also be selected in toric back-surface, in front surface and in multifocal. Fitting 3L lenses makes every RGP approach

many important contact lens companies since 1987. At the same time, private Contact Lens Practitioner. TSLAC Contact Lens Project Design Manager. Industry Contact Lens Educator (IACLE).

He’s writing on several important italian optometry and contact lens magazines

Advertisement

!AZ.indd 1 44_TSLAC.indd 45

22.01.15 17:14 12.03.15 22:37

SPOTLIGHTS

IACLE launches agenda for future of global contact lens education

In addition to IACLE members, delegates will attend from

How might augmented reality and wearable technologies be

(AOCLE) and British Universities Committee of Contact Lens

used alongside iPads and e-books in contact lens teaching of

Educators (BUCCLE).

the Association of Optometric Contact Lens Educators

the future? That’s just one of the intriguing questions to be Third IACLE World Congress on Contact Lens Education. The

Do you have a “hot shot” for the 2015 BCLA photo competition?

four-day meeting of the International Association of Contact

The British Contact Lens Association (BCLA) is inviting all

Lens Educators will be hosted by the University of Manchester,

“happy snappers” to now submit their entries online for this

UK from 24th to 28th May 2015.

year’s photographic competition, by the closing date of Friday

The theme for the congress is “Shaping the Future of Contact

24 April. The prestigious BCLA photographic competition

Lens Education”. Delegates will hear experts from a wide range

culminates during the Association’s Clinical Conference and

of backgrounds explore technologies and approaches that can

Exhibition and attracts entries from contact lens practitioners

be applied to contact lens teaching.

across the globe. As well as receiving the accolade of best

Sessions will also be broadcast live online as Web Lectures for

photograph of the year and a great prize, all winning entries

IACLE members around the world to take part.

are subsequently published in the BCLA peer-reviewed journal,

Keynote speakers and topics include:

Contact Lens & Anterior Eye.

Dr Helen Crompton, Assistant Professor of Instructional

Last year’s winner was Antonio Calossi from Italy with his

Technology at Old Dominion University Virginia, USA, who

piggyback contact lens image, and he received a prize kindly

will review the latest and future educational technologies such

d o n a t e d by D av id G o u ld .

as augmented reality, wearable technologies and robotics.

Immediate Past BCLA President,

posed when educators from around the world gather for the

Joe Moretti

Apple Distinguished Educator

Andy Yorke, presented Antonio

Joe Moretti, who will look at

with his winner’s certificate

the iPad as a powerful mobile

during the 38th Clinical Conference

tool for explaining concepts and

and Exhibition in Birmingham.

nurturing understanding, and for

All entries will be showcased on

creating electronic books to

display screens in the exhibition

distribute to students.

hall of the ACC Liverpool, and

The use of Cloud-based note-

the winner will be announced at

t a k ing, blended lea r n ing

2.30pm on Sunday 31 May at the BCLA stand. The winner and

approaches and teaching

runners-up in the 2015 Poster Competition will also be revealed

Antonio Calossi

strategies for evidence-based practice will be among other

at this time.

topics discussed.

BCLA President, Susan Bowers, said: “If you have taken a

Keynote speaker Professor Patrick Caroline of the Pacific

photograph of the anterior eye over the last year that you are

University College of Optometry in Oregon, USA will share

proud of, whether it was taken with a smart phone or a SLR

his expertise in inspiring optometric students and demonstrating

camera, we want you to share it.”

the importance of “life-long learning”.

The 39th BCLA Clinical Conference and Exhibition takes place

The program will also feature a special symposium discussing

at the ACC Liverpool from 29-31 May. Visit the BCLA website,

“How can educators grow contact lens penetration around

www.bcla.org.uk, for full details and to download a copy of

the world?”

the programme.

IACLE Vice President and Congress Chair, Professor Philip Morgan, commented: “This unique Congress will have a focus that’s very different from other contact lens events in that it’s

Contamac announced further

tailored specifically to the needs of educators. We look forward

enhancements to the Professional

to learning about these exciting technologies and their potential

Services Vision Care and Sales

future applications.“

Teams.

