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Background: Whereas hearing aids have long been considered effective for providing relief from tinnitus, controlled clinical studies evaluating this premise have been very limited. Purpose: The purpose of this study was to systematically determine the relative efficacy of conventional receiver-in-the-canal hearing aids (HA), the same hearing aids with a sound generator (HA+SG), and extended-wear, deep fit hearing aids (EWHA), to provide relief from tinnitus through a randomized controlled trial. Each of these ear-level devices was a product of Phonak, LLC. Research Design: Participants were randomized to HA, HA+SG, or EWHA and wore bilaterally fit devices for about 4 months. Fittings, adjustments, and follow-up appointments were conducted to comply with company guidelines and to ensure that all participants attended appointments on the same schedule. At 4–5 months, participants returned to complete final outcome measures, which concluded their study participation. Study Sample: Participants were 55 individuals (mean age: 63.1 years) with mild to moderately-severe hearing loss who: (a) did not currently use hearing aids; (b) reported tinnitus that was sufficiently bothersome to warrant intervention; and (c) were suitable candidates for each of the study devices. Data Collection and Analysis: The primary outcome measure was the Tinnitus Functional Index (TFI). Secondary outcome measures included hearing-specific questionnaires and the Quick Speech in Noise test (QuickSIN). The goal of the analysis was to evaluate efficacy of the EWHA and HA+SG devices versus the HA standard device. Results: There were 18 participants in each of the HA and EWHA groups and 19 in the HA+SG group. Gender, age, and baseline TFI severity were balanced across treatment groups. Nearly all participants had a reduction in tinnitus symptoms during the study. The average TFI change (improvement) from baseline was 21 points in the HA group, 31 points in the EWHA group, and 33 points in the HA+SG group. A “clinically significant” improvement in reaction to tinnitus (at least 13-point reduction in TFI score) was seen by 67% of HA, 82% of EWHA, and 79% of HA+SG participants. There were no statistically significant differences in the extent to which the devices reduced TFI scores. Likewise, the hearing-specific questionnaires and QuickSIN showed improvements following use of the hearing aids but these improvements did not differ across device groups. Conclusions: There is insufficient evidence to conclude that any of these devices offers greater relief from tinnitus than any other one tested. However, all devices appear to offer some improvement in the functional effects of tinnitus.

PURPOSE: To understand long-term contact lens prescribing habits of Canadian optometrists.METHODS: One thousand optometrists were surveyed annually from 2000 to 2015. Information was requested on the first ten patients examined after receiving the survey.RESULTS: Over the 16-year survey period, 1987 optometrists provided information on 19,143 patients. Mean age of the patients was 32.7±14.4years. Ratio of females to males was 2:1, the ratio of new fits to refits was 2:3. Soft contact lenses represented 94.5% of all fits. Rigid lenses were more often used as a refit compared to a new fit. Over the 16 years, market share for silicone hydrogel materials grew from 0% to 69.6%, mid-water content materials declined from 75.7% to 14.1%. The multifocal market share grew at the expense of spherical designs, with no change in toric lens fitting. Monthly soft lens replacement remained the preferred option at 48.2%, followed by daily disposable at 40.8%; two-weekly replacement declined to less than10% of patients by 2015. Extended wear was likely used to refit and only to a small proportion of wearers, representing 2.6% of SCL by 2015. The lens care system of choice throughout the period was multipurpose solutions, although the proportion for peroxide systems more than doubled by 2015 from 9.6%, to 21.1%.CONCLUSIONS: Over the 16-year period, SCL material preference changed to silicone hydrogels with monthly replacement being preferred; daily disposables replacing 2-weekly as the alternate. Lens care preference continued to be multipurpose solutions. Rigid lenses appear to be sustained for specialist fitting.

Intracorneal haemorrhage is a rare complication of modern contact lens wear. While a limited number of reports have described intracorneal haemorrhages (typically stromal) associated with the extended wear of soft contact lenses with limited oxygen permeability for the correction of aphakia, this case report documents the management and resolution of a significant intraepithelial corneal haemorrhage associated with long-term rigid contact lens wear for keratoconus and high myopia.

Purpose The relative risks of ocular pathology with increasing myopia have been described; the absolute lifetime risk of vision impairment from myopia is yet to be compared to the childhood and lifetime risks of contact lens wear for myopia control. Methods Using peer-reviewed data, the absolute risks of microbial keratitis (MK) in daily disposable soft, reusable soft and orthokeratology contact lens (CL) wear were calculated over both a childhood (age 8–18) and a lifetime (age 8–65) of CL wear. This was compared to the previously published cumulative risk of vision impairment by age 75 based on increasing myopia and axial length. Data were converted utilizing the Council of International Organizations of Medical Sciences (CIOMS) classification system for frequency of adverse events, with 95 % confidence intervals included. Results The lifetime risk of vision impairment in axial lengths over 26 mm and more than 6D of myopia is greater than the lifetime risk of MK in any CL modality, except for adult SCL extended wear. If axial length is below 26 mm and myopia lower than 3D, a lifetime of CL wear is more risky in comparison, except in the case of daily disposable wear. Ten years of childhood CL wear of any modality presents lower likelihood of MK than any comparable risk of vision impairment. Conclusion The comparative lifetime risks of contact lens wear commenced at age 8 for myopia control are less than the lifetime risks of vision impairment with myopia more than 6D or axial length more than 26 mm. When only childhood CL wear is considered, the risk comparison is clearly skewed towards the positive impact of CL wear, especially in daily disposable wear. Clinicians should be confident to proactively recommend myopia control CL wear to younger children, as both the safety profile and potential preventative ocular health benefits are evident.

