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Purpose: To determine the changes in keratometry measurements and refraction in patients having the thermo-mechanical periorbital skin treatment, Tixel®, to treat dry eye disease (DED)., Methods: A multi-centre, prospective, non-masked study was conducted. DED patients were recruited in 3 international centres and were evaluated in 5 visits separated by an interval of 2 weeks except for the last visit which took place after 18 weeks from visit 1. The same clinical examination was performed at all visits: OSDI questionnaire, tear stability, keratometry, best corrected visual acuity and refraction. Tixel® treatment was applied at the first 3 visits., Results: 89 participants (24 males/65 females; mean age: 55.0 ± 14.2 years) were included: 20 presented moderate DED symptoms and 69 severe DED symptoms. Significant differences were found for the spherocylindrical refraction (vector analysis) between visit 1 and visits 2 and 3. Following cumulative analysis, 11.86 % and 16.94 % of participants had more than 0.5 dioptre (D) change in mean keratometry and keratometric astigmatism, respectively, at 3 months post-treatment. A total of 5.40 % had a sphere and cylinder change greater than 0.50D and 16.21 % had the axis changed more than 10 degrees (vector analysis). These changes were particularly significant in patients with severe DED symptoms., Conclusions: Keratometry readings and refraction can change following thermo-mechanical skin treatment for DED, especially in those patients with severe DED symptoms. This should be considered as potential errors in intraocular lens calculations may be induced., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Study supported by Novoxel® (Israel). MBV was supported by: 1) the Ministry of Science, Innovation and Universities, Government of Spain [grant reference: FPU17/02715]; 2) “Movilidad doctorandos y doctorandas UVa 2021”, Spain; 3) “Prácticas Erasmus + 2020–2021”, University of Valladolid, Spain; and 4) IMFAHE’s Excellence Fellowships 2021; all these grants are unrelated to this study., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: To compare the effectiveness of meibomian gland expression (MGX) combined with home-based therapy versus home-based therapy alone for the treatment of dry eye disease (DED) caused by meibomian gland dysfunction (MGD)., Methods: A systematic review of randomized controlled studies (RCTs), reporting the effects of MGX combined with home-based therapy in 2 databases, PubMed and Web of Science, was performed according to the PRISMA statement. The search period was until August 20, 2023. According to the heterogeneity, a random or fixed effects model was performed in the meta-analysis. The standardized mean difference (SMD) was calculated to analyze dry eye symptoms (DES) score, tear film break-up time (TBUT), total corneal fluorescein staining (tCFS) and meibomian glands expressibility (MGE). All analyses were performed by RevMan Web, version 5.7. The Cochrane risk of bias tool was used to analyze the quality of the studies selected., Results: Two RCTs with a total of 99 patients were included. The studies reported that MGX combined with home-based therapy improves DES score, TBUT, tCFS and MGE compared to the home-based therapy. However, the meta-analysis indicated that MGX combined with home-based therapy only seems to be beneficial in reducing DES score (SMD -0.49; 95 % CI: -0.89 to -0.08; P = 0.02; I 2  = 0 %). In addition, although TBUT, tCFS and MGE reported a slight trend in favor of MGX combined with home-based therapy, it was non-significant., Conclusions: While MGX combined with home-based therapy seem to show some evidence of alleviating dry eye symptoms, there is insufficient evidence to conclude the effects of this treatment definitively particularly in improving dry eye signs caused by MGD, such as TBUT, tCFS and MGE. Therefore, further RCTs are needed to elucidate these results., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: Dry eye disease has public health and economic significance. Platelet-rich plasma is rich in anti-inflammatory agents and growth factors, both beneficial for ocular surface repair. This study aimed to conduct a systematic review and meta-analysis to summarize the benefits of platelet-rich plasma for treating dry eye disease and its adverse effects., Methods: Prospective comparative studies using platelet-rich plasma as monotherapy for dry eye disease were included for efficacy assessment. Before-after studies were included for adverse events assessment. Data sources included PubMed, Google Scholar, Web of Science, and Scopus. A systematic review and meta-analysis protocol was pre-registered on PROSPERO (CRD42022347982). PRISMA guidelines were followed. The National Health Institute (NIH) quality assessment tool for before-after studies, the Cochrane risk of bias tool (RoB2), and the methodological index for non-randomized studies were used to assess the risk of bias. Heterogeneity was assessed using the I 2 statistic., Results: 19 studies (10 comparative and 9 before-after) were included in the systematic review and meta-analysis. The occurrence rate of adverse effects was 2.6 % (95 % CI: 0.5 - 4.7). The pooled standardized mean difference (SMD) for dry eye symptoms was 0.81 (95 % CI: 0.25 - 1.37; I 2  = 82 %; p < 0.00001; Z = 2.84, p = 0.004); tear quality was 0.44 (95 % CI: 0.06 - 0.81; I 2  = 67 %; p = 0.003; Z = 2.26, p = 0.02); tear quantity was 0.45 (95 % CI: 0.03 - 0.88; I 2  = 74 %; p = 0.0003; Z = 2.10, p = 0.04); and corneal staining 0.72 (95 % CI: 0.14 - 1.30; I 2  = 85 %; p < 0.00001; Z = 2.43, p = 0.02)., Conclusion: The current study shows that platelet-rich plasma is efficacious in managing dry eye disease, significantly reducing dry eye signs and symptoms. Such significant improvements could translate to improved quality of life., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: In light of the increased roles of optometrists working in primary care in the UK, this research study aimed to gain an insight into perceptions of dry eye disease (DED), knowledge and confidence in diagnosis and management, and satisfaction with currently available treatment options., Methods: Links to an online survey were distributed to optometrists across the UK via optometry websites newsletters, conferences, and local optical committee data bases, between October 2021 and July 2022. The anonymous questionnaire contained a variety of question types including multiple choice, likert-type scale, and free text