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3-D is not just hype. It can help you diagnose binocular vision disorders and build   your practice. You can even help p a...
Make 3-0 Pop Up in Your Prce                                                                    understa nding vbjch ~tate...
Vt~~~W~O                                                                                                               BOO...
In order to assist you in getting                            ing binocular vision simply wont                         any ...
Pha e of Optometric Vision Th rapy                                                            associated dysfunction noted...
4. Almont Green. hnp:/lalrnQfilgreen com. Accessed July          14. Lambooija,M. Fortuillii MF, IJ>SIllsteijn W Heyndenc:...
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You can help your patients see 3-D


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This is a recent article I wrote for the Review of Optometry. They haven't made this available online just yet even though the hard copy just arrived in my box. So I thought I'd share it with you. If you attended by lecture at the American Academy of Optometry or are going to attend my lecture at the Vision Institute of Canada, this paper is a valuable adjuct to my presentation.

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You can help your patients see 3-D

  1. 1. 3-D is not just hype. It can help you diagnose binocular vision disorders and build your practice. You can even help p atients overcome their problem s with 3-D viewing. By Dominick M. Maino, 0.0., M.Ed. W hy is there such Logie Ba ird, while the an incredible 1950s ushered in the interest in 3-D first Golden Age of movies, televi­ commercially success­ sion, video games and the ful and popular 3-D use of 3-D technology in the movies (such as "Bwana classroom? Every time you Devil" and "House of pick up a newspaper, read a Wax"). magazine or a bl og, surf the Thirty years later, Internet or listen to the news, another smaller 3-D you see stories about simulated the most important ques- boom appe.ued which 3-D. Whats aU the hype about? Is tions for the optometrist is: Ca n we was initiated by IivlAX. it rea lly hype or something more improve the actual user of 3-D con­ Unfortunately, there were many important to your patients and tent so that the experience can be difficulties with this method of pro­ your practice? better appreciated, no matter their ducing 3-D viewing because of the Can we improve the entertain­ age or the type of simulated 3-D large size and unusual dimensions ment value of 3-D movies for the content experienced? of the theater screen needed. l movie-going audience? Can we The answer is, of course, yes. As the history of 3-D technol­ make the extra cos t of buying 3-D ogy moved into the present day, televisions worthwhile, even for 3-~ Through the Years "Avatar" (2009) could be noted as those who now have headaches 3-D viewing and its relation bringing the next golden age of 3-D when they watch 3-D program­ to binocular vision is not a new to the masses. In just the past few ming? And, what can we do for phenomenon. Thanks to Charles years weve witnessed a boom in those children wbo cannot appreci­ Wheatstone and his stereoscope (in movies, telev ision, videogames and ate the sense of depth in 3-D video the 1830s) and the soon-to-follow other media depicted in 3-D. games or bene fit from the 3-D stereopticon invented by Oliver It should be no surprise then that classroom educational experience? Wendell Holmes (1862), many the events that soon followed this Can we ensure that they do not could enjoy this new form of 3-D current explosion of interest in 3-D miss out on the fun and improved entertainm ent. should include the Ame rican O pto­ academic learning environment? In more modern times, the first metric Association and an industry When it comes to 3-D viewing stereoscopic 3-D television was group called the 3D@Home Con­ and the patients we serve, one of created in the 1920s by Charles sortium signing a memorandum of54 REVIEW OF OP TOMETRY O,:TOSfH 15 2011