Objective: The Effect of Contact Lenses, humidity, and knowledge on the dry eyes syndrome. Methods: The type of reserach used is observation. The dimensions of study time are cross sectional because of data collection and outcome at one time. Humidity variables were measured using thermohygrometer and users’characteristic were obtained by questionnaire. The statistical test used is multiple logistic regression to find out effect of Contact Lenses Type, length of lens usage, humidity, and knowledge on the dry eyes syndrome. Results: Respondents were students Faculty of Public Health UNAIR from 2014-2017. Based on the type of lens, 90.9% of respondents used daily wear and 9.1% of respondents used overnight wear or extended wear. Based on the length of use of the lens 84.8% using a lens more than 4 hours and 15.2% less than 4 hours. Based on knowledge of 51.5% having high knowledge and 48.5% having low knowledge. Based on the humidity of the space of 54.5% the humidity level of the air conditioned lecture hall is appropriate and 45.5% is not suitable. Logisti regression test results obtained value of 4.732 Wald with a probability of 0.030, which means that there is a significant effect of moisture on the dry eyes syndrome while the user characteristics there is no significant effect. Conclusion: Based on the results of research conducted Students of the Faculty of Public Health, there are some conclusions that most respondents use the type of daily wear lens. Respondents use contact lenses more than 4 hours and users' knowledge in the high category. Humidity of spaces in the Faculty of Public Health is 54.5% stated to be appropriate and 45.5% is declared inappropriate.

Purpose Ocular hypotony after trabeculectomy may be treated medically, surgically and with a tamponade. Three cases are reported in which a scleral lens was applied to treat ocular hypotony after mitomycin C (MMC) augmented trabeculectomy. Methods In this retrospective case series the records of three eyes of three patients who developed ocular hypotony after they had undergone trabeculectomy augmented with MMC were evaluated. The patients were between 11 and 69 years of age and the intraocular pressure (IOP) after surgery ranged between 3 and 6 mmHg. All three patients showed a negative Seidel test; one had suspected hypotonic maculopathy and one had a collapsed anterior chamber. After unsuccessful treatment with large bandage lenses all three patients were subsequently fitted with a scleral lens. The scleral lens was fitted to fully cover and compress the bleb. Scleral lenses were worn continuously with a check-up after one night of wear and subsequent check-ups when needed. One patient continued to wear the scleral lens for a further 6.5 months on a daily wear basis. Results In all three eyes the IOP was higher after wearing the scleral lens. Two patients stopped wearing the scleral lens after the IOP was stable. One patient developed a cataract; the cataract surgery was combined with a bleb revision and scleral lens wear was therefore discontinued. Discussion The scleral lens might be a useful tool in the treatment of ocular hypotony after trabeculectomy augmented MMC surgery. The effect of the scleral lens on the ocular pressure is unpredictable. Caution is advised in vulnerable corneas due to risk factors such as hypoxia and infection. Further research is warranted to establish the safety of the procedure, the patient selection and the overall success in a larger patient group.

Optimal management of surgical wounds is an important part of postoperative recovery. The aim of postoperative wound care is to facilitate rapid wound closure, while preventing complications and promoting minimal disturbance, to achieve the best functional and aesthetic results. Health professionals should seek to optimise the process of acute wound healing, observe progress, and prevent wound complications. Dressings that permit extended wear time, and are transparent and so allow early recognition without the need for unnecessary changes, have the potential to minimise the effect on patients and the wider health economy. This article reviews recommendations for surgical wound care, and introduces the recently launched Leukomed Control dressing that is entirely transparent and allows greater flexibility, breathability, and visualisation of the wound.

Bacterial cellulose (BC) hydrogels are among the most efficient materials already being used for the treatment of complex wounds. The moist environment provided by the BC dressing is a key feature assuring efficient wound recovery. Improving the dressings' moisture-holding ability facilitates its application and leads to an economically preferable extended wear time. To produce materials with reduced moisture loss, BC dressings were impregnated with a secondary hydrophilic component: alginate. The feasibility of an industrial fabrication of this composite was evaluated on pilot scale equipment. It was shown that the procedure can easily be scaled up without significantly increasing the manufacturing time. The resultant composite possessed improved water-retention properties, providing a smooth dressing exchange as demonstrated by a wound-imitating model. The new materials were moreover shown to be compatible with an antimicrobially active compound, which assures their efficiency in the treatment of highly colonized wounds.

