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There have been significant advancements in toric soft contact lens design and manufacturing technology, and increased product availability, over the past half a century. The purpose of this work is to update earlier surveys by describing international trends in toric soft lens fitting between 2000 and 2023, inclusive. An annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000 and 2023, inclusive. Data relating to 220,934 standard soft daily wear single vision lens fits undertaken in 20 countries returning reliable longitudinal data were analysed in respect of toric soft lens fitting. Overall, toric soft lens prescribing almost doubled over the time-course of this survey, from 24.4 % of standard soft daily wear single vision lens fits in 2000 to 46.2 % in 2023 (p < 0.0001). There were significant differences between countries in toric soft lens prescribing (p < 0.0001). Of all standard soft daily wear single vision contact lenses prescribed to males, 32.0 % were toric soft lenses, compared with 28.7 % for females (p < 0.0001). The mean age of toric soft lens wearers was 30.5 ± 12.5 years, compared to 27.9. ± 12.1 years for spherical soft lens wearers (p < 0.0001). Analysis of 13,582 recent toric soft lens fits (2019–2023, inclusive), in terms of material type and replacement frequency, revealed the following proportions: reusable silicone hydrogel – 51 %; daily disposable silicone hydrogel – 27 %; daily disposable hydrogel – 12 %; and reusable hydrogel – 10 %. There has been a substantial increase in toric soft lens fitting throughout the 24 years of this survey, to a point whereby almost all clinically significant astigmatism is being corrected among those wearing standard soft daily wear single vision lenses. [ABSTRACT FROM AUTHOR]

This study describes efficiency of diagnostic, image-based, and impression-based fitting methods by eye care providers who prescribe scleral lenses (SL) for patients with keratoconus. An electronic survey was distributed to eye care providers with an interest in SL fitting. Demographic data including practice modality, country of residence, and fitting volume were collected. Efficiency of each fitting method (diagnostic, image, and impression-guided) was queried including time required for initial evaluation, number of lenses ordered, and number of office visits required. Practitioners with access to image and impression-based technology were also asked time required to acquire data and to estimate the percentage of time a lens could be manufactured from the initial images or impressions. 423 practitioners who prescribe SL for patients with keratoconus reported completing a median [IQR] 100 [280] SL fittings. There was no difference in the median time required for initial evaluation (30 min; p = 0.5) or median number of lenses ordered during the fitting process (2 lenses; p = 0.2) between diagnostic, image-based, or impression-based SL fitting methods. Median time to acquire initial images was 10 [7] minutes and 15 [10] minutes to obtain impressions. Images obtained were adequate to order an initial lens 80 [45]% of the time while initial impressions were adequate 90 [40]%. In this study, practitioner-reported efficiency of SL fitting was similar between diagnostic, image-based and impression-based methods for patients with keratoconus. [ABSTRACT FROM AUTHOR]

To assess which signs and eye prosthesis care habits are related to subjective discomfort in patients with dry anophthalmic socket syndrome (DASS), using standardized tools from daily practice. 62 anophthalmic sockets were compared with their healthy fellow eye using the Standard Patient Evaluation of Eye Dryness (SPEED) score. The correlations between SPEED questionnaire and the prosthesis care, discharge characteristics score, conjunctival inflammation score, meibomian gland dysfunction (MGD) scores and Schirmer I test were studied. The anophthalmic sockets group achieved a higher SPEED test score (p < 0.01), discharge score (p < 0.01), conjunctival inflammation score (p < 0.01), MGD scores (p < 0.01) and lower Schirmer I test (p < 0.01) compared with their fellow, healthy eye. Patients with a prosthesis replacement of one year or less, those with a current fit time of one year or less and those with a cleaning frequency above one month reported better SPEED, (p < 0.01), conjunctiva inflammation (p < 0.01) and MGD scores (p < 0.01). Most anophthalmic patients suffer mild to severe DASS, which seems related to discharge, conjunctival inflammation and MGD. Moreover, certain practices related to the care of the prosthesis such as replacing with a frequency lower than yearly, current fitting time inferior to one year and a removing and cleaning regime above one month, were related to a lower discomfort sensation, conjunctival inflammation and MGD. Clinicians should consider the DASS when facing patients with anophthalmic socket and discomfort symptoms. [ABSTRACT FROM AUTHOR]

The medical use of contact lenses is a solution for many complex ocular conditions, including high refractive error, irregular astigmatism, primary and secondary corneal ectasia, disfiguring disease, and ocular surface disease. The development of highly oxygen permeable soft and rigid materials has extended the suitability of contact lenses for such applications. There is consistent evidence that bandage soft contact lenses, particularly silicone hydrogel lenses, improve epithelial healing and reduce pain in persistent epithelial defects, after trauma or surgery, and in corneal dystrophies. Drug delivery applications of contact lens hold promise for improving topical therapy. Modern scleral lens practice has achieved great success for both visual rehabilitation and therapeutic applications, including those requiring retention of a tear reservoir or protection from an adverse environment. This report offers a practical and relevant summary of the current evidence for the medical use of contact lenses for all eye care professionals including optometrists, ophthalmologists, opticians, and orthoptists. Topics covered include indications for use in both acute and chronic conditions, lens selection, patient selection, wear and care regimens, and recommended aftercare schedules. Prevention, presentation, and management of complications of medical use are reviewed. [ABSTRACT FROM AUTHOR]

Purpose: To establish the optimum grading increment which ensured parity between practitioners while maximising clinical precision.Methods: Second year optometry students (n = 127, 19.5 ± 1.4 years, 55 % female) and qualified eye care practitioners (n = 61, 40.2 ± 14.8 years, 52 % female) had 30 s to grade each of bulbar, limbal and palpebral hyperaemia of the upper lid of 4 patients imaged live with a digital slit lamp under 16× magnification, diffuse illumination, with the image projected on a screen. The patients were presented in a randomised sequence 3 times in succession, during which the graders used the Efron printed grading scale once to the nearest 0.1 increment, once to nearest 0.5 increment and once to the nearest integer grade in a randomised order. Graders were masked to their previous responses.Results: For most grading conditions less than 20 % of clinicians showed a ≤0.1 difference in grade from the mean. In contrast, more than 50 % of the student graders and 40 % of experienced graders showed a difference in grade from the mean within 0.5 for all conditions under measurement. Student precision in grading was better with both 0.1 and 0.5 grading increments than grading to the nearest unit, except for limbal hyperaemia where they performed more accurately with 0.5 unit increment grading. Limbal grading precision was not affected by grading step increment for experienced practitioners, but 0.1 and 0.5 grading increments were both better than the 1.0 grading increment for bulbar hyperaemia and the 0.1 grading increment was better than the 0.5 grading increment and both were better than the 1.0 grading increment for palpebral hyperaemia.Conclusion: Although narrower interval scales maximise the ability to detect smaller clinical changes, the grading increment should not exceed one standard deviation of the discrepancy between measurements. Therefore, 0.5 grading increments are recommended for subjective anterior eye physiology grading (limbal, bulbar and palpebral redness). [ABSTRACT FROM AUTHOR]

Aim: To study the prevalence of lagophthalmos and its related complications among the unconscious patients admitted in the intensive care units (ICU)/wards of a tertiary care centre.Methods: Cross-sectional observational study.Results: A total of 87 unconscious patients were included. 44 were children and 43 were adults. The overall median age of patients was 16 years (range: 9 days- 85 years). 53/87 (60.91%) showed signs of lagophthalmos, among which 56.60% (30/53) were children and 43.40% (23/53) were adults. There was no significant difference in the exposure patterns between children and adults (p = 0.25). Exposure related manifestations (conjunctival/corneal) were found in 49/87 patients (56.32%). The most common conjunctival manifestation was chemosis, occurring in 28/53 patients (52.83%). Corneal exposure was seen in 31/53 patients (58.49%), of which fragile epithelium was the commonest finding (32.08%). Only 17/31 (54.83%) cornea exposed eyes were taped, of which 15 were sub-optimal. 6 patients were unnecessarily taped. Signs of infection were noted in 8/53 eyes (15.09%).Conclusion: Optimal eye care in unconscious patients can avert the development of exposure-related complications and subsequent ocular morbidity. Adoption and implementation of systematic protocols can help improve the standard of care. [ABSTRACT FROM AUTHOR]