  2. 2. Make 3-0 Pop Up in Your Prce understa nding vbjch ~tated their With the unending attention centered on 3-D movies, 3-D televisions, 3-D video games, intent to hare da ta an d joi nt ly p ro­ and 3-D in the cfassroom, your office should take advantage of the educational and mar­ mote vision healrh urili.7i n~ tereo­ keting possibilities. Your existing and potential patients are aware of many of the issues scopic 3-D d isplays.2 Borb [he AOA surrounding simulated 3-D viewing, but have you made them knowledgeable about the an d 3D@Home ha ve joined forces services you offer so that they can enjoy the digital dazzle associated with this new tech­ by collaborating o n a new enrure: nology? 3deyehealrh.oq;. Heres how: • Offer a seminar about 3-D in your office. Use this article or other resources to Creating 3-~ help tell your patients how simulated 3-D is produced and why some individuals have As every optometrist kn ws, the problems associated with 3-D Vision Syndrome. Use prism to make individuals in the audi­ creation of simu lated 3-D conte nt ence diplopic. Use the Brock string to see how many in the audience have binocular vision requires the input of one image into dysfunctions-l did this at the 2011 Consumer Electronics Show and the response was the right eye and 3.nother si milar astounding! [Watch the video at httn:llmamosmemos.blogspolcoml2011J04/dr-domiOlck­ but laterally disp laced image into maino-at·consumer.html.j the other eye. W hen rJ1e brain • Set up a Google Alert search on 3-D. Find all the media topics and post links on your receives the two images, fUSion office webpage. Also post these links with commentary on your blog, Facebook page and occurs and a sense of depth is cre­ Linkedln page. ated. Whcn optomctric visiun • Let your patients know you can diagnose and treat or refer for treatment those thera py i ~ uscd to trcat those with with 3-D Vision Syndrome. binocul a r vis io n dysfuncti n, thi ~ i • Obtain copies of "3-D in the Classroom See Well, typically done by havi ng the patient Learn Well" from the AOA and send it to the schools in wear anaglyph (red/green or rcd/ your area with compliments from your office. Put links on blue) gbsses, p( la roid glasses, or your office web page and social media sites to this document by synchronIzing the timing of thc and send email toalltheteachers.principals. school admin­ image to be received by eac h eye in istrators and parents you know. (Go to for such a way sO that only one cye secs more information.) an image a t any me timc. T his is • Display 3-D art, movie posters and photographs in also true for m ost of the 3-D con­ your office. (See the astounding work of Almont Green at tent our patients view commercially. He creates great 3-D photographic art. There are several ty pes of glasses There are also 3-D movie posters available from www.all­ that consumers can I I e to expe­!·sV3-0-Movie-Posters c118624 .hlm, while rience simulated 3- ~. T hey arc vintage 3·D movie posters can be found at www.3dstereo. catego rized as pa s ivc polarized or comlviewmaster/3dposters.html.) activ sh uttcr. ( 1 here is als() a yvay • Offer 3-D glasses with your patients prescrip­ to create 3-D withou t t be nt ed for tion in them. Samsung displayed a number of active shutter prescription ready glasses at glasse , s uch as w ith the Nimendo the 2011 Consumer Electronics 3-DS or the photograp hic art o f Show. Other manufacturers offer Al mo nt G reen, but I ll limit the dis­ prescription-ready glasses as cussion to the passive polarized and well (such as those by Marchon, active shu tter gla se .3-4) which now offers Marchon 3-D Passive po larized glasse are glasses and even 3-D clip-ons, either linearl y or cir ularly p o lar­ www.marchon.comIM3D. and ized . Linear p ,I ri zed -D t>la . e G unnar Optiks, www.gunoars. w ork with th e older Stereo p roj ec­ com!shoolPremium"30-EyeweaO. Gunnar Opliks Anime 3-D glasses tors, Stereo Jet prints, and m ode rn Remember that 3-D TV glasses projecto r systems wi th li near p olar­ only work with specified televisions. Make sure you mention this to your patients so they izers. If Y OLl use li near polarized know that a new pair of glasses may be necessary if they buy a different TV. gLasses, yo u ca nno t turn or til t your • Make your own 3-D art and photographs and display them in your office head witho m 10 ing the 3-D effect. (www.3d-lmage.netl. Cir cular polarized glasses a ll ow you more leeway in terms o f head56 REVI EW OF OPTOMETRY OCfOSEI1 15 ,2011
