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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.

IntroductionAcanthamoeba keratitis is often caused when Acanthamoeba contaminate contact lenses and infect the cornea. Acanthamoeba is pervasive in the environment as a motile, foraging trophozoite or biocide-resistant and persistent cyst. As contact lens contamination is a potential first step in infection, we studied Acanthamoeba’s behavior and interactions on different contact lens materials. We hypothesized that contact lenses may induce aggregation, which is a precursor to encystment, and that aggregated encystment would be more difficult to disinfect than motile trophozoites.MethodsSix clinically and/or scientifically relevant strains of Acanthamoeba (ATCC 30010, ATCC 30461, ATCC 50370, ATCC 50702, ATCC 50703, and ATCC PRA-115) were investigated on seven different common silicone hydrogel contact lenses, and a no-lens control, for aggregation and encystment for 72 h. Cell count and size were used to determine aggregation, and fluorescent staining was used to understand encystment. RNA seq was performed to describe the genome of Acanthamoeba which was individually motile or aggregated on different lens materials. Disinfection efficacy using three common multi-purpose solutions was calculated to describe the potential disinfection resistance of trophozoites, individual cysts, or spheroids.ResultsAcanthamoeba trophozoites of all strains examined demonstrated significantly more aggregation on specific contact lens materials than others, or the no-lens control. Fluorescent staining demonstrated encystment in as little as 4 hours on contact lens materials, which is substantially faster than previously reported in natural or laboratory settings. Gene expression profiles corroborated encystment, with significantly differentially expressed pathways involving actin arrangement and membrane complexes. High disinfection resistance of cysts and spheroids with multi-purpose solutions was observed.DiscussionAggregation/encystment is a protective mechanism which may enable Acanthamoeba to be more disinfection resistant than individual trophozoites. This study demonstrates that some contact lens materials promote Acanthamoeba aggregation and encystment, and Acanthamoeba spheroids obstruct multi-purpose solutions from disinfecting Acanthamoeba.

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.

Since contact lenses directly contact the cornea, the surface roughness of the lens may cause various side effects. In addition, gold nanoparticles can realize a variety of colors and characteristics depending on their shape and size. In this study, the surface roughness of tinted lenses containing gold nanoparticles of various sizes was analyzed using atomic force microscopy (AFM) at aspect ratio(surface to volume ratio) ranging from 1:1 to 1:10. The characteristics of the lenses were then confirmed. As a result, tinted lenses with different colors depending on the size of the gold nanoparticles were manufactured. The surface roughness of the lens decreased with increasing size of the gold nanoparticles. However, at aspect ratio of 1:10, increase in surface roughness was observed. In addition, it was confirmed that the wettability and antibacterial properties of the lens had the same effect according to the average surface roughness value. Therefore, it was confirmed that the addition of gold nanoparticles reduced the surface roughness of the lens, which had a great effect on properties such as wettability and antimicrobial properties of the lens. The produced copolymer controls the surface roughness of the lens, and thus it is judged that it can be used as a material for various ophthalmology applications.

In this paper, a method is described to perform ion concentration measurements on both sides of an inserted contact lens, without physical contact with the eye or the contact lens. The outer surface of an eye is covered with a tear film that has multiple layers. The central aqueous layer contains electrolytes and proteins. When a contact lens is inserted, it becomes localized in the central layer, which creates two layers known as the pre-lens tear film (PLTF) and the post-lens tear film (PoLTF). The PoLTF is in direct contact with the sensitive corneal epithelial cells which control electrolyte concentrations in tears. It is difficult to measure the overall electrolyte concentration in tears because of the small 7 μL volume of bulk tears. No methods are known, and no method has been proposed, to selectively measure the concentrations of electrolytes in the smaller volumes of the PLTF and the PoLTF. In this paper, we demonstrate the ability to localize fluorophores on each side of a contact lens without probe mixing or diffusion across the lens. We measured the concentration of sodium in the region of the PoLTF using a sodium-sensitive fluorophore positioned on the inner surface of a contact lens. The fluorescence measurements do not require physical contact and are mostly independent of eye motion and fluorophore concentration. The method is generic and can be combined with ion-sensitive fluorophores for the other electrolytes in tears. Instrumentation for non-contact measurements is likely to be inexpensive with modern opto-electronic devices. We expect these lenses to be used for measurements of other ions in the PLTF and the PoLTF, and thus become useful for both research and in the diagnosis of infections, keratitis and biomarkers for diseases.