Purpose: To compare existing and novel diagnostic techniques for confirming ocular Demodex infestation and to recommend the most reliable method for routine use by eye care practitioners, based on yield and clinical applicability.Methods: Fifteen participants with a prior Demodex blepharitis diagnosis or featuring typical cylindrical dandruff (CD) collarettes, and seven healthy controls were enrolled. Demodex presence was assessed using five techniques, applied consecutively, on a minimum of two different eyelashes on each eyelid of every participant, for each test, in situ: 1. using fine-point forceps and 25-40x biomicroscopy magnification, by eyelash rotation as proposed by Mastrota (ROT); 2. by removing cylindrical dandruff and exposing the eyelash insertion point at the lid margin (CDR); and 3. by laterally tensioning the eyelash (LET) following CDR. The typical appearance of cigar-shaped mite tails protruding from each assessed eyelash follicle was observed, and mite tails counted and averaged per participant for each assessment technique. 4. Lash epilation, and mite presence evaluated using bright-field microscopy at 10-40x magnification (EPI). 5. Finally, eyelash follicles were imaged using in vivo confocal microscopy (IVCM) and the images visually inspected for mite presence.Results: In the Demodex group, the highest numbers of mites/eyelash were identified by LET (3.8 ± 1.4), versus CDR (2.4 ± 1.6) and ROT (1.1 ± 1.2), alone (all p < 0.002). An average of 1.0 ± 0.8 mites/lash was identified by EPI. IVCM failed to offer unequivocal evidence of Demodex presence even in confimed cases.Conclusions: A novel technique for the clinical diagnosis and grading of Demodex in situ is described. By removing cylindrical dandruff and applying static, lateral tension to the eyelash without epilation, large numbers of mites are visible at the exposed eyelash follicle. The proposed method is convenient and clinically applicable, requiring only forceps and 25-40x biomicroscope magnification, and allowing rapid, efficient evaluation of large numbers of eyelashes. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has necessitated government-imposed restrictions on social interactions and travel. For many, the guidance has led to new ways of working, most notably a shift towards working remotely. While eye care practitioners (ECPs) may continue to provide urgent or emergency eye care, in many cases the travel restrictions present a unique challenge by preventing conventional face-to-face examination. Telephone triage provides a useful starting point for establishing at-risk and emergency patients; but patient examination is central to contact lens patient care. The indeterminate period over which conventional practice will be suspended, and the risk that resumption of 'normal' practice could be impeded by a potential secondary peak in COVID-19 cases, hastens the need for practitioners to adapt their delivery of eyecare. Specifically, it is prudent to reflect upon supportive evidence for more comprehensive approaches to teleoptometry in contact lens practice. Smartphone based ocular imaging is an area which has seen considerable growth, particularly for imaging the posterior eye. Smartphone imaging of the anterior eye requires additional specialised instrumentation unlikely to be available to patients at home. Further, there is only limited evidence for self-administered image capture. In general, digital photographs, are useful for detection of gross anterior eye changes, but subtle changes are less discernible. For the assessment of visual acuity, many electronic test charts have been validated for use by practitioners. Research into self-administered visual acuity measures remains limited. The absence of a comprehensive evidence base for teleoptometry limits ECPs, particularly during this pandemic. Knowledge gaps ought to be addressed to facilitate development of optometry specific evidence-based guidance for telecare. In particular, advances in ocular self-imaging could help move this field forwards. [ABSTRACT FROM AUTHOR]

Daily disposable (DD) contact lenses first came to the market approximately 25 years ago and eye care professionals (ECPs) started prescribing silicone hydrogel (SiH) contact lenses, primarily for extended or continuous wear, approximately 20 years ago. It has now been over ten years since SiH DD contact lenses have been available, and while SiH materials are routinely prescribed by ECPs for reusable daily wear, hydrogel materials are still frequently selected for the DD modality of contact lens wear. This article reviews the evidence to support the benefits of both a DD modality and SiH materials and how patients' needs may be met with SiH DD contact lenses, with respect to clinical performance, health outcomes, satisfaction, compliance and convenience. Factors which may enable or constrain ECPs from prescribing SiH DD contact lenses, as opposed to hydrogel DD and reusable contact lenses, for more of their patients are discussed with the objective of providing ECPs with a greater understanding of the advantages that can be afforded by prescribing SiH DD contact lenses to both their new and existing contact lens wearers. [ABSTRACT FROM AUTHOR]

Purpose: A survey in 2015 identified a high level of eye care practitioner concern about myopia with a reported moderately high level of activity, but the vast majority still prescribed single vision interventions to young myopes. This research aimed to update these findings 4 years later.Methods: A self-administrated, internet-based questionnaire was distributed in eight languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy of available strategies and adoption levels of such strategies, and reasons for not adopting specific strategies.Results: Of the 1336 respondents, concern was highest (9.0 ± 1.6; p < 0.001) in Asia and lowest (7.6 ± 2.2; p < 0.001) in Australasia. Practitioners from Asia also considered their clinical practice of myopia control to be the most active (7.7 ± 2.3; p < 0.001), the North American practitioners being the least active (6.3 ± 2.9; p < 0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by pharmaceutical approaches and approved myopia control soft contact lenses (p < 0.001). Although significant intra-regional differences existed, overall, most practitioners did not consider single-vision distance under-correction to be an effective strategy for attenuating myopia progression (79.6 %), but prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients (63.6 ± 21.8 %). The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (20.6 %) and inadequate information (17.6 %).Conclusions: While practitioner concern about myopia and the reported level of activity have increased over the last 4 years, the vast majority of eye care clinicians still prescribe single vision interventions to young myopes. With recent global consensus evidence-based guidelines having been published, it is hoped that this will inform the practice of myopia management in future. [ABSTRACT FROM AUTHOR]

A hospital-based survey to explore lens rinsing habits of orthokeratology (ortho -k) patients, including the solution used for rinsing. An anonymous survey, via an online questionnaire, was administered to ortho -k lens wearers or their parents when they attended Fudan University Eye and ENT Hospital for routine follow-up visits. Three major issues were investigated: basic demographics, lens rinsing solution used, and specific rinsing habits. Relationships between demographics and rinsing solution used and rinsing behaviours were explored. Of the total of 541 online questionnaires delivered, 296 were completed and returned. The respondents were the person responsible for lens care, either the ortho -k users themselves, or their parents. The median age of the lens wearers was 12.0 years (range: 8–22 years), and the median period of ortho -k lens wear was 18.0 months (range: 1–109 months). The most common rinsing solutions reported were a particular brand of multidose preserved saline (28.4%), cooled boiled water (23.3%), and non-preserved multidose saline (16.2%). Overall, the main reason for choice of rinsing solution was recommendation of eye care practitioners (90.2%). The respondents with a longer lens wear history tended to use commercially available bottled water, drinking water, or cooled boiled water rather than non-preserved saline (unidose or multidose) (p ≤ 0.009) and were more likely to use the rinsing solution to soak their lenses (p = 0.009). Lens wearers who rinsed the lenses themselves tended to use tap water compared to those whose lenses were handled by parents (p = 0.040). Inappropriate choice and usage of rinsing solution appeared to be a common issue among ortho -k lens wearers in Shanghai, China. The problem was more pronounced in long-term wearers and in those who performed rinsing themselves. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate soft contact lens replacement, overnight (ON) wear, and contact lens case compliance in a non-clinical sample.Methods: Subjects (n = 297) were recruited at the Center for Science and Industry (COSI) in Columbus, Ohio. Adult (≥ 18 years) soft contact lens wearers completed a survey about contact lens replacement, ON contact lens wear, and contact lens case replacement habits.Results: Two-week replacement lenses (according to the manufacturer's replacement schedule [MRS]) were most common (45.5%), followed by monthly (34.3%) and daily replacement (20.2%). Non-compliance with replacement schedule was reported in 38.7% of subjects. Age (p = 0.02), years of lens wear (p = 0.02), and MRS (p <0.0001) affected replacement compliance. Post-hoc analysis showed daily replacement wearers were more compliant than two-week (p <0.0001) and monthly (p <0.0001) replacement wearers with prescribed lens replacement. Non-compliance with prescribed ON wear was reported in 23.9% of subjects. Subjects who were non-compliant with lens replacement were more likely to be non-compliant with ON wear (p = 0.02) and had worn contact lenses for less time (p = 0.02). Of the subjects who used contact lens cases, 74.6% were unsure when they should replace their case. Frequency of case replacement was not associated with age (p = 0.5), gender (p = 0.5), years of contact lens wear (p = 0.7), MRS (p = 0.4), replacement compliance (p = 0.3), or ON wear compliance (p = 0.7).Conclusions: Daily replacement wearers were most likely to be compliant with contact lens replacement, but all subjects, including daily replacement wearers, had similar ON wear non-compliance. Non-compliant lens replacement was associated with non-compliant ON wear, but contact lens case replacement was not related to either compliance category. The majority of subjects had no knowledge of proper contact lens case replacement, despite compliance in other categories. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effectiveness of a modified and previous fitting guide for multifocal (MF) contact lenses that share a common optical design, lotrafilcon B, nelfilcon A, and delefilcon A, in current soft contact lens (CL) wearers needing presbyopia correction.Methods: This international multicenter, prospective, randomized, subject-masked study assessed the superiority of the modified guide relative to the previous guide as determined by the number of MF CLs needed to successfully fit each eye at the screening/fitting visit.Results: A total of 183 presbyopic subjects were randomized to fitting using the modified (n = 99) and previous (n = 84) MF CL fitting guides. The mean ± SD numbers of lenses required to fit each eye at the screening/fitting visit using the modified and previous fitting guides were 1.2 ± 0.5 and 1.4 ± 0.5, respectively. The least-squares mean difference (0.2) met predetermined criteria for superiority of the modified fitting guide. At the screening/fitting visit, 82.8% (164/108) and 65.1% (105/166) of presbyopic eyes were fit with one pair of MF lenses using the modified and previous guides, respectively, and 98.0% (194/198) of eyes were fit with 1-2 pairs of MF lenses using the modified guide. A higher percentage of eye care practitioners gave the highest ratings for ease of fit for the modified than for the previous fitting guide (63.6% [7/11] vs 33.3% [3/9]).Conclusions: The modified fitting guide was superior at reducing the number of MF lenses required to successfully fit each presbyopic patient. [ABSTRACT FROM AUTHOR]

