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Background: The dropout rate of contact lens users has not decreased significantly over the years. Despite continuous improvements in contact lens (CL) designs, materials and surface treatments, the number of CL users who drop out remains similar to the number of new CL users. The aim of this study is to analyse the improvement in contact lens-associated dry eye disease (CLADE), quantified with the OSDI questionnaire when changing maintenance system solution from multipurpose solution to hydrogen peroxide., Methods: This study included contact lens users for over a year as the multipurpose solution for the maintenance system, suffering from CLADE, and those who scored over 13 in the ocular surface disease index questionnaire, and did not manifest any clinical signs over 3 in the EFRON scale. The non-parametric data distribution was verified with the Kolmogorov-Smirnov test and Wilcoxon signed-rank test, which was used to compare the visual acuity (VA), OSDI score and bulbar redness (EFRON scale) of the follow-up visit against the baseline value., Results: Thirty-eight patients were included. Analysing the clinical parameters between the initial and final visit after one month of hydrogen peroxide use, a statistically significant improvement was found in the VA, bulbar hyperemia, OSDI scale and their subscales of the total sample ( P  < 0.04)., Conclusion: This study is intended as a first step towards a standardised protocol of actions to improve CLADE in an attempt to reduce contact lens dropout using OSDI as a tool for detection., Competing Interests: Susana Castro, Laura Garcia-Aguilar, Eduardo Garcia-Brion, Sofia Perez-Garcia, Consuelo Rosique and Carmelo Baños are employed by General Optica., (©2024 Castro et al.)

Objectives: To retrospectively compare frequency of contact lens (CL) complications in soft CL users of hydrogen peroxide (H2O2) and multipurpose solutions (MPS)., Methods: This was a multicenter, retrospective chart review of CL records from each patient's three most recent eye examinations at academic and private practices. Patients must have used the same solution type for at least 3 years. Univariate analyses were conducted using t tests, and chi-square or Fisher's exact test for categorical measures., Results: There were 1,137 patients included, with 670 (59%) using MPS and 467 (41%) H2O2. In total, 706 (62%) experienced at least one complication; 409 used MPS and 297 used H2O2. There was no difference in the proportion of patients experiencing at least one complication between MPS (61%) and H2O2 (64%) (P=0.38). Multipurpose solutions users were more likely to report discomfort compared with H2O2 users (P=0.04). Presumed microbial keratitis was experienced by 16 MPS and nine H2O2 users (P=0.60)., Conclusions: No significant differences were found in the frequency of CL complications between MPS and H2O2. H2O2 users were less likely to report discomfort and thus switching to a H2O2 system may be an alternative in CL users with discomfort., Competing Interests: J. J. Nichols: Alcon (research and consultant), Bruder Healthcare (research and spouse-consultant), Allergan (spouse-consultant and spouse-research), Kala pharmaceuticals (spouse-research and spouse-consultant), Olympic Ophthalmics (consultant), Shire (consultant and spouse-consultant), Johnson and Johnson Vision Care (research), Sun Pharmaceuticals (spouse-consultant), ScienceBased Health (spouse-consultant), Oyster Point (spouse-consultant), Sight Sciences (spouse-consultant), Silk Technologies (spouse-consultant), Topivert (spouse-consultant), TearSolutions (spouse-research), Tearfilm Innovations (spouse-stock/other equity) CORE has received research funds from Alcon, Allergan, CooperVision, GL Chemtec, J&J Vision, Menicon, Nature's Way, Novartis, PS Therapy, Shire, SightGlass, and Visioneering. Dr. L. W. Jones (PI) has received honoraria from Alcon, CooperVision, Johnson & Johnson Vision, Santen and Shire, and has served on advisory boards for Alcon, CooperVision, Johnson & Johnson Vision, Novartis, and Ophtecs. K. Walsh has received honoraria from Alcon, CooperVision, and Johnson & Johnson Vision. The remaining authors have no conflicts of interest to disclose., (Copyright © 2020 Contact Lens Association of Ophthalmologists.)