Many individuals suffer from myopia or hyperopia and astigmatism owing to the refractive defects of the eye optics or because of the use of inappropriate contact lenses. This study dealt with three polymers Poly(methyl methacrylate) (PMMA), Poly(Hydroxyl methacrylate) (PHEMA), and Poly(glycidyl methacrylate) (PGMA) and doping them with TiO2 nanoparticles to evaluate the difference between the effect of each lens on the human eye. The TiO2 NPs were prepared in this work by the sol–gel method to obtain 70–90 nm sized particles. Modulation transfer (MTF) and spot diagram were assessed to measure ocular performance. The PGMA-TiO2 contact lens provided the highest image quality at the lowest probability (P) of about p < 0.0001 when inserted on an aberrated eye system because of its ability to eliminate the chromatic aberrations created inside the eyes having a smaller spot size. [ABSTRACT FROM AUTHOR]

Purpose: The primary aim of this study is to investigate Acanthamoeba in clinical samples of keratitis cases (n = 60), in contact lens (CL) and lens care solutions of asymptomatic CL users (n = 41), and to identify the genotypes in positive samples. The secondary aim is to assess the risk factors and clinical features of Acanthamoeba keratitis (AK) patients. Methods: All samples from patients and asymptomatic CL users were examined by microscopy and inoculated in non-nutrient agar plates. PCR was performed using the DNA isolated from corneal scrapings, CL and lens care solution samples. Positive DNA samples were sequenced to determine the genotype of Acanthamoeba. Results: In none of the samples, Acanthamoeba was identified by microscopy, while Acanthamoeba was detected in a patient with keratitis by culture method. However, Acanthamoeba was detected in 11.66% (7/60) of the keratitis patients by PCR. The genotypes of these isolates detected by sequencing were T4 (4), and T5 (3). Acanthamoeba was detected in none of the samples of asymptomatic CL users by any of the three methods. Conclusion: To best of our knowledge, this is the first study to detect T5 genotype in AK patients from Turkey. In addition, the CL use was found to be an important risk factor for AK. [ABSTRACT FROM AUTHOR]

Glaucoma is treated by frequent instillation of 0.2% w/v brimonidine tartrate eye drop solution, which showed poor ocular bioavailability of 1–3%. Medicated contact lenses can be used to improve the ocular drug bioavailability. However, drug loading in the contact lens matrix showed high burst release and changes the optophysical properties of the contact lens material. In this paper, a novel brimonidine loaded silica nanoparticles-laden silicone contact lenses (Bri-Si) were designed to achieve controlled drug delivery without altering the optophysical properties of the contact lens. Silica nanoparticles were prepared by polymerizing octadecyltrimethoxysilane (OTMS) molecules at the oil/water interface of microemulsion. Traditional soaking method (Bri-SM), direct brimonidine-loading method (Bri-DL) and microemulsion-laden contact lens (Bri-ME) were developed for comparison. The Bri-Si lens showed improved swelling, transmittance, oxygen permeability and lysozyme adherence compared to Bri-SM, Bri-DL and Bri-ME lenses. The Bri-DL lens showed high brimonidine leaching during extraction and sterilization steps, with low cumulative drug release. While, Bri-Si lens show controlled brimonidine release for 144 h. In a rabbit tear fluid model, the Bri-Si lens showed high brimonidine concentration for 96 h compared to Bri-ME lens and eye drop therapy. Based on histopathological studies of cornea, the Bri-Si lens was found to be safe for human applications. The data demonstrated the novel application of silica nanoparticles to control brimonidine release from the contact lens without altering the optophysical properties of the contact lens. Graphical Abstract [ABSTRACT FROM AUTHOR]

As contact lens (CL) wear affects the ocular surface, this cross-sectional study aims to assess the effects of soft CL wear and its duration on the tear film and meibomian gland (MG) drop-out and visibility. Thirty non-CL wearers (22.5 ± 2.3 years) and twenty-four soft CL wearers (23.8 ± 2.2 years) participated in this study. The Keratograph 5M was used to assess the ocular surface. CL users were surveyed on years of CL wear and hours per week. MG visibility was assessed using a previously developed method based on analysing pixel intensity of meibographies. The CL group showed higher gland drop-out (p < 0.001) and lower gland visibility (p < 0.022). Gland drop-out was independently associated with CL wear (p = 0.006). When gland drop-out was excluded, the relative energy of pixel intensity values showed an independent association with CL wear (p = 0.005). Prolonged hours of CL wear were associated with higher dry eye symptoms and entropy of MGs (p < 0.029). A reduction in non-invasive keratograph break-up time was associated with using CLs for ≥8 years (p = 0.030). Overall, gland drop-out was higher and gland visibility lower in soft CL wearers. New gland visibility metrics might help to assess MGs in soft CL wearers quickly and objectively. [ABSTRACT FROM AUTHOR]