Around 100 delegates are expected to attend the Congress,

Dr Jedlicka joins the Contamac

including educators from IACLE’s three global regions: Asia

team bringing nearly 20 years of

Pacific, Americas and Europe/Arica - Middle East. Participation

contact lens fitting and design

for IACLE members will be facilitated by IACLE, thanks to

experience. Having completed a

the generous support of Platinum Sponsors Alcon, CooperVision and Johnson & Johnson Vision Care.

46

46_Spots.indd 46

Contamac: Expanding the team

Dr Jedlicka

Cornea and Contact Lens Residency in 1997, he subsequently was the GlobalCONTACT 1-15

13.03.15 14:06

!AZ.ind

SPOTLIGHTS

Director of Contact Lens Services at the University of Minnesota

and 65 staff members providing

for 11 years, and is currently the Chief of Contact Lens Services

customer service at all levels.

at the Indiana University School of Optometry. He was a founding

Vanessa then expanded her

member of the Scleral Lens Education Society and is the Immediate

international interests living

Past President. He is a fellow of the Contact Lens Society of

abroad for almost 3 years working

America and a diplomate in the Cornea and Contact Lens Section

in the clothing retail and travel

of the American Academy of Optometry. He has been involved

industry. Vanessa has strong

with research and the design of lens materials and solutions for

language skills, speaking fluent

several companies over the last 10 years, and has served as a

Vanessa Ruiz

French, German and English and

consultant to the contact lens industry. He brings a diverse

has developed a good understanding

background covering both the specialty and standard realms of

of customer relationship management, across cultures and markets.

both GP and soft lenses.

Vanessa stated: “I am very excited to be part of the Contamac

On joining Contamac Dr Jedlicka commented, “I am excited

team and will continue to develop my understanding of the

to have this opportunity to join Contamac's Professional Services

industry and the market. I look forward to supporting the

Team. The chance to work with a strong international company

delivery of outstanding customer service which Contamac is

as well as other leaders in the contact lens profession is a rare

proud of and moreover, being part of delivering unique value

opportunity. With an established product line as well as many

added services in support of our customers’ businesses.”

new products about to be released, Contamac is primed to have an increasing impact on contact lens practice around the world.

I feel fortunate to be able to be a part of a team that brings such quality products to contact lens practitioners and their patients”.

Vanessa Ruiz appointed as Sales Executive at Contamac Contamac is also pleased to announce the appointment of Vanessa Ruiz as a new Sales Executive. Having developed a passion for sales and marketing during a Business Administration Degree at the Berufsakademie of Thueringen, Germany, Vanessa decided to pursue an international sales career. She gained a strong sales background working for the grocery chain Lidl in Germany where she was District Manager, responsible for up to 5 stores

Advertisement

46_Spots.indd 47 !AZ.indd 5

13.03.15 04.02.15 14:06 16:37

INDUSTRY NEWS

TRIOPTICS DELIVERS THE FIRST OPTISPHERIC IOL PRO 2 SYSTEMS TRIOPTICS successfully delivered the first OptiSpheric IOL PRO 2 instruments for measurements of IOL lenses. The system is designed for high volume production and is fully automated. It measures up to 100 lenses on one tray. All measurements are carried out in accordance with EN ISO 11979, both in situ and in air, and comply with international standards. In addition, the measured data is stored and processed in accordance with the relevant FDA requirements. OptiSpheric IOL PRO 2 is designed for measurement of all kinds of IOLs, including multifocal, trifocal and aspheric lenses. Toric lenses can even be measured independently of the orientation. Furthermore, there are no restrictions with regard to material or structure. The increasing demand and first deliveries to customers show that a fully automated IOL testing system that complies with DIN ISO 11979 is capable of meeting the quality assurance requirements for IOL lenses that become more and more sophisticated.