Purpose: To evaluate the risk factors associated with contamination of lens cases in a group of orthokeratology (ortho-k) lens wearers., Method: Ortho-k patients attending the Contact Lens Clinic of the Hospital were required to complete a checklist about their routine daily care and handling of lens cases. Their cases were then collected for analysis. Contamination was evaluated by determining the optical density (OD) of crystal violet stained biofilm present in the cases. OD values were divided into three groups, lower, middle, and upper tertiles, and associations between risk factors were determined by multivariate analysis., Results: A total of 194 subjects were recruited. Twenty-five subjects used cylindrical lens cases (CC), 98 flat cases with ridges (FCR), and 71 flat cases without ridges (FC). FCRs were the most heavily contaminated and CC showed least contamination (FCR > FC, OR 2.16, CI 1.11-4.18, p =  0.023; FCR > CC, OR 8.86, CI 2.97-26.44, p <0.001; FC > CC, OR 2.33, CI 1.35-12.45, p =  0.013). Replacing lens cases monthly significantly reduced the risk of high contamination (OR 0.013, CI 0.06-0.30, p <  0.001), compared to those used for three months. Cases that were not rinsed (OR 3.44, CI 1.50-7.86, p =  0.003) or rinsed by other methods (OR 4.07, CI 1.67-9.92, p =  0.002) had significantly more contamination, compared to those rinsed with multipurpose solution. Lens cases, which were not dried (OR 11.36, CI 2.06-62.93, p =  0.005) or air-dried (OR 8.71, CI 1.16-65.56, p =  0.036), showed more contamination compared to those wiped with tissue daily., Conclusion: Case design (cylindrical), monthly replacement, daily rinsing with MPS, and wiping with tissue daily can effectively reduce biofilm formation in contact lens cases., (Copyright © 2019 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To compare the biocompatibility and subjective symptoms of four multipurpose solutions marketed in Palestine with hydrogel contact lenses., Methods: 50 habitual soft contact lens wearers were recruited in this interventional crossover study. Subjects were asked to attend the optometry clinic five times. A new pair of hydrogel lenses (Bioxifilcon-B) were fitted each time. This pair was soaked randomly overnight in one of the following four-multipurpose solutions (NEOPLUS ® , AvizorUnicaSensitive ® , ReNuMultiPlus ® and COMPLETERevitaLens ® ) which contain different disinfecting agents (PHMB, Phx, PAPB, and PQ-1+Alexidine, respectively), or non-preserved saline. At each visit, corneal staining, ocular redness and subjective symptoms were assessed., Results: The percentage of corneal staining increased significantly (P≤0.050) after soaking the lenses with PHMB (86%), PAPB (64%) and Phx (32%) based-solutions. However, a non-significant increase was noticed after the use of PQ-1+Alexidine based solution (30%, P=0.083). Ocular redness evaluation showed a significant increase (P≤0.050) in limbal hyperemia after the use of all solutions, while bulbar redness was significantly increased after the use of biguanide-based solutions (P≤0.050). The subjective assessment analysis showed a non-significant change in comfort, dryness, photophobia and scratchiness (P≥0.050) at 2-h intervention using all solutions, except for the PHMB based solution which showed a significant change in subjective symptoms (P≤0.050)., Conclusion: The combination of Bioxifilcon-B hydrogel contact lenses and solution containing PHMB, PAPB and Phx-disinfectants induced a significant increase in corneal staining after 2h of CL-wear with a higher severity when the PHMB-based solution was used, while the PQ-1+Alexidine-based solution did not. Only the PHMB-based solution triggered a significant change in subjective symptoms which might which suggests that it might be related to the severity of staining rather than the induction of staining., (Copyright © 2019 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.)

