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Background: Epidemiologic data demonstrate a rise in myopia prevalence. Therefore interventions to reduce the risk of myopia and its progression are needed and increasingly often asked for., Methods: Systematic literature search via PubMed in MEDLINE., Results: Myopia progression can be reduced by the following means which are listed according to their efficacy: (1) Atropine eye drops low dosed to avoid clinically relevant side effects, (2) optical means aiming at the correction of peripheral hyperopic defocus, e. g., multifocal contact lenses, and (3) increased daylight exposure., Conclusion: Daylight exposure reduces the risk of incident myopia. Children should be advised to spend sufficient time outdoors, especially before and in primary school. Myopia progression can be effectively attenuated by low-dose topical atropine and multifocal contact lenses.

Jay Mashouf,1 Keith Wan,1 Brad Hall2 1Scripps Optometric Group, San Diego, CA, USA; 2Sengi, Penniac, NB, CanadaCorrespondence: Jay Mashouf, Scripps Optometric Group, 10549 Scripps Poway Pkwy, Ste. G, San Diego, CA, 92131, USA, Tel +1-858-530-2800, Email jaymashouf@gmail.comPurpose: To evaluate the subjective wearing experience of lehfilcon A toric lenses among subjects who were already satisfied with their comfilcon A toric lenses.Methods: This was an open-label, single arm study of currently satisfied comfilcon A soft toric contact lens (Biofinity Toric, CooperVision, Pleasanton, CA) wearers that were refit with lehfilcon A soft toric lenses (Total30® for Astigmatism; Alcon Vision LLC, Fort Worth, TX). Subjects were administered a questionnaire about satisfaction with comfort, visual performance, end of day comfort, and ease of handling with lehfilcon A toric lenses.Results: A total of 40 subjects completed the study. After one month of wear the median and interquartile range (IQR) was 8 (2) for overall satisfaction with lehfilcon A comfort, 8 (1.25) for visual performance, 7 (3.25) for end of day comfort, 9 (2) for ease of handling, and finally 8 (2) for overall satisfaction.Conclusion: A high proportion of subjects were satisfied with the subjective wearing experience with lehfilcon A toric lenses, including satisfaction with comfort, visual performance, end of day comfort, and ease of handling.Plain Language Summary: There are many different types of contact lens materials and replacement schedules for patients to suit individual needs. Despite the diversity of options, contact lens dropout continues to be high, likely influenced by discomfort and poor vision. A new frequent replacement toric contact lens is available that may offer good subjective comfort for patients. However, there is minimal data on the performance of this lens. The purpose of this study was to evaluate the subjective wearing experience with the new contact lens among patients who were already satisfied with their current toric contact lenses. The results of this study suggest that a high proportion of patients were satisfied with the subjective wearing experience with the new toric contact lens, including satisfaction with comfort, visual performance, end of day comfort, and ease of handling.Keywords: comfort, toric, contact lens, lehfilcon A, Total30 for Astigmatism

Congenital cataract is among the main causes of treatable vision loss in childhood. The first weeks and months of life are a critical time for the development of vision. Therefore, early cataract surgery and effective multifaceted treatment of the resulting aphakia in the early stages of life are of great value for the management of vision development. Among the treatment models, contact lenses (CL) have an important place in infancy and early childhood up to the age of 2 years. Although good visual gains were not considered very likely, especially in unilateral aphakia, important steps have been taken in the treatment of pediatric aphakia thanks to the surgical techniques developed over time and the increasing experience with optical correction systems, especially CLs. This review examines current developments in the types of CL used in pediatric aphakia, their application features, comparison with other optical systems, the features of amblyopia treatment in the presence of CL, and the results obtained with family compliance to CL wear and occlusion therapy in the light of existing studies.

Purpose: To investigate and compare the anatomic and functional outcomes of chandelier-assisted scleral buckling (CASB) surgery using contact versus non-contact lens-based wide-angle viewing systems (WAVSs) in rhegmatogenous retinal detachment (RRD) patients. Methods: This was a retrospective, multicenter study evaluating the anatomic (reattachment rate) and visual acuity (VA) outcomes at 6 months post-CASB for primary RRD. Results: Forty-seven RRD patients underwent CASB with a non-contact WAVS (Group C1) and 90 with a contact lens WAVS (Group C2). Preoperative parameters including myopia, macula-off RRD, posterior vitreous detachment, number of retinal breaks, and retinal dialysis as the etiology of RRD did not differ significantly between the two groups. The outcomes of retinal attachment (85.11% of C1 patients and 76.67% of C2 patients, P = 0.34) and final visual outcome (VA ≥6/12: C1 = 61.7%; C2 = 46.67%, P = 0.13) were also comparable. Furthermore, no significant difference in postoperative complications such as cataracts, glaucoma, infection, buckle exposure, and buckle failure was observed. Finally, both groups were comparable in terms of re-detachment rates (10.64% in C1 and 23.33% in C2, P = 0.11). Conclusion: The two WAVS approaches used in CASB surgery have comparable surgical and functional outcomes and postoperative complications. The operating surgeon can freely choose between these viewing platforms during the contemporary scleral bucking (SB) surgery without impacting the outcome.

Karl R VanDerMeid, Mirzi Grace Byrnes, Kimberly Millard, Catherine A Scheuer, Nitasha R Phatak, William Reindel Vision Care, Bausch & Lomb Incorporated, Rochester, NY, USACorrespondence: Nitasha R Phatak, Vision Care, Bausch & Lomb Incorporated, Rochester, NY, USA, Tel +1 585-413-6397, Email nitasha.phatak@bausch.comPurpose: Contact lens (CL) wear challenges the balance of the ocular surface environment by increasing water evaporation and tear osmolarity. Maintaining ocular surface homeostasis during CL wear remains a goal of lens manufacturers and an important consideration for eye care professionals. The purpose of this study was to measure the metabolic activity and inflammatory responses of a transformed human corneal epithelial cell (THCEpiC) line under hyperosmotic conditions in the presence of CL packaging solutions.Methods: CL packaging solutions sampled from seven daily disposable silicone hydrogel CL blister packages were prepared at 25% and made hyperosmolar (400 mOsm/kg) with NaCl. THCEpiCs were incubated with each solution for 24 hr, after which cell culture supernatants were collected. THCEpiC metabolic activity was determined by an alamarBlue assay. Concentrations in cell culture supernatants of inflammatory cytokine (interleukin [IL]-6) and chemokine (IL-8), as well as monocyte chemoattractant protein-1 (MCP-1), were quantitated by specific enzyme-linked immunosorbent assays.Results: THCEpiC metabolic activity under hyperosmolar conditions decreased in the presence of somofilcon A and senofilcon A solutions (p=0.04 and 0.004, respectively), but no other solution (all p≥ 0.09). Concentrations of IL-6 increased in the presence of delefilcon A, somofilcon A, narafilcon A, and senofilcon A solutions (all p≤ 0.001), but no other solution (all p≥ 0.08), while those of IL-8 increased in the presence of all solutions (all p≤ 0.03) but kalifilcon A (p> 0.99), and those of MCP-1 increased in the presence of delefilcon A, verofilcon A, somofilcon A, and stenfilcon A solutions (all p< 0.0001), but no other solution (all p> 0.99).Conclusion: CL packaging solutions differ in their capacity to inhibit epithelial inflammation. THCEpiC inflammatory response was less in the presence of a CL packaging solution containing osmoprotectants than in solutions lacking osmoprotectants under moderately hyperosmolar conditions in vitro. Clinical studies are warranted to further substantiate the benefit of osmoprotectants.Keywords: contact lens, cornea, TFOS, hyperosmolarity, osmoprotection, homeostasis