  3. 3. Vt~~~W~O BOOTH 1519 IN BOSTON, MA I Hightech U.S. manufacturingposition and are the glasses most often used in movietheaters. Active shutter glasses work when voltage is applied Mark your calendar to one of the lenses, which makes it turn dark whilethe other lens remains clear and vice versa. This quickalternation of the image is synched with the screen for year-end savings.showing the 3-D content being viewed by each eye at M HAl Labs your one-stop shop for specular and akea slight lateral disparity, which creates the 3-D effect. sMost 3-D movies use various polarizing techniques, digital anterior segment slit lamp imaging at thewhile 3-D TVs favor active shutter methodologies. Academy of O ptometry, October 12-15. The most frequently used technologies for 3-Dentertainment in theaters are those produced byIMAX 3D, RealD 3D, Dolby 3D and XpanD 3-D. HAl SL-SOOOWhen lMAX first started showing 3-D, it used active The full-featured HAl Sl-5000 slit lamp comes standard with shutter glasses, but it now uses linear polarization.RealD 3D uses circularly polarized glasses, which our digital kit for high-resolution anterio s r egment videos and reduces problems when viewers tilt their heads. Dolby photos. Get the complete system with ~3D, however, uses a special color wheel attached to our HAl PC and robust imaging software .the projector. This color wheel splits the wavelengths starting from $13,800. used by the left and the right eyes. The glasses usedfor Dolby 3D have very accurate color filters (dichroicor interference filters) that send the appropriate wave­lengths of light into the eyes of each movie patron. NEW! HAl MOT-X60 Lastly, XpanD 3-D uses active shutter glasses that are Add on our ADA standards-compliant synchronized with the projector using infrared signals. wheelchair-accessible power stand to any Diagnosing 3-D Vision Syndrome (3DVS) system package for only $500. Although the technology to produce 3-D viewingis constantly being improved, not everyone is able toexperience and enjoy simulated 3-D because of visionproblems tl1at cause headaches, nausea, diplopia andother symptoms. This is not only true for children butalso for adults. 6 According to the American Optometric Associa­tions 2011 American Eye-Q survey, parents areconcerned about the possible detrimental effects of3-D viewing. Fifty-three percent of respondents withchildren 18 or younger believe that 3-D, vievving isharmful to a childs vision. 7 However, the AOA andseveral other organizations note that there is currentlyno research to support the belief that 3-D viewing isharmful to a childs vision. What the primary care optometrist needs to do isimprove the patients binocular vision skiLls. This willcreate a better 3-D viewing audience that can partici­pate in an enhanced and symptom free 3-D experi­ence. The first step to making this happen is to useall the resources available to you to get the word outabout how optometry can help make the 3-D viewingexperience more enjoyable. This will enable you toreach those patients most in need.
  4. 4. In order to assist you in getting ing binocular vision simply wont any binocular vision problems pres­ the word o ut abou t what optom­ see 3-D. Whil e this doesnt pose ent to determine if your patient has etry can do to improve the 3-D any problem viewing the screen, 3-D vision syndrome (see "Diag­ viewing experience, the AOA, it certainly significantly detracts nosing 3-D Vision Syndrorne," 3D@Home Co nso rtium a nd 3deye­ from the enj oyment most experi­ beloW).9-1r 3-D vision syndrome health. o rg havE come together to let ence while viewing 3-D content and (3DYS) is comprised of a group of the public know about "The 3Ds of ma kes spending the extra money sym ptoms that collectively indicate 3-D Yi ewi ng": for the 3-D experience worthless. the presence of a functiona l vision • Disco mfort: Beca use 3-D view­ This can, however, serve as a pub­ disorder which adversely affects the ing is based on the eyes converging lic hea lth " vision screening" that enjoyment level of watching 3-D in front of or beyond the screen, something is abnormal with the content. 