Search

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]

Rigid contact lenses have an important role in contact lens practice. The purpose of this work is to update earlier surveys by describing global trends in rigid lens fitting between 2000-2023. An annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000 and 2023. Data relating to 342,500 fits undertaken in 20 countries returning reliable longitudinal data were analysed in respect of rigid lens fitting, defined as the fitting of any design of a contact lens manufactured in a rigid material. Overall, rigid lens prescribing increased slightly over time, from 14.2 % of lens fits in 2000 to 15.2 % in 2023 (p < 0.0001). However, post-hoc analysis shows that the change over time is best described as a decline between 2000 and 2012, followed by a steady increase subsequently. There were significant differences in rigid lens prescribing between countries (p < 0.0001). The difference between the percentage of males fitted with rigid lenses, as a proportion of all contact lenses (12.7 %), and females (12.0 %) is significant (p < 0.0001), although not clinically meaningful. Rigid lens wearers are older at fitting than soft lens wearers (38.7 vs 31.3 years, respectively) (p < 0.0001). Analysis of 5,994 rigid lens fits prescribed currently (2019–2023) were categorised as: corneal sphere – 30 %; scleral and corneo-scleral – 28 %; corneal myopia control/orthokeratology – 21 %; and corneal complex (including toric, multifocal and monovision) – 16 %. There has been a slight increase in rigid lens fitting during the second decade of this century. This increase is apparently due to a 'repurposing' of rigid lenses, with the growth of scleral/corneo-scleral and myopia control/orthokeratology lens fits essentially replacing conventional spherical corneal lens fits. [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]

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]

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 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]

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]

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]

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]

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 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]

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: 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 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 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]

Abstract: Purpose: To assess the clinical and subjective performance of a one-step hydrogen peroxide (H2O2) lens care system compared to a multi-purpose disinfecting system (MPDS) when used with silicone hydrogel (SiH) lenses. Methods: This was an eight-week, contralateral (lens type) clinical trial with a randomized, cross-over (care system) design. The H2O2 system was Clear Care ((AO Sept Plus) CIBA VISION) and the MPDS was OPTI-FREE RepleniSH (Alcon) and the SiH materials were lotrafilcon B (Air Optix; CIBA VISION) and senofilcon A (Acuvue OASYS, Johnson & Johnson Vision Care). Investigators and subjects were masked to lens care and lens type, respectively. Clinical variables and ocular health assessments were conducted at a baseline, two-week and four-week visit for each cross-over phase. Comfort, dryness and vision were rated on 0–100 scales. Wearing times and comfortable wearing times were also recorded. Results: Twenty-six subjects were enrolled: nine male, 17 female, mean age (±standard deviation) 31±12 years (range 17–59 years) and 24 subjects completed the study. Clinical variables showed no difference between solutions (all p >0.05), however one subject exhibited solution-induced corneal staining with both lens materials and the MPDS. There was no difference between solutions in subjective overall ratings of comfort, dryness or vision (p >0.05). The H2O2 resulted in longer reported comfortable wearing times than the MPDS (10.93±1.71 vs 9.84±1.47h; repeated measures ANOVA, p <0.01). Conclusions: While both lens care systems performed well with the SiH lenses used, the H2O2 resulted in a longer reported comfortable wearing time then the MPDS. [Copyright &y& Elsevier]

Abstract: Purpose: Ultraviolet radiation (UVR) blocking contact lenses provides ocular protection factors (PF) that vary with lens thickness and the nature of the polymer dopant. This study measured the UVR PF of silicone hydrogel lenses outdoors and compares this to known methods for determining PF mathematically. Methods: Ambient measurements were taken using an UVA-B radiometer, adapted to hold the test lenses over its sensor to quantify their UVR blocking capabilities. The UVR blocking silicone hydrogel lenses tested included galyfilcon A, senofilcon A, and enfilcon A. The first UVR blocking hydrogel lens, vasurfilcon A, and a non-blocking silicone hydrogel lens, lotrafilcon B, served as a comparison. Lens transmittance at the centre and periphery was measured and PF calculated to predict signal reduction for comparison with field measurements. Results: There was a significant range of cut-off wavelengths across the lenses, ranging from 370nm for enfilcon A to 390nm for vasurfilcon A, with lotrafilcon B transmitting down to 265nm, with a 3nm shift from centre to periphery across the −3.00 D UVR blockers. The UVR reduction calculated from the transmittance data correlates well with field data, ranging from 90–98% for the UVR blockers to 13% for the non-blocker. Conclusions: The silicone hydrogel lenses showed a wide range of transmittance curves with increasing PF from centre to periphery. PF calculations work well but do not always compare precisely with measured data due to factors such as sensor spectral response and the nature of the incident solar spectrum. [Copyright &y& Elsevier]