Purpose: To gain a better understanding of eye care professionals' (ECPs) perceptions regarding the benefits of silicone hydrogel (SiH) daily disposable contact lenses (DDCL), particularly with respect to health, comfort and patient satisfaction.Methods: A survey was conducted with 300 ECPs in the United States, United Kingdom and Japan during November 2017. The survey comprised 34 statements relating to SiH DDCLs, to which the ECPs provided their level of agreement using a 6 point Likert scale. A minimum of 70% agreement was set to define majority agreement. Categories of statements included Health, Comfort, Patient Experience, and Standard of Care.Results: ECPs rated the highest levels of agreement to perceptions within the Patient Experiences and Health categories. The six statements receiving the highest ratings were "Silicone hydrogel 1 day lenses satisfy today's patients' demanding lifestyles" (93% agreement); "Silicone hydrogel 1 day lenses are the best choice to safeguard my patients' eye health related to contact lens wear" (92%); "Silicone hydrogel 1 day lenses provide the best benefits to my patients" (92%); "Silicone hydrogel 1 day lenses provide better long term eye health for my patients than hydrogel 1 day lenses" (91%); "Silicone hydrogel is the healthiest lens material for my daily disposable patients" (90%); and "Silicone hydrogel 1 day lenses provide a better wearing experience for my patients than hydrogel 1 day lenses" (90%).Conclusion: ECPs perceive that SiH DDCLs offer long-term eye health
and comfort for the patient and although the ECPs surveyed would not necessarily prescribe SiH DDCLs to all their patients, they would prescribe them to most of their patients. The results support the premise that while ECPs consider SiH 1 day contact lenses as the current "standard of care"; the principal barrier continues to be the perceived higher cost of these lenses. [ABSTRACT FROM AUTHOR]

Purpose: In Singapore, optometrists' roles are limited compared to their counterparts elsewhere. The purpose of the survey is to investigate optometrists' current roles, views on extended roles, self-reported primary eye care knowledge, needs for continuing professional education (CPE) and views on suitable modes for CPE.Methods: Members of the Optometrist and Optician Board (OOB) were invited via email to take part in an anonymous online survey. The survey questions covered the following areas: current scope of practice, self-rated primary eye care knowledge, confidence in screening, co-managing minor eye conditions, CPE and referral behavior.Results: A total of 230 optometrists completed the survey (response rate 30%). Their current roles were limited to diagnostic refraction (92%), colour vision assessment (65%), contact lens fitting and dispensing (62%) amongst others. The average self-rated score for primary eye care knowledge was 8.2 ± 1.4; score range 1-10 (1-Very poor, 10-Excellent). Self-rated confidence scores for screening for cataract, diabetic retinopathy, chronic glaucoma and age-related macular degeneration were 2.7 ± 1.5, 3.7 ± 1.9, 4.0 ± 1.9 and 3.8 ± 1.8, respectively. 71% of the optometrists felt that they should undertake regular CPE to improve their primary eye care knowledge. Blended learning (eLearning and traditional face-to-face lectures) (46.1%) was the most preferred mode for CPE delivery.Conclusion: Optometrists in Singapore represent a skilled underutilized primary eye care provider. Though their self-reported primary eye care knowledge is high, their confidence in screening and co-managing chronic eye conditions is low. Enabling them for extended primary eye care role would require further training.Significance: Singapore ageing population has led to greater eye care demands. Task-shifting from ophthalmologists to optometrists has been proposed in the literature to handle this growing care demands. At this juncture, this study provides evidence based answers to issues revolving around optometrists' readiness for a role expansion in Singapore. [ABSTRACT FROM AUTHOR]

To investigate the impact of relative humidity (RH) and climate variables of the place of residence on symptoms of dry eye disease (DED) in primary eye care practice. A cross-sectional analysis of the Ocular Surface Disease Index (OSDI) dry eye classification of 1.033 patients [classified as non-DED (OSDI ≤22) and DED (OSDI >22)] was conducted in a multicentre study in Spain. Participants were classified according to the 5-year RH value (data from the Spanish Climate Agency - www.aemet.es) into two groups: those who lived in low RH (<70%) places and those who lived in high RH (≥70%) places. Additionally, differences in daily climate records (EU Copernicus Climate Change Service) were assessed. The prevalence of DED symptoms was 15.5% (95% CI 13.2%–17.6%). Participants who lived in places with <70% RH showed a higher prevalence of DED (17.7%; 95% CI 14.5%–21.1%; P < 0.01 adjusted for age and sex) than those who lived in places with ≥70% RH (13.6%; 95% CI 11.1%–16.7%) and a closer, but not statistically significant, risk for DED (OR = 1.34, 95% CI 0.96 to 1.89; P = 0.09) than previously described DED risk factors [age older than 50 years (OR = 1.51, 95% CI 1.06 to 2.16; P = 0.02) and female sex (OR = 1.99, 95% CI 1.36 to 2.90; P < 0.01)]. Some climate data showed statistically significant differences (P < 0.05) between participants with DED and non-DED (mean wind gusts; atmospheric pressure; mean and minimum relative humidity); these variables did not significantly increase DED risk (OR close to 1.0 and P > 0.05). This study is the first to describe the impact of climate data on dryness symptomatology in Spain, confirming that participants who live in locations with RH <70% have a higher prevalence (corrected for age and sex) of DED. These findings support the use of climate databases in DED research. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this project was to evaluate which personal protective equipment (PPE) eye care practitioners (ECP) will use during the next months and also what they will ask the patient to use in clinical practice.Methods: A social-media survey was carried out, asking 257 optometrists and opticians in Germany, Austria and Switzerland (i) which PPE they intended to use in the future (after lockdown and before herd immunity and / or vaccine availability) and (ii) what they would ask the patient to do in terms of this.Results: 75 % of the ECPs planned on wearing masks during refractions and 69 % when fitting contact lens. 62 % of the ECPs also expected their patients to wear masks in these tasks. This number is higher than for distance tasks such as fitting frames. Around 90 % of the ECPs would, in addition to hand washing, disinfect their hands and around 80 % expected their patients to do so too. Less than one third of ECPs favoured wearing safety spectacles, gloves and / or protective facial shields. 73 % planed on disinfecting frames after they would have been tried on by customers.Conclusions: In summary, most ECPs planed on continuing to use higher standards of PPE. Those, who intended to wear masks themselves, would ask their patients to also do so, combined with hand disinfection. [ABSTRACT FROM AUTHOR]