Fungal keratitis, a disease in which the cornea becomes inflamed due to an invasive fungal infection, remains difficult to treat due in part to limited choices of available treatments. Topical eye drops are first-line treatment, but can be ineffective as low levels of drug reach the target site due to precorneal losses and the impenetrability of the cornea. The aim of this study was to determine the corneal delivery of econazole using a novel topical enhancement approach using a composite delivery system based upon cyclodextrins and soft hydrogel contact lenses. Excess econazole nitrate was added to hydroxypropyl-α-cyclodextrin (HP-α-CD) and hydroxypropyl-β-cyclodextrin (HP-β-CD) solutions, and the solubility determined using HPLC. Proprietary soft hydrogel contact lenses were then impregnated with saturated solutions and applied to freshly enucleated porcine eyeballs. Econazole nitrate 'eye drops' at the same concentrations served as the control. After 6 h, the corneas were excised and drug-extracted, prior to quantification using HPLC. Molecular dynamic simulations were performed to examine econazole–HP-β-CD inclusion complexation and dissociation. The minimum inhibitory concentration (MIC) of econazole was determined against four fungal species associated with keratitis, and these data were then related to the amount of drug delivered to the cornea, using an average corneal volume of 0.19 mL. The solubility of econazole increased greatly in the presence of HP-β-CD and more so with HP-α-CD (p < 0.001), with ratios >> 2. Hydrogel contact lenses delivered ×2.8 more drug across the corneas in comparison to eye drops alone, and ×5 more drug delivered to the cornea when cyclodextrin was present. Molecular graphics demonstrated dynamic econazole release, which would create transient enhanced drug concentration at the cornea surface. The solution-only drops achieved the least satisfactory result, producing sub-MIC levels with factors of ×0.81 for both Fusarium semitectum and Fusarium solani and ×0.40 for both Scolecobasidium tshawytschae and Bipolaris hawaiiensis. All other treatments delivered econazole at > MIC for all four fungal species. The efficacies of the delivery platforms evaluated were ranked: HP-α-CD contact lens > HP-β-CD contact lens > contact lens = HP-α-CD drops > HP-β-CD drops > solution-only drops. In summary, the results in this study have demonstrated that a composite drug delivery system based upon econazole–HP-β-CD inclusion complexes loaded into contact lenses can achieve significantly greater corneal drug delivery with the potential for improved clinical responses. [ABSTRACT FROM AUTHOR]

The aim of this study is to prepare ciprofloxacin (CIP) or levofloxacin (LEVO)-incorporated and polydopamine (PDA)-coated nephrite composites for application in drug-eluting contact lenses. PDA was coated onto the surface of nephrite to improve antibacterial activity and to payload antibiotics. CIP or LEVO was incorporated into the PDA layer on the surface of nephrite. Furthermore, CIP-incorporated/PDA-coated nephrite composites were embedded into the contact lenses. PDA-coated nephrite composites showed dull and smooth surfaces according to the dopamine concentration while nephrite itself has sharp surface morphology. CIP- or LEVO-loaded/PDA-coated nephrite composites also have dull and smooth surface properties. Nano and/or sub-micron clusters were observed in field emission-scanning electron microscopy (FE-SEM) observation, indicating that PDA nanoparticles were accumulated and coated onto the surface of nephrite. Furthermore, CIP- or LEVO-incorporated/PDA-coated nephrite composites showed the sustained release of CIP or LEVO in vitro and these properties contributed to the enhanced antibacterial activity of composites compared to nephrite or PDA-coated nephrite composites. CIP-incorporated/PDA-coated nephrite composites were embedded in the contact lenses and then, in an antibacterial study, they showed higher bactericidal effect against Staphylococcus aureus (S. aureus) compared to nephrite itself or PDA-coated nephrite composites. We suggest that CIP- or LEVO-loaded/PDA-coated nephrite composite-embedded contact lenses are a promising candidate for therapeutic application. [ABSTRACT FROM AUTHOR]

In some cases, where the patient decides not to proceed with contact lenses, no Medicare fee is payable because the patient has not taken delivery of the lenses' i . Keywords: Astigmatism; contact lens; keratoconus; Medicare EN Astigmatism contact lens keratoconus Medicare 552 555 4 07/05/22 20220701 NES 220701 Introduction Given the advances in the detection and management of irregular astigmatism in recent years, including the use of corneal tomography, an increase in scleral lens prescribing, and the introduction of new ophthalmological procedures such as corneal collagen crosslinking, an analysis was undertaken to determine if these changes in clinical practice had altered contact lens prescribing for irregular astigmatism in Australia. Variation in the total number of services or procedures per year relative to the year 2000 for item number 10924 (black), the control group (average of contact lens bulk item numbers for refractive conditions 10921, 10922, 10923, 10925) (red), corneal grafts for keratoconus (green), and penetrating keratoplasties (PK) and deep anterior lamellar keratoplasties (DALK) (blue). [Extracted from the article]

Symbols are commonly used to represent information of health care products included multipurpose solutions (MPSs) for contact lens (CL) care. Little knowledge is available about recognition and comprehension by regular soft CL wearers of commonly used symbols in the instructions of CL MPSs marketed worldwide. CL wearers from the UK and Spain were invited to answer an anonymous on-line questionnaire (distributed though Facebook and Twitter) concerning the recognition and comprehension of seven common symbols (ISO 15223:2017 and EN 980:2008) included in MPS package instructions. Answers of one hundred-ten soft CL wearers who use MPS (27 in the UK and 83 in Spain) were analysed showing low recognition and comprehension of the surveyed symbols even in wearers with > 5 years of CL wear (71.8%). The CE marked was the most recognised (96% in the UK and 88% in Spain, P = 0.29) and understood (78% in the UK and 85% in Spain, P = 0.25) symbol, but other important symbols, such as 'Caution' and 'Do not reuse', were under recognised (22% in the UK and 19% in Spain, P = 0.78 and 11% in the UK and 6% in Spain, P = 0.40 respectively) and understood (close to 30% in both countries P > 0.15). Participants with > 5 years of experience, showed slightly higher comprehension (P < 0.05) in some symbols ('Sterilised'; 'Do not reuse'; 'Use by date' and 'CE marked'). These results suggest an insufficient comprehension of seven common symbols included in MPS instructions among regular CL wearers in the UK and Spain without high impact of CL wear experience. Improving the education and symbol comprehension of regular CL wearers could help to get better patients' behaviour and safe use of MPS in soft CLs care. [ABSTRACT FROM AUTHOR]