Keith Wan,1 Jay Mashouf,1 Brad Hall2 1Scripps Optometric Group, San Diego, CA, USA; 2Sengi, Penniac, NB, CanadaCorrespondence: Keith Wan, Scripps Optometric Group, 10549 Scripps Poway Pkwy Ste, San Diego, CA, 92131, USA, Tel +1 858-530-2800, Email keithmwan@gmail.comPurpose: To subjectively evaluate comfort with a daily disposable (delefilcon A for astigmatism) contact lens compared to other common weekly/monthly soft toric contact lenses in symptomatic wearers.Methods: This open-label, single arm study enrolled current reusable soft toric lens wearers with minimum score of 12 on the contact lens dry eye (CLDEQ-8) questionnaire. Subjects were also administered the CLDEQ-8 after 1 replacement schedule of their optimized habitual toric lenses (2 to 4 weeks), and after 2 weeks of wear with delefilcon A toric daily disposable lenses (Dailies Total1 for Astigmatism; Alcon Vision LLC, Fort Worth, Texas).Results: A total of 85 subjects completed the study. Mean total CLDEQ-8 score was 16.8 ± 8.1 for subjects refit with their optimized habitual toric lenses and 12.4 ± 7.5 for subjects refit with delefilcon A toric lenses, a difference of 4.3 ± 10.4 (p < 0.001). With delefilcon A toric lenses, 78.9% of subjects reported little to no intensity of eye discomfort, compared to 51.7% for the habitual toric lenses (p = 0.005). In addition, 77.7% of subjects reported little to no intensity of dryness for delefilcon A toric lenses, compared to 50.6% for the habitual toric lenses (p = 0.001).Conclusion: The subjective comfort in symptomatic habitual reusable toric contact lens wearers was improved by refitting with delefilcon A toric lenses.Plain Language Summary: Discomfort while wearing contact lenses is often a reason why patients decide to stop wearing their lenses. There are many different contact lens materials to choose from, and each may affect discomfort differently. The replacement schedule of a contact lens may also be a factor for discomfort, with lenses replaced daily (daily disposables) offering advantages over those replaced weekly or monthly (frequent replacement). The purpose of this study was to subjectively evaluate comfort with a new daily disposable toric contact lens. The results of this study suggest that subjective comfort in symptomatic habitual reusable toric contact lens wearers was improved by refitting with a new daily disposable toric lens.Keywords: comfort, toric, contact lens, delefilcon A, Dailies Total1 for Astigmatism

Contact lens(CL)is currently one of the most common methods of vision correction, with more than 140 million users worldwide and the demand is rising yearly as constantly development of materials and features. Wearing CL can lead to a variety of complications such as dry eye, corneal abrasions, giant papillary conjunctivitis, and infectious keratitis is one of the most severe complications. According to research, bacteria account for 80%～95% of the pathogens that cause CL-associated infective keratitis, it may have been related to the bacterial composition, virulence mechanism, biofilm formation and the combined effect of the lens itself and the process of use, which is prone to introducing pathogens, reducing antimicrobial capacity of the cornea and tears and causing ocular surface hypoxia and ocular surface inflammation. Overnight and prolonged lens wear, irregular lens purchase, use and care procedures can also be risk factors for bacterial infections. This article reviews the studies on the pathogenesis, risk factors, diagnosis, treatment and prevention of CL-related bacterial keratitis.

Abstract Introduction Keratoconus has a significant impact on patients’ quality of life (QoL), from diagnosis to the advanced stages of the disease. The aim of this research was to identify domains of QoL affected by this disease and its treatment. Methods Phone interviews were conducted using a semi-structured interview guide, with patients with keratoconus stratified according to their current treatment. A board of keratoconus experts helped identify the guide’s main themes. Results Thirty-five patients (rigid contact lenses, n = 9; cross-linking, n = 9; corneal ring implants, n = 8; and corneal transplantation, n = 9) were interviewed by qualitative researchers. Phone interviews revealed several QoL domains affected by the disease and its treatments: “psychological”, “social life”, “professional life”, “financial costs” and “student life”. All domains were impacted, independently of the treatment history. Few differences were found between treatment regimens and keratoconus stages. Qualitative analysis enabled the development of a conceptual framework based on Wilson and Cleary’s model for patient outcomes common to all patients. This conceptual model describes the relationship between patients’ characteristics, their symptoms, their environment, their functional visual impairment and the impact on their QoL. Conclusions These qualitative findings supported the generation of a questionnaire to evaluate the impact of keratoconus and its treatment on patients’ QoL. Cognitive debriefings confirmed its content validity. The questionnaire is applicable for all stages of keratoconus and treatments and may help tracking change over time in regular clinical settings. Psychometric validation is yet to be performed before its use in research and clinical practices.

Abstract Objective To evaluate the epidemiologic profile of microbial keratitis in Alexandria- Egypt, with special emphasis on risk factors, visual outcome and microbiological results. Methods This retrospective study reviewed files of patients treated for microbial keratitis during a period of 5 years at Alexandria Ophthalmology Hospital Cornea Clinic, Alexandria- Egypt, between February 2017 and June 2022. The patients were evaluated for the risk factors e.g., trauma, eyelid disorders, co-morbidities, and contact lens use. They were also evaluated for their clinical picture, the identified microorganisms, visual outcomes, and complications. Non-microbial keratitis and incomplete files were excluded from the study. Results A total of 284 patients were diagnosed as microbial keratitis in our study. Viral keratitis was the most common cause of microbial keratitis (n = 118 (41.55%)), followed by bacterial keratitis (n = 77 (27.11%)), mixed keratitis (n = 51 (17.96%)), acanthamoeba keratitis (n = 22 (7.75%)) and the least cause was fungal keratitis (n = 16 (5.63%)). Trauma was the most common risk factor for microbial keratitis (29.2%). Fungal keratitis had a statistically significant association with trauma (p

Abstract Background To investigate ocular biological characteristics for myopic children with axial length (AL) reduction during orthokeratology (Ortho-K) treatment and provide clinical clues for better myopia control effects. Methods Changes in ocular parameters and treatment zone (TZ) in 75 subjects who completed one-year Ortho-K treatment were retrospectively reviewed. The subjects were divided into two groups according to one-year AL change: the AL reduction group (n = 37) and the AL elongation group (n = 38). Univariate and multivariate regression analyses were performed to determine the association between TZ, ocular parameters, and AL change. Results There was no significant difference in baseline between the two groups (all P > 0.05). After one year of Ortho-K treatment, compared with those in the AL elongation group, children in the AL reduction group had a decreased anterior chamber depth (ACD) (P

AIM: To determine the amount of ultraviolet (UV) light irradiance that various layers of the eye receive as sunlight passes through the eye, and to investigate the protective benefits of UV light-blocking contact lenses. METHODS: Twenty-four porcine eyes were prepared in one of three ways: isolated cornea, cornea and lens together, or whole eye preparation. UV light irradiance was measured with a UV-A/B light meter before and after the eye preparations were placed over the meter to measure UV light penetration in each eye structure. In the whole eye preparation, a hole was placed in the fovea to measure light as it passed through the vitreous. Subsequently, UV-protective contact lenses were placed over the structures, and UV light penetrance was measured. Measurements of UV light exposure were taken outdoors at various locations and times. RESULTS: Cornea absorbed 63.56% of UV light that reached the eye. Cornea and lens absorbed 99.34% of UV light. Whole eye absorbed 99.77% of UV light. When UV-protective contact lenses were placed, absorption was 98.90%, 99.55%, and 99.87%, respectively. UV light exposure was dependent on directionality and time of day, and was greatest in areas of high albedo that reflect significant amounts of light, such as a beach. CONCLUSION: Cornea absorbs the majority of UV light that reaches the eye in this model. UV-protective contact lenses reduce UV exposure to the eye. Locations with high albedo expose the eye to higher levels of UV light.

