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Contact lens (CL) wearers often suffer from ocular discomfort, which leads to cessation of CL wear. About 30% to 50% of CL wearers complain of dry eye (DE) symptoms. Meibomian gland dysfunction (MGD) is considered the most common cause of evaporative DE. Numerous studies have investigated whether CL wear might affect the meibomian glands. This manuscript reviews studies examining the relationship between CL use and MGD. A PubMed database search was conducted for studies published between 1980-2021 with one or a combination of search terms related to “meibomian gland”, “meibomian gland dysfunction”, “contact lens”, and/or “dry eye”. Of the 115 papers reviewed, 22 articles were identified that examined the association between CL and MGD. Fifteen showed that CL wear affects the morphology and function of meibomian glands (MGs), while seven reported no significant impact of CL wear on MGs. This review provides an overview of these studies, emphasizing the diagnostic tests of MGD and conclusions. The review highlights the need for longitudinal prospective large cohort studies with control non- CL wearers to clarify the ambiguous relationship between MGD and CL wear, with special attention to varying CL material and wear times in order to identify the long-term impact of CLs on MG.

Objectives: To evaluate the corneal subbasal nerve morphology, corneal sensitivity, and anterior segment alterations in short-term silicone hydrogel contact lens (SiHCL) users by confocal microscopy. Materials and methods: The study included 25 right eyes of 25 male volunteers aged 25-30 years who had never used SiHCLs before. ocular surface disease index (OSDI), tear break-up time, Schirmer test, tear meniscus area, strip meniscometry tube, corneal sensitivity, and corneal subbasal nerve morphology were evaluated before and after 1 month of CL use. Results: OSDI was 10.6±1.1 before CL use and 17.2±1.2 after 1 month of CL use (p0.05). Tear film break-up time was 7.1±0.4 s before and 6.2±0.3 s after CL use (p>0.05). The tear meniscus area was 0.026±0.002 mm2 before and 0.024±0.001 mm2 after 1 month of CL use (p>0.05). Strip meniscometry tube results were 5.4±0.9 mm before and 4.9±0.8 mm after 1 month of CL use (p>0.05). Corneal sensitivity values were 3.2±0.4 mm before and 2.95±0.3 mm after 1 month of CL use (p>0.05). Dendritic cell density evaluated by confocal microscopy was 14.84±3.1 cells/mm2 before and 32.57±4.2 cells/mm2 after 1 month of CL use (p0.05). Subbasal nerve density was measured as 4726±310 pixels/frame before and 4570±272 pixels/frame after 1 month of CL use (p>0.05). Conclusion: After a month of SiHCL use, no significant changes were observed in tear secretion, corneal sensitivity, tear meniscus volume, subbasal corneal nerve density, reflectivity, or tortuosity, while a significant increase was found in OSDI and dendritic cell density.

Significance: Frequent and effective patient-practitioner communication is essential to ensure instructions regarding contact lens use, care and maintenance are understood and followed. Given the relevance of good patient compliance, the responsibility of practitioners to provide adequate information may not be neglected. Purpose: To determine the content and type of information Licensed Optometrists in Spain provide their patients during the first contact lens fitting and at follow-up visits. Methods: A self-reported ad hoc survey was distributed to Licensed Optometrists in Spain to investigate, amongst other factors, whether practitioners provided information on several aspects of contact lens use and maintenance, how was this information provided and whether in-office practical demonstrations were conducted at all contact lens appointments. Results: Respondents of 321 surveys had a median of 20 years of contact lens fitting experience and worked on independent practices (67.6%), national (29.0%) and regional chains (3.4%). Type of practice influenced continuous education habits (P = .03). Overall, 28.0% of participants did not always instruct patients on the need to rub contact lenses, 34.3% did not always address contact lens replacement and 6.8% did not always explain storage case hygiene and replacement. At the follow-up visit, only 8.4% of respondents asked their patients to demonstrate their care routines. Information was mostly oral (48.6%) or oral and written (43.0%). Contact lens-related complications were reported more frequently by participants with less continuous education training (P = .01), by those not always recommending rubbing (P = .002) and by those not providing written information about storage case hygiene and replacement (P = .002). Conclusion: Patient-practitioner communication was good, albeit several areas were identified were information was insufficient or not provided in a correct and timely format. Precise, written information on rubbing and storage case hygiene and replacement may improve compliance and assist in avoiding complications and drop-out.

To determine the demographic, etiological, microbiological, and clinical characteristics and present treatment results of contact lens (CL)-associated microbial keratitis (CLAMK).Medical records of patients who were followed in our clinic for CLAMK between January 2014 and May 2020 were retrospectively analyzed. Demographic characteristics, symptom duration, CL and usage characteristics, risk factors, isolated microorganisms, lesion characteristics, hospital stay, recovery and follow-up times, and best corrected visual acuities (BCVA) at first and last examination were recorded.The 22 patients (16 females, 6 males; 22 eyes) had a mean follow-up time of 13.0±18.3 months and mean age of 26.9±14.3 years. Most of the female patients (13/16) were under 35 years old. At least one risk factor associated with improper CL usage was identified in 21 patients (95.4%). The most common risk factor was sleeping with CL (n=15, 68.1%). Causative microorganisms were detected on microbiological examination in 15 cases (68.1%). The most common microorganism wasMistakes in CL use are a frequent predisposing factor in patients with CLAMK. Informing CL users in detail about CL usage and cleaning may reduce the frequency of these mistakes and thus infections. Current antibiotic options that should be preferred in empirical treatment remain largely effective against likely pathogens. Favorable visual outcomes can be obtained in most cases with detailed diagnostic examination and appropriate treatment approaches.

Purpose To describe a case of traumatic soft contact lens dislocation into the vitreous space after a large-sized corneal perforation with a clout nail, causing aniridia but leaving the crystalline lens intact. Methods A case report of a Forty-four-year-old male patient with a corneal perforation. Results A patient presented with a traumatic corneal perforation after a large clout nail impacted on his left eye. Aniridia and inferior zonulolysis were seen, but the crystalline lens was perfectly clear. Since computed tomography imaging and B-scan ultrasonography showed no signs of intraocular foreign body, a vitrectomy was performed seven days after primary repair to allow for proper wound closure. During vitrectomy, a completely intact soft contact lens was found in the vitreous cavity. The soft contact lens was stained with MembraneBlue-Dual® (D.O.R.C., the Netherlands) to enhance visualization and ensure complete removal by the vitreous cutter. Conclusion MembraneBlue-Dual® can be used to facilitate complete removal of a clear and otherwise difficult to see corneal contact lens from the vitreous cavity. This case also demonstrates the importance of exploratory vitrectomy in all trauma cases with posterior segment involvement, even when imaging modalities show no signs of intraocular foreign bodies.

A 27-year-old immunocompetent woman presented to our clinic with redness, mild pain and blurring of vision in her left eye (LE) for 3 weeks with no preceding history of injury or contact lens wear. At presentation, her visual acuity was 20/20 and 20/60 in the right eye and LE, respectively. Slit

Objectives: To evaluate and compare the risk factors, presenting features, and outcomes of patients with culture-positive and culture-negative microbial keratitis (MK) who presented to a tertiary referral center. Materials and Methods: We conducted a retrospective review of the medical records of 314 patients who were diagnosed with MK in our clinic between 2012 and 2019. Results: Among 314 patients, 142 had positive cultures (45.2%). The mean ages of the culture-positive and-negative patients at the time of diagnosis were 51.39 +/- 21.31 (range, 14-90) years and 56.68 +/- 21.34 (7-94) years, respectively (p=0.028). The mean best corrected visual acuity (BCVA) of the culture-positive and-negative patients were1.74 +/- 1.25 (0-3.1) LogMAR and 1.91 +/- 1.23 (0-3.1) LogMAR prior to treatment and increased to 1.21 +/- 1.30 (0-3.1) LogMAR and 1.27 +/- 1.29 (0-3.1) LogMAR at last visit, respectively. There was no statistically significant difference between culture-positive and-negative patients' BCVA levels at presentation or last visit. Ninety-two patients (64.7%) were infected with bacteria and 50 patients (35.2%) with fungi. The most common pathogen was Pseudomonas aeruginosa (18.3%), followed by Streptococcus pneumoniae (11.2%) and Fusarium spp. (11.2%). Keratitis foci were either centrally or paracentrally located in 105 eyes (73.9%) of culture-positive patients and 149 eyes (86.6%) of culture-negative patients. Multiple foci were present mostly in culture-positive patients (p=0.001). There was no significant difference between the culture-positive and-negative groups in terms of hypopyon presence (p=0.364). The proportion of contact lens (CL) wearers was 33% (n=47) among culture-positive MK patients and 13.3% (n=23) among culture-negative MK patients, respectively (p

