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The article presents a scenario by which a 25-year old right-handed male patient, who has been presented for a routine eye care, desiring contact lenses. The patient accordingly disclosed that he had been told he had a problem with his pupils and has been experiencing muscular parenthesis, which he described as jumping and twitching in his right hand fingers. Pupillary anomalies are said to be challenging due to its underlying cause that can range from benign conditions to potentially life-threatening disorders. It is further stated that patients with any pupillary abnormality, even without associated neurological symptoms, need to be further evaluated.

Background: Refractive errors are the commonest cause of vision impairment in Pakistan, but control efforts are hampered by a paucity of data for planning. To address these information gaps, a study design was developed to look at both the demand and supply sides. The objectives were to review the available human resources, determine the methods of provision of refractive services, determine the level and gaps in infrastructure available for refractive services, estimate the number of refractions provided and identify the training needs for these services. Methods: Stakeholder consultation between the National Steering Committee for Prevention of Blindness and the Pakistan Association of Opticians, to agree on objectives and method, desk research study, two population-based studies and situation analysis of refractive services provided by public and private sectors. Results: The prevalence of visually disabling refractive errors (visual acuity less than 6/12) is about 3.7% and rises with each decade after 30 years, mostly due to presbyopia. Over 6 million refractions are done annually by 868 ophthalmologists in the private sector, 235 hospitals, 1352 of the 2049 opticians and less than 200 optometrists. More than 2 million pairs of spectacles are dispensed per year. The training needs identified by opticians include optometry, refraction and contact lenses (65%), fitting of lenses and "edging" (57%), powering of lenses (45%), low vision (38%) and artificial eyes (35%). Conclusions: One of the strategies to control refractive errors is training and widespread deployment of optometrists/refractionists in public and private sectors. The current training programs cannot address the need; new programs must be set up, and existing programs must increase their intake. New programs are required for training dispensing opticians. [ABSTRACT FROM AUTHOR]

The article discusses issues related to wearing of contact lenses, including possible secondary complications. The author points out that one of the most common issues facing wearers is epithelial erosion, which results from abrasions caused by a break in the epithelial layer involving superficial cells. Another is the occurrence of acanthamoeba infection in wearers, which presents in either motile trophozites and non-motile cysts. Other concerns include conjunctival damage, lens deposits and dimple veiling.

The article examines the research which reveals that a piggyback contact lens fits for a keratoconus eye patient in Canada. It says that the piggyback system of fitting contact lenses has gained more popularity over the past few years. It consists of a rigid gas permeable (RGP) lens placed on top of a soft contact lens. Meanwhile, it elaborates several categories of patients who benefit from the piggyback system which includes those patients who are experiencing discomfort with their RGP contact lenses, patients with poor RGP centration, and patients who experience corneal compromise from contact lenses. It also offers information on which contact lenses to choose and discusses the aspects of fitting assessment.

The article reports on the approval on the usage of topical prostaglandins by the Food and Drug Administration (FDA) in Canada. It informs that the topical prostaglandin, manufactured by California-based Allergan Inc., is used for the growth and fullness of eyelash. It also mentions that FDA has previously ordered other companies to cease manufacturing the same drug due to the side effects such as redness of eyes, irritation, and headaches. In addition, it also offers information on the study conducted by Claes Feinbaum from University of Rostock, Germany related to the disadvantage of soft contact lenses.

The article focuses on the historical facts about contact lenses. It is stated that cosmetic colored contact lenses were used as early as 1950 and became popular in the celebrity world. From that time, the movie stars have utilized contact lenses for special effects, such as Bella Lugosi, for instance, who wore contact lenses for the role of Dracula. The author also emphasizes that the said lenses have been used to create the effect blindness and were removed after the miracle in motion picture roles.

The article highlights the advent of soft contact lenses, which became a globally recognized therapeutic contact lenses for the treatment of a diseased and damaged cornea. It says that in 1970, Herbert Kaufman, professor and chairman of the Department of Ophthalmology at the University of Florida in Gainesville, initiated a program for the development of soft contact lens material to act as a bandage therapeutic lens. At the course of the program, he found out that many diseased and damaged corneas healed best under a soft lens. Prior to such discovery, and with the help of some highly respected ophthalmologists like Antonio Gasset and Hikura Hamano of Japan, it soon became clear that the soft lens was an innovation of major importance with widespread applications.

The article provides several updates related to the eye care industry. According to the article, Eye-care firm, Alcon Inc., has asserted that its fourth-quarter earning rose on higher sales of prescription drugs. In addition, Essilor of America Inc., leading manufacturer of ophthalmic lenses, has announces the availability of its Thin&Lite high-index product. Furthermore, the Canadian Association of Optometrists have also revealed that their Motion M-409 bill was passed unanimously in the Parliament.

The article focuses on multifocal lenses particularly the Varilux which was first introduced to eye care professionals (ECP) in 1959 by the company Essilor. It says that the first Varilux was created in crown glass and was prohibitively expensive because of the type of instrument being used in the lens. It likewise notes that the Varilux has faced several issues in the past because of its changing design that sometimes does not fit to patients. On the other end, every major lens manufacturer like Rodenstock, Zeixx, and Signet Armorlite were in a race to produce a better progressive addition lens (PAL) than Varilux, however, the marketing of Varilux was so extensive and aggressive that for many years, the name Varilux remained synonymous with PAL.

The article highlights the research on the development and use of scleral contact lenses in Ontario. The author stated that the first scleral shell, which has been made from glass has been considered as the first practical contact lense and has been documented as a system for drug delivery to the cornea. In addition, scleral lenses in 1938 has been created in polymethylmethacrylate (PMMA), a more usable, lighter and plastic material to create a mould of the front surface of the eye. Meanwhile, the rigid gas-permeable (RGP) scleral lens developed in 1983 has become an invaluable management tool for several corneal and ocular surface diseases.

The article highlights the research on the importance of understanding the different designs of contact lenses to get the translation to the proper viewing position for the required visual function in Ontario. The author stated that the most popular of the multifocal designs is the simultaneous design, which is available as either an aspheric design or a concentric design. In addition, the aspheric lense is optimized to the eye with the use of wavefront technology. Meanwhile, the gas-permeable lenses, which is available in simultaneous design must get the translation to the proper viewing position for the required visual function.

The article offers a look at articles published in past issues that targeted all four areas of primary eye care such as ophthalmology, optometry, opticianry, and administrative and technical support. The article "Multifocals: Yesterday, Today, and Tomorrow," by Y. Ali Khan introduces members of the eye care team to the wording of the multifocal lens system and potential problems encountered when imperfections occur. An article by Jil Beardmore et al focused on the new advanced lens processing system and another by Mark Dunbar presents updates on ocular coherence tomography (OCT) in retina and glaucoma.