questions., Results: The survey was completed by 131 optometrists, with a broad range of experience, who reported examining 33.3 ± 31.0 dry eye patients per month. Forty-eight percent of respondents were involved in the provision of an extended service. Fluorescein tear breakup time, corneal fluorescein staining, and anterior lid assessment were the most used clinical procedures, both for diagnosis and monitoring purposes. Sixty percent of respondents reported that they believed their patients were satisfied/managed with artificial tear alone, with the availability of a preservative free option being the top consideration, particularly with increasing severity. Of the 18.7% of respondents who held Independent prescriber status, 68% felt this had widened their ability to diagnose and treat DED. This was evidenced by an increase in steroid recommendation for moderate and severe disease., Conclusions: Although dry eye disease was perceived to be an important condition, opinions varied widely regarding knowledge and confidence in diagnosis and management. Involvement in an extended service did not alter patient management. However, an increase in therapeutic management and the employment of a stepwise approach to management has been identified., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)

Purpose: To conduct a review of the literature in order to identify the potential association between physical activity or exercise and the objective signs and/or subjective symptoms of dry-eye disease., Methods: A review of PubMed and Web of Science databases was performed, according to the PRISMA guidelines. The papers included in the review addressed the relationship of physical activity or exercise with dry-eye associated signs (changes in tear volume, osmolarity or biochemical composition) and/or subjective symptoms., Results: A total of 16 papers were included. In eight, the changes in tear film volume, osmolarity and/or biochemical composition were studied after a single, acute bout of aerobic exercise. In another eight, changes in dry-eye associated symptoms were studied in relation to the habitual practice of physical activity or to prescribed exercise programmes. Acute responses of the tear film to exercise included: a) an increase of tear volume, without an increase of the tear break-up time; b) a trend to increase tear osmolarity, although within its physiological range; and c) a reduced concentration of several cytokines, and other molecular markers of inflammation or oxidative stress. Long-term exposure to physical activity or exercise programmes was associated with relief of dry-eye associated symptoms and a trend to increased tear break-up time., Conclusions: Despite a high heterogeneity in the studied population, study designs and methods, the current body of evidence suggests a potential role for physical activity as a modulatory stimulus for the proper functioning of the tear film and/or the relief of dry-eye symptoms., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Background: Meibomian gland dysfunction (MGD) reduces quality-of-life and hinders work productivity of millions of patients, with high direct and indirect societal costs. Thickened meibum obstructs the glands and disrupts ocular surface health. Heating the eyelids to soften and express meibum from the glands can be beneficial. The most accessible method for eyelid warming uses heated, wet towels. However, the efficacy of this treatment is reliant on the methodology, and evidence-based best-practice recommendations are needed., Purpose: To evaluate the literature on hot towels in MGD treatment and recommend a best-practice protocol for future research and patient treatment., Methods: Studies were identified through PubMed on the May 28, 2021, with the search terms: (warm* OR heat* OR thermal* OR towel OR wet towel) AND (meibomian OR MGD OR eyelid OR "dry eye" OR DED). All relevant original articles with English full-text were included., Results: The search yielded 903 results, of which 22 met the inclusion criteria. Across studies, hot towels were found to be effective at reducing ocular symptoms. However, without reheating, the temperature quickly fell below the therapeutic range, which was deemed to be between 40 °C and 47 °C. Towels heated to around 45 °C and reheated every-two minutes were most effective at increasing eyelid temperature, comparable or better than several commercially available eyelid warming devices. No adverse effects were reported in the studies., Conclusion: Hot towel treatment effectively warms the eyelids and reduces ocular symptoms, but must be standardized, and towels reheated to achieve maximum benefit. Future research should assess patient satisfaction with different hot towel treatment methods that reheat or replace the towel at least every-two minutes, to establish which methods yield the greatest compliance. Guidelines or clinical recommendations that do not mention the need for regular reheating during hot towel compress treatment should be updated to include this., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Morten Schjerven Magno: Nothing to disclose. Jonatan Olafsson: Nothing to disclose. Marie Beining: Nothing to disclose. Emily Moschowits: Nothing to disclose. Neil Lagali: Nothing to disclose. James S. Wolffsohn is the Chief Scientific Officer of the International Myopia Institute, on the Executive of the Tear Film and Ocular Surface Society and Academic Chair to the BCLA. Honoraria for consultancy received from AtiaVision, Bausch and Lomb, Alcon, CooperVision, Johnson and Johnson Vision, Nevakar, Novartis and Thea Pharmaceutical. He has also received research funding from Alcon, Allergan, Johnson and Johnson Vision, Novartis, M2C Therapeutics, Rayner, and Thea Pharmaceuticals. He is a founder and shareholder in Aston Vision Sciences, Eyoto and Wolffsohn Research ltd. Jennifer P.Craig is founder of the Ocular Surface Laboratory at the University of Auckland, New Zealand which in the last three years has delivered talks for and/or received financial support for research and education in the area of dry eye and ocular surface disease from Alcon, Azura Ophthalmics, E-Swin, Johnson & Johnson Vision, Laboratoires Théa, Manuka Health NZ, Novartis, Resono Ophthalmic, and Topcon. Jelle Vehof has received financial support for talks and education in the area of dry eye and ocular surface disease from Santen. Tramedico, Théa Pharma and Horus Pharma, and is consultant for Santen and Tramedico. Vehofis the Dutch Global Ambassador for Tear Film and Ocular Surface Society (TFOS). Darlene A. Dartt: Nothing to disclose. Tor Paaske Utheim is co-founder and co-owner of The Norwegian dry eye clinic and the Clinic of eye health, Oslo, Norway, which delivers talks for and/or receives financial support from the following: ABIGO, Alcon, Allergan, AMWO, Bausch&Lomb, Bayer, European school for advanced studies in ophthalmology, InnZ Medical, Medilens Nordic, Medistim, Novartis, Santen, Specsavers, Shire Pharmaceuticals and Thea Laboratories. He has served on the global scientific advisory board for Novartis and Alcon as well as the European advisory board for Shire Pharmaceuticals.Utheimis the Norwegian Global Ambassador for Tear Film and Ocular Surface Society (TFOS), a Board Member of the International Ocular Surface Society, a Consultant at the Norwegian Association for the Blind and Partially Sighted, and the Editor-in-Chief of Oftalmolog, an eye journal distributed to all eye doctors in the Nordic region since 1980., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: To determine the effects of a thermo-mechanical action-based peri-orbital fractional skin treatment (Tixel®) on dry eye disease., Methods: This prospective, controlled, open labelled study was conducted at two study centres: Midland Eye, Solihull, UK, and Vallmedic Vision, Andorra. Participants were screened at the baseline visit (visit-1), received three Tixel® treatments at 2-weeks intervals including further assessment (visits 2, 3 and 4). Participants were followed up for three months post-treatment (visit 5). Vision, intraocular pressure (IOP), dry eye symptomatology were assessed, including the Ocular Surface Disease Index (OSDI) questionnaire, non-invasive tear break-up time (NIBUT) and tear osmolarity as well as detailed ophthalmic assessments., Results: Seventy-four participants (41 in Birmingham and 33 in Andorra) with periorbital wrinkles and moderate to severe dry eye disease (DED) were enrolled. The mean age was 59.3 ± 13.3 years and 57 were females. No adverse events, no change in vision (p = 0.310) or IOP (p = 0.419) were observed. Tixel treatment was associated with clinically and statistically significant improvement in the DED symptoms, which was supported by a reduction of 21.40 ± 15.08 (P < 0.001) of the OSDI index. Non-invasive tear break-up time improved by 2.10 ± 0.91 s (p < 0.001) in the Birmingham cohort and 6.60 ± 2.13 s (p < 0.001) in the Andorra cohort. Tear osmolarity reduced from 299.8 ± 13.3 mOsm/L to 298.8 ± 15.6 mOsm/L following the Tixel treatment (p = 0.271)., Conclusions: Thermo-mechanical action-based peri-orbital fractional skin treatment Tixel® could be an attractive, safe and effective treatment for DED. This treatment is associated with high clinical and statistically significant improvement in DED signs and symptoms with no adverse events., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Introduction: The diagnosis of dry eye is challenging for eye health practitioners (EHP) and recently, a variety of new diagnostic tests have emerged. This study assesses the attitudes of EHP to dry eye and testing and compares these with attitudes in 2003., Methods: An electronic questionnaire was disseminated to EHP in Australasia between December 2020 to March 2021. Participants rated the likelihood that presenting symptoms/signs were associated with dry eye, the utility of diagnostic tests, the value of test characteristics, and their satisfaction with dry eye diagnostics. Qualitative responses were categorised into positive, negative, or neutral themes., Results: 144 responses were received, with 117 (81.3%) from Australia and 27 (18.7%) from New Zealand. Posterior blepharitis was significantly more likely to be associated with dry eye than other factors (p < 0.01). Clinical history, fluorescein staining and FBUT were judged significantly more useful in diagnosing dry eye compared to other tests (p < 0.01). Test validity was judged significantly more important in choosing a test than other qualities. Qualitative attitudes towards dry eye presentations and diagnostic tests were positive in 42.2% and 24.3%, negative in 32.4% and 41.9%, and neutral in 25.5% and 33.8% respectively., Conclusions: The opinions of EHP regarding dry eye tests were variable, but most favour history and corneal staining for diagnosis. Patterns of responses were similar to that reported by Turner et al 16-years ago, however, there is a higher satisfaction with available tests and therapeutic options. There is a need to develop a consensus amongst real-world clinicians regarding an optimum diagnostic pathway for dry eye, particularly in relation to newer diagnostic tests., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To evaluate the comfort performance of ACUVUE OASYS® 1-Day with HydraLuxe™ Technology among symptomatic contact lens wearers by using Contact Lens User Experience (CLUE) comfort scores and Contact Lens Dry Eye Questionnaire 8 (CLDEQ-8) discomfort and dryness scores., Methods: Three clinical trials evaluated comfort and dryness when refitting symptomatic contact lens wearers to ACUVUE OASYS® 1-Day with HydraLuxe™ lenses. This analysis combined the CLUE comfort and CLDEQ-8 scores obtained at baseline and 2-week follow-up and compared average scores between visits. Subjects were grouped by habitual lens modality (daily disposable or daily wear reusable) and habitual lens material (silicone hydrogel or hydrogel). The analysis included data from 107 subjects., Results: Significant increases in mean CLUE comfort scores between baseline and 2-week follow-up occurred in all subject groups across habitual lens modality and material, indicating an improvement in overall comfort. CLUE comfort score improved clinically (≥5-point increase) among 75.7% of subjects (81/107). Similarly, significant decrease in mean CLDEQ-8 scores between baseline and 2-week follow-up occurred in all subject groups, indicating a decrease in the prevalence of dryness and discomfort symptoms. CLDEQ-8 score improved clinically (≥3-point reduction) among 82.2% of subjects (88/107). A majority of subjects (57.0%) became asymptomatic (CLDEQ-8 score ≤ 11 points) after 2 weeks of bilateral wear., Conclusion: Refitting symptomatic contact lens patients to ACUVUE OASYS® 1-Day with HydraLuxe™ can improve overall comfort and reduce symptoms of dryness and discomfort, irrespective of the previous lens modality or habitual lens material., Competing Interests: Declaration of Competing Interest All authors are employees of Johnson & Johnson Vision. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier Ltd.)