PURPOSE To compare outcomes of contact lens assisted corneal cross linking (CACXL) and transepithelial corneal cross linking (TECXL) with standard 'epithelium off'' ('epi -off') cross linking (CXL) for progressive keratoconus. SETTING Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh , India. DESIGN Retrospective, comparative study. METHODS Patients with progressive keratoconus undergoing CXL with a minimum follow up of 24 months were included. CACXL and TECXL was performed in patients with 'epithelium on' minimal pachymetry between 350 µm to 450 µm. Main outcome measures included change in maximum keratometry (Kmax), corrected distance visual acuity (CDVA), and efficacy in halting progression (increase in Kmax ≥ 1 diopter [D]). RESULTS Standard 'epi -off' CXL, CACXL and TECXL was performed in 34,14 and 10 eyes respectively. Baseline Kmax and CDVA were comparable for all groupsKmax reduced significantly by -2.83 ± 3.35 D, -3.18 ± 2.74D and -2.02 ± 1.66 D in standard 'epi-off' CXL (p

Contact lens have been proposed as a mean of ocular drug delivery, but the conventional soaking method to load hydrophobic drugs, such as latanoprost shows low drug loading and high burst release with alteration in the critical lens properties. In this paper, a novel latanoprost-loaded PEGylated solid lipid nanoparticles (LP-pSLNs) were developed to increase the latanoprost loading capacity of contact lenses (LP-pSLN-L), while also sustaining ocular drug delivery. The pSLNs were spherical in shape with an average size of 105‒132 nm (nanometer) and a zeta potential ranging from ‒29.1 to ‒26.7 mV (millivolt). The LP-pSLNs led to improved swelling, transmittance, and protein adherence of the lens compared to the non-pegylated SLNs congeners (LP-SLN-L) and conventional soaked lens (LP-SM-L). The LP-SM-L lens showed low drug loading, high burst release, and a short release duration of 24 h. The LP-SLN-L and LP-pSLN-L lenses showed high drug uptake and sustained drug release up to 120 h and 96 h, respectively. The pegylation reduced the size of nanoparticles and improved the drug loading capacity, while the release rate was high in the initial hours. The LP-pSLN-L lens was found to be safe based in histopathological studies. In animal studies, the LP-pSLN-10-L batch showed high drug concentration at all-time points up to 96 h compared to the LP-SM-L and eye drop solution. In conclusion, pSLNs improved the latanoprost loading in the contact lens and showed sustained drug release, and thus can be used as a substitute to eye drop therapy.

Purpose To review safety and efficacy of combined plasma rich in growth factors (PRGF) eye drops and scleral contact lens (SCL) therapy in patients with ocular surface disease. Methods Patients with ocular surface disease of various etiologies were screened for at least 3 months of concurrent treatment with PRGF and SCL. Retrospective pre- and post-treatment measurements were collected, including patient satisfaction, severity and frequency of dry eye symptoms measured by a modified Symptom Assessment in Dry Eye (SANDE) questionnaire, visual acuity, and number of concurrent treatments. Results 26 patients with ocular surface disease were included in the study with 20 patients answering the questionnaire (77% response rate). There were no adverse events reported. Most patients thought the combined therapy was better than previous treatments and would recommend to others (80%, 90% respectively). SANDE scores significantly decreased after use of concurrent therapy. There was a small but significant decrease in the number of other concurrent treatments. Visual acuity was unchanged. Conclusions This retrospective cohort study found PRGF used in combination with SCL is safe and significantly decreases symptoms in patients with recalcitrant ocular surface disease.

PurposeTo investigate the effects of the global COVID-19 pandemic on contact lens education around the world.MethodsAn online survey among contact lens educators (educator members of the International Association of Contact Lens Educators), conducted in May 2020.ResultsA total of 214 responses were received from 32 countries (representing a 39% response rate). Overall, 71% of respondents’ institutions were closed to students to attend at that time. A majority (58%) were delivering more online education than they would normally provide. Live online lectures and discussion was the most commonly used method (68%). Zoom was the most common videoconferencing technology (56%) and the most popular social media platform for communicating with students was WhatsApp (48%). About half (54%) were running online exams or assessments, 24% holding these for students to attend in person, and 27% were conducting practical sessions. Two in three (68%) said they would conduct more than 50% of their total teaching online by the end of 2020, and 12% anticipated 90% or more of their teaching would be online. Of all respondents, 74% expressed interest in an online platform delivering educational resources.ConclusionThe COVID-19 pandemic has had a major impact on the teaching of contact lenses, as educational institutions worldwide move to online delivery. Major challenges remain with online contact lens education, with respect to teaching practical skills, student assessment and interaction. More support will be needed for educators to meet these challenges as the recovery from the pandemic continues.

Purpose Children with high ametropia who have difficulties with spectacle or contact lens wear benefit from gains in visual function after intraocular collamer lens (ICL) surgery. Here we assess safety by reporting rates and case specifics of peri-operative and longer-term adverse events (AE).[LINE SEPARATOR] SETTING:: St. Louis Children's Hospital at Washington University Medical Center. Design Retrospective Case Series. Methods Clinical data were collated retrospectively for 95 special-needs children (160 eyes) implanted with a Visian ICL over the last 5 years. All surgeries were performed at St Louis Children's Hospital under brief general anesthesia. Follow-up was a mean 2.0 ±1.4 years (range 0.5-5.2). Results Average age at implantation was 9.3 ± 5.2 years (range 1.8-25) and mean pre-operative SEQRE was -11.2 ± 3.9 D (range - 4-22). Sixty-two children (65%) had a neurodevelopmental disorder. The minor AE rate was 2% (3 eyes), consisting of steroid-response ocular hypertension (OHT), which resolved with cessation of topical steroid drops. Endothelial cell loss averaged 8.1 % over 2 years, comparable to that reported in ICL implanted adults. The most common major AE (4%, 7 eyes) was post-operative pupillary block, requiring revision of the peripheral iridotomy. One child (0.6%, 1 eye) with self-injurious behavior required repair of a wound leak. One child (0.6%, 1 eye) with Down syndrome developed a cataract 2.8 years after ICL surgery. And one child (0.6%, 1 eye) with severe Autism Spectrum Disorder experienced traumatic retinal detachment 1.2 years after implantation. Conclusion The most common major AE among our Visian ICL cohort was pupillary block due to closure of the iridotomy. Overall, the AE rate was low in this higher risk, difficult-to-manage population of special-needs children.

Objective: To evaluate the lubricating effect of hyaluronic acid (HA) on soft contact lenses (SCLs) measured using a pendulum-type friction tester. Methods: We measured the coefficient of friction (CoF) of narafilcon A, delefilcon A, and etafilcon A with polyvinylpyrrolidone (PVP), daily disposable SCL material, using a modified pendulum-type friction tester. Sample SCLs were set on an acrylic plastic half-ball and placed into the polyethylene terephthalate hemisphere cup filled with 0.4 mL of test lubricants that included saline and 0.05%, 0.1%, 0.2%, 0.3%, 0.4%, and 0.5% (wt/vol) HA (molecular weight, 850 kDa). The viscosities of saline and HA were measured using an Ubbelohde viscometer. Results: The CoF of the SCL under a low concentration (0.05%) of HA was the lowest and significantly lower than saline in narafilcon A and delefilcon A (P

Objective: To investigate the level of awareness of ophthalmologists towards COVID-19 and their perceptions towards infection control in ophthalmic practice. Methods: A web-based survey was conducted using Google Forms during the month of December 2020. All ophthalmologists practicing in Sudan were invited to participate in the study. Participants who did not agree to the terms of the electronic consent form presented at the beginning of the questionnaire as well as those who did not complete the survey, were excluded from the analysis. Knowledge of causes, symptoms, and methods of transmission of COVID-19; ophthalmologists’ attitudes and perceptions towards COVID-19 and clinical practice, including contact lens practice, were assessed using a set of 26 multiple-choice close-ended questions. Results: Of the 307 participants, 77.4% were in the age range 30-40 years and 73% were contact lens practitioners. While 96.1% acknowledged the scientific name of COVID-19, 46.9% were aware of its cause. Ophthalmologists aged 40-50 years were more likely to agree that air-puffing tonometer risks infection spread (OR 1.62, 95% CI: 0.27-9.70, p Conclusion: Ophthalmologists in Sudan demonstrated a mixed level of knowledge of the causes, symptoms, and modes of transmission of COVID-19. While the majority were able to identify the protective measures generally required by medical practitioners and patients, there was a limited level of knowledge regarding protective measures specific to ophthalmic practices, especially when dealing with contact lenses. Official national guidelines about safe ophthalmic service provision during the COVID-19 pandemic are recommended.