Find more information on www.trioptics.com

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Benz Research & Development 6447 Parkland Dr Sarasota, FL 34243 USA Phone: +1 941 758 8256 Fax: +1 941 758 1191 lpomroy@benzrd.com www.benzrd.com

Contact Lens Material

Boston Products Group Bausch + Lomb Luisenstrasse 7 69469 Weinheim Germany Phone: +49 6201 17869 Fax: +49 6201 62184 marcel.kopito@bausch.com www.fit-boston.com

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Contamac LTD Bearwalden Business Park Saffron Walden Essex CB11 4JX United Kingdom Phone: +44 1799 542000 Fax: +44 1799 543000 sales@contamac.co.uk www.contamac.com

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EyeBrid-inside EyeBrid-inside 14 place Gardin 1414000 place Caen Gardin 14000 Caen France France Phone: +33 688 248 855 Phone : +33231 688866 248 855 Fax: +33 686 Fax : +33 231 866 686 www.eyebrid-inside.com info@eyebrid-inside.com info@eyebrid-inside.com www.eyebrid-inside.com

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12.03.15 16:28

YELLOW PAGES

K & Y Diamond Ltd. 2645 Diab Street Ville St. Laurent Quebec, H4S 1E7 Canada Phone: +1 514 3335 606 Fax: +1 514 3395 493

LAMBDA-X S.A. Rue de l'Industrie 37 B-1400 Nivelles Belgium

Larsen Equipment Design 1117 N.W. 52nd Street Seattle, WA 98107 USA

Phone: +32 67 79 40 80 Fax: +32 67 55 27 91

Phone: +1 206 789 5121 Fax: +1 206 789 7756

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35

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Phone: +49 9131 691500 Fax: +49 9131 691511

Phone: +44 1684 892859 Fax: +44 1684 893037

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sales@optocraft.de www.optocraft.de

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48_YellowIndu.indd 49

Media Service 49

12.03.15 16:28

NEXT TIME 2015_02

MASTHEAD

EFCLIN CONGRESS & EXHIBITION From 7 to 9 May, EFCLIN members will meet for their 42nd Annual Congress & Exhibition in Venice, Italy. The exhibition will showcase the latest machiner y, tools, mater ials, instruments, software, accessories, consumables and other products relevant to the manufacture of contact lenses and intra ocular lenses (IOLs).

Read more in the upcoming issue!

GLOBAL CONTACT The Website and the Magazine: The complete communication system for the contact lens industry. The magazine, 2,500 copies, is distributed to contact lens laboratories, wholesalers and other organizations active in the contact lens and IOL industry.

The website, www.global-cl.com is free for all industry related professionals PUBLISHERS ADDRESS MediaWelt GmbH Papiermühlenweg 74, D-40882 Ratingen Tel.: +49-2102-1678-0 Fax: +49-2102-1678-28 Website: www.global-cl.com E-mail: info@global-cl.com

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CEO AND PUBLISHER Jörg Spangemacher (SPA) E-mail: j.spangemacher@mediawelt-services.de EDITOR-IN-CHIEF Dipl.-Ing (FH) Silke Sage E-mail: s.sage@mediawelt-services.de

MediaWelt Services Verlag für Optometrie Ophthalmo Verlag China FOCUS Publishers Beijing - Hong Kong - Xi'An

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Members of

EDITOR Jörg Spangemacher E-mail: j.spangemacher@mediawelt-services.de USA CORRESPONDENT FOR CONTACT LENSES Tom Baugh E-mail: tkbaugh@hotmail.com

THE HIGH ART OF LOGISTICS – VISIT TO COOPER VISION IN LIÈGE To find out about how a contact lens order is processed by a major supplier, in August 2014 GlobalCONTACT met with Volker Lindner, CEO of Cooper Vision, Germany, and Michele Bosa, Logistics Director for Europe, in Liège, Belgium.