Definitive treatment of dry eye disease (DED), one of the commonest ocular surface disorders, has remained elusive despite several recent advances in better diagnostics and the introduction of newer therapeutic molecules. The current treatment paradigms rely heavily on lubricating eye drops and anti-inflammatory agents that may need to be used long-term and are mainly palliative. Research is ongoing not only for a curative treatment option but also to improve the potency and efficacy of existing drug molecules through better formulations and delivery platforms. In the past two decades, significant advancement has been made in terms of preservative-free formulations, biomaterials such as nanosystems and hydrogels, stem cell therapy, and creation of a bioengineered lacrimal gland. This review comprehensively summarizes the newer approaches to DED treatment, which are biomaterials such as nanosystems, hydrogels, and contact lenses for drug delivery, cell and tissue-based regenerative therapy for damaged lacrimal gland and ocular surface, and tissue engineering for developing artificial lacrimal gland. Also, their potential efficacies in animal models or in vitro studies and possible limitations are discussed. The ongoing research looks promising and needs to be supported with clinical efficacy and safety studies for human use.

Dry eye disease (DED) is prevalent in all age groups and is known to cause chronic ocular discomfort and pain, and greatly affects the quality of life. Patients with ocular surface disease (OSD) may also have reduced tear secretion due to lacrimal gland damage, thus leading to aqueous deficient DED. Even with conventional management modalities such as lubricating eyedrops, topical corticosteroids, autologous serum eyedrops, or punctal plugs, many patients continue to suffer from debilitating symptoms. Contact lenses are increasingly being used in OSD providing surface hydration, protection from environmental insults, mechanical damage from abnormal lids, and as a modality for constant drug delivery to the ocular surface. This review describes the role of soft lenses and rigid gas-permeable scleral lenses in the management of DED associated with OSD. The efficacy of contact lenses, lens selection, and optimal lens fit are reviewed for specific indications.

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). Stripmeniscometry 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.

Conventional eye treatment formulation such as eye drops has shortcomings including low drug utilization and poor patient compliance. The contact lens(CL), well-known as visual correction lens, is considered to be a more promising ophthalmic drug delivery vehicle owing to its good biocompatibility, long-term wearing comfort, prolonged drug residence time and improved bioavailability. In order to improve the drug loading efficiency and prolong the release time, researchers have developed a variety of strategies to modify traditional CL, including the introduction of vitamin E molecular barrier, application of molecular imprinting technology of CL, increasing interactions between the drug and polymer matrix by introducing special genes, and incorporation of nanocarriers or drug-loaded polymer films. In this paper, the preparation methods and pros and cons of drug-loaded CL are reviewed. At last, the existing problems and future developments of CL as ophthalmic drug delivery carrier are briefly discussed.

Gina Wesley,1 Brad Giedd,2 Bradley Hines,3 Katherine Bickle,4 Christopher Pearson,5 Holly Lorentz6 1Complete Eye Care of Medina, Hamel, MN, USA; 2Kindred Optics at Maitland Vision, Maitland, FL, USA; 3Optometry Group, Memphis, TN, USA; 4ProCare Vision Center, Granville, OH, USA; 5OMEGA Vision Center PA, Longwood, FL, USA; 6Alcon Research, LLC, Johns Creek, GA, USACorrespondence: Holly Lorentz, Alcon Research, LLC, 11460 Johns Creek Pkwy, Johns Creek, GA, 30097, USA, Tel +1 678 415 5272, Email holly.lorentz@alcon.comPurpose: The objective of this study was to evaluate the safety and performance of the investigational lens, lehfilcon A, when worn in a daily wear modality and replaced monthly as compared to the commercially available comfilcon A contact lens.Methods: This was a multicenter, prospective, controlled, double-masked, randomized, parallel-group clinical study with bilateral lens wear for 3 months. In all, 115 subjects completed the study (77 with test lehfilcon A and 38 with control comfilcon A contact lenses). Distance visual acuity (VA) was assessed using Snellen VA. Lens performance was assessed by examining lens fit/movement, centration, front surface wettability and front/back surface deposits using slit-lamp biomicroscopy.Results: At the 3-month follow-up visit, all eyes had a distance VA of 20/20 or better. Further, lens fit/movement was assessed as optimal in 92.9% of the eyes with lehfilcon A and 89.2% with comfilcon A. There were no ratings of unacceptably tight or loose fits for either contact lens material. Lens centration was assessed as optimal in 98.7% of eyes with lehfilcon A and 94.6% with comfilcon A. For front and back surface deposits, both materials showed minimal lens surface deposits. Front surface wettability was assessed as grade 0 or 1 for most of the study lenses in both lens groups across all attended study visits. There were no ocular adverse events related to the study lenses.Conclusion: Overall, lehfilcon A showed excellent VA, optimal lens fitting characteristics, a clean surface, high wettability, and low risk for adverse events after 3 months of lens wear.Keywords: biomimetic, comfilcon A, lehfilcon A, visual acuity, water gradient, contact lens

Nada N Alwohaibi,1 Malak Bamashmoos,2 Abdulaziz Al Somali3 1Ophthalmology Department, King Fahad Hospital of the University, Khobar, Eastern Province, Kingdom of Saudi Arabia; 2Ophthalmology, Dhahran Eye Specialist Hospital, Dammam, Saudi Arabia; 3Department of Ophthalmology, College of Medicine, King Faisal University, Al Ahsa, Saudi ArabiaCorrespondence: Nada N Alwohaibi, Tel +00966563229600, Email Alwohaibinada@gmail.comPurpose: To describe the predisposing factors, causative organisms, treatment modalities, and visual outcomes of childhood non-viral microbial keratitis in our region.Patients and Methods: All cases with the clinical or microbiological diagnosis of non-viral microbial keratitis in patients ≤ 18 years presenting to Dhahran Eye specialist Hospital, a tertiary eye care hospital in Dhahran, Eastern Province, Saudi Arabia, between 2010 and 2020 were included. A retrospective chart review was conducted. Demographic data, predisposing factors, clinical characteristics, isolated microorganisms, and visual outcomes were recorded.Results: Fifty-nine patients were included in this study, of which three cases were bilateral. The mean age was 9.3 ± 6.3 years (range: 14 days - 18 years). Predisposing factors were identified in 89.8% (n=53) of cases. Contact lens wear was the leading cause 35.6% (n=21), followed by trauma 27.1% (n=16), ocular diseases 11.9% (n=7), systemic diseases 10.2% (n=6), and ocular surgery 5.1% (n=3). Out of all cases, 66.1% (n=39) have undergone corneal scraping, out of which 43.6% (n=17) showed positive growth. Gram-negative organisms accounted for 47.1% (n=8) isolates of all culture-positive cases. Pseudomonas aeruginosa was the most common pure isolate, which accounted for 41.2% (n=7) of culture-positive cases, followed by Staphylococcus aureus 11.8% (n=2). The most common complication was corneal scar in 71.2% (n=42). Nineteen (32.2%) patients had poor outcome. Seven patients (11.9%) required further intervention, these included penetrating keratoplasty (n=1), deep lamellar keratoplasty (n=3), Photorefractive keratectomy (n=2), and Phototherapeutic keratectomy (n=1).Conclusion: Childhood non-viral microbial keratitis is uncommon; however, it carries significant risks. Most cases were associated with preventable risk factors, with contact lens wear being the leading cause. Early detection and management are mandatory to reduce the risk of vision-threatening complications. The difficulty in assessment should not jeopardize proper evaluation and management of suspected cases.Keywords: bacterial, keratitis, pediatric, contact lens, trauma