Background: Inadequate meibomian glands (MGs) secretion can lead to dry eye signs and symptoms. Tear film lipid layer (TFLL) secreted by MGs protects and prevents rapid evaporation of tear film. The purpose was to assess TFLL alteration and function in patients with evaporative dry eye (EDE) using tear interferometry after optimal pulse light technology (OPT) intense pulsed light (IPL)., Methods: This prospective randomized examiner-masked sham- controlled study included 86 participants (142 eyes) with DED. IPL or sham procedure was performed on day 0, 21, and 42. Ocular Surface Disease Index (OSDI), non-invasive breakup time (NITBUT), interferometric fringe pattern determined TFLL quality, fluorescein staining (FS), and meibum gland (MG) were assessed at day 0, 21, 42 and 3-month., Results: At 3-month, TFLL, NITBUT, MG drop-out, MG quality, MG expressibility, FS and OSDI improved significantly (P < 0.05) in the IPL group, while the sham group had no significant improvements. Except for Meibo-score and FS, all parameters significantly correlated with the improvement in TFLL following IPL treatment. Additionally, artificial tears usage was significantly less in the IPL group from D-42 onwards., Conclusion: IPL treatment demonstrated the ability to improve TFLL quality and clinically reduced sign and symptoms of DED thereby reducing the frequency of artificial tears use., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: The use of contact lenses (CL) is often associated with hallmark symptoms of dry eye disease (DED) such as red eye and dryness. Even though lipid-based artificial tears are already marketed for DED, there is little evidence that supports their use while wearing soft CL., Methods: An oil in water (O/W) nanoemulsion was formulated with a highly-stable oily phase composed of castor oil and 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC). Physicochemical characterization of the DMPC-based nanoemulsion (DMPC-NE) was performed using the Zetasizer Nano ZSP, and its long-term stability was evaluated over 24 months; in addition, the in vitro cytotoxicity of DMPC-NE was determined by Neutral Red Uptake (NRU) and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays. Finally, the physical compatibility of the DMPC-NE with soft CL was tested by measuring the power, diameter, thickness and UV transmittance of two different types of CL., Results: DMPC-NE had a mean particle size of 86.48 ± 4.22 nm, a polydispersity index of 0.22 ± 0.01 and a zeta potential of -33.23 ± 0.93 mV that remained with no changes after 24 months. DMPC-NE formulation, free of preservatives, showed no cytotoxicity and it was compatible with the physical properties of FDA-class II and -class IV CL., Conclusion: DMPC-NE is a highly stable formulation for dry eye that is safe to be used while wearing soft CL., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Aim: The prevalence of contact lens related dry eye (CLDE) is high and can lead to ocular discomfort, reduced quality of vision and life. The aim of this study was to assess the efficacy of intense pulsed light (IPL) treatment in alleviating signs and symptoms of CLDE., Design: Prospective, randomised, examiner masked study., Methods: This prospective study was conducted on 152 eyes of 76 patients (IPL group, n = 76 eyes; control group, n = 76 eyes) wearing contact lens (CL) and experiencing CLDE for more than 1 year. The IPL treatment group underwent two IPL treatment sessions at 3-week intervals while the control group received sham IPL treatment. Best-corrected visual acuity (BCVA), ocular surface disease index (OSDI), non-invasive breakup time (NITBUT), tear film lipid layer (TFLL) quality, fluorescein staining (FS), meibum gland (MG) quality and expression, endothelial cell count (ECC) and intraocular pressure (IOP) were assessed at baseline (D-0), day-21 (D-21) and day-42 (D-42) after IPL treatment., Results: The mean age of treatment group and control group was 28.47 ± 5.16 years (21 females, 28 %) and 28.58 ± 4.33 years (23 females, 30 %) respectively. IPL treatment group had clinically and statistically significant improvement in mean NITBUT was observed at D14 (5.24 s, P<0.001) and D28 (6.08 s, P<0.001). OSDI, TFLL score and MG quality and expressibility all improved significantly (P<0.001) at D-42, whereas BCVA, ECC and IOP showed no significant changes at D-21 and D-42 in IPL treatment group. The control group showed no significant improvement in all parameters at D-21 and D-42., Conclusion: Our findings suggest that CL related DE can be safely alleviated with IPL treatment as it reduced the severity of symptoms, improved the overall tear film stability and reduced artificial tear use in participants with CLDE., (Copyright © 2021. Published by Elsevier Ltd.)

Purpose: To explore the journey taken by patients in a range of different countries to manage their dry eye symptoms., Method: Members of the general public who responded positively to the question "Do your eyes ever feel dry?" completed a questionnaire describing their demographics, the impact of their symptomology, the advice they have received and the management options they have tried. The Ocular Surface Disease Index (OSDI) questionnaire was also completed., Results: A total of 916 individuals (Canada = 235, Mexico = 127, New Zealand = 157, Taiwan = 246, UK = 151) of similar age distribution (median 38 years, IQR: 27-50) completed the survey. The reported duration of symptoms was longest in Canada (median 4 years, range 2-10) and least in Taiwan (2 years, range 1-3; p < 0.001), and similar trends were observed for symptom severity (p = 0.001). However, there was no statistically significant difference between countries with respect to the impact of symptoms on quality of life (median 3/10; p = 0.08). Less than half of the individuals in any country had consulted with a health professional. About half had tried a treatment for their dry eye symptoms, with artificial tears being the most common treatment, followed by warm compresses, and both therapies were rated as reasonably effective (median 5-7/10)., Conclusion: Many people with dry eye symptoms are not consulting health care professionals who can confirm the diagnosis, exclude differential diagnoses, and offer a wide range of treatments targeted at the dry eye subtype., (Copyright © 2021 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To study the effect of daily disposable contact lens (DDCL) refitting in monthly contact lens (CL) wearers suffering from contact lens discomfort (CLD), and to assess if there is a placebo effect associated with this CLD intervention., Methods: Symptomatic CL wearers, according to the Contact Lens Dry Eye Questionnaire 8 (CLDEQ-8 ≥ 12 points), were divided into two groups. The study group was provided with DDCLs (delefilcon A) and the control group with a masked pair of their habitual monthly CLs (placebo effect) and were assessed after one month. Then, the control group was provided with the same DDCLs and evaluated one month later. The symptoms were recorded with the CLDEQ-8 and global rating of change scale (GRCS). Non-invasive tear break-up time (NITBUT), conjunctival hyperaemia, fluorescein staining, and lid wiper epitheliopathy (LWE) were evaluated. Changes between visits, groups, and the effect of each intervention were analysed., Results: Thirty-one participants (mean age: 23.2 ± 5.3 years) were recruited. The study group (n = 14) showed an improvement of -39.6 ± 25.8 % (p < 0.001) in CLDEQ-8 and 31.3 ± 14.6 points in GRCS (p < 0.001) after one month of DDCL use, while no changes in clinical tests were found. In the control group (n = 17), symptoms improved significantly after wearing the masked monthly CL (CLDEQ-8: -26.1 ± 31.0 %, p = 0.03; GRCS: 14.9 ± 17.0, p = 0.002), however a worsening in bulbar (26.5 ± 40.0 %; p = 0.02) and limbal hyperaemia (21.6 ± 34.7 %, p = 0.02) and an improvement of -19.1 ± 37.0 % (p = 0.049) in LWE was found. When the control group was fitted with the DDCL, improvements in GRCS (20.5 ± 25.5, p = 0.02), NITBUT (37.9 ± 42.3 %, p = 0.002), and conjunctival staining (-47.1 ± 59.9 %, p = 0.005) were noted., Conclusions: Refitting symptomatic monthly CL wearers with Delefilcon A DDCL is effective in reducing symptoms related to CLD. However, clinicians and researchers must be aware of the existence of a placebo effect when assessing the effectiveness of any CL refitting., (Copyright © 2020 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