Free-living amoebae (FLA) are widely spread in the environment and also known to cause rare but often serious infections. The present work focuses on a local survey on FLA. It is essential to know the prevalence and distribution of these microorganisms in order to get infections caused by them under control. In this study, FLA isolated from domestic tap water samples from homes of contact lens wearers were identified by morphology and by 18S rRNA gene sequence analysis. Morphological analysis and partial sequencing of the 18S rDNA revealed the presence of Acanthamoeba genotype T4 and Vermamoeba vermiformis in the investigated tap water samples. Naegleria fowleri, Balamuthia mandrillaris, and Sappinia spp. were not detected during this study. It was shown that species of FLA known to cause eye infections in humans are widely distributed in tap water in Istanbul, Turkey. Contact lens wearers should be aware of the risk of contamination from tap water and strictly apply stringent contact lens hygiene. With this study, we established Acanthamoeba genotype T4 and Vermamoeba vermiformis as contaminants of tap water in Istanbul., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: To elucidate the bioburden of a lens care system in patients with contact lens (CL)-related keratitis., Methods: In this prospective case-control study, the CL storage case was used as the target of bioburden assessment. Participants were CL wearers with (n = 26) or without (n = 24) keratitis in southern Taiwan. The case fluid sample was consecutively collected and assessed using a dot hybridization assay (DHA) for bioburden assessment. The DHA was composed of 3 universal bacterial probes for detecting all bacteria, genus-specific probes for Pseudomonas and Acinetobacter, and 1 probe for Acanthamoeba. The receiver operating characteristic curve was used to analyze the differentiating performance of a probe., Results: The storage case bioburden was significantly higher in those with CL-related keratitis than in control subjects; patients with CL-related keratitis had stronger standardized signals in all universal bacterial probes. Moreover, in the cases of these patients, the bioburden was significantly heavier in confirmed infectious keratitis than in presumed noninfectious keratitis. Receiver operating characteristic analysis showed that stronger signals in all 3 universal bacterial probes and the Pseudomonas probe might suggest that the wearers have infectious keratitis. Only the storage case of the Acanthamoeba keratitis case showed positive detection by the Acanthamoeba probe., Conclusions: A heavier bioburden in the lens storage case was associated with a higher risk of CL-related keratitis and infectious keratitis. Inappropriate maintenance of the CL will lead to microbial contamination and transfer the pathogen onto the ocular surface causing keratitis accordingly. The DHA assessment for the lens storage case might provide an alternative way to differentiate infectious from noninfectious CL-related keratitis.

Objectives: This article will examine the current literature, as it relates to contact lens discomfort (CLD) secondary to contact lens solutions. The reader will better understand the characteristics of contact lenses, as they uniquely interact with each type of contact lens solution and also gain a better comprehension of the components of contact lens solution such as preservatives, surfactants, and chelating agents, which may contribute to discomfort. By investigating corneal staining theory and the mechanisms that contribute to its presence, the reader will gain insight into this clinical finding, which relates to selection of contact lens solutions. The FDA standards for testing solutions and how this relates to contact lens keratitis will also be appraised in regards to current ISO recommendations. Finally, better selection of multipurpose contact lens solution (MPS) and hydrogen peroxide-based solutions for patients should be accessible to the clinician based on this review and preexisting clinical findings or diagnoses., Methods: A review of current published literature from peer reviewed journals and online journals was conducted to gain an understanding of contact lens solution's impact on contact lens discomfort., Conclusions: Many studies have been conducted comparing comfort between various types of contact lens solutions. It is challenging to decipher this information and apply it clinically when selecting solutions for patients. By comparing solution components, how contact lens solutions interact with different types of lenses, keratitis related to contact lenses, and preexisting ocular conditions, this review will improve a clinician's ability to eliminate CLD.

Multipurpose contact lens disinfecting solutions (MPDS) are widely used to cleanse and disinfect microorganisms. However, disinfection efficacy of these MPDS against Acanthamoeba cyst remain insufficient. 2, 6-dichlorobenzonitrile (DCB), a cellulose synthesis inhibitor, is capable of increasing the amoebical effect against Acanthamoeba by inhibiting its encystation. In this study, we investigated the possibility of DCB as a disinfecting agent to improve the amoebicidal activity of MPDS against Acanthamoeba cyst. Eight commercial MPDS (from a to h) were assessed, all of which displayed insufficient amoebicidal activity against the mature cysts. Solution e, f, and h showed strong amoebicidal effect on the immature cysts. Amoebicidal efficacy against mature cysts remained inadequate even when the 8 MPDS were combined with 100 μM DCB. However, 4 kinds of MPDS (solution d, e, f, and h) including 100 μM DCB demonstrated strong amoebicidal activity against the immature cysts. The amoebicidal activity of solution d was increased by addition of DCB. Cytotoxicity was absent in human corneal epithelial cells treated with either DCB or mixture of DCB with MPDS. These results suggested that DCB can enhance the amoebicical activity of MPDS against Acanthamoeba immature cyst in vitro.