AIM A series of proof-of-principle extended wear (EW) contact lens studies were conducted to assess what effect different interventions had on adverse events (AEs). Comparative analysis of AEs across studies was conducted to determine whether some interventions were more effective at reducing inflammatory AEs. METHOD Multiple logistic regression analysis of AEs from 30-day EW studies each with a different intervention including (1) nightly replacement (NR) of lenses, (2) morning replacement (MR) of lenses, (3) instillation of prophylactic antibiotic drops (AB) each morning/evening, (4) daily lens cleaning (LC) each morning. All studies conducted at the same site using same lens type (lotrafilcon A) and EW schedule. RESULTS Comparison of the different interventions to the individual control groups showed no difference in significant corneal infiltrative event (CIE) or mechanical events. Replacing lenses nightly, during an EW schedule, had the highest incidence of significant CIEs (4.9% [NR] vs. 2.5% [MR] vs. 1.8% [AB] vs. 0% [LC]); however, adjusted logistic regression analysis of the combined control data compared with the individual interventions showed no difference in significant CIEs (P=0.086) or mechanical AEs (P=0.140). CONCLUSIONS Replacing lenses each night seemed to be inferior compared with the other interventions of replacing lenses each morning, daily lens cleaning, and daily antibiotic drop instillation during EW. The results of the collective studies and additional analysis suggest that overnight wear of contact lenses seems to create an adverse environment that remains, despite the various interventions intended to improve this adverse environment.

Polymer gels are worn in our steadily lives for extended wear lenses, superabsorbent polymers, etc., and more fancy applications are in development. They are among the most interesting and functional materials. Gels are characterized as polymers and their swollen matters with three-dimensional chain structures that are insoluble in any solvents. The capacity of polymer gels to experience considerable swelling and crumpling as an element of their surroundings is a standout among the most admirable properties of these materials. Polymer gels ordinarily contain a lot of portion of solvent, which gives them a singular quality started from a fluid nature. Additionally, they can keep up shape like strong materials, unless extra stress is applied. Subsequently, the mix of flexibility and shape maintenance capacity gives special properties, especially mechanical properties. Gels are wet and moldable and resemble a strong material yet are set up for experiencing considerable distortion. This property is as opposed to most modern materials, for example metals, earthenware production, and plastics, which are dry and hard. This chapter focuses on polymer gels in terms of molecular design, assembly, crosslink formations, and practical application.

A comprehensive clinical study on the effects of various aviation stresses on soft and semisoft contact lenses was carried out to find out their compatibility in aviation environment. Twenty subjects (11 aircrew and 9 non air-crew) participated in the study. Twelve of them were given soft lenses of water contents of 38%, 50% and 78% and rest 8 were given semisoft lenses of daily wear and extended wear type. The environmental trial consisted of exposure to hypoxia, rapid decompression, acceleration, pressure breathing, vibration and high temperature. On successful completion of environmental trials on ground simulators, the inflight trials on high performance aircraft, transport aircraft, passenger aircraft and helicopters were conducted. The soft lenses with low, medium and high water contents and extended wear semisoft lenses (large diameter) were found compatible with all types of aircraft flying.

Purpose To determine whether mucin ball (MB) formation is protective against corneal infiltrative events (CIEs) as previously reported. Methods Two hundred eighty-two eligible participants were enrolled at three sites in the USA. Participants began a 1-month continuous wear run-in period with high modulus lotrafilcon A lenses to assess their ability to form MBs (phase 1). Subsequently, they were stratified by this characteristic and randomized to balafilcon A or comfilcon A lenses for 7-day extended wear and followed for 1 year (phase 2). MB formation in each phase was defined as repeated presence of any MBs on a person level. Multivariable Cox proportional hazards regression was used to model the probability of a CIE as a function of MB formation in each phase and other covariates. Results Of the 282 participants who entered phase 1, 218 of them entered the phase 2 randomized trial during which 33 CIEs occurred. Overall, 74%, 61%, and 79% of participants repeatedly produced MBs in lotrafilcon A, balafilcon A, and comfilcon A lenses, respectively. Early repeated MB presence in phase 1 with lotrafilcon A lenses significantly increased the rate of CIEs in phase 2 (12-month follow-up) by 466% (HR 4.66, 95% confidence interval 1.10-19.79, P = .0372). Repeated, longer-term MB presence during wear of balafilcon A or comfilcon A in phase 2 did not significantly reduce the incidence of CIEs; however, it significantly decreased the rate of CIEs by 62% (hazard ratio (HR) 0.380, 95% confidence interval 0.145-0.998, P = .0494). Conclusions The overarching hypothesis that MB formation is protective against CIEs throughout extended wear was not supported. Although a protective effect of longer-term MB presence on rate of CIEs was detected, early-onset MB formation substantially increased the hazard for CIE in subsequent wear with different lens types.