To examine the role of incomplete blinking in contributing to blink inefficiency, symptoms of dry eye and ocular surface disease. To review methods for diagnosing blink inefficiency (including both reduced overall blink rate and increased incomplete blink rate) and the role of remediation for efficient complete blinking as an essential part of the lacrimal functional unit in maintaining tear homeostasis. Diagnosis and remediation of blink inefficiency appear to have been somewhat misunderstood in the management of dry eye disease. To the extent that a high incomplete blink rate ranks in significance with low blink frequency in contributing to blink inefficiency, measures and remediation of only total blink rate are of reduced usefulness in the diagnosis and treatment of blink inefficiency-related ocular surface exposure, dry eye symptoms and ocular surface disease. In addition, a patient's blink performance during a biomicroscopy or any other clinical assessment of blink efficiency, is unlikely to be characteristic of or relevant to the blink inefficiency that develops and causes symptoms during their various day-to-day activities. There appears to be a strong case for prescribing blink efficiency exercises in the management of many cases of dry eye symptoms and ocular surface disease. Remediation of spontaneous blink inefficiency may require that a motor memory of voluntary complete, rapid, relaxed and natural looking blink formation is established and maintained as the basis for efficient spontaneous blinking. Voluntary forceful blinking may undermine the motor memory of efficient blinking and risk the depletion of any reserves of lipid., (Copyright © 2020 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To determine the effectiveness of the Aurai water propelled, heating Eye Massager (AEM) in managing dry eye disease and its effects on the ocular adnexa., Methods: This prospective, randomised cross-over study enrolled 15 participants (aged 25.8 ± 5.45 years, 5 male). Participants wore a smart watch 24 h a day to track their sleeping cycle and heart rate for 4 weeks, using the AEM twice a day for 2 of those weeks. A cycle of 6 min of a controlled heat and vibration pattern in the morning and another cycle in the evening were applied with the AEM. Primary outcomes of symptomatology (Ocular Surface Disease Index (OSDI) and Symptom Assessment iN Dry Eye (SANDE)), tear film and ocular surface homeostasis markers (osmolarity, non-invasive breakup time (NIKBUT), tear meniscus height (TMH), lipid layer thickness and ocular staining) and safety measures (ocular redness and intraocular pressure), were assessed at baseline, after 2 weeks of AEM use and after 2 weeks of no treatment (in random-sequence). Sleeping tracking (ST) and heart rate/blood oxygen detection over these periods was also assessed., Results: There was a significant change in OSDI score from 34.3 ± 19.5 at baseline to 18.8 ± 17.5 after treatment (p = 0.001) and also for the SANDE (5.7 ± 2.4 vs 3.7 ± 2.1; p = 0.001). Heart rate was not affected by treatment (p = 0.956), nor sleep pattern (p = 0.529), but this varied by day (p = 0.001). Tear film and ocular surface homeostasis, the ocular adnexia and safety measures were not affected by treatment (p > 0.05)., Conclusion: The Aurai water propelled Eye Massager may reduce the severity of symptoms of dry eye, but there were no detectable effects on tear stability and ocular surface disease from two weeks use., (Copyright © 2020 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: Dry eye disease (DED) is an important public health concern given its increasing prevalence and impact on patient quality of life. Blinking frequency and completeness are reduced during digital screen exposure, compromising meibum secretion and distribution, causing tear film instability and leading to DED. This study evaluated the effects of blinking exercises on blink pattern and clinical signs and symptoms of DED., Methods: Fifty-four participants with dry eye symptoms received instructions to perform a ten-second cycle of blinking exercises every 20 min during waking hours for four weeks. Symptoms were assessed using the 5-item Dry Eye Questionnaire (DEQ-5) and Ocular Surface Disease Index (OSDI); blinking patterns measured with the TearScience LipiView II; and tear film and ocular surface parameters assessed with the Oculus Keratograph 5M. Measures at baseline and on day 28 were compared., Results: Forty-one participants completed the study, reporting an average of 25.6 daily blinking exercise cycles. Improvements were noted in DEQ-5 (from 11 ± 4 to 7 ± 3; p < 0.001), OSDI (36 ± 18 to 22 ± 17; p < 0.001), non-invasive tear film breakup time (6.5 ± 2.4 to 8.1 ± 4.8 s; p < 0.04), the proportion of incomplete blinks (54 ± 36 to 34 ± 29 %; p < 0.001), but not in tear meniscus height or tear film lipid layer thickness., Conclusion: Blinking exercises can modify poor blinking patterns and improve dry eye symptomology, with modest changes in objective measures of tear film quality. Incorporating such routines into clinical care recommendations may improve blinking habits and help protect against the impact of digital device use on tear film quality and DED onset and evolution., (Copyright © 2020 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this study was to compare the efficacy of artificial tears and warm compress with an eyelid warming mask (EWM) in alleviating dry eye syndrome (DES) in contact lens wearers METHODS: This study was a prospective, randomized, active-controlled trial. Participants included 81 university students aged 19 or over, who had been wearing contact lenses for more than 1 year; they were randomly categorized into three groups. In the artificial tear group, one single-use artificial tear was administered every day as needed over a period of 4 weeks. In the EWM group, participants were instructed to apply a warm compress using a disposable EWM for 30 min before bedtime daily. Participants in the control group maintained their normal lifestyle without any treatment regimen. Ocular Surface Disease Index (OSDI) and Schirmer test scores for all participants were checked before the experiment and after 4 weeks., Results: After treatment, the EWM and artificial tears group had significantly decreased OSDI scores compared with the control group. However, there was no significant difference between the former two groups. The post-treatment Schirmer test scores for the right eye did not differ between three groups, whereas those for the left eye were significantly higher in the two treatment groups than in the control group. However, there was no significant difference between the EWN and artificial tears groups., Conclusion: Contact lens wearers who were instructed to apply a warm compress using EWM had significantly increased OSDI and Schirmer test scores, indicating that it has a positive effect on DES. In conclusion, applying a warm compress with EWM can be recommended as a treatment for DES in contact lens wearers who use lenses for an extended period., (Copyright © 2020 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To investigate the association between levels of MMP-9, a common marker of inflammation in tears, and changes to the meibomian glands accompanying soft contact lens (CL) wear., Methods: Flush tears were collected from: (1) three groups of CL wearers who had worn CLs on a daily basis for different durations (Short: 2 ± 1 years, Moderate: 5 ± 1 years and Long experience: 10 ± 2 years); (2) a group of previous CL wearers (PWs) who had ceased wear for at least 6 months; and (3) healthy non-wearers (NW) as a control group. Total MMP-9 and its inhibitor, tissue inhibitor of MMPs-1 (TIMP-1) concentration were established using sandwich enzyme-linked immunosorbent assay. The MMP-9: TIMP-1 ratio was calculated for every individual, and then the average of all ratios for each group were compared. The non-parametric statistical Kruskal Wallis one-way analysis of variance was used for comparison, with Dunn's testing post-hoc., Results: Tear samples from 100 participants (51 females; mean age ± SD: 25.4 ± 4.1 years) were analysed. MMP-9 concentrations and MMP-9:TIMP-1 ratio were significantly different between groups (Kruskal Wallis p = 0.001 and p < 0.001 respectively), while the concentration of TIMP-1 did not vary statistically between study groups (Kruskal Wallis, p = 0.32). Post hoc analysis indicated that only CL wearers with short experience had MMP-9 concentrations that were significantly high compared to NWs (23.1 ± 17.9 ng/mL and 4.1 ± 4.1 ng/mL, respectively, Dunn p < 0.001). Additionally, the ratio of MMP-9 to TIMP-1 concentration was only significantly greater in CL wearers with short experience (mean ratio ± SD = 1.15 ± 0.76) when compared to NWs (0.19 ± 0.29, Dunn P < 0.001), CL wearers with moderate experience (0.37 ± 0.41; P = 0.01) and PWs (0.38 ± 0.36; P = 0.02)., Conclusions: The early years of CL wear appear to be associated with increased expression of MMP-9 relative to its inhibitor TIMP-1. This may be indicative of low-level inflammation during this phase of wear. The role this plays in propagating dry eye disease and MGD in CL wear requires further exploration., Competing Interests: Declaration of Competing Interest This work is original, has not been published and is not being considered for publication elsewhere. Part of this study was presented at the 2015 ARVO conference, Denver. There are no conflicts of interest for any of the authors that could have influenced the results of this work., (Copyright © 2019 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To compare the effects on ocular temperature and tear film parameters following a single application of a latent heat eyelid warming device at a range of temperature settings., Methods: Fifteen subjects were enrolled in a prospective, investigator-masked, randomised, cross-over trial. On separate days, participants were randomised to 10-minute application of a research latent heat device (Laboratoires Théa) at device temperature settings of 45 °C, 50 °C and 55 °C. Outer eyelid and corneal temperatures, tear film lipid layer grade, and non-invasive tear film breakup time (NIBUT) were measured at baseline and immediately after 10 min of device application., Results: Baseline measurements did not differ between treatment groups (all p > 0.05). Ocular temperatures, lipid layer grade and non-invasive tear film stability rose significantly following device application in all treatment groups (all p < 0.05). The 55 °C setting effected a mean ocular surface temperature rise in the order of +4 °C from baseline, which was 1.46 and 1.26 times greater than at the 45 °C and 50 °C temperature settings, respectively (all p < 0.05). Similarly, improvements in mean non-invasive tear film stability from baseline in the order of +7 s were observed, which were 2.43 and 1.66 times greater than those at the lower temperature settings of 45 °C and 50 °C, respectively (all p < 0.05)., Conclusions: At all temperature settings, the latent heat device resulted in clinically and statistically significant increases in ocular temperature, lipid layer grade, and non-invasive tear film stability. However, the 55 °C setting proved to be most effective at raising ocular temperature (in the order of +4 °C from baseline) and improving tear film stability., Competing Interests: Declaration of Competing Interest None., (Copyright © 2019 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To compare the single application and two week treatment effects of device-applied (Eyepeace) and manually-applied eyelid massage techniques, as an adjunct to warm compress therapy, on ocular surface and tear film parameters., Methods: Twenty participants (11 females, 9 males; mean age, 27 ± 11 years) with dry eye symptoms were recruited in a two week, investigator-masked, randomised, contralateral-eye trial. Following 10 min of warm compress therapy application (MGDRx EyeBag ® ) on both eyes, eyelid massage therapy was applied to one eye (randomised) by device, and to the fellow eye by manual eyelid massage, once daily for 14 days. Ocular surface and tear film measurements were conducted at baseline, and 15 min post-application by a clinician, then again after 14 days of self-administered daily treatment at home., Results: Baseline clinical measurements did not differ between the treatment groups (all p > 0.05). Following two weeks of treatment, tear film lipid layer grade improved significantly with device massage (p = 0.008), and was marginally greater than manual massage by less than 1 grade (p = 0.03). Although immediate post-treatment improvements in tear film stability were observed in both groups (both p < 0.05), no significant long-term cumulative effects or inter-treatment differences in stability measures were detected (all p > 0.05). Visual acuity, tear meniscus height, conjunctival hyperaemia, ocular surface staining, and meibomian gland dropout did not change during the treatment period (all p > 0.05)., Conclusions: Two weeks of treatment with the eyelid massage device, as an adjunct to warm compress therapy, effected marginally greater improvements in tear film lipid layer thickness than the conventional manual technique, which were statistically but not clinically significant. Future parallel group trials with longer treatment periods and a greater range of disease severity are required., (Copyright © 2019 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

The purpose of this study was to investigate the effect of the Bruder Moist Heat Compress on contact lens (CL) discomfort in subjects with contact lens-related dry eye (CLDE). This was a 4-week, single-center, three-arm, randomized, open-label clinical trial in subjects diagnosed with CLDE using the Contact Lens Dry Eye Questionnaire. Fifty-one CL wearers were randomized to one of three treatment groups: application of the Bruder Compress twice a day, Bruder Compress once a day, or warm washcloth used for ten minutes twice a day without reheating. Subject diaries were monitored for compliance and collected data on daily CL comfort upon awakening and throughout the afternoon. Clinical assessments included tear film break-up time (TBUT), lipid layer thickness (LLT), and meibomian gland evaluation. Statistical tests included a generalized linear model and one-way analysis of variance (ANOVA) to investigate treatment effect on comfortable wear time. Fifty-one subjects (98% female) completed the study. After treatment, subjects using a washcloth reported more uncomfortable contact lens wear time on average (mean = 5.1 ± 2.8 h) when compared with subjects who had used the Bruder Compress in Group 1 (mean = 2.8 ± 1.6 h) (p = 0.02). In the Bruder Compress groups, there was a significant reduction in the blockage of meibomian glands (p < 0.01). No significant difference in uncomfortable wear time was found between subjects using the Bruder Compress twice daily versus once daily (p = 0.48). Subjects using the Bruder Compress once daily had the highest rate of compliance at 90.2% (p < 0.01). No significant improvements were observed in TBUT (p = 0.76) or LLT (p = 0.78). The Bruder Moist Heat Compress resulted in a significant improvement in comfortable CL wear time in subjects with CLDE., (Copyright © 2019 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: We aimed to determine the long-term effects of intense pulsed light (IPL) treatment in rosacea-associated meibomian gland dysfunction (MGD)., Methods: We enrolled 17 rosacea subjects with moderate and severe MGD who underwent four IPL sessions at 3-week intervals and were followed up for 12 months. The subjects underwent clinical examinations at baseline (first IPL) and at 3 (second), 6 (third), 9 (fourth), and 12 weeks, as well as 6 and 12 months, after baseline. Ocular surface parameters, including the Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), staining score, and noninvasive Keratograph tear break-up time (NIKBUT), as well as meibomian gland parameters, including the lid margin vascularity and meibum expressibility and quality, were evaluated., Results: All ocular surface and meibomian gland parameters for all subjects exhibited significant changes from baseline to the final examination (Friedman, P < 0.050 for all). In particular, improvements in the lower lid margin vascularity, meibum expressibility and quality, and ocular symptoms persisted up to the final examination (Wilcoxon, P < 0.050 for all). However, the improvements of TBUT, staining score, and NIKBUT after IPL were not maintained at 6 and 12 months after baseline., Conclusions: In rosacea-associated MGD, four IPL treatments at 3-week intervals can improve long-term lid parameters and ocular symptoms without adverse effects., (Copyright © 2018. Published by Elsevier Ltd.)