THEFT BY STAFF: PREVENTIVE MEASURES We don’t like to talk about theft by our own staff; after all there are other industries where the problem is far more acute. But in our industry there is obviously a temptation for certain employees to enrich themselves. Since we are only talking about a few Euros in each cases, it is hardly worth going to great lengths to control the problem. In the end it is a matter of trust and the boss cannot imagine having "thieves" among his own employees. The perpetrators do not think of it as "stealing" but rather as "helping themselves" because it is not about very much. The taking of items of low-value is not considered serious by the offenders, not least because they are usually unaware of the consequences if they get caught.

IN ADDITION • Meeting on site with Erik Larsen – a visit to Accu Lens, Lakewood, CO • Manufacturers’ Forum The information above may be subject to change.

50

50_50_ClosingWords.indd 50

TRANSLATIONS John Saniter, Bopfingen, Germany EDITORIAL BOARD Wim Aalbers, Dr. Thomas Baugh, Dr. Patrick Benz, Erik Larsen, Eef van der Worp PRODUCTION & LAYOUT Efstathios Efthimiadis E-mail: litho@mediawelt-services.de Data Transfer: +49-2102-1678-240 DISTRIBUTION PressUp GmbH, Postbox 70 13 11, D-22013 Hamburg Tel.: +49-40-41448460, Fax: +49-40-41448499 MEDIA CONSULTANT Constanze Classen Tel.: +49-2102-1678-26 Fax: +49-2102-1678-28 E-mail: constanze.classen@mediawelt-services.de ADVERTISING AGENT GREAT CHINA Beijing FOCUS Optics Culture Commnication Co. Ltd. Room 319, Building 2, Nr. 1, Northbank 1292, Nr. 15 Jianguo Eastroad, Beijing 100024 (Chaoyang), P.R. China Mrs. Jian Wang Tel.: +86-10-8537-6529 Email: jennywang_focus@126.com Skype: jennywang611 焦点视光（北京）文化传播有限公司 北京市朝阳区建国东路15号院甲一号北岸1292 二号楼319室 邮编：100024 电话：+86-10-8060 2704 电邮：jennywang_focus@126.com ADVERTISEMENT RATES Price list No. 6, valid from January 01, 2014 Publication Schedule 3 issues 2014: March, August, October SUBSCRIPTION COSTS PER YEAR European Union 80,00 € (plus VAT for German companies), Overseas Seamail 90,00 €, Overseas Airmail 110,00 €, United States Seamail 95,00 €, United States Airmail 125,00 €, Single issue 20,00 € (plus mailing costs) The Publisher requires three months written notice on cancellation. Subscribers please note that proof of notice may be required.

BANK DETAILS Bank account: Commerzbank AG Bank No.: 300 800 00 Acc. No.: 0303 108 100 IBAN: DE 72 30080000 0303108100 SWIFT: DRES DE FF 300 PRODUCTION & PRINT Stürtz GmbH, Alfred-Nobel-Str. 33, D-97080 Würzburg The publisher takes no responsibility for unsolicited manuscripts. Please note also that photographs submitted for use in GlobalCONTACT cannot be returned. The publisher's written permission is required for any reproduction, translation or recording of material published in GlobalCONTACT, including extracts of such material. Permission will normally be given, subject to the usual acknowledgement. Copies made of published items must be limited in number and for personal use only.

PHOTO CREDITS P.10: istockphoto.com/procurator • P.16: shutterstock.com/Juergen Priewe • P.20: shutterstock.com/Centurion Studio • P.26: Silke Sage • P.30: shutterstock.com/Churikov Eduard • P.32: shutterstock.com/ARZTSAMUI • P.34: shutterstock.com/VetrovaMaria • P.38: shutterstock.com/baranq • P.38: shutterstock.com/Dennis van de Water • P.50: shutterstock.com/leoks • P.50: istockphoto.com/chestnutphoto •

GlobalCONTACT 1-15

13.03.15 14:49

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OPHTHALMIC LABS & INDUSTRY

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More than 32 years of experience in publishing in the field of Ophthalmology and Optometry.

Committed to your success.

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