Introduction: The aim of this study was to describe the prevalence of AK among microbial keratitis as well as their clinical features and to compare their risk factors to those of other infectious keratitis, over the last five years in a referral center in the region of Cap Bon, Tunisia, North Africa., Methods: A retrospective review of the charts of 230 patients (230 eyes) diagnosed with presumed infectious keratitis between January 2011 and December 2016 at the department of ophthalmology of the university hospital of Nabeul in Tunisia. After a detailed ocular examination using standard technique, corneal scrapes were performed under aseptic conditions from each ulcer. Plates were incubated at 30 °C and screened daily for Amoeba. The treatment was adjusted according to the results of microbiological findings and the response of initial treatment. The mean follow up was 11.4 months (1 month-26 months)., Results: A total of 230 corneas were scraped. The prevalence of Acanthamoeba keratitis was 6% (14 cases of 230). All cases of Acanthamoeba keratitis with a history of contact lenses were diagnosed thanks to the test of Contact lenses, their cases or their storage solution, while their corneal scrapings were negative. The corneal scraping was positive for Acanthamoeba only in 4 cases of 14. Acanthamoeba was identified more in young patients (92.8%). Significantly, more patients (54 of 74; 73%) with fungal keratitis and Acanthamoeba keratitis (11 of14; 78.6%) were rural population The most cases of Acanthamoeba keratitis (10 of 14; 71.4%) used contact lenses. Ocular injury was identified in 4 cases of 14 AK (28,5%). Coexistent ocular disease was seen in seven cases of 14 (50%). Of the 230 microbial keratitis, an early diagnosis (≤30 days) was done in 200 cases (86.95%), while a late diagnosis (≥30 days) was made in 30 cases (13%). In AK, most cases (11 of 14; 78,5%) were diagnosed with a delay of more than 30 days. Slit-lamp examination showed stromal infiltrate in 12 cases (85,7%), hypopion in 2 cases (14,3%), immunitary ring in 2 cases (14,3%) and radial keratoneuritis in one case (7,1%)., Conclusion: Contact lenses were identified as the main risk factor of Acanthamoeba keratitis in our study. The diagnosis of AK should be considered in case of atypical keratitis especially among CL wearers in the rural regions of CapBon where the rules of hygiene are not respected., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To assess the incidence of adverse events during the use of a povidone-iodine disinfecting solution (cleadew) and the microbial contamination in contact lens cases., Methods: A prospective, single-center, open-label, controlled study evaluating the use of cleadew cleaning and disinfecting system in existing daily wear soft contact lens wearers over a 3-month period was conducted. Ocular signs and symptoms during lens wear were assessed at baseline and after 1 and 3 months of using cleadew. Contact lens cases were assessed for the frequency of microbial contamination and the types of microbes, using traditional microbial culture, followed by identification of bacteria using 16S rRNA sequencing., Results: Use of cleadew was well tolerated. There was reduction in corneal staining (0.5±0.5 at 3 months of use) compared with the participant's habitual multipurpose disinfecting system (1.1±1.0); all other clinical signs were not significantly different. There were no cases of solution-induced corneal staining. There was a low adverse event rate of 0.8% per 100 participant-months. Contact lens case contamination was low, with 30% of cases having no culturable microbes. Comparison with previously published data showed that use of cleadew resulted in low frequencies of Gram-positive (49%) and fungal (8%) contamination and a low, but higher than some other disinfecting solutions, level of Gram-negative bacteria., Conclusions: Cleadew cleaning and disinfecting system was associated with low levels of adverse events during use. Contact lens cases were significantly less frequently contaminated than for some other types of disinfecting solutions.