Abstract: Purpose: This two-phase survey aimed to identify the beliefs and attitudes that create a barrier towards contact lens (CL) fitting among adolescents (aged 12–18 years) and their parents attending eye care practitioner clinics in Italy (phase 1) and Iberia (Spain and Portugal; phase 2). In phase 2, the sample was further focused, by limiting it to those adolescents who did not already wear CL. Methods: The extent to which CL satisfy aesthetic, visual, and practical needs and their effectiveness, safety, and comfort in the general population and in adolescents was rated by respondents on a 5-point Likert scale. Results: In phase 1, approximately one-third of adolescents (n =146) and parents (n =114) were CL wearers. Most adolescents (77.5% of 223) and parents (66.2% of 230) expressed a high interest in CL use in phase 2 despite none of the adolescents currently wearing CL. Parents, but not adolescents, perceived that CL were significantly less safe in adolescents than in the general population (p <0.05) in phases 1 and 2. Across both phases, adolescents and parents agreed that CL met an aesthetic need in adolescents (p <0.05 versus general population). Among 50% of parents (mainly mothers), significant concerns regarding CL were difficulties following instructions and taking care of the CL and potential eye damage, which, in mothers, led them to show less agreement towards CL use by the adolescent (p <0.001). Conclusions: These findings highlight an essential need for improved education on CL use in the population. [Copyright &y& Elsevier]

Abstract: Purpose: To examine the objective clinical performance of ‘comfort-enhanced’ daily disposable contact lenses over a 16-h day. Methods: Four contact lenses (Hilafilcon B, Etafilcon A Plus, Nelfilcon A and Nelfilcon A Plus) were evaluated in an investigator masked, open label trial at the end of a week''s bilateral wear. Pre-lens non-invasive tear break-up time (PL-NITBUT), tear prism height, bulbar hyperaemia and ocular surface temperature (OST) were measured with the lens in situ at 8, 12 and 16h of wear. Results: There was no difference between how many hours the lenses types were worn each day (F =0.90, p =0.44). The PL-NITBUT decreased with the duration of daily lens wear (F =32.0, p <0.001) and was more stable with Nelfilcon A Plus (F =6.00, p =0.002) than with the other lenses evaluated. Bulbar blood vessels increased in coverage (F =11.5, p <0.001) but not overall redness (F =0.0, p =0.99) with the duration of daily lens wear, but there was no difference between the lenses (p >0.05). The tear prism height decreased with the duration of daily wear (F =27.0, p <0.001) and differed between lenses (F =2.9, p =0.04). The OST decreased with the duration of lens wear (F =119.7, p <0.001) and was reduced by daily disposable lens wear (F =7.88, p <0.001), but did not differ between lenses (F =0.88, p =0.45). Conclusions: Objective measures of tear film indicated a difference between the lenses evaluated for PL-NITBUT and tear prism height, but not for wearing time or bulbar conjunctival hyperaemia. Therefore clinical benefits of daily disposable ‘comfort enhancing’ contact lenses can be measured, but challenges remain in producing contact lenses that do not compromise anterior eye physiology over the whole day. [Copyright &y& Elsevier]