The purpose of the study was to measure contact lens lipid spoliation of silicone hydrogel PureVision (balafilcon A) and hydrogel Acuvue 2 (etafilcon A) contact lenses worn for 10 hours single use (DD) and 7 days of extended wear (EW).Two similar study populations (DD, n = 55; EW, n = 53), were enrolled at four study sites. In each population, a bilateral, randomized, crossover (lens material), subject-masked experimental design was followed. Worn contact lenses were analyzed for lipid uptake using high-performance liquid chromatography by two laboratories: Alcon Laboratories (right lens total uptake) and OTG ResearchConsultancy (left lens total uptake and individual lipid classes).Lipid uptake was different for the two materials: total lipid (p0.007), cholesterol esters (p0.001), cholesterol (p0.001 EW only), and triglycerides/phospholipids (p0.001) were higher for balafilcon A, whereas fatty acid (p0.0025 EW only) was higher for etafilcon A. The ratio of the extracted lipids was also different: higher percentages of triglycerides/phospholipids (p0.001) and cholesterol (p0.001 EW only) for balafilcon A and higher percentages of fatty acids/di- and monoglycerides (p0.014) for etafilcon A.Total lipid uptake was highly material dependent. Both laboratories measured a greater uptake of lipids by the silicone hydrogel than the hydrogel material, a difference that was evident after only 10 hours of DD. Total lipid uptake was greater after 7 days of EW compared with 10 hours of DD. Of interest for contact lens spoliation and its avoidance was the differential lipid uptake profile, indicating material selectivity. Whereas greater differentiation between materials was possible after 7 days of EW for each material, the lipid uptake profile was similar for DD and EW, indicating a greater material effect than a wear modality effect.

This study aimed to examine the integrity of the ear canal skin and its microbiological changes caused by an extended-wear hearing device. An extended-wear hearing device, Lyric2 (Phonak AG, Switzerland), which is the second generation of the Lyric device, was fitted to 52 ears of 27 subjects. A refit of the device was done for a selection of ears (n = 15) for which the initial fitting was interrupted (28 ears). A matching control group consisted of 10 ears of 10 subjects with no history of using any form of hearing aid for 3 months. The ear canal skin of ears fitted with the hearing device was inspected using an otoendoscope, and signs of problematic pathological conditions were graded. Microbiological examinations were performed at three different stages following fitting. Wearing the device was interrupted in 28 (53.8%) out of the 52 ears for the initial fitting, and 17 of the 28 interrupted cases (60.7%) were due to issues of the ear canal skin. In 3 of 15 ears (25%) following a refitting, wearing the device was interrupted yet again, and 1 of these 3 interruptions was caused by ear canal skin pathologies. Growth of bacteria was not enhanced or prompted by wearing the Lyric2, and Gram-negative bacteria could not be cultured while the device was in place. Based on aspects of ear canal skin pathology, continuous and nonproblematic uses of the Lyric2 device are presumed to be obtained if the fitting is done carefully. Wearing of the Lyric2 device can be considered safe from a microbiological perspective and does not promote growth of Gram-negative bacteria.

Contact lens-induced papillary conjunctivitis (CLPC) continues to be a major cause of dropout during extended wear of contact lenses. This retrospective study explores risk factors for the development of CLPC during extended wear of silicone hydrogel lenses.Data from 205 subjects enrolled in the Longitudinal Analysis of Silicone Hydrogel Contact Lens study wearing lotrafilcon A silicone hydrogel lenses for up to 30 days of continuous wear were used to determine risk factors for CLPC in this secondary analysis of the main cohort. The main covariates of interest included substantial lens-associated bacterial bioburden and topographically determined lens base curve-to-cornea fitting relationships. Additional covariates of interest included history of adverse events, time of year, race, education level, gender, and other subject demographics. Statistical analyses included univariate logistic regression to assess the impact of potential risk factors on the binary CLPC outcome and Cox proportional hazards regression to describe the impact of those factors on time-to-CLPC diagnosis.Across 12 months of follow-up, 52 subjects (25%) experienced CLPC. No associations were found between the CLPC development and the presence of bacterial bioburden, lens-to-cornea fitting relationships, history of adverse events, gender, or race. Contact lens-induced papillary conjunctivitis development followed the same seasonal trends as the local peaks in environmental allergens.Lens fit and biodeposits, in the form of lens-associated bacterial bioburden, were not associated with the development of CLPC during extended wear with lotrafilcon A silicone hydrogel lenses.

BACKGROUND Although surface characteristics of food contact materials are known to alter the efficacy of cleaning procedures there is a lack of data establishing how cleaning/sanitization practices affect the surface characteristics of materials used for produce handling on-farm. The overall objective of this work was to characterize the effects of cleaning and sanitization procedures on the surface properties of new and extended-wear polyethylene bins used for produce harvest and handling. RESULTS Compared to detergent cleaned samples, chlorine and quaternary ammonium sanitization resulted in a decrease in advancing contact angle from 100° to 88° and 59°, respectively, after 2 min exposure. However, changes in surface chemistry were not observed. Increasing sanitization time to 144 min (representative of 4320 sanitization cycles) resulted in an increase in contact angle to 73° for quaternary ammonium sanitization and a decrease in contact angle to 75° for chlorine sanitization. Abrasion increased contact angle hysteresis due to enhanced surface roughness. The hysteresis effect of abraded material was reduced with quaternary ammonium treatment. CONCLUSIONS This work indicates that sanitizing agents employed in on-farm cleaning can alter the surface characteristics of polyethylene picking bins and should be considered in developing cleaning and sanitization procedures. © 2013 Society of Chemical Industry