Purpose: To ascertain the effect that four contact lens (CL) multipurpose solutions (MPS) have on the viability and release of pro-inflammatory cytokines from human corneal epithelial cells (HCEC)., Methods: HCEC were exposed to four different MPS at various concentrations for 18 hours. The cells were also exposed to phosphate buffer, borate buffer, and PHMB. The cell viability was evaluated using the alamarBlue assay. The release of pro-inflammatory cytokines was measured using a Multiplex electrochemiluminescent assay., Results: MPS-A, MPS-B and MPS-C all reduced cell metabolic activity p < 0.05 from control with MPS-A showing the greatest cytotoxic effect (maximum reduction, 90.6%). In contrast, MPS-D showed no significant reductions in cytotoxicity except at the highest concentration tested (19% reduction at 20% MPS concentration). Of the four cytokines evaluated MPS-C showed a substantial increase in the release of IL-1β, IL-6, IL-8, and TNF-α at higher concentrations when compared to control p < 0.05. At the 20% concentration of MPS-A and MPS-B the release of IL-1 β increased p < 0.05 but the release of IL-6, IL-8, and TNF-α decreased. MPS-D did not cause a change in the release of cytokines IL-1β, IL-6, IL-8 and TNF-α p > 0.05. Exposing the cells to borate buffer and PHMB caused an increase in the release of TNF-α p < 0.05., Conclusions: This investigation demonstrates that at different concentration levels, several of the MPS tested showed a decrease in viability and an increase in the release of inflammatory cytokines from HCEC. The borate buffer component as well as PHMB appears to contribute to this pro-inflammatory reaction., (Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: The aim is discussing the origins of worsening of external eye condition (EEC) and of tear film (TF) instability after wear of silicone-hydrogel contact lenses (CLs) with hydrogen-peroxide (H 2 O 2 ) care system., Methods: EEC and TF stability were evaluated before and after 15days of wear combined with different care systems: (1) H 2 O 2 , (2) detergent solution and H 2 O 2 , (3) multipurpose solution (MPS), (4) H 2 O 2 and artificial tears. In-vitro cell mortality tests were performed after 24h cell incubation with CLs treated with H 2 O 2 . Photon correlation spectroscopy (PCS) was carried out on tears of non-wearers and CL wearers who used MPS or H 2 O 2 solution., Results: Worsening of EEC was observed only for the group using H 2 O 2 (group 1). In-vitro, cell mortality was found higher for worn CL than for unworn CLs. Worsening of TF stability was observed regardless of care system and also PCS results on tears of CL wearers were found different compared to non-wearers regardless of care system. The only observed remedy for tear instability of CL wearers was found to be the administration of artificial tears., Conclusions: Worsening of EEC of CL wearers using H 2 O 2 is attributed to H 2 O 2 scarce cleaning efficacy, which can be solved by adding a CL detergent solution. The origin of TF instability is found to be different. A remedy was found to be the administration of artificial tears, whose effect could be attributed either to the role of specific components or to rinsing and replacement of TF during wear., (Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To understand soft contact lens (SCL) and gas-permeable (GP) lens wearers' behaviors and knowledge regarding exposure of lenses to water., Methods: The Contact Lens Risk Survey (CLRS) and health behavior questions were completed online by a convenience sample of 1056 SCL and 85 GP lens wearers aged 20 to 76 years. Participants were asked about exposing their lenses to water and their understanding of risks associated with these behaviors. Chi-square analyses examined relationships between patient behaviors and perceptions., Results: GP lens wearers were more likely than SCL wearers to ever rinse or store lenses in water (rinsing: 91% GP, 31% SCL, P < 0.001; storing: 33% GP, 15% SCL P < 0.001). Among SCL wearers, men were more likely to store (24% vs. 13%, P = 0.003) or rinse (41% vs. 29%, P = 0.012) their lenses in water. Showering while wearing lenses was more common in SCL wearers (86%) than GP lens wearers (67%) (P < 0.0001). Swimming while wearing lenses was reported by 62% of SCL wearers and 48% of GP lens wearers (P = 0.027). Wearers who rinsed (SCL; P < 0.0001, GP; P = 0.11) or stored lenses in water (SCL; P < 0.0001, GP P = 0.007) reported that this behavior had little or no effect on their infection risk, compared with those who did not. Both SCL (P < 0.0001) and GP lens wearers (P < 0.0001) perceived that distilled water was safer than tap water for storing or rinsing lenses., Conclusions: Despite previously published evidence of Acanthamoeba keratitis' association with water exposure, most SCL, and nearly all GP lens wearers, regularly expose their lenses to water, with many unaware of the risk.

We aim to highlight the key factors for a good outcome of fungal keratitis. We describe a case of contact lens-related Fusarium keratitis in a young girl. After identification of Fusarium spp under direct microscopic examination and in culture, a prolonged treatment with topic natamycin 5% was started and administered for five months with restitutio ad integrum of the eye. Prompt microbiological diagnosis and a specific and prolonged treatment are essential for correct management of Fusarium keratitis.