Chris W Lievens,1,2 Elyse Rayborn1 1Southern College of Optometry, Memphis, TN, USA; 2Anglia Ruskin University, Cambridge, UKCorrespondence: Chris W Lievens, Southern College of Optometry, 1245 Madison Ave, Memphis, TN, 38104, USA, Tel +1 901 722 3330, Fax +1 901 722 3280, Email clievens@sco.eduIntroduction: Tribology is known as the science of friction, lubrication and the determination of what occurs when two surfaces slide against one another. The required partners in this science are a minimum of two surfaces and relative motion. Tribology could be a key factor in dissecting the issues that surround and confound dry eye in patients as well as contact lens discomfort and intolerance. Specifically, it is this issue that is a potential causative underlying factor that could lead to conditions like lid wiper epitheliopathy (LWE).Methods: Peer-reviewed literature was reviewed as It pertains to ocular tribology and the application to the ocular anatomy. A PubMed review was performed using the keywords: tribology, friction, lid wiper epitheliopathy, contact lens, and dry eye. All manuscripts were reviewed for mentions of tribology and friction. The exact same process was performed with The Association for Research in Vision and Ophthalmology (ARVO) abstracts.Results: In relation to the ocular surface, tribology describes the mechanical interactions between the upper and lower lid wipers and the globe. The Stribeck curve can be applied, as the sliding partners are separated by a complex, lubricating tear film. The surface brush anatomy at the eye to eyelid juncture reduces friction and alters the Stribeck curve in favor of the hydrodynamic regime, allowing for high velocity movement with minimal wear. Changes to the tear film or the introduction of a contact lens can displace the Stribeck curve, increase friction, and induce wear thus leading to patient symptomology.Conclusion: Further studies may provide new insight into contact lens discomfort and ocular surface disease, including LWE; however, adaptation of tribology work performed in vitro to in vivo patient care is challenging.Keywords: tribology, friction, lid wiper epitheliopathy, contact lens, dry eye

Myopia is a common ocular disorder. In recent years, the incidence of myopia presents an increasing trend year by year. Patients with high myopia are at an increased risk for severe visual impairment. The economic and societal impacts of complication associated with myopia are enormous. Therefore, it is essential and imminent for implementing effective myopia control strategies. The results of the current study suggest that uncontrolled axial elongation produced by periphral hyperopic defocus could be one of the possible mechanisms for myopia development, multiple strategies especially optical defocus technology based on this are increasingly becoming part of the mainstream clinical practice in myopia management. This article reviews the principle of optical defocus on myopia control, experimental research on defocus myopia animals, and the latest clinical applications of different optical defocus technologies on myopia control, summarizes the clinical research results of myopia control using progressive addition spectacle lenses, peripheral defocus spectacle lenses, defocus incorporated multiple segments spectacle lenses, orthokeratology contact lenses and multifocal soft contact lenses. It is proposed to provide a new option for the treatment plan to delay the progression of myopia.

Objectives:To evaluate and compare the risk factors, presenting features, and outcomes of patients with culture-positive and culturenegative 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 culturepositive MK patients and 13.3% (n=23) among culture-negative MK patients, respectively (p

Ana Marta,1,2 João Heitor Marques,1 Daniel Almeida,1 Diana José,1 Irene Barbosa1,2 1Department of Ophthalmology, Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal; 2Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto, PortugalCorrespondence: Ana MartaDepartment of Ophthalmology, Centro Hospitalar e Universitário do Porto, Largo do Prof. Abel Salazar, Porto, 4099-001, PortugalEmail analuisamarta2@gmail.comPurpose: To analyze the visual performance in contact lens wearers with keratoconus.Methods: A retrospective study including contact lens (CL) wearers was performed. The current best-corrected visual acuity with contact lens (BCVA-CL) and with spectacles (BCVA-S) correction, contrast sensitivity (CS) (by Metrovision-MonPack3®), analysis of light scattering in the retina and vision break-up time (HD Analyzer®), and corneal tomography (Oculus Pentacam® HR) were evaluated.Results: This study included 96 eyes of 59 patients with Keratoconus. Rigid gas permeable contact lenses (RGPCL), hybrid contact lenses (HCL), and silicone hydrogel/hydrogel contact lenses (HGCL) were fitted in 67, 17, and 12 eyes, respectively. Dynamic objective scatter index (OSI) (p = 0.024), minimum OSI (p = 0.037) and maximum OSI (p = 0.040) were significantly better with RGPCL and worse with HGCL. Mean CS in photopic conditions was significantly worse with HGCL and better with HCL (p = 0.006), without differences in mesopic conditions (p = 0.121). RGPCL wearers showed a higher mean K (p = 0.020), and a lower corneal thickness at the thinnest point (p=0.011).Conclusion: Visual quality varied significantly with different types of CL. Although RGPCL was fitted in patients with worse Pentacam tomographic parameters, RGPCL was associated with a better dynamic visual quality.Keywords: keratoconus, contact lens, visual performance, optical quality

Abstract Purpose: To assess contrast sensitivity in clear and colored soft contact lenses under different lighting conditions. Methods: This study was performed on 34 medical students. Visual acuity was measured using a tumbling E chart at a distance of 6 m, and contrast sensitivity was determined by Pelli Robson chart at a distance of 1 m. These tests were repeated in mesopic (3 lux) and glare (2000 lux) conditions. Then, a clear contact lens was applied to one eye and a colored contact lens was applied to the other. After 2 hr, visual acuity and contrast sensitivity were measured for each individual. The results were compared with and without contact lenses under normal, mesopic, and glare conditions. Results: The mean refractive error was 0.44 ± 0.20 diopters. Repeated measures ANOVA showed a decline in contrast sensitivity with colored and clear contact lenses as compared to no-lens condition (P < 0.001). Additionally, lighting conditions had a significant impact on contrast sensitivity (P < 0.001); contrast sensitivity was lower in mesopic and glare conditions than under normal lighting condition. Conclusion: In addition to the drop in contrast sensitivity under unusual lighting conditions (e.g., glare and mesopic), wearing soft contact lenses can further reduce contrast sensitivity in different lighting conditions. Therefore, people who wear contact lenses should be aware of this reduction in visual performance in conditions like driving at night or in the fog.

This literature review describes the effect that orthokeratology lenses render on various eye’s structures. The use of these lenses, in addition to the expected changes can cause undesirable effects. The positive aspects include stopping or slowing the myopia’s progression, as well as a temporary improvement of uncorrected visual acuity by changing the shape of the anterior surface of the cornea. Undesirable moments are a change in the homeostasis of the tear film, epitheliopathy, the lens binding, in addition, there is the appearance of an iron arch, an increase in the visibility of fibrillary lines, a transient change in the biomechanical properties of the cornea. On the positive side, these changes do not affect visual function and eye health; moreover, they are reversible. At the same time, the terms of recovery of various structures of the eye can differ from several weeks to several months, depending on the duration of treatment and the target refraction. Thus, the use of orthokeratology lenses is a safe and effective method for correcting and “controlling” myopia.