Objectives To evaluate the efficacy of high-plus contact lenses as a form of optical penalization in children with unilateral aphakia. Methods An internal database review was used to identify 10 patients with unilateral aphakia after congenital cataract extraction who underwent treatment with a high-plus contact lens in their sound eye after a period of failure with traditional occlusive patching. The details surrounding the switch from patching to optical penalization with contact lens were recorded along with related changes in compliance and any demonstrable effect suggestive of an improvement in visual ability. Results After an average 15-month delay between the end of occlusive patching and the start of optical penalization with high-plus contact lenses, 6 of 10 patients achieved good compliance with high-plus contact lens therapy and most families were able to successfully administer the lenses according to the prescribed regimen. Three patients showed evidence of a fixation switch to the contact-lens-corrected aphakic eye during optical penalization of the sound eye. No safety issues were reported. Conclusion Using a high-plus contact lens to optically penalize the sound eye of a unilaterally aphakic child seems to have the potential as an effective alternative to occlusive patching for those with compliance issues. A prospective study is warranted to assess long-term safety, and above all, efficacy in visual outcome.

Purpose During wear of contact lenses on a daily wear basis, it is necessary to disinfect the lens overnight before reinserting the lens the next day. The ability of the solutions used for this to disinfect lenses and lens cases is important for safe lens wear. Methods The literature on the disinfecting ability of multipurpose disinfecting solutions (MPDS) commonly used with silicone hydrogel lenses reported during the period 2000 to 2012 is reviewed, as this is the period of time during which these lenses have been commercially available. Particular emphasis is placed on the ability of disinfecting solutions to control colonization of lens cases by microbes and changes in composition and use of the solutions. In addition, the literature is reviewed on ways of minimizing lens case microbial contamination. Results Maintaining the hygiene of contact lenses and lens cases is important in minimizing various forms of corneal infiltrative events that occur during lens wear. Although lens case contamination is not associated with different lenses, it is determined by use of different MPDS. MPDS that allow more frequent or heavy contamination of cases by Gram-negative bacteria are associated with a higher incidence of corneal infiltrative events. MPDS are now available that contain dual disinfectants. Wiping lens cases with tissues or using lens cases that incorporate silver are associated with reductions in contamination in clinical trials. Similarly, using MPDS to rub and rinse lenses before disinfection may reduce levels of microbes on lenses. The MPDS also contain surfactants that help reduce deposition and denaturation of proteins on lenses. Conclusions Improvements in MPDS formulations and hygiene practices may help to reduce the incidence of adverse events that are seen during use with silicone hydrogel lenses.

Aim: To study the corneal endothelial changes after soft contact lens wear, to correlate these changes with the duration of soft contact lens wear, and to study the pattern of use and preferences of contact lens among young adults. Materials and Methods: This observational study was carried out in 100 eyes of 50 soft contact lens users aged between 19 and 27 years. Both eyes of 50 medical students who had never worn contact lenses served as controls. Data from each subject were collected using a structured questionnaire of 24 items that included demographic profile, pattern of contact lens use, symptoms, brand name, number of years worn, and hours of daily wear. These data were analyzed using Chi square for association. Specular microscopy was done using TOPCON SP-3000P. Computerized morphometry was used to evaluate central corneal thickness, size, shape, mean cellular density, hexagonality, coefficient of variation, and polymegathism of the corneal cells . Results: It was found that central corneal thickness was 0.532 ± 0.0309 mm in lens users and 0.514 ± 0.03 mm in controls, cell density was 2570.91 ± 432.06 cells/mm 2 in lens users and 2723.17 ± 327.64 cells/mm 2 in controls, while hexagonality was 54.81 ± 39.72% in lens users and 67.65 ± 36.49% in controls. Conclusion: Despite the known effects of long duration of soft contact lens use on corneal endothelial cell morphology, this study could not draw a significant correlation between them. However, a significant difference was found in the corneal endothelial thickness, cell density, and hexagonality. Among the soft contact lens users, 62% used soft disposable type while 38% used soft extended wear contact lens. Contact lenses were preferred over spectacles for better cosmetic appearance, comfort, and wider visual field.

Non-penetrating ocular injuries from badminton shuttlecocks can result in severe damage and life-long complications. This case series highlights the morbidity of such injuries, particularly in regard to post-traumatic glaucoma.This is a retrospective case series of 12 patients with shuttlecock-related blunt eye injuries sustained during badminton play without eye protection. By approaching colleagues through conference presentations and networking, the authors have attempted to gather all known cases of shuttlecock ocular injury managed in tertiary ocular emergency departments or private ophthalmological clinics in Victoria and New South Wales, Australia in 2015.This is the first multicentre case series to describe badminton-related ocular injuries in Australia. Our case series demonstrates, in particular, long-term glaucoma-related morbidity for patients over a large age range (16 to 77 years), with one patient requiring ongoing management 26 years following their initial injury. The cases reported further add to the literature promoting awareness of badminton-related ocular injury.We encourage player education and advocacy on badminton-related eye injuries and appropriate use of eye protection to reduce associated morbidity.