In recent years, a rise in the number of contact lens users in the UK and worldwide coincided with an increased incidence of microbial keratitis. The aim of this study was to investigate the antimicrobial activities of polyhexamethylene guanidine (PHMG), polyaminopropyl biguanide (PAPB), and guazatine in comparison to the common contact lens disinfectant constituent, polyhexamethylene biguanide (PHMB). The study investigated these compounds against a broad range of organisms, including Acanthamoeba castellanii, Acanthamoeba polyphaga, Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans. This study demonstrated that PHMG, PAPB, and guazatine are equal in activity to PHMB against Acanthamoeba trophozoites and cysts. PHMG and PAPB are also equal in activity to PHMB against S. aureus and P. aeruginosa, whereas PHMG shows significantly better activity than PHMB against C. albicans (p < 0.001). To our knowledge, this is the first study to demonstrate the effectiveness of PHMB, PHMG, PAPB, and guazatine against Acanthamoeba and other ocular pathogens. As alternatives to PHMB, these compounds warrant further investigation for inclusion in contact lens solutions and for the treatment of keratitis. [ABSTRACT FROM AUTHOR]

• A dual sensing elements wearable contact lens sensor for wireless monitoring of the IOP is developed. • The contact lens sensor is flexible and incorporate no rigid component. • The fabrication processes promise a mass production of the contact lens sensor. • Tests on human eyes show that the sensor has high sensitivity and good applicability in IOP monitoring. Intraocular pressure (IOP) fluctuation is an independent risk factor for glaucoma and a key to clarify its pathogenesis. We have developed a contact lens integrated with a conformal LC resonance circuit made of liquid alloy (Galinstan) for non-invasive continuous IOP monitoring. The contact lens is fabricated using polydimethylsiloxane (PDMS), in which the LC resonance circuit can sense corneal strain proportionally caused by IOP variation. The Galinstan configuration is formed to the designed pattern by UV-laser treating the carbon-doped Ecoflex (c-Ecoflex) stamps and then selectively transferring the Galinstan onto the stamp to form the LC resonance circuit pattern. The tests conducted on silicone model eyes demonstrate high sensitivity in the frequency responses to variations in IOP, reaching 649 ppm/mmHg. IOP measurement on human eyes during head-down tilt bedrest confirms its applicability. With process optimization, this contact lens sensor has great potential for mass production and wide application in monitoring IOP. [ABSTRACT FROM AUTHOR]

Previous studies have demonstrated that contact lenses coated with the antimicrobial cationic peptide Mel4, a derivative of melimine, can reduce the occurrence of keratitis. However, the antimicrobial activity of Mel4 weakened over time due to its susceptibility to proteolytic degradation. Oligo- N -substituted glycine peptoids such as TM5 and TM18 possess antimicrobial properties and are resistant to proteolytic breakdown. This study focused on exploring methods for covalently attaching these peptoids to contact lenses to enhance their durability and performance in vitro. The peptoids TM5 and TM18 were covalently attached to etafilcon lenses via carbodiimide chemistry (EDC/NHS), oxazoline plasma, and plasma ion immersion implantation (PIII). The lenses were analysed using X-ray photoelectron spectroscopy (XPS), surface charge, and hydrophobicity. Inhibition of adhesion of multidrug-resistant Pseudomonas aeruginosa and cytotoxicity on corneal epithelial cells were evaluated. The impact of moist heat sterilization on activity was also assessed. XPS confirmed peptoid binding to lenses. Peptoid coatings slightly increased contact angles (≤23°) without affecting overall charge. Peptoids, bound via carbodiimide, inhibited P. aeruginosa adhesion by over 5 log10 CFU per lens, outperforming melimine, which required six times the concentration for a 3 log10 reduction. Peptoids attached via oxazoline or PIII reduced adhesion by > 5 log10 CFU. All covalent methods significantly reduced bacterial adhesion compared to untreated lenses (P < 0.0001). Peptoid-bound lenses were non-toxic to corneal epithelial cells. Sterilization did not affect carbodiimide-treated lenses but reduced the activity of oxazoline and PIII surfaces by 1–2 log10 CFU. Peptoids TM5 and TM18 effectively reduced P. aeruginosa adhesion on lenses, with carbodiimide-bound surfaces retaining activity post-sterilization, showing promise for the development of antimicrobial contact lenses. • Novel use of antimicrobial peptoids : Developed contact lens surfaces that reduced the adhesion of Pseudomonas aeruginosa using peptidomimetic compounds. • Surface modification : Employed advanced attachment methods, including carbodiimide chemistry, plasma immersion ion implantation, and antimicrobial polymer coatings, to improve the performance of biomaterial surfaces. • Surfaces have potential for future development : These surfaces have the potential to be developed into antimicrobial contact lenses that may reduce the incidence of microbially-driven adverse events during contact lens wear. [ABSTRACT FROM AUTHOR]