CLINICAL RELEVANCE Contact lens multipurpose solutions (MPSs) contain several components that have the potential to cause corneal epithelial cell toxicity. Evaluating the components and the toxic effect of MPS should be considered for effective eye care. BACKGROUND The cytotoxic and wound healing effects of five commercially available MPSs on human corneal epithelial cells (HCECs) are is investigated. METHODS The following commercially available MPSs were used: Queen's PLURISOL®, Frenz®, Boston SIMPLUS®, DL+PLUS EYE® (DL), and NEW YORK DEFINE® (NY). The proliferation of HCECs exposed to each MPS for 1, 6, and 24 h and the cytotoxicity of these solutions were analyzed using methyl thiazolyl tetrazolium-based colorimetric and lactate dehydrogenase leakage assays, respectively. The cellular morphology was evaluated by inverted phase-contrast and electron microscopy. A scratch-wound assay was performed to measure wound widths 24 h after confluent HCEC monolayers were scratch-wounded. RESULTS The tested MPS had a time-dependent inhibitory effect on HCEC proliferation and cytotoxicity, significantly at 24 h after exposure (p

Objective: In the present research, the main objective was to investigate the possibility of designing, fabricating, and optimizing a disposable ocular film-based drug delivery system. Methods: Moxifloxacin hydrochloride was loaded onto the prepared disposable ocular films by the soaking method. Results: The drug loading conditions were studied, and it was found that the maximum drug loading was achieved in 3 hours at pH 6.5 of the drug solution. It was also observed that the drug loading efficacy and in vitro drug release profile can be monitored by varying the ocular film composition. The ocular films were then characterized for thickness uniformity, size uniformity, weight uniformity, swelling index, surface pH, breaking on elongation, folding endurance, bio-adhesive strength, transparency, drug loading efficiency, moisture content, morphological characteristics, and in vitro drug release profiles. Conclusion: Based on the results, it was concluded that the developed disposable ocular films demonstrate a significant prolonged drug release within the therapeutic range of up to 12 h, which is promising as a novel disposable contact lens-based ocular drug delivery system.

Nowadays, keratoconus (KC) is very well treatable in a stage-oriented manner. A wide range of designs and materials of contact lenses (CL) are available for the treatment of KC. The aim of this study was to evaluate the possibilities, the possible challenges and the visual outcome of lens fitting in KC eyes.This retrospective study includes data from 200 patients who received a lens fitting trial in our contact lens service between 2006 and 2016. We documented ophthalmological parameters, the type of prescribed CL, the number of required trial lenses and possible causes of the failure of the lens fitting.The mean age at initial lens fitting was 33.9 ± 12.5 years. In 98.8% of the cases, the fitting was performed with rigid gas permeable lenses, in 90.1% with four-curve lenses. Of the total number of aspheric lenses prescribed, 87.5% were fitted in keratoconus stages "1" to "2" (topographic keratoconus classification; Oculus Keratograph). Back surface toric lenses or bitoric lenses were fitted to 61.7% in keratoconus stages "2 - 3" to "4". Before patients received their final CL, a median of 2 trial lenses were required (max. 16). Mean visual acuity with lens correction was 0.8 ± 0.2 at the initial fitting, mean visual acuity with glasses correction was 0.5 ± 0.3. In 7.7% of the eyes, the KC lens fitting was discontinued due to the advanced stage of keratoconus, requiring a corneal transplant. Reasons for discontinuing contact lens fitting included lens intolerance (2.3%), application problems (0.3%) or acute corneal hydrops (0.3%). Discontinuation of lens wearing due to incompatibilities or application problems occurred in only four cases (1.1%) in the further course after lens fitting.The use of contact lenses is an integral part of the stage-appropriate therapy of keratoconus. Good visual acuity can be achieved in all stages of keratoconus with a low drop-out rate. In most cases, the adjustment is carried out with rigid gas permeable lenses with a four-curve geometry. In initial stages, aspherical lenses may be sufficient. Toric lenses can be fitted in advanced stages when rotationally symmetrical lenses cannot achieve a satisfactory fit. If contact lenses have been successfully fitted, there are only a few cases in which patients abandon their contact lenses because of intolerance.Der Keratokonus (KK) kann heutzutage sehr gut stadiengerecht therapiert werden. Bei der Versorgung des KK stehen eine Vielzahl an Designs und Materialien von Kontaktlinsen (KL) zur Verfügung. Unser Ziel war es, die Möglichkeiten, die Hindernisse und den visuellen Erfolg der KL-Anpassung beim KK zu evaluieren.Die vorliegende retrospektive Studie beinhaltet die Daten von 200 Patienten, die im Zeitraum von 2006 bis 2016 einen Linsenanpassungsversuch in unserer KL-Ambulanz erhielten. Wir dokumentierten u. a. ophthalmologische Parameter, die Art der verordneten KL, die Anzahl der benötigten Probelinsen sowie eventuelle Abbruchursachen.Das mittlere Alter bei der KL-Erstanpassung betrug 33,9 ± 12,5 Jahre. In 98,8% der Fälle erfolgte die Versorgung mit formstabilen, in 90,1% der Fälle mittels 4-kurviger KL. In Bezug auf die Gesamtheit der verordneten asphärischen KL erfolgte in 87,5% der Fälle die Anpassung in den KK-Stadien „1“ bis „2“ (topografische KK-Klassifizierung; Oculus Keratograph). Die Anpassung rückflächentorischer oder bitorischer KL erfolgte bei 61,7% der Augen in den KK-Stadien „2 – 3“ bis „4“. Bis zur endgültigen KL wurden im Median 2 (maximal 16) Probelinsen benötigt. Der mittlere Visus mit KL-Korrektur betrug bei der Erstanpassung 0,8 ± 0,2, der mittlere Visus mit Brillenkorrektur 0,5 ± 0,3. Bei 7,7% der Augen wurde die Anpassung der KK-Kontaktlinse aufgrund des fortgeschrittenen KK-Stadiums mit notwendiger Keratoplastik nicht weitergeführt. Gründe für einen Abbruch der KL-Anpassung waren u. a. eine Linsenunverträglichkeit (2,3%), Anwendungsprobleme (0,3%) oder ein akuter KK (0,3%). Ein Abbruch des KL-Tragens aufgrund von Unverträglichkeiten oder Anwendungsproblemen erfolgte nur in 4 Fällen (1,1%) im weiteren Verlauf der Linsenanpassung.Die KL-Versorgung ist ein integraler Bestandteil der stadiengerechten Therapie des KK. Es kann in allen Stadien ein guter Visus mit einer geringen Abbruchquote erreicht werden. Die Anpassung erfolgt mehrheitlich durch hoch gasdurchlässige, formstabile KL mit einer 4-kurvigen Geometrie. In Anfangsstadien ist die Versorgung teilweise mit asphärischen KL möglich. Torische KL können in fortgeschrittenen Stadien angepasst werden, wenn kein zufriedenstellender Sitz mit rotationssymmetrischen KL erreicht wird. Sofern KL einmal erfolgreich angepasst werden, erfolgt im weiteren Verlauf nur noch bei wenigen Patienten ein Abbruch aufgrund einer Linsenunverträglichkeit.