Purpose: To determine whether variations in multipurpose disinfecting solution (MPDS) storage osmolarity from inappropriate contact lens (CL) case cleaning affect ocular surface integrity and wearer comfort., Methods: There were twenty contact lens cases (study CLCs) in the study group. Ten were filled with ReNu Multiplus(®) and 10 with SoloCare Aqua™ (MPDS-1 and -2, respectively) and kept closed for 8h; the cases were then emptied and kept open for air-drying for 16h. This procedure was carried out every day for two months. Storage solution osmolarity was measured on days 0, 15, 30, 45 and 60. Ten subjects were then fitted with both month-old lenses stored in the study CLCs and with new lenses stored in new cases with fresh solution for 24h (control CLCs). Symptoms, tear osmolarity and percentage of subjects whose conjunctival hyperaemia and ocular surface staining scores changed were determined after 1h of wear., Results: Study CLC osmolarity increased in both solutions after two months (p<0.05). For MPDS-1 there were differences in stinging between study CLCs and control CLCs after 10min of CL wear (p=0.04), and in comfort after 10 (p=0.035) and 60min wear (p=0.042). Significant (p<0.05) differences between study CLC and control CLC groups were also found for MPDS-2 in limbal hyperaemia (study: 50% change; control: 0% change) and bulbar and corneal staining (study: 80% change; control: 20% change)., Conclusion: The stored-MPDS osmolarity increase caused by air-drying the CLCs could affect the ocular surface. This increase might reduce lens wear comfort., (Copyright © 2016 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To describe dendritiform keratopathy associated with exposure to polyquaternium-1, a common preservative found in contact lens solutions and tear replacement products., Design: Case series., Participants: Sixteen patients who demonstrated dendritiform keratopathy during topical ophthalmic exposure to polyquaternium-1., Methods: Records were reviewed of all patients diagnosed with dendritiform keratopathy between 1999 and 2014 who had documented exposure to contact lens care disinfecting solutions or artificial tear solutions containing polyquaternium-1. Patients were excluded who had coexisting potential causes for dendritiform keratopathy, such as prior herpes simplex keratitis, varicella-zoster viral keratitis, the linear form of Thygeson's superficial keratitis, epithelial regeneration line, Acanthamoeba keratitis, mucus plaque keratopathy, medication-related keratopathy, or limbal stem cell deficiency characterized by conjunctivalization of the corneal epithelium., Main Outcome Measures: Effect of discontinuation of exposure to polyquaternium-1 on the dendritiform keratopathy., Results: Sixteen patients demonstrated dendritiform keratopathy after exposure to the preservative polyquaternium-1. Thirteen patients had a history of recent exposure to contact lens disinfecting solutions (Opti-Free, Equate) containing polyquaternium-1. Three patients used a tear replacement product (Systane) containing a polyquaternium-1 preservative. Four patients were treated with antiviral medications for presumed herpes simplex keratitis; 4 patients underwent diagnostic testing for Acanthamoeba keratitis. Two additional patients were diagnosed sequentially with herpes simplex keratitis, then Acanthamoeba keratitis before referral. All dendritiform lesions resolved within 2 to 6 weeks after elimination of exposure to polyquaternium-1., Conclusions: Ophthalmic products containing polyquaternium-1 may cause dendritiform keratopathy that may be confused with infections of the superficial cornea, such as herpes simplex virus keratitis or Acanthamoeba keratitis., (Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the safety and efficacy of a new multipurpose disinfecting solution (MPDS) with a formulation that includes aloe vera on its composition., Methods: This is a prospective, randomized, double-masked clinical trial with a crossover design that included seven examinations. Two different MPDSs, Avizor Alvera® (study solution) and All Clean Soft® (control solution), each were used for 1 month. Comfilcon A silicone hydrogel contact lenses were used during the trial. The main outcome variables were corneal staining and deposits on the surfaces of the contact lenses. Other parameters including ocular surface response, contact lens wettability, user satisfaction, and adverse events, were analyzed according to the International Organization for Standardization (ISO) 11980:2010 guidance for clinical investigation., Results: Twenty subjects (10 women, 10 men) (mean age, 27.7±5.6 years; range, 20-41) were included. No differences between both MPDSs were found in the percentage of subjects with corneal staining >0 at day 30 (study: 35%, control: 50%; p=0.46); neither in the percentage of subjects with deposits on the surface of the contact lens >0 at day 30 (study: 26.32%, control: 52.63%; p=0.18). The study MPDS received higher rates in comfort (study: 8.14±1.09, control: 7.94±0.92; p=0.56) and satisfaction at day 30 (study: 8.63±0.91, control: 8.29±0.80; p=0.19), however the scores were not significantly different with the control MPDS., Conclusions: The clinical trial showed that the study MPDS is safe, efficient, and has acceptable physiologic tolerance, according to the ISO 11980:2010 guidance for clinical investigation., (Copyright © 2014 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.)