Objectives: To evaluate the corneal confocal microscopy and dry eye findings in patients with contact lens discomfort., Methods: The study included 3 groups of participants: Contact lens wearers using silicone hydrogel soft contact lenses who are symptomatic (CLD, n=15) or asymptomatic (ACL, n=11) and non-wearers as controls (n=14). Duration of contact lens wear, Ocular Surface Disease Index (OSDI) questionnaire responses, fluorescein tear break-uptime (FBUT), and corneal confocal microscopy findings were recorded., Results: Mean age was 25.7±8.2 years and male/female ratio was 7/33. Demographic findings were similar regarding the groups. CLD patients had a longer lens use history than ACL (median 5 vs 2 years, p<0.001). OSDI scores were higher in CLD group than ACL or controls (p<0.001, p=0.002). FBUT was significantly lowest in CLD group, compared to controls and ACL (p<0.001, p=0.039). FBUT was also lower in ACL patients compared to controls (p=0.036). There was no difference between basal epithelium cell counts between all 3 groups. Anterior stromal activated keratocyte numbers were similar between contact lens using groups but was lower in controls (p=0.005). However, dendritiform cells in the sub-basal nerve layer were higher in CLD group compared to controls but similar to ACL (p<0.001, p=0.058). Graded sub-basal nerve tortuosity was more prominent in CLD group than the ACL (p=0.014)., Conclusion: Patients with CLD had been wearing contact lenses for longer than those without symptoms. OSDI and FBUT scores were worse in CLD patients. In contact lens discomfort patients, there were increased dendritiform cells, indicating intensified inflammatory status of the cornea., (Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: This study sought to provide an evidence-based profile of the diagnosis, treatment and knowledge or opinions on dry eye among optometrists and ophthalmologists in Ghana., Methods: This was a cross-sectional survey RESULTS: The responses of 162 participants are included in the analysis. The most commonly used test to diagnosed dry eye disease was tear break-up time followed by patient history. The most common symptom doctors heard from dry eye patients were burning sensation followed by foreign body sensation. The most often prescribed first- line treatment for dry eye was aqueous-based artificial tears followed by lipid-based artificial tears. Most practitioners considered meibomian gland dysfunction as the most common cause of dry eye followed by pterygium. The most often used test to guide or gauge therapeutic effect is patient history followed closely by tear break-up time. Most practitioners reported that 10%-20% of all their patients they see in a day are diagnosed of dry eye., Conclusion: This study showed tear break up time was the main test majority of practitioners in Ghana used to diagnose dry eye but patient history was the main test used to gauge therapeutic effect over time. Burning sensation was the commonest symptom practitioners heard from dry eye patients whilst artificial tears was their main and first-line treatment for dry eye., (Copyright © 2016 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: Meibomian gland dysfunction (MGD) is one of the most common causes of evaporative dry eye. Warm compresses (WC) are recommended as adjunct therapy to slowly transfer heat to the meibomian glands to melt or soften the stagnant meibum with targeted temperatures of 40-45°C. This clinical study evaluated the heat retention profiles of commercially available eyelid warming masks over a 12-min interval., Methods: Five eyelid-warming masks (MGDRx Eyebag(®), EyeDoctor(®), Bruder(®), Tranquileyes XR™, Thera°Pearl(®)) were heated following manufacturer's instructions and heat retention was assessed at 1-min intervals for 12min. A facecloth warmed with hot tap water was used as comparison., Results: Twelve (n=12) subjects participated in the study (10F:2M, ranging in age from 21 to 30 with an average of 23.2±3.8years). Each mask demonstrated a unique heat retention profile, reaching maximum temperature at different times and having a different final temperature at the end of the 12-min evaluation. After heating, all eyelid warming masks reached a temperature near 37°C within the first minute. The facecloth was significantly cooler than all other masks as of the 2-min mark (p<0.05)., Conclusions: Reusability, availability and heat retention profiles should be considered when selecting an eyelid warming masks for adjunct WC therapy in the management of MGD. All masks tested, with the exception of the facecloth, demonstrated stable heat retention throughout the 12min, bringing further awareness that patient education is required to discuss the shortcomings of the heat retention of the facecloth, if only heated once., (Copyright © 2016 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To test for associations between Pentacam(®) derived topography variables and to evaluate the predictive power of those variables in relation to scleral contact lens (SCL) fit., Setting: Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo-SP, Brazil., Design: Prospective observational non-randomised, non-comparative study., Methods: Forty-seven patients (63 eyes) were indicated for the use of Esclera(®) SCL. All patients underwent Scheimpflug imaging before the initial SCL evaluation. The following parameters were measured by Pentacam: corneal elevations, thickness, density, and anterior chamber depth (ACD). Correlations between the SCL parameters and the Pentacam measurements were analysed with Pearson's correlation coefficients. A simple linear regression model was created for each lens parameter using the most-correlated Pentacam variable., Results: In the total group, the results show correlations between the SCL parameters and the corneal astigmatism, ACD and pentacam-measured corneal height (Hm), with p<0.001 each. In addition, an inverse correlation between the lens sagittal depth (LSD) and the anterior radii minimum was shown (p<0.001). In the keratoconus group, the results show correlations between the SCL parameters and ACD and Hm (p<0.001, each). An inverse correlation between the LSD and the total thickness corneal density average was also observed (p=0.003)., Conclusion: There was a positive correlation between the LSD and ACD, even as LD and ACD in the keratoconus group. Thus, these results suggest that certain Pentacam measurements can be good predictors of the most appropriate Esclera lens to be fitted in keratoconus patients., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