Purpose: To assess the prevalence and general knowledge of contact lens wearers among college students in Chengdu, a metroplolitan of Chinaand find out the routine habits of use and hygienic conditions when wearing contact lenses.Method: The questionnaire was distributed to 1,600 ametropic participants who were from 8 different universities. Data about demographics, general contact lens handling habits, personal attitudes, hygiene behaviors and eye health conditions were collected. We made the analysis ofthe demographics and wearing of contact lenses. Possible reasons for behaviors related to the care of contact lenses were analyzed.Results: The prevalence of contact lens use was 19.80%. Most users (82.15%) were females. An aesthetic effect was cited as the first reason for using (57.91%). The comfort of eyes was the first consideration (75.76%) when buying. To keep clean and use safe, 86.20% subjects washed hands before handling and 83.50% cleaned the lens carefully after removing. There was significant difference between males and females regarding the replacement of the solution (p=0.014). 32.66% wears knew the removal of protein deposits. A total of 54.88% were not informed of the potential complications of contact lens. The incidence of ocular discomfort was 44.78%. Only 3.03% of the students paid regular visits to ophthalmic clinics.Conclusion: The prevalence of contact lenses was relatively low in Chengdu. The wears had limited knowledge about using and careof contact lens. More education on standard lens wear and care should be provided to wearers. [ABSTRACT FROM AUTHOR]

Purpose: The aim is discussing the origins of worsening of external eye condition (EEC) and of tear film (TF) instability after wear of silicone-hydrogel contact lenses (CLs) with hydrogen-peroxide (H2O2) care system.Methods: EEC and TF stability were evaluated before and after 15days of wear combined with different care systems: (1) H2O2, (2) detergent solution and H2O2, (3) multipurpose solution (MPS), (4) H2O2 and artificial tears. In-vitro cell mortality tests were performed after 24h cell incubation with CLs treated with H2O2. Photon correlation spectroscopy (PCS) was carried out on tears of non-wearers and CL wearers who used MPS or H2O2 solution.Results: Worsening of EEC was observed only for the group using H2O2 (group 1). In-vitro, cell mortality was found higher for worn CL than for unworn CLs. Worsening of TF stability was observed regardless of care system and also PCS results on tears of CL wearers were found different compared to non-wearers regardless of care system. The only observed remedy for tear instability of CL wearers was found to be the administration of artificial tears.Conclusions: Worsening of EEC of CL wearers using H2O2 is attributed to H2O2 scarce cleaning efficacy, which can be solved by adding a CL detergent solution. The origin of TF instability is found to be different. A remedy was found to be the administration of artificial tears, whose effect could be attributed either to the role of specific components or to rinsing and replacement of TF during wear. [ABSTRACT FROM AUTHOR]

Soft contact lens discontinuations have a dramatic impact on the overall success of this form of vision correction, and evidence suggests that the reasons for contact lens cessation are different for new wearers than for established lens users. In descending order, these relate to vision, discomfort, handling, inconvenience/loss of interest, ocular health and cost. This paper considers the background and underlying evidence for these causes of soft lens discontinuation in new wearers, and presents clinical management strategies to minimise this phenomenon. Such measures can reasonably be expected to significantly reduce the number of contact lens discontinuations leading to happier patients, increased satisfaction for eye care professionals (ECPs), and greater success for both individual practices and the contact lens industry more broadly. [ABSTRACT FROM AUTHOR]

Purpose: To determine the first-year retention rate for patients fitted with contact lenses (CLs) and identify factors associated with retention and dropout.Methods: This multi-site study was a retrospective chart review of the status of neophyte CL wearers fitted in representative UK eye care practices.Results: Consecutive records for 524 patients at 29 sites were reviewed. Mean age at dispensing was 34 years (range 8-79), 68% were under 45 years and 61% female. Soft CLs were fitted to 98% of patients. After 12 months, 388 were still CL wearers, a retention rate of 74% (95% CI: 70.1-77.6). Of the 136 lapsed, 25% discontinued during the first month and 47% within 60 days. The main reasons cited for discontinuation included poor distance vision (26%; of whom, 37% were toric and 51% multifocal), poor near vision (16%), discomfort (14%) and handling problems (15%). In 32% of cases, the reasons for discontinuation were unknown. For 71% of dropouts, no alternative lens or management strategy had been tried. Significant factors associated with retention in univariate analysis were: age (younger), sphere power (higher), lens type (sphere vs multifocal) and purchase frequency (regular). Multivariate analysis showed lens sphere power, purchase frequency and lens material to be significant factors. There was a wide variation in retention rates between sites (40-100%).Conclusions: During the first year of CL wear, the overall retention rate for neophyte CL wearers was 74% (spherical CLs 79%, torics 73%, multifocals 57%), with many lapsing during the first 2 months. Factors associated with retention and dropout in these patients include: lens power, material and type, and purchase frequency. While handling and comfort are the most commonly cited performance-related reasons for discontinuing in new spherical lens wearers, visual problems are the most common among new wearers of toric and, in particular, multifocal CLs. [ABSTRACT FROM AUTHOR]

There remains a lack of information on the perception and adoption of myopia control strategies among African eye care practitioners (ECPs). This study provides an African perspective to similar previous studies conducted in other parts of the world. A self-administered survey in English and French was distributed to ECPs across Africa. The items on the questionnaire assessed their level of concern about the increasing prevalence of paediatric myopia, perceived efficacy, opinions on, and adoption of various myopia management modalities. Responses were obtained from 330 ECPs working in 23 African countries. Respondents were highly concerned about the increasing prevalence of paediatric myopia in their clinic (median 8/10) and perceived approved myopia control soft contact lenses as the most effective at slowing myopia progression (mean perceived reduction in myopia progression ± SD; 53.9 ± 27.1%), followed by single vision spectacles (53.1 ± 30.9%), and orthokeratology (52.8 ± 28.0%). Multifocal soft contact lenses (40.4 ± 25.8%) and pharmaceutical agents such as topical atropine drops (39.5 ± 27.1%) were perceived as least effective in slowing myopia progression. Although ECPs reported being aware of various myopia control strategies, they still mainly prescribed single vision spectacles to a large proportion (64.3 ± 29.9%) of young progressing myopes. Nearly one-third (27%) of ECPs who prescribed single vision lenses stated they were concerned about the cost implications to patients. Other reported concerns included safety of, and inadequate information about myopia control options. African ECPs continue to prescribe single vision lenses for progressing myopes despite being aware of the various myopia control options. Practitioners' perceptions of the efficacy of several modalities to slow myopia progression do not align with the current best evidence. Clear practice guidelines and continuing education on myopia control are warranted to inform and guide the management of myopic patients in Africa. [ABSTRACT FROM AUTHOR]

Purpose: Contact lenses offer a good option for patients with presbyopia, especially with improved optical designs available in modern multifocal contact lenses. Due to the ageing population there is good opportunity to increase contact lens penetration by managing these patients better. However, multifocal contact lenses achieve low penetration in the market.Methods: A questionnaire was administered to people aged above 40 years, to investigate their perceptions of contact lenses for presbyopia. Only people, with presbyopia, who were existing contact lens wearers or willing to try contact lenses were included. Participants were recruited from United Kingdom (UK), United States of America (USA), Netherlands, Germany, France, Spain and Italy.Results: Data from 1540 participants above the age of 40 years was collected, 57.9% were females and 42.1% males. Overall, 50.8% of the participants wore contact lenses, but contact lens wear was less common amongst older participants. Some data supported earlier studies, such as 6.1% wore gas permeable lenses. However, only 25% of the contact lens wearers used multifocal contact lenses. The reasons the participants wanted to wear contact lenses were similar to younger patient such as sports or cosmesis reasons. Reasons why participants had dropped out of contact lenses included discomfort and dry eye related issues. Poor visual performance with contact lenses was a reason to dropout of contact lenses for the older participants.Conclusions: The study highlights some failings by eye care practitioners in the management of patients with presbyopia. It seems that patients of this age group are seeking suggestions and recommendations from their eye care practitioner including upgrading contact lenses and dual wear options. The day-to-day problems encountered by the contact lens wearers in this study seem to be, in the main, things that could be easily tackled by additional counselling and instruction from the eye care practitioners. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether variations in multipurpose disinfecting solution (MPDS) storage osmolarity from inappropriate contact lens (CL) case cleaning affect ocular surface integrity and wearer comfort.Methods: There were twenty contact lens cases (study CLCs) in the study group. Ten were filled with ReNu Multiplus(®) and 10 with SoloCare Aqua™ (MPDS-1 and -2, respectively) and kept closed for 8h; the cases were then emptied and kept open for air-drying for 16h. This procedure was carried out every day for two months. Storage solution osmolarity was measured on days 0, 15, 30, 45 and 60. Ten subjects were then fitted with both month-old lenses stored in the study CLCs and with new lenses stored in new cases with fresh solution for 24h (control CLCs). Symptoms, tear osmolarity and percentage of subjects whose conjunctival hyperaemia and ocular surface staining scores changed were determined after 1h of wear.Results: Study CLC osmolarity increased in both solutions after two months (p<0.05). For MPDS-1 there were differences in stinging between study CLCs and control CLCs after 10min of CL wear (p=0.04), and in comfort after 10 (p=0.035) and 60min wear (p=0.042). Significant (p<0.05) differences between study CLC and control CLC groups were also found for MPDS-2 in limbal hyperaemia (study: 50% change; control: 0% change) and bulbar and corneal staining (study: 80% change; control: 20% change).Conclusion: The stored-MPDS osmolarity increase caused by air-drying the CLCs could affect the ocular surface. This increase might reduce lens wear comfort. [ABSTRACT FROM AUTHOR]