Abstract: Purpose: To determine whether hypo-osmotic saline drops can improve contact lens associated discomfort and dryness by decreasing contact lens osmolality. Methods: Fifteen symptomatic subjects wore Lotrafilcon A lenses bilaterally for 6h on two different days. According to randomisation, hypo-osmotic (280mmol/kg) or hyper-osmotic (380mmol/kg) saline drops were applied four times during each day and ocular symptoms, tear film and contact lens parameters, and contact lens osmolality were assessed. Results: Sixty percent of the subjects preferred the hypo-osmotic saline drops, compared to 33%, who preferred the hyper-osmotic ones. Subjects experienced significantly less dryness and lens awareness with hypo-osmotic saline drops compared to hyper-osmotic ones (p <0.05). Using the hypo-osmotic drops, there was a trend for decreased contact lens osmolality from 379 to 343mmol/kg (p =0.06). There were no differences in lipid layer, non-invasive tear film break-up time, lens surface wettability, lens water content after wear, lens movement on eye or ocular staining and indentation between saline drops (all p >0.05). Interestingly, the difference in contact lens osmolality between drops did not reflect the osmolality difference between the two saline drops. Conclusion: Hypo-osmotic saline drops were preferred by a greater number of subjects and contact lens osmolality tended to be lower with the use of hypo-osmotic saline. Hypo-osmotic drops have the potential to decrease contact lens osmolality which in turn may help improve ocular comfort. This has possible impact on the practitioners’ choice of the lens rewetting drop recommended and the design of future lens rewetting drops. [Copyright &y& Elsevier]

Abstract: Purpose: To evaluate and compare the effect of gravity and gaze direction on toric lens orientation and visual acuity (VA). Method: This was a 14 subject, randomised, unmasked, non-dispensing study, relating to the effect of gaze direction and posture on toric lens orientation and VA. Four lens types were assessed: Acuvue™ Oasys® for Astigmatism (AOfA), Purevision® Toric (PVT), Air Optix® for Astigmatism (AOT) and Proclear® Toric (PCT). In the first part of the study, subjects were positioned on their side and once lenses had settled, VA was measured and photographs taken of the lens orientation position. In the second part, the subjects were positioned at a slit-lamp and video-recordings taken as they changed from the primary gaze position to the eight cardinal directions of gaze. Results: In Part 1, all lenses rotated as a result of change in posture and head position. With subjects in a recumbent position mean rotation ranged from 11.0° with AOfA to 29.1° with PCT. The consequent mean reduction in VA ranged from 0.05logMAR for AOfA to 0.15logMAR for PVT and was significantly worse with PVT and PCT compared with AOfA (P <0.05). In Part 2, lenses tended to show inferio-nasal rotation on upgaze and inferio-nasal rotation on downgaze. The AOfA lenses showed less rotation on inferio-nasal version than each of the other designs (P <0.005). The AOT lenses showed significantly less rotation on superior-temporal version than PVT (P =0.01). Conclusion: Toric soft contact lens stability in extreme versions and postural positions can affect orientation and VA. [Copyright &y& Elsevier]

Abstract: Introduction: This study investigated the modality, type and duration of contact lens wear as well as compliance and hygiene related issues (hand and case hygiene, use of tap water, dozing and overnight wear) in the UK and Germany. Questionnaires were collected anonymously from 417 UK and 767 German patients attending optometric practices for contact lens appointments. It is the seventh of a series of contact lens wearer profiles conducted since 2000. Results: The proportion of rigid gas permeable lenses worn was significantly higher at 55.4% in Germany, compared to 16.1% in the UK. Overall, a significantly larger proportion of German participants used tap water to rinse their lenses and cases (P <0.001). Also, German respondents changed their lens cases less frequently (p <0.001). Fewer UK than German respondents stated they washed their hands before lens insertion (p =0.009), removal (p =0.01), before eating (p <0.001). German participants were less likely to wash their hands before preparing food (p =0.042) and after using the toilet (p =0.002). The two sample groups differed significantly regarding the care regimens they used for their CLs (p <0.001). Conclusion: The differences between Germany and the UK highlighted in this study were caused by differences in legal regulations, plumbing and practitioners’ guidance. Although many of the questions relating to hygiene differed statistically between the two participating sample groups, the absolute differences in figures were not considered to be large. [Copyright &y& Elsevier]