Dysfunction of the meibomian glands alters secreted meibum quantitatively and qualitatively that can lead to damage to the ocular surface epithelium. In response to an unstable tear film cause by meibomian gland dysfunction, ocular surface epithelium is damaged and expresses inflammatory cytokines leading to secondary ocular inflammation. In turn, inflammatory disorders of the palpebral conjunctiva and lid margin may affect the structure and function of meibomian gland. The disorders include allergic conjunctivitis, long-term usage of contact lenses, dermatological diseases that affect conjunctival homeostasis, Stevens-Johnson's syndrome or chemical burning of the ocular surface and lid margin.

Purpose: To report a case of Pseudomonas aeruginosa microbial keratitis in a patient wearing the same soft contact lenses in both eyes. Methods: 14-year-old girl with soft contact lenses she was diagnosed with a corneal ulcer in her right eye. Scrapings were positive for P. aeruginosa, started on fortified topical antibiotics, came one day after treatment then did not show up in her follow-ups. Two weeks later, she came after using the same contact lens in her left eye, diagnosed with a corneal ulcer, scraping of the corneal ulcer and contact lens were again positive for P. aeruginosa, she was admitted due to her poor compliance, treated with fortified topical antibiotics. Results: The microbial keratitis healed with successful treatment. Conclusions: Sight-threatening microbial keratitis can occur after using the same soft contact lenses in both eyes two week apart, showing how fertile is the contact lens for the growth of bacteria. [ABSTRACT FROM AUTHOR]

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

Presbyopia is often corrected by progressive soft contact lenses (CL), and the resulting visual acuity-based parameters can be affected by the lens design and pupil size under different lighting conditions. In this study, we examined the effect of CL design (spheric vs. aspheric) on objective parameters of visual acuity-based parameters under mesopic vs. photopic lighting conditions. In a prospective, double-blind study, pre-presbyopic and presbyopic patients were fitted with spheric (Dispo Silk; 8.6 base curve, 14.2 diameter) and aspheric (Dispo Aspheric; 8.4 base curve, 14.4 diameter) CLs. The low contrast (10%) and high contrast (100%) visual acuity (VA), amplitude of accommodation (AA) (push-away method, Diopters) and distance contrast sensitivity (CS) (FACT chart, cycles per degree (CPD)) were measured with both types of CLs under mesopic and photopic lighting conditions. The eye with the better visual acuity was tested and analyzed. Thirteen patients (age range: 38–45 years) were included. The mean CS was significantly better with spheric compared to aspheric lenses for low spatial frequencies (3 CPD: 81.69 ± 7.86, 67.62 ± 5.67, respectively; p < 0.05), though there was no significant difference for lower or higher spatial frequencies (1.5, 6, 12, 18 CPD). The low-contrast (10%) and high-contrast (100%) VAs were not different between the two lens designs. However, there were significant differences between near VA, distance low-contrast VA and AA obtained under mesopic (dim) vs. photopic (bright) conditions with the aspheric design correction modality. In conclusion, photopic lighting conditions improved both the visual acuity and measured amplitude of accommodation with both lens designs, though the amplitude of accommodation was significantly higher with aspheric lenses. However, contrast sensitivity demonstrated the superiority of the spheric lens at a 3 CPD spatial frequency. This suggests that the ideal lens differs from patient to patient, depending on the visual demands.

A 32-year-old contact lens-wearing man with recent travel history to the Caribbean was referred for a corneal infiltrate in the left eye that worsened following 1-week of steroid-antibiotic therapy. Corneal cultures were obtained and sent to our facility's clinical microbiology laboratory for analysis. Same-day in vivo confocal microscopy revealed fungal elements. Nucleic acid sequencing performed on the isolated determined it to be a member of the entomopathogenic genus Metarhizium. Over the course of 3 months, the patient's corneal infiltrate ultimately resolved following topical natamycin 5 % therapy. This is the first reported case to have originated in the Caribbean and to utilize in vivo confocal microscopy to aid diagnosis. Our case also supports previous reports of success with natamycin therapy in treatment of Metarhizium sp. keratitis. [ABSTRACT FROM AUTHOR]

The intraocular pressure (IOP) is the principal indicator for diagnosis of glaucoma which is one of the leading causes of blindness. The IOP can vary throughout the day, and traditional methods of measuring it in a clinical setting only provide a fraction of the patient’s IOP pattern. This article presents a cost-effective way for continuous monitoring of IOP by utilizing a soft contact lens with strategically placed holes. The deformation of these holes due to the change in IOP can be used to detect the pressure variations throughout the day. Extensive COMSOL Multiphysics simulations are conducted to optimize the design and to test the viability of this method. The optimized lens design can achieve a large deformation ratio sensitivity of 0.39 per mmHg with an applied pressure range of 10 mmHg to 40 mmHg.