Purpose: Compliance with practitioner recommended lens care guidelines was assessed and compared in two test groups: patients belonging to a subscription membership group and a nonaffiliated group of 2-week frequent replacement (2WFR) soft contact lens wearers.Methods: Wearers (143 members and 149 nonmembers), whose clinical records were available for 18-24 months from September 2010 to August 2012, were queried by a written questionnaire: (1) source of lens purchase; (2) "rub" or "no-rub" care solution; (3) replacement interval of lens care products; (4) lens cleaning method; (5) noncompliant behaviors; and (6) replacement frequency of lens storage cases.Results: The questionnaires were completed by 104 members and 100 nonmembers. Of member group wearers, 63.0% correctly recognized the types of lens care products used ("rub', "no-rub") vs. 77.4% of nonmembers. Of member wearers, 82.2% used "rub" and rubbed each time vs. 76.3% of nonmembers. The replacement interval for care products was 26.2% (members) and 27.6% (nonmembers) for 1 month or less, while replacement frequency of storage cases was 22.3% and 19.2% for 1 month or less in each group respectively. There were no significant differences observed between each of these group comparisons (p>0.05, Fisher exact test).Conclusions: Compliance with practitioner recommended lens care regimens was equally poor in both test groups. Subscription membership of CLs which does not provide lens care products is not accompanied by an increase in compliance with lens care practices. [ABSTRACT FROM AUTHOR]

Purpose: To determine (1) the factors associated with a high degree of self-reported symptoms with Japanese translations of the 8-Item Contact Lens Dry Eye Questionnaire (J-CLDEQ-8) in a cross-section of soft contact lens (SCL) wearers in Japan and (2) whether the difference in translation of the CLDEQ-8 affects the scores between validated and non-validated versions of the Japanese translation.Methods: Habitual SCL wearers completed the validated J-CLDEQ-8 and a previous non-validated version. Demographics and SCL history questions were queried when they presented for routine eye care in nine geographically distinct clinics across Japan. The following risk factors for high J-CLDEQ-8 scores (≥11) were tested: sex, age, SCL replacement (daily disposable vs. bi-weekly and monthly reusable), years of SCL wear, and self-reported use of rewetting drops. The scores of the validated and non-validated questionnaires were compared.Results: Significant patient-related risk factors for high J-CLDEQ-8 scores were female sex, use of reusable SCLs, longer years of SCL wear, and use of rewetting drops. Scores for six out of eight questions in the validated J-CLDEQ-8 were significantly higher than those of the non-validated version, resulting in a significant difference in the average total score between the two questionnaires (validated J-CLDEQ-8: 10.5 ± 5.9 vs non-validated J-CLDEQ-8: 9.5 ± 5.8, P < 0.001).Conclusions: Female sex, use of reusable SCLs, longer years of SCL wear, and use of rewetting drops were significant risk factors for high J-CLDEQ-8 scores in a cross-sectional clinical population of Japanese SCL wearers. Symptoms with SCL are not predicted by age and must therefore be queried at follow-up visits for all SCL wearers. Differences in the two translations affected the ability of the questionnaire to identify individuals with high symptoms associated with SCL wear. [ABSTRACT FROM AUTHOR]

A contaminated contact lens case can act as a reservoir for microorganisms that could potentially compromise contact lens wear and lead to sight threatening adverse events. The rate, level and profile of microbial contamination in lens cases, compliance and other risk factors associated with lens case contamination, and the challenges currently faced in this field are discussed. The rate of lens case contamination is commonly over 50%. Coagulase-negative Staphylococcus, Bacillus spp., Pseudomonas aeruginosa and Serratia marcescens are frequently recovered from lens cases. In addition, we provide suggestions regarding how to clean contact lens cases and improve lens wearers’ compliance as well as future lens case design for reducing lens case contamination. This review highlights the challenges in reducing the level of microbial contamination which require an industry wide approach. [ABSTRACT FROM AUTHOR]

Aim To appraise history and symptom taking for contact lens consultations, to determine current practice and to make recommendations for best practice. Method The peer reviewed academic literature was reviewed and the results informed a survey completed by 256 eye care practitioners (ECPs) on their current practice and influences. Results The last eye-test date, last contact lens aftercare (for existing wearers) and reason for visit are key questions for most ECPs. Detailed use of contact lens questions are more commonly applied in aftercares than when refitting patients who have previously discontinued wear (87% vs 56% use), whereas questions on ocular and general history, medication and lifestyle were generally more commonly utilised for new patients than in aftercares (72% vs 50%). 75% of ECPs requested patients bring a list of their medication to appointments. Differential diagnosis questioning was thorough in most ECPs (87% of relevant questions asked). Attempts to optimise compliance included oral instruction (95% always) and written patient instructions (95% at least sometimes). Abbreviations were used by 39% of respondents (26% used ones provided by a professional body). Conclusion There is scope for more consistency in history and symptom taking for contact lens consultations and recommendations are made. [ABSTRACT FROM AUTHOR]

Purpose It was the main purpose of this study to investigate the influence of the moistening solution on TBUT measurements in an asymptomatic population. Methods An online survey was employed to determine the compliance of Spanish eye care practitioners with the recommended normalized procedure to administer TBUT. For the purpose of examining the clinical relevance of discrepancies from the recommended procedure, a randomized, double-masked, bilateral study was designed in which a micropipette was used to moisten fluorescein strips with a controlled volume of six different solutions, commonly available in the contact lens office, and TBUT was measured in 58 non-dry eye (OSDI < 15) subjects (age from 19 to 32 years). Results Results from the online survey revealed that 64% of Spanish practitioners frequently use (or have used) different solutions to moisten fluorescein strips during TBUT assessment. Statistically significant differences in TBUT values were found between the various solutions as a whole ( χ 2 = 198.384, p < 0.001), as well as between all solutions when explored pair-wise (all p < 0.001), except for the two saline solutions. Conclusions The present findings support the relevance of selecting the appropriate solution when conducting TBUT for the evaluation of the tear film. Deviations from the recommended procedure may result in misdiagnosis of dry eye and unnecessary patient referral. [ABSTRACT FROM AUTHOR]

Purpose To investigate the agreement in dry eye care management between general practitioners (GPs) and optometrists in the Netherlands. Methods A web-based survey was used to investigate the agreement in symptoms associated with dry eye, causes of developing dry eye, and investigative techniques used in practice, between GPs and optometrists. Additional questions surveyed knowledge of the latest research, and co-management of dry eye disease in primary healthcare. The anonymised questionnaire contained 16 forced-choice questions with Likert scales, and was sent to 1471 general medical practitioners and 870 registered optometrists. The response data was stored on an online database, and was converted directly to text format for analysis using SPSS 21 statistical analysis software. Results 138 optometrists and 93 GPs responded to the survey (Cronbach α = 0.885, optometrists, and 0.833, GPs). Almost no agreement was found for all the questions: a statistically significant difference (Chi-square p < 0.0001) was found between the optometrists and GPs in the use of investigative techniques, associating symptoms, causes of dry eye ( p > 0.0001), and dry eye symptoms, except for ‘burning sensation of the eye’ and ‘irritation of the eye’ as agreed symptoms, and agreement that dry eye is an age-related disease. Conclusions As the optometrist and the GP are the gatekeepers for secondary healthcare, the fundamental differences in the methods of investigation and interpretation of dry eye-related symptoms, the possible cause of developing dry eye disease, and the therapy given by GPs and optometrists in the Netherlands, may have a significant impact on consistency of patient care. [ABSTRACT FROM AUTHOR]