Purpose: Presenting a simple technique using an inversely implanted contact lens to create a temporary diaphragm to assist DMEK surgery in aphakic, partially aniridic and vitrectomized eyes. Observations: The postoperative course was without pressure abnormalities and the anterior chamber remained deep. The cornea completely cleared within 3 weeks and remained clear after removal of the contact lens showing a corneal thickness of 544 μm and an intact endothelial cell pattern on endothelial cell microscopy after 3 months. Conclusion and Importance: The inversely implanted contact lens provides an easily accessible temporary diaphragm, making DMEK surgery a safer procedure even in complex eyes without an adequate posterior barrier.

AIM:To investigate the application of multi-mode teaching steered by “HOPE” in the clinical teaching of contact lens.METHODS: Prospective study. Two classes(totally 80 students)of 2018 grade major in optometry, Nanjing Medical University, were randomly selected as experimental group(40 students, 18 males, 22 females)using multi-mode teaching(including problem-based learning, case-based learning and flipped classroom),and control group(40 students, 19 males, 21 females)using traditional teaching mode. At the end of the course, the teaching effects were evaluated by usual performance, network examination, theory test, operation test and questionnaire.RESULTS: The assessment result at ordinary times: the points of experiment group(16.46±2.19)points was higher than the control group(13.81±2.95)points(t=6.36, P

Post-surgical or traumatic corectopia is among the rare causes of monocular diplopia. A 26-years-old student presented to the Institute with a complaint of monocular double vision in the left eye. He had a penetrating ocular injury in the left eye and subsequently, undergone for multiple ocular surgeries. Following the final intraocular lens implantation, he experienced a monocular double vision in his left eye. Upon contact lens clinic presentation, visual acuities were 20/20 in the right and 20/320 in the left eye (improved to 20/25 with pinhole). Slit-lamp examination on the left eye revealed scarring in the superior nasal quadrant of the cornea, irregular mid-dilated pupil with exposed aphakic and pseudophakic portions. A range of different optical management options were implemented to eliminate monocular diplopia and to correct refractive error. Finally, a combination of prosthetic soft contact lens and spectacle correction was able to remove diplopia and provide binocular single vision.

Bariah Mohd-Ali, NorAisyah Azmi Optometry and Vision Science Program and Research Centre for Community Health, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, MalaysiaCorrespondence: Bariah Mohd-AliOptometry and Vision Science Program and Research Centre for Community Health, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 50300, MalaysiaTel +60392897602Email bariah@ukm.edu.myPurpose: To investigate the wearing pattern and awareness about contact lens care among secondary school students in Kuala Lumpur.Patients and Methods: This is a cross-sectional study using self-administered validated questionnaires. A total of 2500 questionnaires were distributed to secondary school students (aged 13 to 18 years) from 5 selected schools in Kuala Lumpur. Descriptive statistics were used to analyze the results.Results: A total of 987 completed questionnaires were returned and analyzed. The response rate was 39.5%. Mean age of respondents was 15.5± 2.5 years with 54.6% females. Around 9.9% of the respondents were contact lens wearers with female majority (78.6%) and the main reasons for wearing contact lenses were cosmesis (42.8%) and comfort (32.7%). Majority (92.2%) were soft contact lens wearers and daily wear (monthly disposable) is the preferred modality. Nevertheless, 42.4% purchased their lenses from unlicensed vendors and 18.4% rinsed their lenses using tap water. Regarding contact lens care, more than 50% of the respondents were not aware about the correct way of handling contact lenses.Conclusion: Soft contact lens wear is popular among the secondary school students in Kuala Lumpur but the level of practice and knowledge about CL care are unsatisfactory. Thus, health communication strategies and aggressive public ocular health education that can influence behavior changes in teenagers are needed to overcome these issues.Keywords: teenagers, contact lens, public health

The purpose of this case report is to demonstrate the efficacy of an asymmetric peripheral design scleral contact lens in a case of highly irregular corneal-scleral pattern due to trauma. A 63-year-old patient was involved in a jeep accident which caused a partial-thickness penetrating injury to the peripheral cornea of his left eye. The subsequent corneal irregularity extended beyond the limbus into the sclera which made it difficult to stabilize a contact lens. A quadrant specific peripheral curve (quadrant asymmetric periphery) scleral contact lens successfully resulted in improved comfort and visual acuity. This is the first known published case to use this lens design to correct a post-trauma irregular cornea-scleral relationship. Quadrant asymmetric periphery scleral contact lenses can be effective in cases of severe irregular corneal-scleral patterns.

Abstract Symptoms of dryness discomfort in soft contact lens wearers frequently lead to discontinuation from wear. The negative influence of pre-fitting tear dysfunctions appears likely to be exacerbated by the challenges to tear homeostasis caused by contact lenses. The corneal mechanisms for symptoms in contact lens wearers are different to those for dry eye disease because the cornea is insulated by the lens from ambient conditions as well as from lid wiper friction during blinking. Symptoms of dryness discomfort might be the consequence of increased lid wiper friction during blinking when the lens front surface becomes soiled and dry and exhibits very rapid tear break up. It is possible that some cases of contact lens intolerance and discontinuation could be a function of lid wiper neuropathy. In relation to the possibility of corneal neuropathy, a stagnant post-lens tear pool with the possibility of increased concentrations of metabolic by-products, cellular debris, and bacterial exotoxins, might have the potential to disturb the corneal epithelial and sub-basal nerves. Contributions by contact lens-induced inflammation to any neuropathic changes may partly depend on the degree to which inflammatory mediators are concentrated in a stagnant post-lens tear pool. It does not appear to be known if corneal neuropathic changes could develop under these conditions. The chances of neuropathic involvement may be greater if discomfort develops after a significant period of successful wear and there is a history of comorbid pain conditions. Esthesiometry and in vivo confocal microscopy in discontinued contact lens wearers may support a diagnosis of contact lens-related corneal neuralgia.

Miriam Heynen,1 Alan Ng,1 Elizabeth Martell,1 Lakshman N Subbaraman,1 Lyndon Jones1,2 1Centre for Ocular Research and Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada; 2Centre for Eye and Vision Research (CEVR), Hong Kong Science Park, Hong KongCorrespondence: Miriam HeynenCentre for Ocular Research and Education (CORE), School of Optometry and Vision Science, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, CanadaTel +1 519 888 4567Fax +1 519 888 4303Email heynen@uwaterloo.caPurpose: The amount of protein deposition on soft contact lenses and to what extent the proteins are denatured may have an impact on comfortable wearing times of contact lenses. The purpose of this study was to evaluate the effects of two lens care systems on total protein and the quantity and activity of lysozyme deposited on worn senofilcon A, silicone hydrogel contact lenses.Participants and Methods: Thirty symptomatic soft contact lens wearers were enrolled into a 4-week prospective, randomized, bilateral eye, daily-wear, crossover, double-masked study. Participants were fitted with biweekly senofilcon A lenses and were assigned either a polyquaternium-1 and myristamidopropyl dimethylamine-containing system (OPTI-FREE RepleniSH) or a peroxide-based system (CLEAR CARE). After each wear period, proteins were extracted from the lenses and analyzed for total protein, total lysozyme quantity and activity.Results: The use of either the peroxide-based system or the polyquaternium-1 and myristamidopropyl dimethylamine-containing system resulted in no difference (P> 0.05) to the amount of total protein deposited on the lenses (6.7 ± 2.8 micrograms/lens versus 7.3 ± 2.8 micrograms/lens, respectively) or to the amount of denatured lysozyme deposits (0.8 ± 0.7 versus 0.9 ± 0.7 micrograms/lens), respectively. The total amount of lysozyme deposited on the lenses was significantly lower when using the peroxide-based system (1.3 ± 0.9 micrograms/lens) compared to the polyquaternium-1 and myristamidopropyl dimethylamine-containing system (1.7 ± 1.0 micrograms/lens) (P=0.02).Conclusion: The inactivation of lysozyme deposited on senofilcon A lenses when disinfected with the peroxide-based or the polyquaternium-1 and myristamidopropyl dimethylamine-containing systems were neither statistically nor clinically significant and the overall amounts of denatured lysozyme recovered from the lenses were low (< 1 microgram/lens).Keywords: contact lens, contact lens care system, lysozyme, protein activity, silicone hydrogel