Abstract: Background: The rate and reasons for discontinuation of contact lens wear by young patients are not well known. The Contact Lenses in Pediatrics (CLIP) Study surveyed participants 3 months after the final study visit to determine the percentage of participants who continued to wear contact lenses after study conclusion. The factors associated with continued contact lens wear and differences in behaviors between the children and teens were also determined to provide insights to practitioners who provide refractive correction for patients in those age groups. Methods: Three months after the CLIP Study completion, participants and parents returned mailed surveys that assessed post-study lens purchase and symptoms related to contact lens wear if contact lenses wear had been continued. Responses were compared between the children and teens using χ 2 or Fisher''s exact test. Results: Almost 92% of the surveys were returned. Eighty percent of teens’ parents reported purchasing lenses after the study, vs. 63% of the children''s parents (p =0.02). Symptoms reported at the last study visit were not significantly associated with future purchase, though there was a trend towards more light sensitivity in those who did not purchase more contact lenses (23.1% vs. 11.8%). Satisfaction with contact lenses was high among both those purchasing additional contact lenses and those who did not. Both children and teens reported similar frequencies of symptoms such as burning, itching or tearing eyes 3 months following study completion. Teens reported having contact-lens-related dry eyes more frequently than children. Conclusions: A large proportion of children and an even higher proportion of teens continued wearing their lenses 3 months after completing the CLIP Study. Children and teens reported similar contact lens comfort and low frequencies of most symptoms, though teens experienced more dry-eye symptoms. Overall, reports of symptoms in this sample were lower than had been reported in adult populations by other investigators. [Copyright &y& Elsevier]

Abstract: Purpose: To investigate the quantity and severity of contact lens complications referred into Hull Royal Infirmary Ophthalmic A&E, their impact on resources and whether their management and treatment was appropriate. Methods: A survey was conducted over a 7-month period at Hull Royal Infirmary Ophthalmic A&E Unit. In this time 100 patients were enrolled, all completed a questionnaire including information about lens type and wearing schedule, and were photographed. All were examined, and where necessary treated by the Ophthalmic A&E doctor. Results: Contact lens complications accounted for 9.1% of the referrals into Ophthalmic A&E, a total of 323 appointments. Microbial keratitis was the most common diagnosis (22%), and Klebsiella and Pseudomonas the most common pathogen implicated. A case of Fusarium was also recorded. Optometrists/contact lens practitioners were the most common referral source (41%). Soft lens wearers were most common (67%), followed by silicone hydrogel wearers (28%) and least common were rigid gas permeable wearers (5%). Ten percent of the patients referred into the department were admitted. Conclusion: Education of the patient in their wear schedule and hygiene are still significant factors in their risk of developing contact lens complications. A closer working relationship needs to be fostered between Community Optometrists and Eye Departments to give the most appropriate management of contact lens related problems which would help alleviate undue burdens on Ophthalmic A&E. [Copyright &y& Elsevier]

Abstract: Introduction: The aim of the present studies was to investigate the effect on spherical aberration of different non custom-made contact lenses, both with and without aberration control. Methods: A wavefront analyser (Zywave™, Bausch & Lomb) was used to measure the aberrations in each subject''s right eye uncorrected and with the different contact lenses. The first study evaluated residual spherical aberration with a standard lens (Focus Dailies Disposable, Ciba Vision) and with an aberration controlled contact lens (ACCL) (Definition AC, Optical Connection Inc.). The second study evaluated the residual spherical aberrations with a monthly disposable silicone hydrogel lens with aberration reduction (PureVision, Bausch & Lomb). Results: Uncorrected spherical aberration was positive for all pupil sizes in both studies. In the first study, residual spherical aberration was close to zero with the standard lens for all pupil sizes whereas the ACCL over-corrected spherical aberration. The results of the second study showed that the monthly disposable lens also over-corrected the aberration making it negative. The changes in aberration were statistically significant (p <0.05) with all lenses. Conclusion: Since the amount of aberration varies individually we suggest that aberrations should be measured with lenses on the eye if the aim is to change spherical aberration in a certain direction. [Copyright &y& Elsevier]