Objectives: To determine whether Asian and white subjects differ in clinical signs or subjective symptoms in response to the use of different biguanide-preserved contact lens care solutions., Methods: Forty-two subjects (15 Asian and 27 white) wearing lotrafilcon B silicone hydrogel contact lenses used a preservative-free lens care solution bilaterally for 2 weeks, then used two biguanide-preserved solutions (solution 1: ReNu MPS; solution 2: AQuify MPS) contralaterally in randomly assigned eyes for 4 weeks. Comprehensive ocular surface examinations were performed and symptomatology questionnaires were administered every 2 weeks. Investigators were masked as to solution assignment during examinations, whereas subjects were not to avoid potential difficulties in compliance with the protocol., Results: With solution 1, most Asian and white subjects had grade 2 or greater corneal staining after 2 weeks (67% and 59%, respectively) and 4 weeks (60% and 67%, respectively). With solution 2, grade 2 or greater corneal staining occurred in 40% of Asians after 2 weeks and in 13% after 4 weeks, but in only 4% of whites after 2 weeks and 0% after 4 weeks. Whites reported significantly better average comfort (P=0.046) and less dryness (P<0.001) than did Asians., Conclusions: Asians and whites differ in both ocular response to the use of contact lens care solutions and in reporting subjective symptoms. Racial and ethnic differences should be considered when evaluating and treating contact lens patients in a clinical setting.

Purpose: To evaluate the effects of a chemically preserved multipurpose contact lens care solution (MPS) on the corneal epithelial surface and Pseudomonas aeruginosa (PA) internalization in the rabbit corneal epithelium., Methods: Rabbits were fit in one eye with a silicone hydrogel lens (balafilcon A) soaked overnight in a borate-buffered MPS (BioTrue). The contralateral eye was fit with a lens removed directly from the blister pack containing borate-buffered saline (control). Lenses were worn for 2 hours. Upon lens removal, corneas were challenged ex vivo with invasive PA strain 6487 and assessed for PA internalization. Ultrastructural changes were assessed using scanning electron (SEM) and transmission electron microscopy (TEM)., Results: Scanning electron microscopy showed frank loss of surface epithelium in MPS-exposed eyes, while control eyes exhibited occasional loss of surface membranes but retention of intact junctional borders. Transmission electron microscopy data supported and extended SEM findings, demonstrating the presence of epithelial edema in MPS-treated eyes. There was a 12-fold increase in PA uptake into the corneal epithelium following wear of the MPS-treated lens compared to control (P = 0.008)., Conclusions: These data demonstrate that corneal exposure to MPS during lens wear damages the surface epithelium and are consistent with our previous clinical data showing an increase in bacterial binding to exfoliated epithelial cells following MPS use with resultant increased risk for lens-mediated infection. These findings also demonstrate that the PA invasion assay may provide a highly sensitive quantitative metric for assessing the physiological impact of lens-solution biocompatibility on the corneal epithelium., (Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.)

Purpose: A pilot study was conducted to evaluate human corneal epithelial cell shedding in response to wearing a silicone hydrogel contact lens/solution combination inducing corneal staining. The nature of ex vivo collected cells staining with fluorescein was also examined., Methods: A contralateral eye study was conducted in which up to eight participants were unilaterally exposed to a multipurpose contact lens solution/silicone hydrogel lens combination previously shown to induce corneal staining (renu® fresh™ and balafilcon A; test eye), with the other eye using a combination of balafilcon A soaked in a hydrogen peroxide care system (Clear Care®; control eye). Lenses were worn for 2, 4 or 6 hours. Corneal staining was graded after lens removal. The Ocular Surface Cell Collection Apparatus was used to collect cells from the cornea and the contact lens., Results: In the test eye, maximum solution-induced corneal staining (SICS) was observed after 2 hours of lens wear (reducing significantly by 4 hours; p < 0.001). There were significantly more cells collected from the test eye after 4 hours of lens wear when compared to the control eye and the collection from the test eye after 2 hours (for both; n = 5; p < 0.001). The total cell yield at 4 hours was 813 ± 333 and 455 ± 218 for the test and control eyes, respectively (N = 5, triplicate, p = 0.003). A number of cells were observed to have taken up the fluorescein dye from the initial fluorescein instillation. Confocal microscopy of fluorescein-stained cells revealed that fluorescein was present throughout the cell cytoplasm and was retained in the cells for many hours after recovery from the corneal surface., Conclusion: This pilot study indicates that increased epithelial cell shedding was associated with a lens-solution combination which induces SICS. Our data provides insight into the transient nature of the SICS reaction and the nature of fluorescein staining observed in SICS.