Chantaka Supiyaphun,1 Passara Jongkhajornpong2 1Department of Ophthalmology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand; 2Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Passara JongkhajornpongDepartment of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Thanon Rama VI, Thung Phaya Thai, Ratchathewi, Bangkok, 10400 Tel +662 2012729Email passaraj@yahoo.comPurpose: Little is known about contact lens (CL) use in young generation. This study aimed to investigate the patterns, behavior and knowledge of CL wear and care in Thai university students.Methods: A cross-sectional study using online questionnaires was conducted during July 2019 to February 2020 in two Rajabhat universities, Bangkok, Thailand. Participant characteristics, CL information, knowledge and behaviors were collected. Factors associated with poor behaviors and CL-related corneal ulcers were analyzed using logistic regression.Results: Of 493 students participating in the survey, 336 students (66.78%) were current CL users and completed the questionnaires. Mean age was 19.2 ± 1.4 years with female predominance (80.36%). All students wore soft CL with a major replacement schedule of monthly disposable (90.18%). Good CL wear and care behaviors were found in 190 students (56.55%). The most common poor CL behavior and poor CL knowledge were CL overuse (44.64%) and sleeping with lenses (31.85%), respectively. There were no correlations between behaviors and knowledge (r = 0.03). Purchasing lens from internet, wearing experience over one year, and long wear duration (> 12 hours) were significantly associated with poor CL behavior. Male gender and swimming with lens were significantly associated with history of corneal ulcers.Conclusion: The study pointed out a low compliance of CL wear and care in Thai university students. Good CL practices, awareness of CL-related complications and purchasing place should be carefully informed and regularly stressed to minimize preventable visual damage in young population.Keywords: contact lens, behavior, knowledge, university students, Thailand

Fungal conjunctivitis is a rare disorder, with low incidence and difficulty in diagnosis due to a lack of specific clinical findings. We report a case of fungal conjunctivitis which exhibited a specific clinical feature of giant papilla formation, and its diagnosis was a complex process. A 19-year-old woman with a history of atopic dermatitis and hard contact lens use was referred to us with a 3-month history of giant papillary conjunctivitis of the right eye in spite of treatment with antiallergic and corticosteroid eye drops, complicated by intraocular pressure elevation. The left eye showed no symptom of ocular surface disorder throughout the clinical course. The right eye did not respond to oral corticosteroid. Polymerase chain reaction of conjunctival scrapings against Chlamydia trachomatis was negative, and she was treated surgically by total papilla resection. Conjunctival giant papilla recurrence was not observed after surgery. Although the primary histopathological diagnosis was chronic inflammation due to atopic keratoconjunctivitis, repeated histopathological survey of excised conjunctival tissue including immunohistochemical staining revealed histiocytes, yeast type spores and hyphae, and phagocytosed spores and hyphae in macrophages. The causative organism was identified morphologically as a Candida species. Later, histopathological examination of a cervical swab revealed the presence of Candida sp. This rare case indicates that a fungal organism may underlie refractory conjunctivitis with specific giant papillary hypertrophy mimicking vernal keratoconjunctivitis.

William Reindel,1 Gary Mosehauer,1 Marjorie Rah,1 Howard Proskin,2 Robert Steffen1 1Vision Care, Bausch & Lomb Incorporated, Rochester, NY, USA; 2Howard M. Proskin & Associates, Rochester, NY, USACorrespondence: Marjorie RahVision Care, Bausch & Lomb Incorporated, Rochester, NY, USATel +1 585-413-6397Email Marjorie.Rah@bausch.comPurpose: The objective of this study was to evaluate and compare the clinical performance of samfilcon A, a unique, polyvinylpyrrolidone (PVP)-containing, silicone hydrogel contact lens with that of the balafilcon A silicone hydrogel contact lens when worn on a 7-day extended wear basis.Subjects and Methods: A total of 669 subjects completed this 12-month, controlled, parallel group, masked, randomized study; of these, 340 wore samfilcon A lenses and 329 balafilcon A lenses. Subjects wore their respective assigned lenses bilaterally on a 7-day extended wear basis. On the seventh night of each wearing week, lenses were removed, cleaned, and disinfected using Biotrue multi-purpose solution (MPS), then re-inserted the following morning. Lenses were replaced with new lenses monthly. At each follow-up visit, investigators completed a slit lamp evaluation, and subjects rated lenses based upon a predefined set of performance criteria.Results: The samfilcon A lens performed comparably to the balafilcon A lens in terms of most graded and ungraded slit lamp findings, differing significantly only for corneal staining Grade 2 or greater, which favored samfilcon A, and anterior segment abnormalities, which favored balafilcon A. Subjects rated both lenses highly when queried about various lens-wearing characteristics. When comparing the number of subjects with findings on either eye on at least one follow-up visit, the two lenses were comparable in many aspects but favored samfilcon A with respect to cleanliness upon removal, overall comfort, comfort at end of day, dryness, vision, vision in low light, vision at end of day, and overall impression (all p < 0.05).Conclusion: While subjects rated both highly, samfilcon A lenses worn for 7-day extended wear and replaced on a monthly basis performed comparably to or better than balafilcon A lenses when worn for the same 7-day wear time and replacement cycle.Keywords: PVP, contact lens, extended wear

AIM: To study the effect of uncrosslinked and crosslinked hyaluronic acid combined with other artificial tear components in patients with dry eye caused by moderate meibomian gland dysfunction. METHODS: Prospective, single-blind, contralateral eye study. Fifty eyes (25 patients) were analyzed. Eye selection for each tear type was random, and the eye drop formulations, 0.4% uncrosslinked hyaluronic acid and 0.2% galactoxyloglucan (tear A) and 0.15% crosslinked hyaluronic acid, crocin, and liposomes (tear B) were used. The determined dosing schedule was three times a day for six weeks, and the study participants underwent a clinical examination before and 45d after lubricant treatment. The Schirmer test, tear breakup time (TBUT) test, and Ocular Surface Disease Index (OSDI) questionnaire were applied before and after instillation period with both types of artificial tears. RESULTS: On the Schirmer test, a significant improvement was obtained with both tear A (P

Abstract Background COronaVIrus Disease 19 (COVID-19) was first reported in Wuhan, China in December 2019 and is now pandemic all over the world. The purpose of this review is to highlight the possible ocular presentation of COVID-19 infection and the consequence of the pandemic in the daily ophthalmology routine. A total of 9 articles was included by searching PubMed database for articles published between December 2019 and April 2020. Main body Conjunctivitis (and keratoconjunctivitis) can be the first symptom in infected patients. The virus can be present in tear and conjunctival secretions, requiring maximum attention. It’s important to understand if COVID-19 could spread through the ocular route or present as the primary infected site. Ocular implications should also be considered for therapy. In fact, one potential treatment is chloroquine and its derivatives, including hydroxychloroquine. Hydroxychloroquine, in fact, can induced retinal toxicity. The exponential increase in lthe number of Covid-19 cases was like a tsunami for health care companies, which were not ready to face this emergency. Ophthalmology departments were also affected by the reorganization of healthcare services. Conclusion The studies analaysed have some limitations. First, the sample size and the covered population consisted mainly of patients with mild disease. Moreover, the studies are often descriptive study, without a correlation analysis. Finally, no normal population was observed in the studies, so a normal control group should be included for comparison in future studies. With the evolving COVID-19 pandemic and with its high infectivity, it is necessary to rearrange ophthalmologist routine clinical practice in order to control viral spread and try to maximize patient and health-care provider’s safety.