Purpose To examine the efficacy and safety of corneal cross-linking (CXL) for stabilization of progressive keratoconus. Design Observer-masked, randomized, controlled, parallel-group superiority trial. Participants Sixty participants 10 to 16 years of age with progressive keratoconus, one eye of each deemed the study eye. Methods The study eye was randomized to either CXL plus standard care or standard care alone, with spectacle or contact lens correction as necessary for vision. Main Outcome Measures The primary outcome was steep keratometry (K2) in the study eye as a measure of the steepness of the cornea at 18 months. Secondary outcomes included keratoconus progression defined as a 1.5-diopter (D) increase in K2, visual acuity, keratoconus apex corneal thickness, and quality of life. Results Of 60 participants, 30 were randomized to CXL and standard care groups. Of these, 30 patients in the CXL group and 28 patients in the standard care group were analyzed. Mean K2 in the study eye 18 months after randomization was 49.7 D (standard deviation [SD], 3.8 D) in the CXL group and 53.4 D (SD, 5.8 D) in the standard care group. The adjusted mean difference in K2 in the study eye was –3.0 D (95% confidence interval [CI], –4.9 to –1.1 D; P = 0.002), favoring CXL. Adjusted differences between groups in uncorrected and corrected vision favored eyes receiving CXL: –0.31 logarithm of the minimum angle of resolution (logMAR; 95% CI, –0.50 to –0.11 logMAR; P = 0.002) and –0.51 logMAR (95% CI, –1.37 to 0.35 logMAR; P = 0.002). Keratoconus progression in the study eye occurred in 2 patients (7%) randomized to CXL compared with 12 patients (43%) randomized to standard care. The unadjusted odds ratio suggests that on average, patients in the CXL arm had 90% (odds ratio, 0.1; 95% CI, 0.02–0.48; P = 0.004) lower odds of experiencing progression compared with those receiving standard care. Conclusions CXL arrests progression of keratoconus in the majority of young patients. CXL should be considered as a first-line treatment in progressive disease. If the arrest of keratoconus progression induced by CXL is sustained in longer follow-up, particular benefit may be derived from avoiding a later requirement for contact lens wear or corneal transplantation.

To identify sociodemographic factors and comorbid conditions associated with receiving keratoplasty for keratoconus (KCN).Retrospective, cross-sectional study.Health records of KCN patients65 years of age from 2011 to 2018 were obtained from the IBM MarketScan Database. A multivariable model adjusted for potential confounders was used to examine factors associated with the risk of receiving keratoplasty.Of 42,086 total patients with KCN identified, 1282 (3.0%) patients had keratoplasty to treat KCN. In the fully adjusted analysis, female sex (odds ratio [OR] 0.87 [95% confidence interval {CI} 0.78-0.98]) and living in metropolitan areas (OR 0.75 [95% CI 0.63-0.90]) were associated with lower odds of receiving keratoplasty. Compared with individuals 10 to 19 years of age, those 20 to 29 years of age (OR 1.77 [95% CI 1.31-2.41]) and 30 to 39 years of age (OR 1.61 [95% CI 1.19-2.17]) were more likely to have keratoplasty, while individuals in the older age groups (50-64 years of age) did not show statistically significant associations. Conditions associated with higher odds of receiving keratoplasty were corneal hydrops (OR 4.87 [95% CI 4.07-5.82]), Leber congenital amaurosis (OR 2.41 [95% CI 1.02-5.71]), sleep apnea (OR 1.46 [95% CI 1.25-1.71]), diabetes mellitus (OR 1.32 [95% CI 1.13-1.54]), and depression (OR 1.22 [95% CI 1.03-1.44]). Conditions associated with lower odds were previous contact lens usage (OR 0.61 [95% CI 0.50-0.74]) and a history of glaucoma (OR 0.60 [95% CI 0.49-0.73]).This analysis of a large sample of patients with KCN reveals previously unidentified risk factors associated with receiving keratoplasty including Leber congenital amaurosis, depression, and diabetes. Future research should examine if young patients with these conditions may benefit from more frequent follow-up and/or early crosslinking to reduce the need for subsequent keratoplasty.

Background and objective: The fitting of orthokeratology (ortho-k) and multifocal soft contact lenses (SCL) is becoming increasingly popular worldwide for reducing the rate of myopia progression. However, overnight wear use of lenses and microbial contamination of contact lenses and storage vials has been shown to increase the risk of corneal inflammatory and infiltrative events (CIEs). Therefore, we conducted a pilot study to compare the rate, level, and type of microbial contamination of contact lenses and storage vialswhen participants wear ortho-k and SCL in combination with a hydrogen-peroxide disinfecting system. Material and Methods: A prospective, single-centre, randomized, crossover study was conducted to evalu-ate the rate and level of contact lens and storage vials contamination during the use of ortho-k and SCL along with a hydrogen-peroxide disinfecting solution over two 10 day wearing periods. Ocular signs and symptoms were assessed during lens wear at baseline and after each wearing period. In addition, contact lens and storage vials were collected, and the type and amount of microbial contamination were evaluated using viable culture and standard identification methods.Results: Twenty-five adults were enrolled, and 21 completed the study. One (5%) ortho-k lens, five (24%) ortho-k storage vials, one (5%) SCL and one (5%) SCL storage vial were contaminated (P > 0.05), predominantly with Gram-positive bacteria. None of the participants had contamination with both ortho-k and SCL. No significant differences were found between the ocular signs, including conjunctival redness and roughness, or conjunctival or corneal staining (all P > 0.05), irrespective of using ortho-k or SCL. Conclusion: This study provides the first data that directly compares microbial contamination of ortho-K versus SCL in patients using a hydrogen-peroxide disinfection system. However, the overall microbial contamination rate of contact lens storage vials was much lower (30%) than the previously reported study with ortho-k lens wear. The results support conducting a larger clinical trial designed to understand differences in microbial contamination with different lens materials and modalities.

The aim of this study was to determine the impact of Acanthamoeba keratitis (AK) caused by contact lens (CL) use on vision-related quality of life (VRQOL) and the sociodemographic factors and disease outcome associated with VRQOL.Sixty-one CL-associated AK cases and 59 asymptomatic CL wearers (mean age ±SD 39.4 ± 16.5 vs. 45.5 ± 15.2 yrs, P = 0.04) were recruited from Moorfields Eye Hospital and Institute for Optometry, London. AK cases were surveyed during active disease and were stratified into "poor" and "good" outcomes based on clinical features. VRQOL was measured using Rasch-transformed scores from the Emotional, Mobility, and Reading domains of the 32-item Impact of Visual Impairment questionnaire. AK cases were compared with controls and "poor" outcomes compared with "good" with multivariable linear regression. Multivariable linear regression models were also used to identify the sociodemographic factors and disease outcome associated with VRQOL.AK was associated with significant and substantial reductions in all 3 evaluated domains of VRQOL (Reading -59.6%, Mobility -59.8%, and Emotional -66.2%) compared with controls, independent of sociodemographic factors. Patients with AK who experienced poor outcomes, those who were of British White race (compared with all other races) and female, had lower VRQOL scores across all domains. Patients with AK with lower incomes scored worse on Reading and Mobility domains, whereas those with lower education had poorer Emotional scores.AK has a considerable detrimental impact on VRQOL. Clinicians should consider the importance of referring patients with AK for rehabilitative support and counseling as part of active disease management.

Purpose To describe a new technique for sutureless and glue-free amniotic membrane transplantation (AMT) and to investigate its effectiveness to treat corneal persistent epithelial defects (PEDs), compared to bandage contact lens (BCL) application alone. Methods We performed AMT with “contact lens sandwich technique” (CLS-AMT) in 8 consecutive patients with central/para-central (up to 4.00 mm from the geometrical centre) PED/ulceration and we retrospectively compared the results with 11 BCL procedures. Results The procedures were performed successfully with no complications. CLS-AMT showed significantly shorter healing time than BCL (24.0 ± 19.1 vs 42.9 ± 14.6 days; P Conclusion CLS-AMT technique, based on the suction effect due to the superposition of a bandage contact lens on the AM-ring complex, represents a quick, low cost, easy to perform and nearly non-invasive AMT technique. This approach is able to provide adequate fixation of AM, and it seems to be a safe and effective treatment for patients with PEDs.