Abstract: Purpose: Symptoms of dry eye are commonly reported in contact lens wearers and are a frequent cause of non-tolerance. The purpose of the present study is to evaluate the effects of oral treatment with particular omega-6 fatty acids in the form of evening primrose oil (EPO) on subjective symptoms, ocular surface signs and tear film characteristic in patients with contact lens associated dry eye. Methods: The study design was randomised, double-masked and placebo controlled. 76 female soft contact lens wearers were treated for 6 months with either EPO or placebo (olive oil). Subjects underwent three examinations (baseline, 3 and 6 months). At each examination subjects were given a questionnaire relating to lens comfort and dry eye symptoms and underwent a series of tests of tear film characteristics (tear meniscus height, break-up time), meibomian gland function (lipid layer thickness and quality) and ocular surface parameters (hyperaemia and staining). Results: The EPO group showed a significant improvement in the specific symptom of ‘dryness’ at 3 and 6 months (p <0.01) and also a significant improvement in overall lens comfort at 6 months (p <0.01). Tear meniscus height was increased in the EPO group at 6 months relative to baseline (p <0.01), although all other objective signs were unchanged. Conclusion: This study provides evidence for a beneficial effect of particular orally administered omega-6 fatty acids in alleviating dry eye symptoms and improving overall lens comfort in patients suffering from contact lens associated dry eye. [Copyright &y& Elsevier]

Abstract: Purpose: To report a case of conjunctival squamous metaplasia associated with oral carbamazepine use. Methods: Following completion of an ocular comfort questionnaire, biomicroscopy and a phenol red thread test, impression cytology from the inter-palpebral zone (nasal) of the bulbar conjunctival surface was undertaken using a Millcell®-CM filter after topical anaesthesia with oxybuprocaine 0.4%. The filter was stained with Giemsa and colour images taken at 400× magnification by light microscopy. The images were graded and also a 35mm was prepared. From the projected image, an overlay method was used to outline the borders such that the cell and nucleus area, and the longest and shortest dimensions could be measured by planimetry. Results: A male subject, added 22 years, presented with slight conjunctival injection but no substantial symptoms and only slight surface staining with fluorescein. The subject reported use of oral carbamazepine (200mg, b.d.s.). Impression cytology showed large sheets of squamous cells (grade 2–3) with few goblet cells. The average cell area was 1509μm2, the long:short dimension ration averaged 1.42 and the average nucleus/cytoplasm (N/C) value was just 0.092 (or 1:11.5 as a ratio). Conclusions: Since the drug has been reported to be excreted in the tear film, and with no other risk factors (such as contact lens wear, smoking or dry eye disease), the squamous metaplasia is attributed to the use of carbamazepine. [Copyright &y& Elsevier]

Abstract: Purpose: To explore the success of the application of a computerised videokeratography (CVK) software system for the fitting of rigid gas permeable (RGP) contact lenses (CLs) on irregular corneal surfaces and compare it to the standard diagnostic fitting procedure. Methods: This was a comparative prospective study, over a 1-year period (2004–2005). It included 41 RGP CL wearers (68 eyes) with irregular corneal surfaces. Of these, 51 (75%) had keratoconus, 7 (10%) corneal scarring (infectious or traumatic), 6 (6.82%) corneal transplants, 2 (2.9%) astigmatism, and 2 (2.9%) aphakia. Each eye was being re-fitted with a new RGP CL based on a topographical measurement in conjunction with a CL fitting software programme. The performance of the CLs was evaluated regarding visual outcome, fitting characteristics, and efficiency of the fitting procedure. Results: Of the 68 eyes, 53 (77.94%) chose the CL fitted using the CVK software system, 9 (13.24%) chose the CL fitted using the standard procedure, and 6 (8.82%) showed no preference for either CL. There was a statistically significant improvement regarding visual outcome [contrast sensitivity at the spatial frequencies of 0.66 (p =0.029), 3.40 (p =0.008), and 17 (p =0.032), subjective vision (p =0.009)], fitting characteristics [grading scale (p =0.00), lens comfort (p =0.00) and daily wearing time (p =0.002)], and efficiency [number of trial lenses required (p =0.00)] with the CL fitted using the CVK software system. Correlating factors for the likely preference for the CL fitted using the CVK software system were subjective vision (p =0.004), lens comfort (p =0.009), and convenience of the fitting procedure (p =0.023). Conclusion: The application of a CVK software system for the fitting procedure of RGP CLs on irregular corneal surfaces was a safe procedure and shown to be more successful and efficient than the standard diagnostic fitting method. [Copyright &y& Elsevier]