Aims To survey eye care practitioners from around the world regarding their current practice for anterior eye health recording to inform guidelines on best practice. Methods The on-line survey examined the reported use of: word descriptions, sketching, grading scales or photographs; paper or computerised record cards and whether these were guided by proforma headings; grading scale choice, signs graded, level of precision, regional grading; and how much time eye care practitioners spent on average on anterior eye health recording. Results Eight hundred and nine eye care practitioners from across the world completed the survey. Word description ( p < 0.001), sketches ( p = 0.002) and grading scales ( p < 0.001) were used more for recording the anterior eye health of contact lens patients than other patients, but photography was used similarly ( p = 0.132). Of the respondents, 84.5% used a grading scale, 13.5% using two, with the original Efron (51.6%) and CCLRU/Brien-Holden-Vision-Institute (48.5%) being the most popular. The median features graded was 11 (range 1–23), frequency from 91.6% (bulbar hyperaemia) to 19.6% (endothelial blebs), with most practitioners grading to the nearest unit (47.4%) and just 14.7% to one decimal place. The average time taken to report anterior eye health was reported to be 6.8 ± 5.7 min, with the maximum time available 14.0 ± 11 min. Conclusions Developed practice and research evidence allows best practice guidelines for anterior eye health recording to be recommended. It is recommended to: record which grading scale is used; always grade to one decimal place, record what you see live rather than based on how you intend to manage a condition; grade bulbar and limbal hyperaemia, limbal neovascularisation, conjunctival papillary redness and roughness (in white light to assess colouration with fluorescein instilled to aid visualisation of papillae/follicles), blepharitis, meibomian gland dysfunction and sketch staining (both corneal and conjunctival) at every visit. Record other anterior eye features only if they are remarkable, but indicate that the key tissue which have been examined. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the influence of lens care solutions (LCS) on interfacial dynamics and rheological properties of human tear-lipid films. Methods: Tear lipids were extracted from Schirmer strips collected from 6 healthy subjects. Sessile bubble tensiometry was used to study interfacial properties at 22 °C. Lipids were deposited on an air bubble immersed into electrolytes solution to form 90 ± 20 nm films. Lipid films were subjected to expansion-compression cycles for dynamic interfacial properties and to step-strain relaxations for assessments of rheological properties. LCS (BioTrue [BT], PureMoist [PM], Revitalens [RL], ClearCare [CC]) were injected into optical chamber and equilibrated for 2 h without or with lipid films. Dynamic interfacial properties of films were measured. Then electrolyte solution was pumped through chamber and properties of films were re-evaluated. Results: Equilibrium surface tension (EST), elasticity modulus (E), and relaxation times (τ) of tear lipids were 22 ± 2.1 mN/m, 10.7-14.8 mN/m, and 80-150 s, respectively. EST for LCS was 45.3 ± 0.8 for CC, 40.3 ± 0.8 for BT, 33.4 ± 1.0 for PM, and 30.1 ± 0.8 mN/m for RL. E for LCS varied within 0.5-6.7 mN/m, and τ varied from 49 to 68 ± 5 s. For mixed lipids + LCS films, EST remained unchanged whereas E and τ were reduced for all LCS types. Exposure to PM and RL noticeably altered the shape of lipid-film iso-cycles. These changes persisted after LCS washout. Conclusions: Some components of LCS bind irreversibly to lipid films and make them less viscous and less elastic. These findings suggest the possibility of tear-film destabilization upon LCS exposure. [ABSTRACT FROM AUTHOR]

Purpose: This study compared the biocompatibility and comfort of 4 lens care solutions currently marketed in France. Methods: This was a randomized, interventional, double-masked, single-center crossover study assessing balafilcon A silicone hydrogel contact lenses, bilaterally, straight from the blister pack solution (control) and pre-soaked in the following lens care solutions: Regard® (containing sodium chlorite), ReNu® (containing a PHMB [polyhexamethylene biguanide] derivative), CyClean™ and MeniCare™ Soft (both containing PHMB). Subjects were randomized to the order of test solution use. For each of the 5 solutions tested, subjects attended a baseline/lens dispensing visit and an intervention visit 2 h later. At both visits, evaluation included slit-lamp examination, corrected-distance visual acuity, corneal staining, and subject-assessed photophobia, ocular comfort, and ocular redness. Results: Thirty subjects were enrolled and 28 were evaluable. Corneal staining severity was significantly worse than baseline after 2 h of wearing lenses soaked in CyClean, MeniCare, or ReNu (P ≤ 0.001). The MeniCare group alone demonstrated a significant improvement in ocular comfort after 2 h of lens wear (P = 0.02). No group demonstrated significant changes in ocular redness or photophobia. Corrected-distance visual acuity was similar between baseline and intervention visits for each test solution. No adverse events were reported during the study. Conclusions: Silicone hydrogel contact lenses presoaked in lens solutions containing PHMB or a PHMB derivative produced an increase in corneal staining after 2 h of lens wear. The higher levels of corneal staining in the 2 solutions did not correlate with increased discomfort within this 2-h timeframe. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To study the effects of ocular lubricants on higher order aberrations in normal and self-diagnosed dry eyes. Methods: Unpreserved hypromellose drops, Tears Again™ liposome spray and a combination of both were administered to the right eye of 24 normal and 24 dry eye subjects following classification according to a 5 point questionnaire. Total ocular higher order aberrations, coma, spherical aberration and Strehl ratios for higher order aberrations were measured using the Nidek OPD-Scan III (Nidek Technologies, Gamagori, Japan) at baseline, immediately after application and after 60min. The aberration data were analyzed over a 5mm natural pupil using Zernike polynomials. Each intervention was assessed on a separate day and comfort levels were recorded before and after application. Corneal staining was assessed and product preference recorded after the final measurement for each intervention. Results: Hypromellose drops caused an increase in total higher order aberrations (p =<0.01 in normal and dry eyes) and a reduction in Strehl ratio (normal eyes: p =<0.01, dry eyes p =0.01) immediately after instillation. There were no significant differences between normal and self-diagnosed dry eyes for response to intervention and no improvement in visual quality or reduction in higher order aberrations after 60min. Differences in comfort levels failed to reach statistical significance. Conclusion: Combining treatments does not offer any benefit over individual treatments in self-diagnosed dry eyes and no individual intervention reached statistical significance. Symptomatic subjects with dry eye and no corneal staining reported an improvement in comfort after using lubricants. [Copyright &y& Elsevier]

Abstract: Purpose: To define a range of normality for the vectorial parameters Ocular Residual Astigmatism (ORA) and topography disparity (TD) and to evaluate their relationship with visual, refractive, anterior and posterior corneal curvature, pachymetric and corneal volume data in normal healthy eyes. Methods: This study comprised a total of 101 consecutive normal healthy eyes of 101 patients ranging in age from 15 to 64 years old. In all cases, a complete corneal analysis was performed using a Scheimpflug photography-based topography system (Pentacam system Oculus Optikgeräte GmbH). Anterior corneal topographic data were imported from the Pentacam system to the iASSORT software (ASSORT Pty. Ltd.), which allowed the calculation of the ocular residual astigmatism (ORA) and topography disparity (TD). Linear regression analysis was used for obtaining a linear expression relating ORA and posterior corneal astigmatism (PCA). Results: Mean magnitude of ORA was 0.79 D (SD: 0.43), with a normality range from 0 to 1.63D. 90 eyes (89.1%) showed against-the-rule ORA. A weak although statistically significant correlation was found between the magnitudes of posterior corneal astigmatism and ORA (r =0.34, p <0.01). Regression analysis showed the presence of a linear relationship between these two variables, although with a very limited predictability (R 2: 0.08). Mean magnitude of TD was 0.89D (SD: 0.50), with a normality range from 0 to 1.87D. Conclusion: The magnitude of the vector parameters ORA and TD is lower than 1.9D in the healthy human eye. [Copyright &y& Elsevier]