To report long-term clinical outcomes and estimated success rates after Bowman layer (BL) inlay transplantation in eyes treated for progressive keratoconus (KC).Thirty-five eyes (29 patients) with progressive KC underwent BL inlay transplantation. Best-corrected spectacle and contact lens visual acuity, Scheimpflug-based corneal tomography [simulated and maximum keratometry (Kmax)], central corneal thickness, thinnest point thickness, complications, and success rate were evaluated up to 8 years postoperatively for the total group and 2 subgroups [group 1: preoperative Kmax69 diopter (D) (n = 26); group 2: preoperative Kmax69D (n = 9)].Mean logarithm of the minimum angle of resolution best contact lens-corrected visual acuity for the total group and the 2 subgroups did not change from preoperative up to the last available follow-up (all P0.05), whereas best spectacle-corrected visual acuity improved for group 1 ( P = 0.03). Group 1 showed an average Kmax reduction of 7D in the first month ( P0.001) with no further changes up to 8 years postoperatively ( P0.05), whereas no significant changes were observed in group 2 (all P0.05). Postoperative KC progression occurred in 4 eyes (n = 3 group 1, n = 1 group 2) and 1 eye (group 2) underwent retransplantation for unsatisfactory visual performance. Kaplan-Meier analysis showed an estimated success rate of 85% at the 5 to 8 years follow-up in group 1 and of 75% at the 5 to 7 years follow-up for group 2.BL inlay transplantation stabilized KC in most eyes along with preservation of contact lens tolerance up to 8 years postoperatively and may be a successful treatment option, in particular for eyes with progressive advanced KC (Kmax69D).

The article describes the effect of decorative cosmetics on the material of soft contact lenses and studies specific features that can be observed in SCL wearers who use cosmetics extensively. Examples of complications associated with the use of various cosmetic products that may occur in contact lens wearers are given. Conclusion: in cases when patients have complaints about discomfort and dry eyes, doctors should pay attention to the amount of decorative cosmetics used as well as study the effect it can have on the surface of the contact lenses.

Background Keratoconus is a disease of the cornea affecting vision that is usually first diagnosed in the first three decades. The abnormality of corneal shape and thickness tends to progress until the patient reaches approximately 30 years of age. Epithelium-off corneal cross-linking is a procedure that has been demonstrated to be effective in randomised trials in adults and observational studies in young patients. Objectives The KERALINK trial examined the efficacy and safety of epithelium-off corneal cross-linking, compared with standard care by spectacle or contact lens correction, for stabilisation of progressive keratoconus. Design In this observer-masked, randomised, controlled, parallel-group superiority trial, 60 participants aged 10–16 years with progressive keratoconus were randomised; 58 participants completed the study. Progression was defined as a 1.5 D increase in corneal power measured by maximum or mean power (K2) in the steepest corneal meridian in the study eye, measured by corneal tomography. Setting Referral clinics in four UK hospitals. Interventions Participants were randomised to corneal cross-linking plus standard care or standard care alone, with spectacle or contact lens correction as necessary for vision, and were monitored for 18 months. Main outcome measures The primary outcome was K2 in the study eye as a measure of the steepness of the cornea at 18 months post randomisation. Secondary outcomes included keratoconus progression, visual acuity, keratoconus apex corneal thickness and quality of life. Results Of 60 participants, 30 were randomised to the corneal cross-linking and standard-care groups. Of these, 30 patients in the corneal cross-linking group and 28 patients in the standard-care group were analysed. The mean (standard deviation) K2 in the study eye at 18 months post randomisation was 49.7 D (3.8 D) in the corneal cross-linking group and 53.4 D (5.8 D) in the standard-care group. The adjusted mean difference in K2 in the study eye was –3.0 D (95% confidence interval –4.93 D to –1.08 D; p = 0.002), favouring corneal cross-linking. Uncorrected and corrected differences in logMAR vision at 18 months were better in eyes receiving corneal cross-linking: –0.31 (95% confidence interval –0.50 to –0.11; p = 0.002) and –0.30 (95% confidence interval –0.48 to –0.11; p = 0.002). Keratoconus progression in the study eye occurred in two patients (7%) randomised to corneal cross-linking compared with 12 (43%) patients randomised to standard care. The unadjusted odds ratio suggests that, on average, patients in the corneal cross-linking group had 90% (odds ratio 0.1, 95% confidence interval 0.02 to 0.48; p = 0.004) lower odds of experiencing progression than those receiving standard care. Quality-of-life outcomes were similar in both groups. No adverse events were attributable to corneal cross-linking. Limitations Measurements of K2 in those eyes with the most significant progression were in some cases indicated as suspect by corneal topography device software. Conclusions Corneal cross-linking arrests progression of keratoconus in the great majority of young patients. These data support a consideration of a change in practice, such that corneal cross-linking could be considered as first-line treatment in progressive disease. If the arrest of keratoconus progression induced by corneal cross-linking is sustained in longer follow-up, there may be particular benefit in avoiding the later requirement for contact lens wear or corneal transplantation. However, keratoconus does not continue to progress in all patients receiving standard care. For future work, the most important questions to be answered are whether or not (1) the arrest of keratoconus progression induced by corneal cross-linking is maintained in the long term and (2) the proportion of those receiving standard care who show significant progression increases with time. Trial registration Current Controlled Trials ISRCTN17303768 and EudraCT 2016-001460-11. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a Medical Research Council (MRC) and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 15. See the NIHR Journals Library website for further project information. The trial sponsor is University College London. This research was otherwise supported in part by the NIHR Moorfields Biomedical Research Centre and the NIHR Moorfields Clinical Research Facility, London, United Kingdom.

Context Acanthamoeba is increasingly implicated in causing keratitis in patients wearing contact lens or ocular trauma and has a poor prognosis. Establishment of an animal model is critical to study the disease pathology, pathogenesis and to evaluate anti-amoebic drugs. Some studies have used contact lenses to establish Acanthamoeba keratitis (AK) in a mouse model, which is expensive and not very successful as lenses get dislodged. Objective To assess the feasibility of using parafilm (Bemis Company Inc., USA) as an alternative to contact lens for the establishment of AK in the mouse model. Methods Thirty-six Balb/c mice in three groups of six mice each for two strains of Acanthamoeba were used to induce AK. Three experimental approaches used were; i) Acanthamoeba impregnated contact lens, ii) Acanthamoeba impregnated parafilm and iii) scratching followed by inoculation of Acanthamoeba suspension. In all three models, tarsorrhaphy was performed. Infection was evaluated by clinical examination and also through microscopic examination of corneal scrapings and corneal sections. Results AK model was successfully established with parafilm whereas only one mouse developed AK with the use of contact lens and none with scratching and Acanthamoeba inoculation. Conclusion The use of parafilm is convenient, reliable and cheaper and can be considered an alternative to contact lenses to induce AK in a mouse model.

Clinical relevance: The analysis of the changes in various biomechanical and tomographic characteristics of the cornea associated with orthokeratology may allow to identify potential mid- and long-term structural alterations, resulting in a better understanding of the governing mechanisms of this procedure and in its optimization. Background: The study aimed at describing short and mid-term changes in CORVIS ST® parameters and indices in orthokeratology (ortho-k), and their diurnal variations. Methods: A prospective observational study was designed in which several CORVIS ST® parameters of 75 new adult participants successfully fitted with overnight ortho-k Seefree® (Conóptica - Hecht Contactlinsen) contact lenses were explored. Measurements were conducted in baseline (BL) conditions and in the morning and evening at the one night (1NM / 1NT), one week (1WM / 1WT) and 3 months (3MM / 3MT) follow-up visits. Results: Statistically significant differences were found in DARatio_2mm, IntRad, ARTh, CBI and TBI following overnight ortho-k, when compared with BL values, with most values reaching stability at 1WM or reverting to BL values at 3MM. The ARTh and CBI parameters showed some of the most significant temporal variations (both p

Purpose : To investigate the effect of corneal related values on the ocular sagittal height and which factors have the greatest influence on the ocular sagittal height. Methods : For 240 healthy eyes in their 20, 30, 40, and 50s, the anterior chamber depth and axial length were measured with IOLMaster 700. The corneal curvature radius and corneal eccentricity were measured with Keratograph 4, and spherical equivalent power was measured using KR-800. The corneal sagittal height was calculated using the formula. Results : The most influential factor in the corneal sagittal height was the corneal diameter, followed by the corneal eccentricity. And the corneal curvature radius had the least effect. A change in corneal saggital height of about 0.10mm corresponds to a change in corneal diameter of 0.20mm, and corneal eccentricity of 0.05 to 0.10 Conclusion : If soft contact lens fitting is greatly affected by the relationship between the sagittal depth of the contact lens and the sagittal height of the cornea, measurements of corneal diameter and corneal eccentricity are considered appropriate methods for selecting parameters of contact lenses. In addition, the numerical relationship between corneal sagittal height, corneal diameter and corneal eccentricity could be used as additional information for soft contact lens fitting.