Abstract: Purpose: To study accuracy and safety, related to sensation (discomfort) and trauma, when using Goldmann applanation tonometry (GAT) on eyes wearing daily disposable soft contact lenses. Methods: The intra-ocular pressure (IOP) of 136 normal eyes of 68 subjects was measured by Goldmann tonometer. Measurements were made in one eye with a contact lens (hilafilcon A) without anaesthetic drops and then without the contact lens using one drop of 0.4% oxybuprocaine hydrochloride. Each contact lens used was identical as to back optic zone, back vertex power. Standard Goldmann procedure only was used for the fellow eye of each subject. Subjective sensation (discomfort) responses to both procedures were studied in a subgroup (66 eyes) using a scale of discomfort, from 1 (no sensation) to 5 (highest sensation). Epithelial staining after tonometry was evaluated for this subgroup. Results: No significant differences were found for the IOP with and without contact lens (t <1; p =0.63) for the IOP range studied. There was a good correlation between the two procedures (r =0.81; p <0.05). Lowest sensation was found with tonometry on the anaesthetized cornea; this condition was significantly different from other conditions (p <0.005). No difference was found among the other conditions (contact lens insertion, tonometry on contact lens and application of topical anaesthetic). Corneal epithelial staining following the standard tonometry procedure was significantly higher than following the procedure with a contact lens (p <0.00005). Conclusions: Measurement of IOP by GAT over a daily disposable soft contact lens is accurate, compared to the standard procedure and within the IOP''s normal range studied here. Also using a contact lens results in less trauma whilst discomfort is similar. [Copyright &y& Elsevier]

Purpose: To describe baseline and longitudinal findings of the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study.Methods: The CLEK Study is an 8-year, multi-center, natural history study of 1209 patients with keratoconus who were examined annually for 8 years. Its goals are to prospectively characterize changes in vision, corneal curvature, corneal status, and vision-specific quality of life.Results: CLEK Study subjects had a mean age at baseline of 39.3+/-10.9 years. At study entry, 65% of the patients wore rigid contact lenses, and 14% reported a family history of the disease. Subjects exhibited a 7-year decrease in high- (2.03 letters) and low- (4.06 letters) contrast, best-corrected visual acuity, with 19% demonstrating decreases of 10 or more letters in high-contrast, best-corrected acuity and 31% of subjects demonstrating decreases of 10 or more letters in low-contrast, best-corrected acuity in at least one eye. Subjects exhibited an average 8-year increase in corneal curvature of 1.60D in the flat corneal meridian, with 24% demonstrating increases of 3.00D or more. The 8-year incidence of corneal scarring was 20%, with younger age, corneal staining, steeper baseline corneal curvature, contact lens wear, and poorer low-contrast visual acuity predictive of corneal scarring. Data from the National Eye Institute Visual Function Questionnaire suggest that the effect of keratoconus on vision-specific quality of life is disproportionate to its low prevalence and clinical severity.Conclusion: Although we report measures of disease severity and visual function across the CLEK sample, clinicians can begin to envisage the course of keratoconus in individual patients by determining whether factors predictive of disease progression are present in those patients. [ABSTRACT FROM AUTHOR]

Abstract: Background: Cocaine hydrochloride (C17H21NO4) is a powerful neuro-stimulatory alkaloid salt which has been abused by many cultures for thousands of years. Crack-cocaine, a derivative of cocaine, has gained notoriety for giving a quick “high” at a relatively lower cost. Crack-cocaine exposure has been reported to cause corneal disturbances ranging from subtle superficial punctuate keratitis to perforation. Case report: A 42-year-old African-American female presented complaining of mucopurulent discharge and pain in her left eye for a month. No history of trauma, contact lens wear or surgery was elicited and she admitted to chronic polysubstance abuse. A deep, paracentral stromal ulcer was present in the left cornea. The patient was hospitalized for culturing and empiric topical therapy. Toxicology screens proved positive for cocaine and heroine. Initial response to treatment was promising yet the patient discharged herself against medical advice and was lost to follow-up. Cultures were positive for Candida albicans. Conclusions: Practitioners should be familiar with the toxic effects that crack-cocaine abuse may have on ocular tissues, particularly the cornea. This case demonstrated the value of hospitalization, toxicology screenings and cultures in the management of the atypical keratopathy associated with substance abuse, specifically that of crack cocaine use. Corneal epithelial disruption and stromal ulceration without a history of contact lens wear, trauma, surgery, predisposing keratopathy or immunodeficiency warrants thorough investigation of patient social habits, including substance abuse. [Copyright &y& Elsevier]