3DVS symptoms include, viewing 3-D images can potentiall y viewers vision. but a re not limited to as thenopia , create eyestrain and headaches. Although not sta ted directly, the headaches, blurred vision, eye­ strain, diplopia, dizziness/nausea Diagnosing 3~D Vision Syndrome and vision-induced motion sickness During the following elements of the examination, consider these factors if you suspect 3-D after watching a 3-D movie, view­ vision syndrome. ing 3-D television programming, • Case history: Always ask if your patient has seen a 3-D movie and experienced participating in a 3-D classroom asthenopia, headaches, blurred vision, eyestrain, diplopia, dizziness/nausea and/or vision­ educational activity or after pla ying induced motion sickness. If they have never seen a 3-D movie, ask why not. The answer a 3-D video ga me. 1 2 may also suggest vision problems are present. While weve known for som e • Visual acuity: If accommodation is affected, visual acuity may vary. Any amblyopia time that 3-D viewing can cause will disrupt 3-D viewing. vision problems to manifest, • Entrance tests: Stereopsis is usually reduced and suppression can occur. research is only now beginning • Oculomotor assessment: Cover test, near point of convergence, Hirschberg, Angle to determine which functio nal or Kappa and Bruckner tests all can indicate a binocular vision problem. group of functional vision disorders • Refractive error. The objective (retinoscopy) and subjective assessment of refractive are involved in causing the 3 DYS­ error can give variable results. The patient may not be able to give a clear, unambiguous associated symptoms. IJ- 1 One or 5 end point during the manifest subjective assessment procedure. more papers suggest that the symp­ • PhoriaNergence: Both distance and near heterophoria findings, as well as positive toms produced are ca used by:1 6 1 S and the negative fusional vergence tests, can indicate the presence of afusional vergence • Excessive demands placed upon anomaly. the linkage of accommoda tion-con­ • Accommodation: Negative and relative accommodation, accommodative facility find­ vergence by viewing fast-moving ings and the monocular estimation method (MEM dynamic retinoscopy), will give high or 3-D images . low, inconsistent or variable results. • Spatial and temporal incon ­ • Ocular health: Eye health will usually be unremarkable. sistencies created by 3-D artifacts from insufficient depth information. For iolonnatWn on how 1 perform ttlestl l~ts. see 0 • 3chl.m D. Maino D. Clm ical beH lal objectives: dSsessmenttechniques for special popufalions In Maino D(ed). ge avl • Blur. Diagnosis and M m 01SpeclJI PopulatiO SI. Louis MO Mosby-Yearbook, Inc . 1995:15Hl8. antlg ent nS. A more recent stud y no tes that • ~Il!liman M W B. Clinical Manage;nenl of Binocular ViS : Heterophoric, AccommodaliV1), and E Movement ick ion ye Discrdw P II.delphi.: Lippincott: 2008. O conflicts in motor responses drive • Pang Y. Gabriel H, Frantz KA. Saeed F. Aprospective study of dilferentlesllargels for the r.ear painl of convergence visual discomfort a nd fatigue OphllJ.]lmiC Physiol Op! 2010 May;30(3)298-303 because, if the visual system does not a ttempt to make a motor • Dizziness: 3-D techno logy ca n fourth D of 3-D viewi ng shou ld be: response when a vergence-accom­ exaggerate visual motion hypersen­ If you do not appreciate 3-D or you modation con£lict is present, no sitivity (YMH) or vision-induced experience asthenopia while watch­ discomfort occurs. 1 This is an 9 moti on sickness which can cause ing 3-D content, you should imme­ interesting finding because at least individuals to feel dizzy o r nau­ diately make an appointment with one other paper suggested the seous during or after viewing 3-D your D octor of Optometry. H primary ca use of symptoms in a t content. Tbe way to crea te a better 3-D least one binocular vision disorder • Lack o f Depth: A viewer lack- viewing audience is first to di agnose (convergence insufficiency) is the60 REVIEW OF OPTOMETRY ~) CI{) ~~ll 1",1011