Objectives: To evaluate the reproducibility of tear film kinetics (TFK) measurements during the full interblink period in habitual wearers of delefilcon A daily disposable contact lenses under different environmentalconditions.Methods: Two independent studies were performed, one involving 90 eyes measurements in 49 subjects and the second involving 58 eyes measurements in 32 subjects, after 3 hours of conventional wear in normal environmental conditions (NEC) and an additional 3 hours of computer use under adverse environmental conditions (AEC), defined as 20% relative humidity (RH). Digital videos were obtained by non-invasive Tearscope illumination, followed by a parallel-group post-hoc comparative analysis by masked investigators of the videos obtained during the two studies. Parameters analyzed included non-invasive break-up time (NIBUT); dehydration speed (DS) between the initial break and the spontaneous blink, and minimum protected area (MPA) of the lens surface by the tear film.Results: After 3 hours of wear in normal environmental conditions, the overall population (n=148) had a mean NIBUT of 7.1 ± 7.0 sec, a mean DS of 0.28 ± 0.66 mm2/sec, and a mean MPA of 93.4 ± 16.6%. After an additional 3 hours in AEC, mean NIBUT was 8.4 ± 9.8 mm2/sec, mean DS was 0.26 ± 0.75 mm2/sec, and MPA was 95.2 ± 14.0%. The TFK characteristics in the two studies were similar for each environmental condition: after 3 hours of conventional wear, the mean [95% CI] differences between the two studies were −0.9 [−3.2, +1.4] sec for NIBUT, 0.00 [−0.22, +0.22] mm2/s for DS, and 2.0 [−3.5, +7.4] % for MPA; after an additional 3 hours of wear in 20% RH, the mean [95% CI] differences between the two studies were −1.3 [−4.5, +1.9] sec for NIBUT, −0.03 [−0.28, +0.22] mm2/s for DS and −0.3 [−4.9, +4.3] % for MPA. Conclusions: This analysis showed that the measurement of pre-contact lens TFK carried out in two differ-ent studies involving habitual wearers of delefilcon A having worn their contact lenses for an initial 3 hours under NEC and a further 3 hours under low (20%) hygrometry (AEC) produced similar on-eye wettability, including a long NIBUT, slow DS following the initial break, and wide MPA at the next blink. The results establish the reproducibility of the measurement of pre-contact lens TFK using the Tearscope; by quantifying the measurement variability, the data makes it possible to carry out precise sample size calculations in future studies involving pre-contact lens TFK measurements to quantify on-eye wettability under both normal and adverse environmental low (20% RH) hygrometric conditions.

SIGNIFICANCE A base-down prism was incorporated on the anterior surface of rigid gas-permeable (RGP) contact lenses to explore potential effects on the residual ocular aberrations after contact lens fitting in keratoconic eyes. PURPOSE This study aimed to evaluate the correction of ocular aberrations with corneal prismatic RGP contact lenses in keratoconic eyes and their impact on visual function. METHODS A cross-sectional and randomized study was performed. Seventeen eyes of 17 keratoconus patients (34.6 ± 11.1 years) were evaluated. Two designs (standard and prismatic) of a corneal RGP contact lens (KAKC; Conoptica, Barcelona, Spain) were fitted to the same eye of each patient in a random order: a standard RGP contact lens as control and a prismatic RGP contact lens with a base-down prism of 1.6 prism diopters. Ocular aberrations were measured for a pupil diameter of 3 mm with and without both contact lenses, whereas high-contrast distance visual acuity, low-contrast distance visual acuity, and contrast sensitivity were measured under photopic and mesopic conditions. RESULTS Both contact lenses improved oblique primary astigmatism, defocus, vertical coma, coma-like, and root-mean-square higher-order aberrations compared with the unaided eyes (P < .05). Furthermore, the prismatic RGP contact lenses offered lower values of vertical coma and root-mean-square higher-order aberrations than the standard RGP contact lenses (P < .05). Both designs (standard and prismatic) produced a positive vertical coma of lower magnitude than the negative vertical coma of the unaided eyes. On the other hand, the improvement achieved in all visual function variables was the same for both contact lens designs (P ≥ .05). CONCLUSIONS The prismatic RGP contact lenses corrected higher levels of higher-order aberrations compared with the standard RGP contact lenses. However, both contact lens designs with the same refractive power were equally efficient at improving visual function.

Background Acanthamoeba keratitis (AK) is an important cause of ocular morbidity in both contact lens wearers and non wearers. Medical management comprises prolonged empiric treatment with multiple drugs, leading to adverse effects and suboptimal cure. The present study evaluated the efficiency and safety of common antimicrobial agents used in treatment of AK. Methods Six Acanthamoeba isolates (four AK, two water samples) were axenized and subjected to in vitro susceptibility testing against chlorhexidine, pentamidine isethionate, polymyxin B, miltefosine, and fluconazole to check for trophocidal and cysticidal activity. The safety profile was analysed by observing the cytotoxicity of the highest cidal concentration toward human corneal epithelial cell (HCEC) line. Results Chlorhexidine had the lowest cidal concentration against both cysts and trophozoites (range 4.16-25 μg/ml) followed by pentamidine isethionate (range 25-166.7 μg/ml). Both agents were nontoxic to HCEC. Polymyxin B (range 25-200 μg/ml) and fluconazole (range 64-512 μg/ml) had relatively higher minimum inhibitory concentrations (MIC); fluconazole was nontoxic even at 1024 μg/ml, but cytotoxicity was observed at 400 μg/ml with polymyxin B. Miltefosine was not effective against cysts at tested concentrations. A. castellanii were more susceptible to all agents (except pentamidine isethionate) than A. lenticulata. Clinical isolates were less susceptible to polymyxin B and fluconazole than environmental isolates, reverse was true for miltefosine. Conclusion Chlorhexidine and pentamidine isethionate were the most effective and safe agents against both trophozoites and cysts forms of our Acanthamoeba isolates. Fluconazole had higher MIC but was nontoxic. Polymyxin B was effective at high MIC but therapeutic dose was found toxic. Miltefosine, at tested concentrations, could not inhibit cysts of Acanthamoeba. Clinical isolates had higher MICs for polymyxin B and fluconazole.

The peripheral refraction profile in myopes with different corrective modalities varies significantly for both distance and near viewing and will have implications in managing myopia.This study investigated how the magnitude of peripheral myopic defocus induced by Ortho-K varies with and without accommodation, and how this compares to single vision spectacles and soft-contact-lenses (SCL).Relative peripheral refraction (RPR) of 18 young adults (spherical equivalent -1.00 D to -4.50 D) was determined along the horizontal meridian (±10°, ±20°, ±25°) during distance (3-metres) and near viewing (0.2-metres), and along vertical meridian (±10°, ±15°) for distance viewing alone. Measurements were obtained in an uncorrected state and with single vision spectacles, soft contact lens and Ortho-K. Changes in RPR and astigmatic components were compared between distance and near viewing with all different modalities.A significant interaction (p = 0.02) between relative peripheral refraction and the target distance (distance and near viewing) was found among different refractive modalities. Single overnight Ortho-K lens wear alone led to relative peripheral myopia for both distance (mean RPR ± SE: -0.92 ± 0.21D and -1.04 ± 0.22D) and near viewing (-0.71 ± 0.17D and -0.76 ± 0.20D). Comparisons of relative peripheral refraction between different corrective modalities at each eccentricity indicated statistical significance of RPR at extreme locations along both temporal and nasal meridian (±20 and ±25°, p 0.05). RPR with soft contact lenses and spectacles were similar for both distance and near viewing (p 0.05).Single overnight Ortho-K lens wear alone shifted the RPR in the myopic direction for both distance and near viewing in comparison with single vision spectacles and soft contact lenses. The Ortho-K lens designs that offer a large amount of mid-peripheral corneal steeping, in-turn leading to high relative peripheral myopia for both distance and near viewing and might offer beneficial effects on myopia control.