The prevalence of keratoconus is 1/2000 in the general population and is high in adolescents. Keratoconus is a progressive disease, which has a great impact on patients’ quality of life and mental health. It can be managed by surgical and non-surgical means, rigid gas permeable (RGP) contact lens as its main non-surgical method is widely used in clinic. The efficacy of wearing RGP contact lens has been confirmed to some extent, but some studies have found that wearing RGP contact lens has adverse effects, which may promote disease progression. In this paper, the advantages and disadvantages of RGP contact lens in controlling keratoconus were reviewed to provide more suggestions and references for the clinical application of RGP contact lens.

Purpose: to compare the tonometry results obtained by transpalpebral scleral tonometry and pneumotonometry for patients with their contact lenses on. Material and methods. Intraocular pressure (IOP) was measured in 30 (60 eyes) patients with various refraction errors including 5 patients (10 eyes) aged 11–63 (45.0 ± 21.0) years with hyperopia of +1.75 to +9.0 D (+4.4 ± 2.6 D) and 25 patients (50 eyes) aged 12–57 (26.4 ± 13.5) years with myopia of -0.5 to -11.25 D (-4.4 ± 2.4 D). In most of cases patients used soft daily disposable contact lenses (spherical or multifocal). IOP was determined in both eyes of each patient using 1) transpalpebral scleral tonometry (EASYTON tonometer), and 2) corneal pneumotonometry. IOP was first measured when the patient was without their contact lenses, by both methods consecutively. 20 minutes after putting the lenses on, IOP was measured once again. Each measurement was taken three times and the average IOP value was determined. The data were analyzed using parametric statistics: the mean value and the standard deviation (M ± SD) of each parameter were calculated. Results. On average, patients without contact lenses showed transpalpebral IOP (IOPtr) of 16.3 ± 2.9 mmHg in the right eye (OD) and 16.6 ± 3.2 mmHg in the left eye (OS) and pneumotonometry IOP (IOPpn) of 16.0 ± 3.8 in OD and 15.6 ± 3.3 mmHg in OS. When the lenses were put on, the values of IOPtr stayed practically the same: 16.0 ± 3.9 mmHg in OD and 16.7 ± 3.1 mmHg in OS. IOPpn also changed insignificantly: 15.7 ± 2.9 mmHg in OD and 15.5 ± 2.8 mmHg in OS, but individual IOPpn data scattered more when the lenses were put on. IOPtr of hyperopic patients both with the lenses (19.5 ± 3.9 mmHg in OD and 19.7 ± 3.3 mmHg in OS) and without them (19.3 ± 2.8 mmHg in OD and 19.6 ± 3.1 mmHg in OS) was higher than IOPpn both with the lenses (14.0 ± 1.8 mmHg in OD and 14.2 ± 1.7 mmHg in OS) and without them (13.5 ± 2.7 mmHg in OD and 13.2 ± 1.6 mmHg in OS). A higher IOPtp in the hyperopic group seems more plausible because most patients in this group were significantly older than in myopic group. In hyperopic patients, IOPpn level in lenses tended to be higher than without them, while IOPtr was the same in either case. It may be due to the fact that contact lenses for high hyperopia are rather thick, which affects the air impact on the cornea during pneutonometry. In the myopic group the difference between IOPtr (15.2 ± 3.5 mmHg in OD and 16.0 ± 2.7 mmHg in OS) and IOPpn (16.1 ± 2.9 mmHg in OD and 15.9 ± 3.0 mmHg in OS) in lenses and IOPtr (15.7 ± 2.6 mmHg in OD and 15.9 ± 2.9 mmHg in OS) and IOPpn (16.6 ± 3.8 mmHg in OD and 16.1 ± 3.4 mmHg in OS) without them was insignificant. Conclusion. Transpalpebral scleral tonometry using EASYTON is an adequate method to measure IOP of patients with contact lenses on and can be the method of choice in a some of clinical cases, since its results and their repeatability are not affected by factors associated with the presence of a contact lens.

Purpose: Literature is relatively silent on safety profile and predictability of orthokeratology lenses in terms of myopia correction and prevention of further progression, especially in semi-tropical countries; this study was designed to fill this gap. Methods: This prospective, intervention case series enrolled 30 eyes of 30 patients with myopia up to –5.5 diopters (D). Patients were randomized into two groups of 15 each; the study group was prescribed overnight orthokeratology (OK) lenses, while the control group used daily wear conventional soft contact lenses. Follow-up examinations were performed after 1 h and 6 h, and then at 1, 7, 15, 30 days, and 4 months post lens wear. Uncorrected visual acuity (UCVA), contrast sensitivity, keratometry, central corneal thickness (CCT), and tear film break up time (TBUT) were evaluated at each follow-up examination. Results: All patients attained a visual acuity of 0.00 Logarithm of the Minimum Angle of Resolution (logMAR) after one week of lens use, which was maintained throughout the study period. While patients allotted to the study group had a gain of 8.1 Snellen lines (UCVA), those in the control group gained 8.9 lines (BCVA) at the end of follow-up period. In the OK group, cornea showed a flattening of 0.8 D (mean keratometry) after single overnight usage of OK lens and overall flattening of 1.2 D compared to baseline, at the end of four months. The change in contrast sensitivity, corneal endothelial specular count, axial length and tear film status was not significant in either group. Conclusion: Orthokeratology is an effective and safe modality to correct moderate myopia in motivated young adults. No side effects were encountered after a short-term follow-up in participants who resided in semi-tropical environments.

Abstract Background The aim of this study was to explore the differences in terms of tear film and meibomian glands (MGs) between young Asian soft contact lens (CL) wearers and non-wearers. Methods A prospective, cross-sectional observational study was conducted using 148 subjects (63 non-wearers, and 85 soft CL wearers who had been wearing CLs for more than 1 year) recruited from a clinic in Tianjin, China. All subjects first responded to an Ocular Surface Disease Index (OSDI) questionnaire and then underwent a standardized dry eye examination, which included measuring tear meniscus height (TMH), non-invasive tear breakup time (NIBUT), and corneal fluorescein staining (CFS). The MGs were evaluated via ImageJ, distorted MG count and the MG dropout were recorded. Results Compared to the control group (non-wearers), the CL group recorded higher OSDI and CFS scores, lower TMH and NITBUT values, a larger distorted MG count, and larger MG dropout (all P

The International Association of Contact Lens Educators (IACLE) is the leading provider of educational and information resources essential to contact lens educators worldwide. The New IACLE Contact Lens Course is its most important resource, used by members around the world to teach their students, the contact lens practitioners of the future. In 2019, IACLE celebrated the 40th Anniversary of its founding meeting. In this article, we trace the early years of the organization and describes its impact on contact lens education in India.