Coatings deposited by laser cladding are characterized by high hardness and extended wear, chemical or thermal resistance. However, inappropriate process parameters or material incompatibility can result in generation of stress that cause coating crack. Since it is a critical fault, such coatings are tested with NDT methods such as PT or MT. This paper presents the outcome of crack detection in metallic coatings with laser spot thermography. The research was conducted with various imaging systems and two laser sources with different wavelengths. The influence of imaging and excitation systems parameters on the inspection sensitivity and robustness to disturbances that arise from inhomogeneous surface were presented.

Purpose. This study evaluates the use of differential gel electrophoresis (DIGE) for tear analysis and applies this technique to establish the effect of extended contact lens wear on the tear proteome. Methods. Flush tears were collected from nine healthy non-contact lens wearers at baseline, during the first day, and after 1 month of contact lens wear. Participants wore AIR OPTIX on an extended wear (EW) schedule. Tears were collected at mid-day and upon waking and analyzed for concentrations of total protein using the bicinchoninic acid assay method. DIGE was then performed to detect biomarkers likely to be affected by contact lens wear. Technique variability, physiological variability, and the effect of EW were established. Proteins with significantly changed abundance during lens wear were cut and identified with mass spectrometry. Results. Both Cy3 and Cy5 identified the same proteins relative to Cy2 with the highest fold difference of 4.4. The proteome varied by 3% at the same time point, with a significant increase in protein spots found between mid-day (257) and upon awakening (298). With EW, of the 311 proteins spots identified upon awakening, 15 differed significantly. Of the five differences between baseline and the first night of EW, all were greater at baseline. Of the differences between baseline and 1 month, six were greater at 1 month and four were greater at baseline. Conclusions. DIGE is a repeatable proteomic technique capable of determining differences in the tear proteome. The extent of the participants' experience with lens wear is an important factor to consider when analyzing the tears from lens wearers, as neophytes appear to differ from those with experience. © 2012 American Academy of Optometry.

Contact lens wear continues to be the highest single risk factor for microbial keratitis, particularly when worn in the extended wear modality. For microbial keratitis to occur, the presence of at least a bacterial load as well as a break in the corneal surface is required. One such break occurs in the case of a corneal erosion. These well-circumscribed areas of full thickness epithelial loss can occur both with and without contact lens wear, however the risk of infection is greater in the presence of a lens due to its capacity to provide a vector for the entry of bacterial pathogens. While erosions in non-contact lens wearers are thought to result from defective epithelial basement membrane anchoring, the underlying causes during contact lens wear are yet unknown. This article sets out to review corneal erosions associated with contact lens wear, their associated risk factors such as extended wear, the mechanisms that may be responsible for their formation and the factors that differentiate them from other contact lens related adverse events. Appropriate diagnosis and understanding of the relevant pathophysiology is important to the effective treatment and an understanding of the aetiological factors responsible for erosions is critical to the development of preventative strategies and effective clinical care.

To determine the association between mucin ball formation and corneal infiltrative events (CIEs) during continuous wear with lotrafilcon A silicone hydrogel contact lenses.Subjects (n = 205) in the Longitudinal Analysis of Silicone Hydrogel Contact Lens Study wore lotrafilcon A contact lenses for 12 months of continuous wear. The primary outcome was a CIE. Kaplan-Meier methods were used to estimate the unadjusted cumulative incidence of remaining CIE free stratified by mucin ball presence. Cox proportional hazards regression was used to model the hazard of developing a CIE as a function of mucin ball formation and other covariates.Over half (54.2%) of the subjects displayed some presence of mucin balls during at least 1 visit and about one third (32.8%) displayed repeated episodes. Mucin ball scores were correlated between the 2 eyes and weakly correlated with corneal curvature (P ≤ 0.005). Univariate analyses revealed that the relative hazard for a CIE was 0.35 [95% confidence interval (CI), 0.19-0.68] if a single episode of mucin balls was detected and 0.17 (95% CI, 0.06-0.43) if repeated episodes were detected. Upon multivariate analysis, repeated presence of mucin balls was associated with an 84% decreased hazard of experiencing a CIE (hazard ratio: 0.16; 95% CI, 0.06-0.44).The presence of mucin balls is significantly associated with a decreased incidence of CIEs, and the effect is greatest when they are repeatedly present over time. We hypothesize that the mucin ball presence represents a more concentrated or viscous mucus layer, which prevents upregulation of the immune response against bacterial ligands.

PURPOSE: To determine the types of contact lenses prescribed for infants (aged 0 to 5 years), children (6 to 12 years), and teenagers (13 to 17 years) around the world. METHODS: Up to 1000 survey forms were sent to contact lens fitters in each of 38 countries between January and March every year for 5 consecutive years (2005 to 2009). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey form. RESULTS: Data were received relating to 105,734 fits [137 infants, 1,672 children, 12,117 teenagers, and 91,808 adults (age ? 18 years)]. The proportion of minors (