• Wearable contact lenses merge electronics and biomaterials for medical marvels. • Diverse biomaterials like PMMA, PET, hydrogel, and silicone enrich contact lens technology. • Biosensing capabilities offer glucose monitoring, drug delivery, and enzyme analysis. • Powering smart contact lenses remains a significant challenge for sustained functionality. • Technological marketing strategies shape the future landscape of contact lens innovation. • Smart contact lenses hold promise for revolutionizing medical diagnostics and vision correction. The development of electronic contact lenses has been underway for over a decade by numerous research laboratories around the globe. The integration of electronics into contact lenses may facilitate medical capabilities, such as the measurement of intraocular pressure, the analysis of tears for glucose levels, and the assistance of individuals with impaired vision. While the science of creating smart contact lenses has advanced considerably, a significant challenge remains: the development of a power source capable of sustaining these devices for extended periods of time. The applications of wearable contact lenses offer a unified field of application in terms of both the electronics and biomaterials disciplines. This review article examines the diverse range of contact lens materials suitable for bioelectronics, encompassing PMMA, PET, PVA, hydrogel-based, silicon-based, and nanomaterial types, among others. It also explores studies investigating these materials in biosensing applications, including diabetic contact lenses, glucose sensing, drug delivery, and the detection of enzymatic biomarkers. [ABSTRACT FROM AUTHOR]

Although microplastics (MPs) are intrinsically toxic and function as vectors for organic micropollutants, their discharge from wastewater treatment plant effluents and human activity remains unknown owing to the limitations of detection and treatment technologies. It is imperative to quantify MPs from human activities involving the consumption of various plastic products. This study warns that contact lenses can generate MPs and nanoplastics (NPs) after being discharged into aquatic environments. Identification via micro-Fourier transform infrared spectroscopy revealed that the fragmented particles (from a few tens to a few hundred micrometres) could not be detected as poly(2-hydroxyl methacrylate), the component of contact lenses, owing to changes in its chemical properties. After the degradation process, the median size of the contact lens particles decreased from 313 to 85 µm. Approximately 300,600 g of contact lens waste is discharged into sewage systems daily in the United States of America (USA), where 45 million people wear contact lenses and throw away one-fifth of them every day. Contact lens waste (1 g) has the potential to release 5653.3–17,773.3 particles of MPs. This implies that the currently reported MP amounts in the environmental matrix exclude significant amounts of MPs and NPs from discharged contact lenses. The identification method should be examined, and a registration of the disposal process should be established.

Introduction: Fungal keratitis can be influenced by different genetic, environmental, and even iatrogenic factors that the impact of such factors can be very different in various populations. Thus, it should be attempted to provide a clear picture of the epidemiological situation of this disease in different areas. The aim of this study was to investigate the epidemiological aspects of fungal keratitis in a population sample from northern Iran. Methods: This cross-sectional study was conducted on all consecutive patients clinically suspected to fungal keratitis that were ultimately diagnosed by positive fungal culture that admitted to Amiralmomenin hospital in Rasht city, Iran, between 2011 and 2019. The sampling method was census. The required information was collected by reviewing the hospital's recorded files. Results: Forty seven patients were examined in the study that 53.2% of the patients were men. Among the population of women, housewives-farmers with the prevalence rate of 45% and among the population of men, those with farm occupation with the prevalence rate of 52% formed the most common occupational subgroups. Most patients (89.3%) had no history of any ocular surgery or manipulation. Aspergillus was the most frequent pathogen (23.4%) followed by Penicillium (19.1%) and Fusarium (17.0%). History of chronic disorders was also revealed in 44.6%. The results of smear and culture obtained from the study were as follows: in 8.5% of patients as positive smear and positive culture, and in 91.5% as negative smear and positive culture. Only 2.1% used the lens. Conclusion: Fungal keratitis affects our male population slightly higher than females with the highest overall prevalence rate in the sixth and seventh decades of life. The most frequent fungal strains responsible for fungal keratitis include Aspergillus followed by Penicillium and Fusarium. [ABSTRACT FROM AUTHOR]

A switchable contact lens prototype was fabricated and tested with integrated off the shelf electronic components to drive a liquid crystal (LC) active lens element. This prototype was capable of changing its focal power by an average of +1.9D, but a maximum of +3.2 ± 0.2D was also measured. Switchable focus contact lenses are intended to help restore functional near and intermediate vision accommodation to those suffering from presbyopia, an inevitable age-related eye condition. The custom poly-methyl-methacrylate contact lens substrates used in this prototype are equivalent to commercially available scleral contact lenses. It was discovered that more careful design considerations are needed when at least one of the substrates is <100 µ m thick (which is needed for a final device). Without these design considerations, the switchable focal power of the lens is susceptible to change as the LC insert layer is able to flex. The prototype has an on-board electronics platform which was self-powered with a battery. Illuminating the electronics package with a 600 Hz infrared signal switched the device on, which passed an AC voltage to the electrodes of the contact lens, reorientating the director of the LC with an electric field. To our knowledge, this is the first demonstration of a battery powered and wirelessly triggered smart contact lens for the treatment of presbyopia. [ABSTRACT FROM AUTHOR]