Abstract: Aim: Theoretically myopes are required to exert more accommodation and vergence when wearing single vision contact lenses compared to glasses and hypermetropes less. This study aims to quantify the effects clinically. Method: Thirty subjects (21 female, nine male, average age 21.0±2.2 years) with a range of refractive errors (−7.87D to +3.50D) viewed in a random order, static targets at 0.1, 0.5, 1.0, 2.0, 3.0, 4.0 and 5.0D accommodative demand that were matched for angular subtense. The subjects were fully corrected with spectacles and daily disposable contact lenses to their full prescription. Accommodation was monitored objectively with the PowerRefractor and Shin-Nippon SRW5000 and vergence and pupil size with the PowerRefractor. Results: Myopes exerted greater accommodative effort for viewing near targets with contact lenses than glasses and hypermetropes less (r 2 =0.35, p =0.001 PowerRefractor). Myopes also exerted greater vergence effort for viewing near targets with contact lenses than glasses and hypermetropes less (r 2 =0.22, p <0.01). Conclusion: Theoretical calculation of the accommodative and vergence requirements with glasses compared to contact lenses reflect clinical findings, although there is reasonable variability between individuals. [Copyright &y& Elsevier]

Abstract: Orthoptic anomalies are prevalent: they are encountered in at least 5% of patients seen in a typical primary eyecare practice. Several cases are reviewed that highlight the role of contact lenses in treating orthoptic anomalies. In particular, contact lenses are the preferred optical approach to the correction of anisometropia, and it is often argued that anisometropia should be corrected as young as possible. However, fitting contact lenses to patients, particularly children, with anisometropic amblyopia has been problematic because there is no immediate binocular acuity improvement when the contact lenses are inserted which reduces patient motivation. Continuous wear with silicone hydrogels represents a breakthrough for these cases and some illustrative case studies are given. The visual deficit in amblyopia can be reduced in some cases solely by fitting contact lenses, without the need for occlusion therapy. Other orthoptic uses of contact lenses are reviewed including: correcting motor deviations, occlusion, and infantile onset nystagmus. It is concluded that there are orthoptic anomalies where contact lenses are the preferred mode of correction. It is in patients’ best interest for practitioners to discuss contact lenses in these cases. [Copyright &y& Elsevier]

Abstract: The purpose of this study was to determine the effect of contact lens wear on the tear film and ocular surface of people tolerant or intolerant to contact lens wear. Twenty subjects participated; 11 tolerants and nine intolerants. Their baseline tear film (no lens wear) was analysed with a range of clinical measurements and protein analyses (lactoferrin, sIgA and lysozyme). The tests were then repeated at the end of 6h of contact lens wear during the day and while lenses were worn. Both tolerants and intolerants showed statistically significant increases in bulbar and overall conjunctival redness after 6h of lens wear. For tolerants only, there was a statistically significant increase in the tear film meniscus area (0.08mm2 ±0.04 compared to 0.14mm2 ±0.06 (p =0.023)) and a statistically significant decrease in the non-invasive tear film break-up time (NI-TBUT; 21.3s±5.7 compared to 3.7s±4.3 (p =0.003)) after 6h of lens wear. There were no changes in other tear film or ocular surface parameters. The protein concentration and lipid layer appearance did not change during lens wear for either population. Prior to lens wear, tolerant subjects had a statistically longer NI-TBUT, higher phenol red thread test and higher tear flow rate. After 6h of lens wear and while wearing lenses, all but NI-TBUT remained statistically different. Lens wear affected only a small number of clinical variables and 6h wear did not effect the concentration of those proteins measured in tears in this study. [Copyright &y& Elsevier]