To determine whether carriage of microbes on the contact lens or ocular surfaces during extended wear (EW) with soft hydroxyethyl methacrylate (HEMA)-based contact lenses predisposes the wearer to adverse events.Participants (non-contact lens wearers) were enrolled in a clinical study involving wear of HEMA-based hydrogel lenses on a six night EW basis with weekly replacement. Type and number of bacteria colonizing the lower lid margins, upper bulbar conjunctiva, and contact lenses during EW after one night, 1 week, 1 month, and thereafter every 3 months for 3.5 years were determined. The association of bacteria with adverse responses was compared between carriers (defined as having significant microbes cultured from two or more samples with 1 year) and noncarriers, and the strength of the association was estimated using multivariate logistic regression.Carriers of gram-positive bacteria on lenses (particularly coagulase negative staphylococci or Corynebacterium spp.) were approximately three and eight times more likely to develop contact lens-induced peripheral ulcers (CLPUs) and asymptomatic infiltrates (AIs), respectively. Staphylococcus aureus was most frequently isolated from lenses during CLPU. Carriers of gram-negative bacteria on lenses were five times more likely to develop contact lens-induced acute red eye (CLARE). Haemophilus influenzae was isolated most frequently from lenses during CLARE and AI events.Bacterial carriage on contact lenses during EW predisposes the wearer to the development of corneal inflammatory events including CLARE, CLPU, and AI.

Purpose To identify risk factors for contact lens-related corneal inflammatory events and mechanical events in wearers of silicone hydrogel lenses on a 30-night extended wear (EW) schedule in India. Methods An interventional study with 188 subjects wearing silicone hydrogel lenses bilaterally on a 30-night EW schedule. Subjects were dispensed with lenses and reviewed at scheduled visits up to 6 months of EW. Multivariate logistic regression, after adjusting for within subject correlation, was used to develop the statistical model. Results Occupations in non-ideal environments were found to predispose a lens wearer to inflammatory events (p = 0.003). Wearers in the non-ideal group, who had varying degrees of exposure to ocular irritants in their work environment had highest incidence of inflammatory events (19.2%). Wearers in a controlled, ideal environment had lowest levels of events (3.3%). Students occupied a position between the two groups (9.3%). Inflammatory rate was higher among wearers with increased microbial contamination of lenses (p = 0.002). Wearers with an inflammatory event had mean colony forming unit of 1.97 log compared with mean colony forming unit of 1.45 log in group with no inflammatory event. Corneal vascularization was associated with the development of inflammatory events (p = 0.001) with 50% of wearers with vascularization experiencing events compared with 7.6% of subjects with no vascularization. Reduced lens movement was associated with inflammatory events with subjects more likely to develop inflammatory events compared with those wearers with optimal lens movement (p = 0.027). Conclusions A multitude of factors, including environmental influences, lens contamination, ocular characteristics, and lens fit, contributes to the development of inflammatory events, information that is of clinical relevance to practitioners worldwide. Occupational environment was also a contributory factor, confirming that a duty of clinicians is to ascertain the nature of the work environment of lens wearers (and potential wearers) and to balance the needs of the wearer with the potential risks.

Over the past forty years, contact lenses have gained increasing popularity for the correction of refractive errors of the eye. At this time, about 140 million patients wear contact lenses world wide, with some 38 million exposed to the device in the United States, and a similar 10–12% of the population of Great Britain (Richard Weisbarth, personal communication). Importantly, for several decades contact lens use has continued to grow at a variable annual rate of 5–15%; thus, sight threatening complications while uncommon, adversely afflict significantly increased numbers of patients each year (Richard Weisbarth, personal communication). If, as recent epidemiological studies continue to confirm, the rates of lens-related microbial keratitis in daily wear remain 1/2500 and 1/500 in overnight or extended wear, then there will be increasing tens of thousands of new lens wearers at risk world wide every year.1–4 Given this challenge, it is critical to identify the biological mechanisms that predispose the cornea to infection in lens use, and search for modifiable risks that could reduce this sight-threatening complication. The purpose of this Castroviejo Lecture is to review significant clinical and basic science publications as well as ongoing studies to achieve the safest possible contact lens wear.

Purpose We further optimized and evaluated the safety of the magnetic levator prosthesis (MLP) for temporary management of severe blepharoptosis, and compared efficacy and comfort against the ptosis crutch. Methods The interpalpebral fissure (IPF) of participants (n = 12) with ptosis was measured during attempted eyelid opening, volitional closing, and spontaneous closing with no device, ptosis crutch, or the MLP. A 10-point scale documented comfort. Additionally, a 20 minute and then 1 week trial of the MLP was offered. Safety measures were skin erythema rating, change in visual acuity, and change in corneal staining. Results The MLP and crutch opened the eye (IPF 11.2 and 9.3 mm), but the MLP allowed better volitional closure (IPF 1.0 vs. 4.9 mm, P = 0.009), but was no better in allowing spontaneous blink (IPF 7.5 vs. 7.7 mm, P = 0.722). Both devices were equally comfortable (both median 8/10 comfort, P = 0.46). With extended use, opening with the MLP showed IPF 9.24 mm at 20 minutes and 9.46 mm at 1 week, and volitional closure was IPF 0.95 and 0.52 mm, respectively. Closure on spontaneous blink improved with extended wear to IPF 5.14 and 5.18 mm, respectively (P = 0.002). Two participants exhibited moderate skin erythema and one had increased corneal staining without change in acuity. Conclusions The MLP is safe and feasible for temporary correction of severe ptosis. Translational relevance First group data in patients showing successful reanimation of the eyelid with magnetic force.