[Display omitted] Although wetting agents have been developed to limit tear film dewetting over contact lenses, systematic analyses correlating wetting agent properties to mechanisms of the tear film destabilization are not readily available. Clarifying destabilization characteristics across key physio-chemical variables will provide a rational basis for identifying optimal wetting agents. We employ an in-house, in vitro platform to comprehensively evaluate drainage and dewetting dynamics of five wetting agents across seventeen different formulations and two model tear film solutions. We consider the film thickness evolution, film thickness at breakup, dewetted front propagation, and develop correlations to contact angle to compare the samples. Zwitterionic wetting agents effectively stabilize the tear film by reducing the film thickness at the onset of dewetting, and delaying the propagation of dewetted regions across the lens. Furthermore, tuning wetting agent surface concentrations and utilizing binary mixtures of wetting agents can enhance wetting characteristics. Finally, despite disparities in wetting agent molecular properties, the time to dewet 50 % of the lens scales linearly with the product of the receding contact angle and contact angle hysteresis. Hence, we fundamentally establish the importance of minimizing the absolute contact angle and contact angle hysteresis for effective wetting performance. [ABSTRACT FROM AUTHOR]

Dry eye disease (DED) is difficult to detect in young contact lens (CL) wearers, who usually have no signs, mild symptoms and an ocular surface disease index (OSDI) below the DED diagnosis values (OSDI ≥ 13). We investigate if some of the 12 OSDI questions (OSDI A—ocular symptoms; OSDI B—vision-related functionality; OSDI C—environmental triggers) contribute the most to classify young CL as symptomatic. TBUT and tear volume are also measured. Age, gender and refraction error-matched eye glasses (EG) wearers participated as the control. CL and EG data were compared with t-test and z-test. Confusion matrices and logistic correlation analyses were performed to define the contribution of each OSDI question to classify symptomatic subjects. OSDI classified symptomatic CL better than the tear volume or TBUT values. In CL, only OSDI B and C values were significantly higher in symptomatic vs. asymptomatic subjects (p < 0.001), while values of all twelve OSDI questions were significantly higher in symptomatic vs. asymptomatic EG (p < 0.05–0.001). All OSDI questions contribute equally to identify symptomatic EG, while only OSDI B questions on daily life visual functions are significant to classify symptomatic CL wearers at risk to develop DED or at a subclinical stage. CL wearers scoring ≥ 2 on the OSDI B questions should be considered for preventive treatments, even if their clinical sings are scarce or absent. [ABSTRACT FROM AUTHOR]

Questionnaires can provide unique information regarding the status of a condition from the perspective of the patient. Contact lens (CL) discomfort (CLD) is a condition subjectively reported by CL users; thus, updated and reliable questionnaires are needed. The objective of this study was to design a new questionnaire for identifying CLD, based on the currently established CLD definition considered in the Tear Film and Ocular Surface CLD Workshop. A survey to characterise CL wearers was created and administered. Some items of the survey were selected by a focus group and analysed using a Rasch model to develop a questionnaire to identify CLD. Unidimensionality was checked applying principal components analysis. To build a plausible CLD classification (symptomatic vs asymptomatic), an unsupervised cluster analysis was used. Gower's general similarity coefficient, the partitioning around medoids algorithm, and the silhouette width were calculated. The reliability of the questionnaire was assessed using the intraclass correlation coefficient and Cohen's kappa coefficient. A study was performed to compare this questionnaire with the Contact Lens Dry Eye Questionnaire (CLDEQ)-8. The 31-item survey was completed by 1104 volunteers, and the posterior analysis resulted in a 9-item questionnaire, the Contact Lens Discomfort Index (CLDI). It showed a good fit with the model (mean square infit and outfit values range was 0.76–1.10), and good unidimensionality (eigenvalues ≤ 1.3). The CLDI score range was 0–18 and the cut-off score for identifying CLD was 8. The intraclass correlation coefficient was 0.88 (95% confidence interval, 0.75–0.94), and kappa was 0.67 (95% confidence interval, 0.41–0.93). Comparison of the CLDI with the CLDEQ-8 in a sample of 58 CL wearers showed that 70.7% were classified equally by both questionnaires. The CLDI is a well-structured instrument, with acceptable psychometric properties, making it a valid and reliable tool to measure CL-related symptoms. [ABSTRACT FROM AUTHOR]

Background: Free-living amoebae (FLA) such as Acanthamoeba spp., are considered as opportunistic and pathogenic protozoans. Acanthamoeba granulomatous encephalitis (AGE) is a serious threat for immunodeficient patients and Acanthamoeba keratitis (AK) for contact lens users. We aimed to identify the presence of free living amoebae in nasal swabs of patients and contact lens users in Qazvin, Iran. Methods: During 2019, 251 nasal and oral swabs (including the pharynx and mouth) were collected from patients with diabetes, AIDS and those under periodic dialysis in Qazvin, Iran. In addition, 27 soft contact lenses were collected from the participants. Following DNA extraction, PCR and sequencing were conducted to identify the genotypes of the amoeba. Phylogenetic analysis of the identified sequences was performed using MEGA 7 software. Results: A strain of Acanthamoeba belonging to the T3 genotype was isolated from hemodialysis patients. Two specimens of Acanthamoeba with T3 genotype were isolated from keratitis patients. Conclusion: The clinicians should pay attention to the possible complication of this organism because this amoeba is potentially pathogenic for immunocompromised patients. Since the amoeba is present in environmental resources, the use of contact lenses should be accompanied by considering proper hygiene. [ABSTRACT FROM AUTHOR]