Abstract: Dry Eye Questionnaire (DEQ) and Contact Lens Dry Eye Questionnaire (CLDEQ) from unselected eye care patients (including current, former and non-contact lens wearers) were analyzed to contrast dryness symptoms among patients with and without contact lenses. Contact lens wearers reported a higher incidence of intense symptoms, especially late in the day (12.7% AM versus 41.1% PM, p <0.0001), that diminished when they removed lenses (p =0.0001). Dryness intensity was not correlated with gender and was inversely correlated with age among contact lens wearers, differing significantly from the pattern among non-lens wearers. Contact lens related dryness differs from dry eye among non-lens wearers. [Copyright &y& Elsevier]

Abstract: Purpose: To explore patient demographics and motivations in choosing refractive surgery (RS) or contact lenses (CL) and factors influencing their choice of practice. Methods: A questionnaire was presented to 212 RS and 115 CL patients at four RS centres and three CL centres, respectively. The authors, with consent from the clinics and patients, collected all data. No patient or clinic refused to participate in the study. Results: There was no statistical difference between RS and CL groups for gender (p =0.28), although in both groups more females presented than males. The mean age of RS patients was 39.2±10.6 years and for CL patients was 32.0±12.4 years (p <0.0001). The occupational differences between RS and CL patients were found to be significant (p <0.0001). Primary motivations for RS or CL were cosmesis and inconvenience of CL and spectacles. The main reason why RS patients did not choose CL was due to the inconvenience; there was little difference in this whether patients had previously worn CL or not. CL patients did not choose refractive surgery due to lack of information and apprehension. RS and CL patients selected their respective centres primarily due to reputation. Conclusions: Refractive surgery appears increasingly to be a lifestyle choice, possibly based on perceptions and psychological aspects that need to be investigated. The popularity of cosmesis as a highly popular factor for RS and CL patients, together with a few patients citing minor contact lens complications suggests that contact lens clinicians may be able to hold onto patients through better management. [Copyright &y& Elsevier]

Abstract: Objectives:: To analyze the influence of multipurpose contact lens cleaning solutions on tear proteins. Changes in tear film protein profiles of contact lens wearers who used several marketed brands of multipurpose contact lens care solutions, were assessed by ProteinChip analysis. Methods:: Three studies were conducted. Study I was a comparison of Complete and OptiFree multipurpose solutions. Study II was a study with Complete Moisture Plus solution, Study II was a comparison of Renu and Solocare contact lens solutions. Wearers of soft contact lenses were assigned to use the contact lens care solutions for 4 weeks. Non-contact lens wearing patients were used as controls. Tear samples of each participant were analyzed with the ProteinChip (SELDI–TOF) system. Multivariate statistical analysis and artificial neural networks were used to determine the tear protein profiles of each study group. Results:: Before starting the use of the solutions, the tear protein composition in all contact lens wearers deviated from the tear composition of the non-contact lens wearing controls. After 4 weeks of using the different care regimens, the tear protein composition of the patients using Complete or Complete Moisture Plus solutions tended to move toward that of the non-contact lens wearing controls. The tear protein composition of patients using the OptiFree, Renu or Solocare solutions did not undergo a measureable change in the protein level. Conclusions:: The ProteinChip system can analyze protein profiles for large-scale applications as in clinical studies. Two multipurpose solutions, Complete and Complete Mositure Plus, demonstrated a beneficial effect on the tear proteins in contact lens wearers. [Copyright &y& Elsevier]

Abstract: After outlining what is meant by wavefront aberration, the history of the field of wavefront technology is sketched and methods for measuring ocular wavefront aberration are briefly described. The variations in aberration of the normal eye with the individual and their pupil size, accommodation and age are summarised. Potential contact lens applications are outlined, including the design and on-eye performance of single-vision lenses, lenses for presbyopes and keratoconics, orthokeratology, tear film studies, and the design and performance of customised contact lenses intended to minimise residual lens–eye wavefront error. [Copyright &y& Elsevier]