We aimed to examine the effectiveness of eye-light therapy in improving the dry eye symptoms.: The retrospective case series where patients who underwent eye-light therapy between March 2019 to May 2020 were analyzed. Twenty patients aged ≥18 years with dry eyes were included. Patients with ocular infections, complications, contact lens users and missing data were excluded. OSDI scores and tear parameters such as noninvasive break up time (NIBUT), lipid layer thickness (LLT), tear meniscus height, meibography of upper and lower lid were evaluated pre and post one month Eye-Light therapy.: Twenty patients with mean±SD age of 43.55±20.53 years and mean spherical equivalent refractive error of 0.69±1.79 diopters were analyzed. OSDI was significantly associated with NBUT (r=-0.50, P = 0.02), lipid layer thickness (r=-0.45, P=0.047) and tear height (r =-0.45, P=0.046). OSDI was positively associated with upper lid meibography (r=0.74, P= Eye-light therapy is effective in reducing dry eye related symptoms with minimal immediate effect on tear film parameters post therapy. Eye-light therapy acts as an adjunct to ameliorate MGD. MGD being a chronic disease requires sustained therapy with environmental changes. Long term evaluation is required to assess the tear film changes and the pattern of efficacy of light therapy.

The aim of this study was to develop an experimental methodology to measure lipid deposition with contact lenses. Contact lenses were incubated in a lipid solution. The amount and types of adsorbed lipids were assessed using mass spectrometry and confocal microscopy. The recovery of lipids from lenses varied with lipid and lens type. Most non-polar and polar lipids were desorbed from lenses during the first 5 min of extraction. Fluorescently labelled phosphatidylcholine bound within the matrix of Senofilcon A lenses but to the surface of Lotrafilcon B lenses, whereas fluorescently labelled cholesteryl ester was found throughout both lenses. The efficacy of extraction of lipids from contact lenses varies for different lipid classes and different lens materials. Differences in the amount and time of lipid desorption probably resulted from the strength of the bond between lipid and lens polymer and the depth of adsorption of lipid in the polymer.

AimsTo examine independent and interactive associations of ophthalmic and systemic conditions with incident dementia.MethodsOur analysis included 12 364 adults aged 55–73 years from the UK Biobank cohort. Participants were assessed between 2006 and 2010 at baseline and were followed up until the early of 2021. Incident dementia was ascertained using hospital inpatient, death records and self-reported data.ResultsOver 1 263 513 person-years of follow-up, 2304 cases of incident dementia were documented. The multivariable-adjusted HRs (95% CI) for dementia associated with age-related macular degeneration (AMD), cataract, diabetes-related eye disease (DRED) and glaucoma at baseline were 1.26 (1.05 to 1.52), 1.11 (1.00 to 1.24), 1.61 (1.30 to 2.00) and (1.07 (0.92 to 1.25), respectively. Diabetes, heart disease, stroke and depression at baseline were all associated with an increased risk of dementia. Of the combination of AMD and a systemic condition, AMD-diabetes was associated with the highest risk for incident dementia (HR (95% CI): 2.73 (1.79 to 4.17)). Individuals with cataract and a systemic condition were 1.19–2.29 times more likely to develop dementia compared with those without cataract and systemic conditions. The corresponding number for DRED and a systemic condition was 1.50–3.24. Diabetes, hypertension, heart disease, depression and stroke newly identified during follow-up mediated the association between cataract and incident dementia as well as the association between DRED and incident dementia.ConclusionsAMD, cataract and DRED but not glaucoma are associated with an increased risk of dementia. Individuals with both ophthalmic and systemic conditions are at higher risk of dementia compared with those with an ophthalmic or systemic condition only.

Background The retinal venous pressure (RVP) is a determining factor for the blood supply of the retina as well as the optic nerve head and until recently has been measured by contact lens dynamometry (CLD). A new method has been developed, potentially offering better acceptance. The applicability and the results of both methods were compared. Methods The type of this study is cross sectional. The subjects were 36 healthy volunteers, age 26 ± 5 years (mean ± s). Tonometry: rebound tonometer (RT) (iCare). The measurements were performed during an increase in airway pressure of 20 mmHg (Valsalva manoeuvre). Principle of RVP measurement: the central retinal vein (CRV) is observed during an increase of intraocular pressure (IOP) and at the start of pulsation, which corresponds with the RVP. Two different instruments for the IOP enhancement where used: contact lens dynamometry and the new instrument, IOPstim. Principle: a deflated balloon of 8 mm diameter—placed on the sclera laterally of the cornea—is filled with air. As soon as a venous pulsation occurs, filling is stopped and the IOP is measured, equalling the RVP. Examination procedure: randomization of the sequence: CLD or IOPstim, IOP, mydriasis, IOP three single measurements (SM) of the IOP with RT or of the pressure increase with CLD at an airway pressure of 20 mmHg, 5 min break, IOP, and three SM using the second method at equal pressure (20 mmHg). Results Spontaneous pulsation of the CRV was present in all 36 subjects. Pressures are given in mmHg. IOP in mydriasis 15.6 ± 3.3 (m ± s). Median RVP (MRVP)) of the three SM: CLD/IOPstim, 37.7 ± 5.2/24.7 ± 4.8 (t test: p t test: p = 0.36). Intraclass correlation coefficient (ICC) of SM: 0.88/0.83. ANOVA in SM: p = 0.48/0.08. MRVP CLD minus MRVP IOPstim: 13.0 ± 5.6. Ratio MRVP CLD/MRVP IOPstim: 1.56 ± 3.1. Cooperation and agreeability were slightly better with the IOPstim. Conclusion This first study with the IOPstim in humans was deliberately performed in healthy volunteers using Valsalva conditions. As demonstrated by ICC and ANOVA, reproducible SM can be obtained by both methods and the range of the SM does not differ greatly. The higher MRVP in CLD could be explained by the different directions of the force vectors.

To explore demographics, disease characteristics, and wear habits in cosmetic contact lens (CL)-related corneal infections in Asia.Prospective multicenter cross-sectional study.Cases of CL-related corneal infection presenting over a 12-month period were prospectively identified from 11 centers in 8 countries in Asia. Case demographics, clinical features, microbiology, and compliance characteristics were compared between wearers using CLs for cosmetic purposes and those using CLs for the correction of refractive errors.Six hundred and ninety-four CL wearers with corneal infection presented: 204 cosmetic CL (29.4%) and 490 (70.6%) refractive CL wearers. Cosmetic CL infections comprised 7%-54% of cases across the region. Compared with noncosmetic CL wearers, cosmetic CLs wearers were significantly more likely to be female (90% vs 59%), young (aged25, 68% vs 44%), and to have a shorter period of wear experience. Lenses worn by cosmetic CL wearers were more likely to be hydrogel materials and manufactured with the pigment located on the back surface of the CL. Presenting disease characteristics and visual outcomes were similar in both groups. Causative organisms were similar between the 2 groups; however, there was a higher rate of Acanthamoeba disease (9%) in cosmetic wearers, compared with refractive wearers (1%; P.005).Cosmetic CL infections represent a significant proportion of CL-related infections in Asia. Cosmetic CL users with corneal infections are generally young, female, and wearing hydrogel CLs. Internet supply, quality control, and regulation of the sale of these products provide significant challenges in managing this population of vulnerable wearers.

Purpose: To determine the prevalence of dry eye disease symptoms and contact lens wear in Mexican high school students. Methods: A cross-sectional association study included a group of high school students who were selected from a random sampling of classrooms. The authors used the Ocular Surface Disease Index (OSDI) questionnaire as a surrogate measure for dry eye disease symptoms, and contact lens wear was also investigated. Results: Seven hundred fifty-nine students with a mean age of 16.12 ± 0.96 years were surveyed and 55.7% of the students were girls (423 of 759). The average OSDI score was 25.11 ± 20.61 points. Girls had higher scores (28.25 ± 21.48 points) than boys (21.14 ± 18.74 points), and the difference was statistically significant ( P < .001). Forty-three students (6.1%) wore contact lenses and had higher OSDI scores (34.26 ± 23.13 and 24.51 ± 20.31 points, respectively) and the difference was also statistically significant ( P = .002). Conclusions: Symptoms of mild and moderate dry eye disease are prevalent in high school students and, as reported in previous studies, girls are more affected than boys. [ J Pediatr Ophthalmol Strabismus . 2021;58(5):287–291.]