The study of oxygen consumption rate under" in vivo" human cornea during contact lens wear has been technically a challenge and several attempts have been made in the last 20 years to model the physiology of the human cornea during contact lens wear. Unfortunately, some of these models, based on a constant corneal oxygen consumption rate, produce areas on the cornea where the oxygen tension is negative, which has no physical sense. In order to avoid such inconsistency, different researchers have developed alternative models of oxygen consumption, which predict the likely oxygen metrics available at the interface cornea/post lens tear film by determination of oxygen flux, oxygen consumption, and oxygen tension through the different layers (endothelium, stroma, and epithelium). Although oxygen deficiency produces corneal edema, corneal swelling, hypoxia, acidosis, and other abnormalities, the estimation of the oxygen distribution below the impact of a contact lens wear is interesting to know which lens transmissibility was adequate to maintain the cornea and avoid epithelial and stromal anoxia. The estimation of minimum transmissibility for a lens for extended wear applications will be very useful for both clinicians and manufacturers. The aim of this work is to present a complete discussion based on Monod kinetics model that permits give an estimation of oxygen partial pressure distribution, the profile distribution of corneal flux and oxygen consumption rate, and finally the estimation of the relaxation mechanism of the cornea depending on the oxygen tension at the interface cornea/post lens tear film. Relaxation time in this context can quantify the capability of the corneal tissue to adapt to increasing concentrations of oxygen. It is proposed this parameter as a biological meaningful indicator of the interaction between contact lens polymers and living tissues such as the corneal cellular layer. [ABSTRACT FROM AUTHOR]

Introduction: Contact lens wearers who do not follow proper eye hygiene are at risk of sight-threatening protozoan keratitis, which can be complicated by fungal keratitis. If timely and proper treatment is instituted, the progression of infection can be stopped and serious ocular complications can thus be prevented. Acanthamoeba keratitis is often associated with contact lens wear. However, to our best knowledge, its coexistence with Fusarium has not been reported in a pediatric contact lens wearer. Case presentation: The aim of the paper is to present a case report of severe protozoan-fungal keratitis in a contact lens wearer. Despite delayed but intensive antiprotozoan, antifungal treatment and corneal transplantation, corneal ulceration resulted in endophthalmitis. The subsequent intervention, i.e., a combination of vitrectomy and corneal transplantation, failed to prevent the spread of infection. As the condition was considered to be life-threatening, a decision was made to perform evisceration. Conclusions: Improper eye hygiene by contact lens wearers promotes the development of corneal infections. Late diagnosis and proper but delayed treatment caused spread of the infection and severe ocular complications. [ABSTRACT FROM AUTHOR]

Giant papillary conjunctivitis (GPC), which is the most severe type of contact lens–induced (CL) papillary conjunctivitis (CLPC), is an inflammatory condition of the upper tarsal conjunctiva. Major symptoms of CLPC include irritation, pain, itching, and redness of the ocular surface. This review provides an update on our current understanding of the pathogenesis and treatment of GPC. GPC is most often associated with the use of non-disposable soft contact lenses (SCL), or soft hydrogel lenses, and infrequent CL replacement. Patients with GPC may require both temporary cessation of CL wear and treatment with medications such as topical mast cell stabilizers, antihistamines, non-steroidal anti-inflammatory agents, or steroids. [ABSTRACT FROM AUTHOR]

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.

A congenital cataract is preventable blindness in children and is associated with intrauterine rubella infection known as congenital rubella syndrome (CRS), mostly found in developing countries. This study aims to describe the profile of unilateral cataracts in children with CRS, which are more difficult to manage than bilateral ones. As a retrospective study, we reviewed complete medical records of children with CRS and unilateral cataracts at Cipto Mangunkusumo hospital from 2017 to 2020. Fifteen patients were included, mostly male and from outside Jakarta.The mean age of onset was 2.9 months, while the average age at first presentation and surgery was 27.7 months and 29.1 months, respectively.No correlation was found between patients’ residential distance from the hospital towards duration between onset of symptoms and first presentation to the hospital. 100% and 66.7% of patients had leukocoria and microcornea as ocular manifestations. The majority of systemic manifestations are congenital heart disease.66.7% of children underwent cataract surgery without IOL implantation. Improvement of visual acuity postoperatively was observed in 13.3% of patients, and 66.7% of patients used contact lenses for visual rehabilitation. 60% of patients had posterior capsule opacity within six months of follow-up. The challenge of wearing contact lenses in children makes the risk of amblyopia even greater