  5. 5. Pha e of Optometric Vision Th rapy associated dysfunction noted in Phase 1 accommodation. lo Monocular: The monocular phase of therapy often includes the following oculomotor, hand­ eye and accommodative therapy procedures: Treating 3DVS • Hart chart saccades No stanJard, successful treat­ • Hart chart accommodative rock ( tX8matodzgs) ment has yet been esta blished for • Rotating pegboard 3DVS. However, at last years • Computer paddle ball ( J American Academy of Optometry • Bunt ball (www,yoytube.comfwatcll?v=BTy3080wONB ) meeting, we presented a single sub­ • Plus and minus lens flippers ject design study that clearl y dem­ • Wayne saccadic fixator ( onstrated how a patient with 3DVS • Vision coach can be treated successfully with optometric vision therapy (OVT)Y Phase 2 (See "Phases of Optometric Vision Biocular: The biocular therapy phase is often used to break down any suppression present Therapy, ., left.) and includes oculomotor, hand-eye, accommodative and anti-suppression therapies: The poster described a 27-year­ • Barrel card (WWW.voutube.comlwatch?v- HtzEHSle-90) old white female who began to • Split vectogram (!walCh?v=Tzieb5g0vJA) experience severe symptoms after viewing a 3-D movie for 15 to 20 Phase 3 minutes. These symptoms includeJ Binocular: This binocular phase of therapy often includes the following oculomotor, hand­ blurred visiun, diplopia, eyestrain, eye (if still needed), accommodative and vergence therapy procedures: visual tracking problems, head­ • lifeSaver cards BI (www.yaulube.comlwalch?v=Ul3KTZOdzbo) ache, nausea and vision-induced • lifeSaver cards BO ( ) motion sickness. A comprehensive • Brock string (!ch?y=EGICVTdNafw) examination noted reduced random • Vectograms (<=0IuzE6hc7NI) dot stereopsis, no positive/negative fusional ranges (immediate diplo­ Fun with vectograms. pia), and high exophoria at near. Also, she reported diplopia while accessing accommodative facility. The initial findings included a vari­ able Monocular Estimation Method (MEM dynamic retinoscopy), pain upon near point of convergence testing, and reduced positive rela­ tive accOlllmodation and accommo­ dative amplitudes. We diagnosed this p<uient with Phase 4 convergence insufficiency, accom­ Integration/Stabilization: This phase includes combined oculomotor/hand-eye/accommoda ­ modative infacilitylinsta biLiry/ tive/vergence therapy. (This is where you might use plus or minus lens and/or prism flip ­ insufficiency, and diplopia . She pers with Vectograms, aperture rule and other vergence and/or oculomotor activities.) was prescribed in-office OVT and • Brock string with flippers ( fYs-EAlO) home VT. After the first six therapy sessions, all symptoms were either Also note that although randomized clinical trials have shown that in-office optometric improved o[ eliminated. Upon com­ therapy is most effective for binocular vision disorders, home computer therapy is helpful pleting a program of out-of-officc for treating these disorders as well. These home therapeutic digital programs include but (eight sessions) and home-based are not limited to Home Therapy Systems ( PVT Perceptual optometric vision therapy, all find­ Visual Tracking and Amblyopia iNet ( and Computer Aided ings normalized and all symptoms Vision Therapy: Track and Read and Computer Vergences ( relieved. The patient was so pleased with62 REVIEW OF OPTOMETRY OCTOBER 15 . 201 1