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., (Copyright © 2015 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To present the ocular manifestation of 2 cases of ectrodactyly-ectodermal dysplasia-cleft syndrome, a multiple congenital anomaly syndrome caused by a single point mutation of the p63 gene that controls epidermal development and homeostasis and to present treatment options., Case Reports and Discussion: Patient 1 presented with mild signs and symptoms of dry eye and limbal stem cell deficiency with retention of 20/30 vision. Patient 2 presented with severe signs and symptoms of limbal stem cell deficiency with diffuse corneal scarring and counting fingers vision. This second patient's course was complicated by allergic conjunctivitis and advanced steroid-induced glaucoma. The cause of visual loss in ectrodactyly-ectodermal dysplasia-cleft syndrome appears to be multifactorial and likely includes inflammation of the ocular surface, tear film abnormalities, eyelid abnormalities, and limbal stem cell deficiency. Treatment modalities including lubrication, contact lenses, and limbal stem cell transplantation are reviewed., Conclusions: The ophthalmic conditions seen in ectrodactyly-ectodermal dysplasia-cleft syndrome frequently lead to vision loss. Early correct diagnosis and appropriate therapy are paramount because p63 gene mutations have a critical role in maintaining the integrity of the ocular surface in the setting of limbal stem cell deficiency, especially if there are other ocular surface insults such as lid disease, meibomian gland dysfunction and toxicity from topical medications. Patients should be monitored at regular, frequent intervals; and particular attention should be taken to avoid adverse secondary effects of these conditions and medications., (Copyright © 2015 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To investigate the ability of pharmacy staff in the United Kingdom (UK) to diagnose and treat dry eye., Methods: A mystery shopper technique to simulate a patient with presumed dry eye was used in 50 pharmacy practices in major towns and cities across the UK. Pharmacies were unaware of their involvement in the study. With the exception of a predetermined opening statement to initiate the consultation, no further information was volunteered. Questions asked, diagnoses given, management strategy advised and staff type was recorded immediately after the consultation., Results: The mean number of questions was 4.5 (SD 1.7; range 1-10). The most common question was the duration of symptoms (56%) and the least common was whether the patient had a history of headaches (2%). All pharmacy staff gave a diagnosis, but the majority were incorrect (58%), with only 42% correctly identifying dry eye. Treatment was advised by 92% of pharmacy staff, with the remaining 8% advising referral directly to the patient's GP or optometrist. Dry eye treatments involved topical ocular lubrication via eye drops (90%) and lipid based sprays (10%). However, only 10% gave administration advice, 10% gave dosage advice, 9% asked about contact lens wear, and none offered follow up although 15% also advised GP or optometrist referral., Conclusions: There is a need for improved ophthalmological training amongst pharmacists and pharmacy staff and establishment of cross referral relationships between pharmacies and optometry practices., (Copyright © 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Objective: To evaluate fitting feasibility and efficacy of mini scleral contact lenses in moderate to severe dry eye patients., Methods: Prospective interventional case series, this study included those patients with grades III and IV dry eye disease, whose symptoms could not be controlled by conventional treatments. Demographic data, UCVA, BSCVA were evaluated before fitting. Mini scleral lens fit was assessed by single experienced practitioner and best corrected vision with mini scleral lens was assessed. After dispensing mini scleral lens, BCVA with mini scleral lens, and possible contact lens related problems were assessed in each visit. Ocular comforts, frequency of artificial tear use, contact lens handling problems were asked in each follow up visit. For those who did not choose to wear lenses, the reason was asked. All data were analyzed using descriptive statistical tests., Results: Twenty eyes of 13 patients were fitted. Mini scleral lens was dispensed for 19 eyes in them assessment of fit was either ideal (n=9) or acceptable (n=10). Seven patients got their lenses; four patients (seven eyes) of them were satisfied with their lenses based on decrease in discomfort and dry eye symptoms, decrease artificial tear need frequency and improvement in visual acuity during mean follow up period of 18.25 months (range: 15-20). None of them was affected with any contact lens related complication., Conclusion: Mini scleral contact lenses can be considered helpful in management of moderate to severe dry eye., (Copyright © 2012 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: The aim of this study was to compare the efficacy of hioxofilcon A and omafilcon A soft contact lenses for the reduction of signs and symptoms of contact lens related dryness among contact lens wearers who presented with symptoms and signs at baseline., Methods: Forty dry eye subjects, 37 females and 3 males, were enrolled in this prospective, single-center, randomized, contra-lateral, cross-over study. Subjects were randomly dispensed hioxifilcon A and omafilcon A lenses for contra-lateral eyes. Lenses were worn daily wear for 3 months; for 6 weeks (2-week lens replacement) then lens types were crossed over to opposite eyes for 6 more weeks. Clinical examinations took place at baseline, 1 and 6 weeks in each cycle. Ocular surface signs and symptoms were evaluated by self-administered questionnaire., Results: Compared to baseline symptoms with habitual lenses, dryness, discomfort, and blurry vision were reported at a lower frequency and intensity with both test lens types (p < 0.05, all comparisons, Wilcoxon Signed Ranks Test). Compared to baseline signs, there was an improvement in overall fluorescein staining for both lenses (p < 0.05). Lissamine green staining showed improvement with omafilcon A lenses only (p < 0.05). There was no change in tear break up time or bulbar redness., Conclusion: Symptoms and ocular surface staining associated with contact lens related dryness can be significantly alleviated by the use of hioxofilcon A or omafilcon A lenses, which yielded similar findings in this study.