Abstract: Purpose: To determine the rates of microbial contamination and identify contaminants associated with contact lens (CL) care accessories. To investigate self-reported compliance levels with care of CL accessories and its association with contamination level. Methods: A total of 46 CL cases and care solutions from asymptomatic soft contact lens wearers were collected. Samples from the CL cases and care solutions were cultured for microbiological identification and enumeration. A questionnaire regarding compliance to care and hygiene procedures were administered to each subject on their visit. Results: The percentage of microbial contamination for CL cases and care solutions was 50% and 10.9%, respectively. All the contaminants were bacterial. Staphylococcus aureus (37.0%, 17 of 46 cases) and Escherichia coli (8.7%, 4 of 46 cases) were the most common microorganisms detected in CL cases. In care solutions, S. aureus (8.7%, 4 of 46 samples), Pseudomonas aeruginosa (2.2%, 1 of 46 samples) were common contaminants. CL cases and care solutions that were used for <3 months were significantly less contaminated than those used for >3 months (10.9% versus 39.1%, p <0.05). Polyquad and Aldox based MPS solution showed no contamination. Subjects with medium or low compliance had highly significant rates of contaminations both in CL cases and solutions than for subjects with high compliance (p <0.05). Conclusions: Nepalese Soft CL wearers are at high risk of developing ocular complications due to high CL case and solution contamination. Frequent replacement of CL cases and solutions, as well as good compliance is recommended to reduce risk of contamination. [Copyright &y& Elsevier]

Soft contact lenses that have been prescribed by eye care practitioners are sometimes substituted for alternative lenses by unqualified, unregulated and sometimes even fully regulated lens suppliers, in the mistaken belief that there is essentially no difference between different soft lens types. This review considers the implications of inappropriately substituting soft contact lens types in terms of (a) lens properties: surface treatment, internal wetting agents, material, total diameter, back optic zone radius, thickness, edge profile, back surface design, optical design, power, colour (tint) and ultraviolet protection; and (b) lens usage: wearing modality (daily versus overnight wear) and replacement frequency. Potential aspects of patient dissatisfaction and adverse events when prescribed soft lenses are substituted for lenses with different properties or intended usage are considered. Substitution of 15 of the 16 lens properties considered (i.e. except for back surface design) was found to be related to at least one - and as many as six - potential sources of patient dissatisfaction and adverse ocular events. Contact lens are medical devices which are prescribed and fitted; they should never be substituted for another lens type in the absence of a new prescription further to a full finalised fitting, for the simple reason that all soft contact lenses are not created equal. A substituted lens may have properties that results in undesirable consequences in respect of vision, ocular health, comfort and cosmetic appearance, and may be incompatible with the lifestyle of the patient. [ABSTRACT FROM AUTHOR]

Aim: To investigate the outcome of contact lens (CL) fitting in aphakic children following lensectomy for congenital cataract.Method: Retrospective data of 205 aphakic children who visited for CL fitting following lensectomy from 2008 to 2018 were collected. Data includes the demographic details, CL parameters in first and last visit, hours of CL wear, reason for discontinuation of CL, surgical procedures underwent and years of follow up.Results: 205 (148 unilateral and 57 bilateral) aphakic children comprised of age group, < 1 month (n = 48), 1-3 months (n = 37), 3-6 months (n = 68), 6-12 months (n = 10), >12 months (n = 42). 173/205(84.39%) children were fitted with rigid gas permeable (RGP) and 32/205(15.6%) were fitted with soft CL at their first visit. 10 children had shifted to soft CL in their follow-up visits due to intolerance to RGP. 97/205(47.32%) children continued CL (55RGP, 42SCL) till the last follow-up for 2.17 ± 2.36 years and wore lens for 3.7 ± 3.65 h per day. Number of lenses replaced was 2 lenses (median) and maximum of 9 lenses over a period of 1-8 visits. The maximum visual acuity achieved was up to 0.2 log Mar units at the youngest age of 4 years on successful CL wear. 60/205(29.26%) children discontinued lenses at different follow-up visits due to IOL implantation(n = 28),using spectacles due to handling difficulty, child uncooperative to lens wear and lens fitting issues(n = 32). 48/205(23.41%) were lost to follow-up after the first visit. The average K (7.46 ± 0.43 mm) showed significant correlation to lens base curve in first visit (7.48 ± 0.41 mm) whereas flat K (7.71 ± 0.38 mm) showed significant correlation in the last visit (7.46 ± 0.39 mm) (p < 0.005). This was well described by a significant diameter change of 8.68 ± 0.31 mm to 9.42 ± 1.77 mm (p < 0.005) at the first and last visit respectively. The refractive error showed a significant difference between first (27.96 ± 5.33D) and last visit (21.97 ± 6.85D) (p < 0.005).Conclusion: This study witnessed successful contact lens wear in only half of the children. The visual rehabilitation following lensectomy depends on right CL choice and close follow-up. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: This was a secondary analysis of an existing dataset of soft contact lens wearers age 8–33 years, who received eye care outside of a clinical trial. The aim was to identify geographical and temporal factors associated with interruptions to contact lens wear. Methods: Data from six academic centers in North America captured 522 events in 3549 patients. Cases were analyzed overall and in subcategories of allergic, and serious and significant adverse events. General estimating equations were used to model the effect of geographic (Northwest, West, Central, Northeast, Southeast) and temporal (season, month, day of the week) factors, along with previously identified risk factors associated with interruptions in lens wear (patient age, contact lens material, overnight wear, lens care system, replacement schedule, and years of contact lens wear). Results: After controlling for established risk factors, both region and temporal factors disrupted the patients’ ability to maintain contact lens wear. About 4% of all visits had complications that led to an interruption in wear. Allergic events were highest in the Central region. Serious and significant adverse events peaked in the Southeast during the Autumn and Winter months (September, October, December). Day of the week was not significant in any model. Conclusions: This study provides evidence of seasonal and regional challenges to contact lens wear. As the use of soft contact lenses expands for both cosmetic and medical reasons, practitioners must examine ways to maintain continuous, safe, and healthy use of contact lenses across all patients. [Copyright &y& Elsevier]

Abstract: Aim: To determine the prevalence and the major types of ocular complications related with soft contact lenses (CL) in a tertiary eye care centre of Nepal. Methods: Medical files of 4064 soft CL wearers who started wearing CL between January 2003 and December 2010 in BP Koirala Lions Centre for Ophthalmic Studies (BPKLCOS) Kathmandu, Nepal, were retrospectively reviewed. Records of patients who visited the hospital with complications were analyzed. Patients with ocular complications non-related with CL wear were excluded. Results: Complications were found in 4.9% of the total soft CL wearers. Contact lens induced papillary conjunctivitis (CLPC) was the most common complication, comprising 36.9% of the total patients with complications. The other commonly found complications were superior punctuate keratitis (SPK) in 16.2%, conjunctivitis in 18.2%, meibomian gland dysfunction (MGD) in 8.6%, contact lens induced peripheral ulcer (CLPU) in 4%, corneal vascularization in 3.5% and microbial keratitis in 3%. The average time of first occurrence of complications after starting of contact lens wear was 14.3±11.4 months. Conclusion: CLPC, conjunctivitis and SPK were the most common types of soft CL related complications found in Nepal. Vision threatening complications like microbial keratitis was also found in some patients. Patient education in CL hygiene, after care schedule and frequent follow up examinations may help to minimize CL related complications. [Copyright &y& Elsevier]

Abstract: The diagnosis of ocular disease is increasingly important in optometric practice and there is a need for cost effective point of care assays to assist in that. Although tears are a potentially valuable source of diagnostic information difficulties associated with sample collection and limited sample size together with sample storage and transport have proved major limitations. Progressive developments in electronics and fibre optics together with innovation in sensing technology mean that the construction of inexpensive point of care fibre optic sensing devices is now possible. Tear electrolytes are an obvious family of target analytes, not least to complement the availability of devices that make the routine measurement of tear osmolarity possible in the clinic. In this paper we describe the design, fabrication and calibration of a fibre-optic based electrolyte sensor for the quantification of potassium in tears using the ex vivo contact lens as the sample source. The technology is generic and the same principles can be used in the development of calcium and magnesium sensors. An important objective of this sensor technology development is to provide information at the point of routine optometric examination, which would provide supportive evidence of tear abnormality. [Copyright &y& Elsevier]

Abstract: Purpose: Eyelid changes have been reported with silicone hydrogel contact lenses. It is hypothesized that those changes are associated with the mechanical interaction between the contact lens front surface and eyelid tissues and, are specific to contact lens type rather than a general effect of the lens category. The purpose of this study was to assess the effect of refitting into a silicone hydrogel on a daily wear basis to current contact lens wearers, lapsed wearers and neophytes on eyelid physiology. Methods: The investigation was a 2-year prospective investigation of ACUVUE® OASYS(R) with HYDRACLEAR® Plus (senofilcon A) used with care systems, representative of current practice. Results: 90 subjects were enrolled of whom 64 subjects completed the investigation. The results obtained were as follows: [(i)] For current non-wearers, lid hyperaemia (p <0.001) was statistically significantly lower and there was no difference in papillae (p =0.078) at the end of the 24-month period of wear compared with baseline. [(ii)] For the established current wearers, lid hyperaemia (p <0.001) and the papillae response (p =0.001) were statistically significantly lower at the end of the 24-month period of wear than at baseline. Conclusions: The results of the study demonstrated that senofilcon A, worn on a daily wear basis and replaced every 2 weeks, did not produce any eyelid tissue changes in previous non-contact lens wearers at baseline and revealed no change or a slight improvement of the eyelid tissues of established contact lens wearers. [Copyright &y& Elsevier]