Purpose: To detect biofilm forming capacity of bacterial isolates obtained from the conjunctiva, contact lens and accessories of contact lens wearers using phenotypic and genotypic methods. Methods: Bacterial strains were collected from the conjunctiva, contact lens and lens storage cases of contact lens wearers. The phenotypic detection of biofilm production was done using the tube method and congo red agar method. The biofilm-forming related genes, icaA, of Coagulase negative Staphylococcus (CONS) and Staphylococcus aureus, and pslA, of P. aeruginosa, were detected using PCR. Results: A total of 265 bacterial isolates which included S. aureus, CONS, Pseudomonas, Nil-fermenter Gram-negative bacilli (NFGNB), Bacillus spp, Diphtheroids, Micrococci, Klebsiella pneumonia, Klebsiella oxytoca, E. coli, Proteus mirabilis, Proteus vulgaris, Citrobacter koseri, Citrobacter freundii, Enterobacter cloacae, Moraxella were obtained. Of the 265 isolates, 53.5% were moderately positive, 33.2% strongly positive and 13.2% negative for biofilm production by tube method and 36.6% were moderately positive, 40% strongly positive and 23.3% negative for biofilm production by congo red agar method. Of the four S. aureus isolates, two (50%) showed the presence of icaA gene. Of the 23 CONS isolates, three (13%) showed the presence of icaA gene. All the Pseudomonas isolates were negative for presence pslA (1119 bp) gene though most of them were phenotypically positive for biofilm formation. Conclusion: Most of the bacterial isolates obtained from contact lens wearers had the potential to produce biofilms. Tube method and Congo red agar method exhibited significant statistical correlation (P-value = 0.006) and picked up a good number of biofilm-forming isolates, hence may be used for detection of biofilm production. The absence of biofilm-forming gene did not rule out the possibility for phenotypic biofilm production by bacteria.

The COVID-19 pandemic has caused disruption in everyone's lives globally. Optometrists, being primary health care professionals are at a higher risk of infection in their practices during these testing times. Optometrists and optical store owners need practically implementable guidelines as lockdown gets lifted in various parts of our country. As these practices gear up to provide eye examination and vision correction to people, they need to take necessary precautions to avoid any cross contaminations. Optometry Council of India guidelines were circulated among optometry and optical associations and among experts in various optometry specialty. A consensus among various bodies were arrived. These guidelines provide recommendation for optical and optometry practices.

Many patients require optical correction post-laser vision correction (LVC). While mildly irregular corneal topographic patterns or asymmetry can sometimes be treated with conventional soft lenses, often this proves inadequate. This article introduces a novel technique to provide visual improvement and comfort for these patients. An inverted senofilcon A (Acuvue Oasys®, Johnson & Johnson Vision Care) lens (off-label)was inserted on a patient's eyes that reported discomfort with his current soft contact lenses, which provided improved centration as was seen with a slit lamp and high molecular fluorescein through a yellow filter. The patient achieved a visual acuity of 6/6+ in each eye and reported that the vision did not fluctuate. The post-lens tear film decreased to 35micron versus 43micron in the conventional position, as shown in OCT. The patient reported that he wore the lenses 9 hours a day. His Dry Eye Questionnaire-8 (CLDEQ-8) score decreased from 22 to 15 when wearing the lenses in the inverted position. This case demonstrates that post-laser vision correction patients with minimal asymmetric topography within the treated zone requiring refractive correction may be helped using an inverted conventional soft frequent replacement lens.

Purpose: To evaluate the risk factors, medical and surgical management, and visual outcomes of patients affected by Acanthamoeba keratitis (AK) over a 16-year period. Observations: Records were reviewed retrospectively for all AK patients treated at University of Iowa between 2002 and 2017. Main outcomes measured were risk factors, time to diagnosis, coinfection types, initial and final visual acuities, and treatment outcomes, with failure of medical therapy defined as need for therapeutic keratoplasty (TK). Effects of steroid use on these outcomes were determined. Among all AK cases occurring during the study period (N = 110), the median age of the AK cohort was 31 years (range 8–80 years), and 49.1% were men. Contact lens wear was the primary risk factor for AK (95/100, 86.4%), and the median time to diagnosis was 0.70 (0.23–1.23) months. Forty-four AK patients (40%) failed medical therapy. Vision outcomes were better for AK patients with successful medical therapy compared to those requiring TK (LogMAR 0.00 v. 0.30; p

Therapeutic contact lens used in the treatment of non-infective corneal pathologies are prone to infection by microorganisms like bacteria, protozoa and fungi. Bacteria cause the majority of contact lens-related infections. Although rare, fungal invasion of soft contact lenses is a potentially severe complication which may cause keratitis and more fulminating infections. Contact lens invasion can present as acute red eye warranting its replacement to prevent the development of keratitis. Different genera and species of fungi are documented to cause contact lens invasion. We report a rare case of fungal invasion of the contact lens by Aspergillus nidulans.

Abstract Objective: To investigate the effects of two types of contact lenses made of two different types of silicone hydrogel material on ocular physiological parameters and tear function tests. Methods: The contact lenses with the appropriate diopters were supplied to the volunteering patients. The patients were evaluated before wearing the contact lenses (visit0:V0), at the first month(visit1:V1) and at the thirth month(visit2:V2) following their wear. At all visits a detailed biomicroscopic examination was done, ocular physiological variables were collected, the tear function tests were performed and the tear meniscus area (TMA) was visualized and measured with anterior segment optical coherence tomography (AS-OCT). Results: The results of Schirmer 1 test were 12.07 ± 1.51 [9-16] mm for the right eyes (samfilcon A group) and 12.09 ± 1.5 [9-16] mm for the left eyes (senofilcon A group) at V0. (p=0.950) At V2, the mean Schirmer 1 test results were 11.92±1.34 [9-15] mm in the samfilcon A group and 12.2±1.41 [9-16] mm in the senofilcon A group (p=0.239). The mean TMA dimensions in the AS-OCT images were 338.42±47.1 [241-401] microns in the samfilcon A group and 338.42±47.1 [241-401]microns in the senofilcon A group at V0. (p>0.05). At V2, the mean TMA dimensions were 337.2±45.53 [241-402] microns in thesamfilcon A group and 340.31±48.22 [240-411] microns in the senofilcon A group (p=0.728). Conclusions: Our study has demonstrated that contact lenses containing samfilcon A and senofilcon A silicone hydrogel material do not cause meaningful ocular surface problems.

Mihori Kita, Mami Kusaka, Hiroshi Yamada, Sachiyo Hama Department of Ophthalmology, National Organization Kyoto Medical Center, Kyoto, JapanCorrespondence: Mihori KitaDepartment of Ophthalmology, National Organization Kyoto Medical Center, 1-1 Mukouhata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, JapanTel +81 75 641 9161Fax +81 75 643 4325Email mihorik@kuhp.kyoto-u.ac.jpPurpose: To assess the updated chandelier illumination-assisted scleral buckle procedures using a 3D visualization system.Subjects and methods: We report a single-center, retrospective, consecutive surgical case series of 18 eyes of 16 patients that underwent scleral buckle procedures combining the use of chandelier endoillumination, a noncontact wide-angle viewing system, an anti-drying contact lens, and a recently developed 3D visualization system. The mean age of the patients was 30.2 years, and the mean follow-up time was 11.3 months.Results: Retinal reattachment was achieved after the first surgery in all cases. There were no cases that required conversion of the 3D visualization to a conventional microscopic view. This updated chandelier-assisted scleral buckle procedure was successfully performed without any intraoperative or postoperative complications, except for the occurrence of postoperative diplopia in one case in which a supplementary radial buckle was used for a deep tear.Conclusion: The updated chandelier illumination-assisted scleral buckling surgery using a 3D visualization system appears to be a valuable and promising method for managing rhegmatogenous retinal detachment due to atrophic holes in lattice degeneration or ciliary tears in younger cases.Keywords: scleral buckling, chandelier illumination, wide-angle viewing system, 3D visualization system, retinal detachment, contact lens