  6. 6. 4. Almont Green. hnp:/lalrnQfilgreen com. Accessed July 14. Lambooija,M. Fortuillii MF, IJ>SIllsteijn W Heyndenc:i<x A.thera py outcomes that several 2011. I. Visual discomlort assoctaled wlih 3D displays. Ploceed­weeks post therapy, while she was 5. Younkin AC. Anderson GJ. Doherty RA. Corriveau PJ. ings of tile Filth International W orkshop 00 Video Processingin the middle of watching a 3-D Toward a comprehensive assessment olliser experience and Quality Metrics for C Qnsurrer E lectronics VPQ M-20 1 0 wilh 3~. Proceedings ollhe Fifth International Workshop Available at hno{/gIlQub lullDO 3S!.t edUiresoIYoar1JllrOOm101movie, she used her cell phone on Video Processing and Qualily Metrics lor Consumer Proceedinus V PQM2Ql ll1<.Pqlll p44.ll!iJ. Awlssed Julyto text me about how much she Eleclronics VPQM-2010. Available at: hllll/leowb lulluo 2011. asuedu/resplvoomivoomlO/PrOCeedlOOS YPOM2QlOi 15. Iwasaki S. KubotaT, T <Ira T loleJance rilllge of av. heenjoyed watching it without experi­ yoarn Il35 W!. Accessed July 20 11 . billocular disparity on a 3D display based on ttle ptryslologi .encing any pain or discomfort! • 6. Maino O C. hase C. Aslhenopia: Technology Induced cal characleristlcs 01 ocular accommodation. Disntays 2009 Visual Impairment Rev Oplom. 201 1;JuneSuppl Part Jan;30(1)44-48 Dr. Maino is a Fellow of the 2: 28-35. Available at: Wo!(N revoQtom com/cmsdocy­ 16 Y S, Ide S, Milsuhashi T . Thwaites H A study of ano meOlst20 tl/6!ll611 b+1 13!hedilion.odt. Accessed July visuallatigue and visual comfort fO 3 D H lVlHDTV r DCollege of Optometrists in Vision 201 1. images. Displays. 2002; 23(4) 191 -20 1Dellelopment and American Acad­ 7. AmericanOptomelric Association websile. New Survey 17. Hoffman OM. GirshicKAR Akeley K. BilnKs MS. V , er­emy o{ Optometry, as well as a Data Reveals Parents Concerns Aboul Eye and Vision H ealth gence-l!Ccommodalion conllicts hinder visual fJertorrnance as More Classrooms Go High-Tech. August 2. 2011. Avail­ and cause visual fatigue. J Visioll 2008 Mar 28;8(3)33 1­Pro{essor o{ Pediatrics/Binocular able at: m .aoo.O!gIx188 1 Wi Accessed Augus120 11 . 0 30.Vision at the Illin ois Eye Institute/ 8.3-0 Vision and E Heallh websile. Avail able ye 18. Lambooij M. Fortuln M IJsselsteiin W Heyndlic!<x I. . A, al www Jde:ieheallh om Accessed July 201 1 . Measuring visual discomlort aSS OCiated w1U1 3-0 display.;Illinois College of 01Jtometry and 9. Maino O Identify Binocular ViSion Disorders. Optome1ric . Proceooings 01SPIE·IS&TEteclrooic lmagmg. 2009. Avail ­ Management 2009 Oec;(12). Available a WI! optometnr, ableat. Mo://ropOllilmy ludell! nlJyrgwftrl! Uld;ffO!5~is in prillate practice in Harwood comladlcle i;jQx?artlcle-.1 Q3756. Accessed July 2011. 2342-4m-ae73-ti97etOd61 Accessed A us12011 . 906 IJQHeights, Jl. 10. Maino D. Thebrnocular vISion dyslunction pandemic 1 Sh ibata T, im J. Hoilma OM. snks MS. nre zolle of 9. n Optom Vis Dev. 2010;41 (1 )6-13. comtort : Predicting visual dlsoornforl willi stereo displals. J1. Schubin M. Eyes wide open: 3-Dlipping poinls loom 11. Scheiman M Wick B. Ctinicat Managem 01Binocular . ent Vision. 2011 July 21;11(8)11 ;1 -29.PriceWaterhouseCoopers. Available at: WI! pwccQ mlen Vision: Heterophoric. Accommodative and EyeMovement 20. MaHan LF. De Land PN. Nguyen A Accommodative L.GXlgx/entertaj O!I!e!JI-medjalodflEye Wjde Ooen 3D no­ Disorders . 3rd ed. Philadelphia: Upprncoi!; 2008. insulticiency is the primary source 01S Y!TIPIOms In chllrnenplno polors adl Accessed July 2011 12. Maine o. Mainoss Memos. What is 3-D Vision diagnosed with conVErgence Insulticlency. O plom Vs Sci.2. TheAmerican Oplometric Association and 3-D@Home Syndrome? Avai lableat: f!1aJnosmemOS bloosooL 2006 May;83(5):281-9Consortium Sign Memorandum ot Understanding. Available cnml20tp/ll/3d;lslao-syndlcme 12 him!. Accessed July 21. Maino 0 The 3 0 Vision Syndrorrre; Ii Case R eonrtat m 3deyebeallh Q rQIAOA-3-QaIHIHDe-MO U-aO!1Qunce­ 2011. labslracIJ. American Academy 01 O ptometry A nnual Meeting!!!OOlJl!!I. Accessed July 2011. 13. Tsukuda S. Murai Y A case report 01 manilest eSOlropia Nov 2010. Sa FrancIsco CA. Available at: ¥(IfN shdesha!p3. Nintendo 3-DS producl iniolmation. Avai lable al /!:!t!!.., alier viewinganaglyph stereoscopic movie. Japanese O rthop­ net/OMAINO!3!1-vlsjoll-syndroflle. Accessed July 2011 .njoleodo cornl3d$/hardWa!e. Accessed July 2011. ticJournal. 1988;18:69-72. YOUR SOLUTION for keeping her lenses Illoist up to 20 ilours. Inspired bV the biol09V of your eyes, Biotrue multi-purpose solution utilizes a lubricant found naturally in he eyes to deliver up to 20 hours of moisture: Recommend Biotrue - and help make wearlnCJ contact lenses easier on your patients eyes.•