Abstract: Purpose: To establish guidelines for contact lens wearers’ hand hygiene practices which achieve a balance between minimising risk of infection and reasonable expectations on the ability of patients to follow them. Methods: Evidence has been obtained from publications via PubMed, Advanced Medline Search, Cochrane Reviews, Google Scholar and using the key words hand hygiene, washing and contact lens. Results: Guidelines for effective hand washing and the bother involved vary according to the level of hygiene required. High levels of non-compliance with hand hygiene practices, even among healthcare workers, gives an indication of how important the level of bother involved when following guidelines can be in contributing to non-compliance. Conclusions: Better patient education to improve hand washing techniques as well as patient attitudes toward hand hygiene are needed to reduce high non-compliance levels. Better hand hygiene techniques and higher frequency of their application give the prospect of reduced risk of infection and of any discomfort that arises from increased lens and ocular bioburden. In order that adoption rates might be maximised, the guidelines which have been distilled from this review attempt to strike a balance between technique redundancy and the associated higher levels of hygiene achieved and the possibility that the perception of too much bother involved could reduce participation rates. The guidelines have been expanded by the inclusion of suggested explanatory information in the expectation that helping patients to understand why the recommendations are made will have the effect of increasing their adoption. [Copyright &y& Elsevier]

Abstract: Purpose: To evaluate compliance to contact lens use in 14 countries, and to identify wearer attributes which indicate lower compliance levels. Methods: A web-based survey was undertaken by 4021 contact lens wearers, revealing information about demographics, and lens and solution information including daily handling details, case care and aftercare frequency. Particular attention was paid to eight modifiable compliance-related behaviours which are associated with an increased risk of microbial keratitis. Results: Full compliance was very rare for most lens users, although better (15% of wearers) for daily disposable lenses. Reduced compliance was demonstrated in South Korea, and for young male full-time contact lens users, especially those who have not consulted their eyecare practitioner for some time. The behaviours associated with the lowest levels of compliance were rubbing and rinsing, handwashing, correct lens replacement and case cleaning. Conclusions: Given other recent literature, which suggests improved contact lens compliance with regular self-review exercises, we encourage clinical colleagues to particularly examine case cleaning, handwashing and rubbing and rinsing at aftercare examinations, especially in young male wearers. [Copyright &y& Elsevier]

Abstract: Purpose: To evaluate the relationship between compliance with replacement frequency (RF) and contact lens (CL)-related problems in silicone hydrogel (SiHy) wearers. Methods: 501 SiHy wearers from seven optometry offices completed surveys regarding their lens wear and any CL related problems which they may have experienced in the preceding 12 months. File review was subsequently conducted at their optometry offices to confirm the information provided. Results: 49% of respondents were wearing 2-week replacement (2WR) and 51% 1-month replacement (1MR) SiHy lenses. 67% wore their lenses for longer than the manufacturers’ recommended RF (MRRF) and 60% for longer than their optometrist''s recommended RF (ORRF). The mean RF was 2.6× the MRRF for 2WR and 1.5× for 1MR wearers (p <0.001) with median values of 31 and 37 days, respectively. Twenty-three percent reported signs or symptoms consistent with potential complications relating to CL wear. This rate was significantly higher for wearers who were non-compliant with the ORRF than compliant wearers (26% versus 18%, p =0.028). It was also higher for those multipurpose solution users who reported never/almost never rubbing and rinsing their lenses when compared with those who did this every night (29% versus 17%, p =0.007). Conclusions: Two thirds of the SiHy wearers did not comply with the MRRF and 2WR wearers stretched the replacement interval of their lenses to a greater degree than 1MR wearers. Failing to replace lenses when recommended and failing to rub and rinse lenses were associated with a higher rate of patient-reported CL problems. [Copyright &y& Elsevier]

Abstract: Purpose: To describe compliant and non-compliant overnight wear (EW) of soft contact lenses from a large observational study. Methods: A retrospective chart review of 3211 SCL patients with known EW status (aged 8–33yrs, SCL power +8.00 to −12.00D) captured data from 10,516 clinical visits (2006–2009). Status of EW was either daily wear (DW), compliant EW (overnight wear of US Food & Drug Administration (US FDA) EW-approved lenses), non-compliant EW (overnight wear of DW-approved lenses). The effect of demographic and clinical characteristics on the likelihood of reporting EW was examined using logistic regression. Additionally, the effect of these same characteristics on the likelihood of non-compliant EW was assessed with logistic models. Results: Eight-hundred and eight patients (25.2%) reported EW. Non-compliant EW was reported by 6% of wearers (13 hydrogel, 2 silicone hydrogel brands) In multivariate models, patient age and lens replacement schedule were significant factors for EW (vs. DW) and for non-compliant (vs. compliant) EW (p <0.0001). Other factors significantly related to EW were gender, smoking, lens material, sphere power, and years of CL wear (p ≤0.007, all). Conclusions: Young people (ages 18–25yrs), males, smokers, myopes, silicone hydrogel lens wearers and patients with >1yr of CL wear were significantly more likely to report EW. Non-compliant EW occurred often in young people and daily disposable wearers, though many brands had non-compliant EW use. Understanding who is likely to wear EW and non-compliant EW will help clinicians pointedly counsel patients more at risk on best practices with EW. [Copyright &y& Elsevier]

Abstract: Purpose: To review important aspects of contact lens compliance and to survey contact lens replacement frequency, steps in lens care and hygiene and replacement of the lens storage case via online surveys. Methods: Random US samples (n =645 and 787) of frequent replacement contact lens wearers answered questions on contact lens wear in online, sponsor-masked surveys. Results: Wearers of lenses prescribed by their practitioner for 2 weekly replacement reported that they replaced lenses as follows: within 2 weeks 45%, within 3 weeks (minor stretching) 68%, within 4 weeks 89%, ≥8 weeks (extreme stretching) 4%, compared to Monthly wearers who reported: within 4 weeks 37%, within 5 weeks (minor stretching) 57%, ≥8 weeks 23% (≥8 weeks extreme stretching, Chi-square p =0.001). Median frequency for cleaning lens storage case was 2–3 times per week, while 33% reported cleaning monthly or less often. Median lens storage case replacement was every 4–6 months, while 48% reported annual replacement or less often. Most patients cleaned their lens case with hot or cold tap water (72%). Conclusions: These internet surveys revealed significant non-compliance with lens care steps, case hygiene and lens replacement schedule. More than half of the contact lens wearers surveyed were not compliant with their 2-weekly or monthly schedule. Lenses prescribed for longer replacement intervals can lead to more extreme stretching of lens life. To encourage better patient habits, eye care providers should reinforce their recommended frequency of replacement of lenses and storage cases and should reinforce care and hygiene steps at each patient visit. [Copyright &y& Elsevier]

Abstract: Purpose: To evaluate sport professionals’ attitudes towards visual correction in sport. Method: A questionnaire was handed out in schools, gyms, sports centres and universities, to coaches, physical education teachers and final year students of motor science. The questionnaire was given to one group of sport physicians prior to a 1-day scientific update course on the benefits of contact lenses (CLs) in sport. At the end of the course, certain questions from the questionnaire were given out again in order to evaluate the effect of the update on their opinions. Results: A total of 245 questionnaires were collected. The interviewees stated that correcting a vision defect during sports practice was important, but their propensity to suggest CLs for sport, though still rather high in value, showed a statistically significant drop. This drop did not occur if the CLs were recommended for competitive sports. This trend remained unchanged if a specific judgement was requested for the adolescent category. The tendency to suggest CLs was higher in CL wearers as compared to non-wearers. The sport with the lowest recommendation of CLs was swimming. In the sample of sports physicians, a specific education on the subject of CLs increased the propensity to adopt CLs in sports. Conclusions: The main “actors” in the sports sector regard correcting a vision defect during sport to be important. Nevertheless, their tendency to suggest CLs is significantly lower. Works that make these categories aware of the benefits of CLs in sport can certainly help to fill this gap. [Copyright &y& Elsevier]