Purpose Contact lens acute red eye (CLARE) and infiltrative keratitis (IK) are inflammatory responses of the eye associated with extended wear of soft contact lenses and are associated with bacterial colonization of contact lenses. Development of animal models to study these conditions is of importance in confirming risk factors and developing preventative strategies. Methods Silicone hydrogel contact lenses contaminated with a human CLARE isolate of Pseudomonas aeruginosa at inocula ranging from 1 x 10 to 6 x 10 colony-forming units (CFUs) for 15 minutes, 1 hour, or 24 hours were worn by guinea pigs for times up to 48 hours in 3 models designed to simulate contamination during wear and contact lens care regimens. Eyes were examined by slit-lamp biomicroscopy and histology to evaluate ocular responses and inflammation. Results Three different models for the effects of bacterial contamination on the etiology of CLARE/IK were developed and tested in the guinea pig eye. Bacterial contamination of contact lenses was confirmed to be a major risk factor for the development of CLARE/IK and a dose response shown. The pathological features of CLARE/IK in the guinea pig were virtually identical to those observed in human eyes. Conclusion The models characterized here provide a useful tool for development of interventional and therapeutic strategies for these important ocular inflammatory conditions.

For decades myopia progression has been reported in adult low Dk/t hydrogel contact lenses wearers 1–3 and to a lesser degree in adults wearing silicone hydrogel lenses. 4–6 In a five-year retrospective study of 291 contact lens wearers aged 20 to 40 years, Bullimore and co-workers reported a mean progression of −0.44 ± 0.60 D during the 5 year period, but found a range from +1.88 to −2.75 D, indicating a high degree of individual variability. In that study myopic progression was greater in younger adult contact lens wearers and for those who began wearing spectacles at a later age.3 This and other studies also showed that the degree of myopia at baseline was not a contributing factor to the amount of myopic progression. Dumbleton and co-workers studied young adults primarily in their 20s for 9 months after initiation of extended wear and found that lower myopes showed significantly more myopic progression with extended wear of low transmissibililty hydrogel contact lenses compared with those with higher refractive error.5 Clearly, quantifying the role of factors such as lens wearing schedule (daily or extended wear), lens material, subject age and refractive status will help the research community determine the importance of each in the changing refractive error of contact lens wearers. The studies comparing myopic progression among low Dk/t hydrogel and silicone hydrogel lens wearers have shown that contact lens material also affects myopic progression, although the relative contribution of physical (lens modulus) versus physiological (corneal oxygen supply) effects are not fully understood.4–7 The most recent of these studies, a 3-year non-randomized, prospective clinical study, compared clinical signs and symptoms in patients wearing lotrafilcon A silicone hydrogel contact lenses up to 30-nights at a time with those wearing low Dk/t hydrogel contact lenses on a daily wear basis.6 Among the reported findings was a comparison of change in refractive error. Because of a substantial difference in the mean baseline age of the groups wearing silicone hydrogel contact lenses and hydrogel contact lenses (38 vs. 23 years), the investigators elected to select two age-matched subsets, each of 36 patients (mean age of 27.9 years each). The age-matched subjects were selected by a masked investigator from among the lens wearers who completed the study. Consistent with other reports among randomized subjects that did not differ in age, 5, 7 the age-matched silicone hydrogel contact lens subset had an increase in myopia of −0.03 D, whereas the low Dk/t hydrogel group increased in myopia by −0.40 D in the 3-year study (p = 0.007). Unfortunately, the two subgroups differed significantly in mean baseline refractive error as well, with the silicone hydrogel contact lens wearers entering the study with a refractive error of −3.59 ± 1.99 D compared with −2.10 ± 1.78 D for the low Dk/t hydrogel contact lens wearers. Since degree of myopia has been shown in some studies to affect myopia progression in adult contact lens wearers, an analysis is required to determine the role of lens material alone. In order to accomplish this, the data from the 3-year study 6 were reanalyzed using strategies that allowed both age and baseline refractive error to be controlled. By using a multivariate analysis, data from all subjects in the study could be used, and not just a limited subset.

Eighty-two hydrogel extended wear contact lenses (EWCL) from four brands were tested for overall quality and variations in specified parameters. Two of the EWCL brands were approved by the United States Food and Drug Administration (FDA) for wear by the public, while two of the brands were uninvestigated. In addition, the packaging solution was examined for osmolarity and pH. All brands were delivered with solutions that had estimated means of pH and osmolarity departing from what may be considered ideal physiologically. The EWCLs all had a consistent power and an acceptable thickness reproducibility. One of the FDA approved brands, demonstrated diameter variations of a magnitude that may produce an unpredictability in the lens fit. Several lenses of one brand suffered from edge quality deficiencies. Although the FDA clinical trial is designed to control the clinical performance of contact lenses prior to the market entry, the results of the present investigation indicate that an authority independent of the manufacturer should regularly sample the lens quality. It is for this purpose imperative that standards for contact lenses are established.