Purpose Preservatives are essential for preventing contact lens (CL)-related microbial keratitis (MK). The purpose of this review is to summarize the current knowledge related to the use of common ophthalmic preservatives in CL care products with respect to both safety and efficacy. Methods Manuscripts written in English were obtained by searching PubMed.gov with the term contact lens plus antimicrobial, benzalkonium chloride, biguanide, Aldox, polyquaternium, preservative, thimerosal, EDTA (ethylenediaminetetraacetic acid), chlorhexidine, or blister pack. Results This review found that first-generation preservatives are no longer used in CL multipurpose solutions (MPS) due to their high levels of ocular toxicity. Modern, high-molecular-weight preservatives, including polyquaternium-1 (PQ-1) and biguanides (PHMB), are generally effective against bacteria, minimally effective against fungi, and not effective against Acanthamoeba. PQ-1 and PHMB are likely safe when used with CLs, but they may cause ocular adverse events, with roughly equal risk between the two preservatives. Some CL MPS contain both PQ-1 and PHMB, but no increased risk of adverse events has been reported when combining the two. Hydrogen-peroxide (H2O2) solutions are effective against all common ocular microbes, including Acanthamoeba, and they have been proven safe with proper compliance. Povidone-iodine (P-I) solutions are not currently commercially available in North America, but they have been shown in other countries to be safe and effective. Conclusion Patients should be monitored when using PQ-1 or PHMB-containing solutions since they have been associated with ocular adverse events. If events are detected, patients should be switched to an alternative solution. H2O2 or P-I solutions are preferred for any patient who may expose their CLs to water because they are the only solution categories effective against Acanthamoeba.

This study prepared silicone hydrogel ophthalmic lenses using 2-hydroxyethylmethacrylate (HEMA), synthesized silicone monomer (SID), dimethylarsinic acid (DMA), N-hydroxyethyl acrylamide (HEA), ethylene glycol dimethacrylate (a crosslinking agent, EGDMA), and azobisisobutyronitrile (an initiator, AIBN). Also, Zirconium oxide (ZrO2), antimony tin oxide (ATO) nanoparticles were added to the silicone hydrogel material to analyze the characteristics of the nanoparticles. The mixture was heated at 130 °C for 2 hours to produce the ophthalmic contact lens by cast mould method. As a result, the manufactured silicone hydrogel lens was prepared having high oxygen permeability and tensile strength while satisfying the basic requirements of ophthalmic hydrogel lens materials. Also, the addition of ZrO2 NPs increased tensile strength of the manufactured lens, and ATO NPs were found to improve wettability. Therefore, ZrO2 and ATO nanoparticles can be used effectively as additives for functional ophthalmic silicone hydrogel lenses.

PURPOSE: To compare the clinical and tomographic properties of adult patients with keratoconus treated with accelerated corneal cross-linking (A-CXL) versus accelerated contact lens–assisted corneal cross-linking (A-CACXL). METHODS: Patients who underwent A-CXL and A-CACXL due to progressive keratoconus were enrolled from January 2015 to January 2018 in this retrospective case–control study. The treatment group (minimum corneal thickness of less than 400 µm after epithelium removal; 30 patients, 30 eyes) was treated with A-CACXL; the control group (minimum corneal thickness of 400 µm or greater, 32 patients, 32 eyes) was treated with A-CXL. Assessments occurred before treatment and 12 months postoperatively. Demographic, clinical, and tomographic data were obtained from outpatient clinic reports. RESULTS: Significant improvement in visual acuity was evident at 12-month follow-up for the control group in uncorrected distance visual acuity (0.62 ± 0.42 vs 0.43 ± 0.31 logMAR, P = .01) and the treatment group in corrected distance visual acuity (0.51 ± 0.30 vs 0.40 ± 0.49 logMAR, P = .03). Progression of keratoconus was halted at similar rates for both groups (76.7% treatment, 84.4% control, P = .21). Mean minimum corneal thickness showed minor but significant thinning at the 12-month follow-up visit compared to baseline (control group = 463 ± 31 vs 450 ± 35 µm, P > .01; treatment group = 398 ± 32 vs 388 ± 41 µm, P = .02). CONCLUSIONS: A-CACXL halted keratoconus progression in 76.7% of eyes and achieved regression in 33.3% of eyes, with rates comparable to A-CXL. Visual outcomes improved for both groups, with similar keratometry changes. A-CACXL is an effective and safe option for patients with keratoconus and thin corneas, with results similar to A-CXL treatment in patients with a minimum corneal thickness of 400 µm or greater. [ J Refract Surg . 2021;37(9):623–630.]

The human eye has been considered to be a promising platform for real-time diagnosis of various biomarkers in tears. The smart contact lens (SCL), as a device which directly accesses surface of human eye, is a miniaturized autonomous system integrating all the required functions on the surface of a thin film. This article presents the first implementation of a set of radio including a wake-up receiver required for SCL. The system performs RF transmission upon wake-up call using a single loop antenna. The receiver path has a baseline-tracking offset control loop to successfully detect wakeup signal in the standby state under noisy environment. The operating frequencies for uplink and downlink are 346 and 433 MHz, respectively. A magnetic-coupled wireless charging of an OFF-chip battery is also provided through the same loop antenna. The designed IC is fabricated using 0.18- $\mu \text{m}$ CMOS process, consuming a power of 2.5 nW in wakeup-ready standby state. The IC is also verified with a loop antenna and a thin-film battery integrated on a substrate of SCL.

Introduction To evaluate patient satisfaction with samfilcon A contact lenses (CLs) in intensive digital device users with myopia and to compare patient satisfaction with samfilcon A lenses to prior experience with senofilcon A or lotrafilcon B CLs. Methods This was a comparative, prospective, national study conducted at 14 centers in Turkey. Subjects were adults aged 18 and 45 years with myopia (range −0.25 D to −6.00 D) who spend a minimum of 3 hours viewing digital devices (e.g., computer, smartphone). A subgroup of patients were habitual lens wearers (senofilcon A or lotrafilcon B lens wear for at least 6 months prior to enrollment). The primary assessment was patient satisfaction with samfilcon A lenses (0–100 Likert scale). Secondary assessments included patient satisfaction with samfilcon A lenses compared to patients’ habitual lenses, investigator satisfaction with samfilcon A lenses and investigator-evaluated slit lamp examination findings. Results Samfilcon A lenses were given high overall ratings from both patients and investigators, with a low incidence of ocular symptoms. Overall, patients were highly satisfied with samfilcon A lenses for comfort, vision and overall performance, and stated that they would consider wearing these lenses in the future. Among habitual senofilcon A or lotrafilcon B lens wearers, samfilcon A lenses were rated significantly better than the habitual lenses in regard to comfort, vision and overall performance. Investigator assessments were also highly favorable, both at initial fit and after 4 weeks of follow-up, with no significant findings noted on slit lamp examination. Conclusion Samfilcon A lenses were rated highly by investigators in regard to fit, handling and slit lamp findings, and by novice and habitual lens wearers in regard to comfort, vision and overall performance. These results support the use of samfilcon A lenses among digital device users who seek day-long comfort and good visual acuity. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-021-00389-4.

PURPOSE To report the successful treatment of 3 cases of recalcitrant fungal keratitis (FK) with high-dose oral posaconazole. METHODS This is a series of 3 patients from a single academic center with a culture-positive FK who were treated with oral posaconazole after failing to respond to conventional treatments. RESULTS All 3 patients had a history of contact lens wear. Two of the 3 cases were culture positive for Fusarium and the other for Paecilomyces. The infections of all 3 failed to respond to conventional antifungal therapies including varying combinations of topical, systemic, and intraocular antifungal therapies. All 3 cases rapidly responded to high-dose oral posaconazole ranging from 500 to 600 mg once daily. In 1 case, multiple courses of high-dose therapy were required to treat delayed recurrences of a latent infection. There were no significant adverse effects with the elevated dose, and treatment was administered with the guidance of an infectious disease specialist. CONCLUSIONS In cases of recalcitrant FK failing to respond to conventional therapies, high-dose posaconazole, in the delayed-release tablet formulation, can be an effective treatment option.

Diabetes is a disease condition characterized by a prolonged, high blood glucose level, which may lead to devastating outcomes unless properly managed. Here, we introduce a simple camera-based optical monitoring system (OMS) utilizing the nanoparticle embedded contact lens that produces color changes matching the tear glucose level without any complicated electronic components. Additionally, we propose an image processing algorithm that automatically optimizes the measurement accuracy even in the presence of image blurring, possibly caused by breathing, subtle movements, and eye blinking. As a result, using in vivo mouse models and human tear samples we successfully demonstrated robust correlations across the glucose concentrations measured by three different independent techniques, validating the quantitative efficacy of the proposed OMS. For its methodological simplicity and accessibility, our findings strongly support that the innovation offered by the OMS and processing algorithm would greatly facilitate the glucose monitoring procedure and improve the overall welfare of diabetes patients.