Physicians in various specialties-and dermatologists in particular-frequently encounter various forms of inflammation of the eyelids and of the anterior surface of the eye. Distinguishing the cause of itchy, painful, red, edematous eyelids is often difficult. Because the uppermost layer of the eyelids is part of the skin that wraps the entire body, almost every skin disease in the textbook can affect the periorbital area as well. In this contribution, we focused on the most common such disorders that require special consideration, as a result of their special appearance, their challenging diagnosis, or the nature of their treatment. We reviewed the key features of several common dermatides that affect the eyelids, such as atopic dermatitis, seborrheic dermatitis, allergic contact dermatitis, airborne contact dermatitis, rosacea, psoriasis, and others. We focused on the special clinical features, causes, and treatments specific to the delicate skin of the eyelids. Because structures of the eye itself (i.e., the conjunctiva, the cornea, the lens, and the retina) may be involved in some of the discussed periorbital skin diseases, we found it useful to add a brief summary of the eyelid complications of those diseases. We then briefly reviewed some acute sight-threatening and even life-threatening infections of the eyelids, although dermatologists are not likely to be the primary care physicians responsible for treating them., (© 2014 Elsevier Inc. All rights reserved.)

Objective: To compare the short-term clinical performance of two dual-disinfectant multipurpose disinfecting solutions (MPDS) when used in conjunction with two silicone hydrogel contact lenses., Methods: Participants wore galyfilcon A and balafilcon A lenses, randomly allocated one type to each eye. Multipurpose disinfecting solutions were double-masked and allocated using a randomized crossover design. Lenses were presoaked overnight in the allocated MPDS, containing either polyquaternium-1/alexidine dihydrochloride (PQ-alexidine) or polyquaternium-1/myristamidopropyl dimethylamine (PQ-MAPDA). Lenses were worn daily for 4 days and disinfected with the same MPDS in which they had been soaked. Clinical assessments occurred immediately after insertion, 2 hours after insertion, and after 2 hours of wear on day 4. Subjective ratings were collected at each assessment and after 6 hours of wear on days 1 to 3. Linear mixed models were used for statistical analysis., Results: Solution-induced corneal staining (SICS) incidence was significantly different between MPDS lens combinations (P=0.01) with PQ-MAPDA-balafilcon A showing the highest incidence (27.8%). The incidence of SICS was significantly higher when balafilcon A lenses were worn compared with galyfilcon A (19.4% vs. 2.8%; P=0.04). There was no significant difference in SICS incidence between MPDS (PQ-alexidine=5.6%, PQ-MAPDA=16.7%; P=0.08). Polyquaternium-1/alexidine dihydrochloride was associated with significantly fewer symptoms of burning/stinging (9.7±0.6 vs. 9.1±2.2; P=0.03) and self-assessed redness (9.8±0.5 vs. 9.2±1.9; P=0.03) on initial lens insertion. There were no significant differences between MPDS for comfort ratings (P>0.05)., Conclusion: These short-term clinical results provide an initial indication that PQ-alexidine is associated with fewer symptoms on insertion but no significant difference in ocular comfort compared with PQ-MAPDA. Longer studies are required to provide further evidence.

Purpose: To report the performance of various contact lenses and lens care solution combinations based on the combined response of subjective comfort and adverse events (AEs)., Methods: A retrospective analysis of 28 lens/solution combinations each tested on approximately 40 participants who wore their assigned combination on a daily wear basis and were followed for a 3-month period, with visits at baseline, 2 weeks, and 1 and 3 months. Lenses included frequent replacement and daily disposables. Solutions included hydrogen peroxide and multipurpose types. Subjective comfort (scale of 1 to 10) and AEs were collected and reported as a group mean and percentage, respectively. The data were converted into a ratio between 0 and 1 to represent the relative performance within the combination series, with a higher ratio indicating better performance in both AE rates and comfort., Results: The overall AE rate was 3.6 events per 100 participant-months (95% confidence interval [95% CI], 2.7 to 4.7%). The rate was found to be lower in daily disposables compared with that in daily wear lenses (3.1 vs. 10.9%, p < 0.001). The overall comfort on insertion rating was 8.3 (95% CI, 8.1 to 8.4), and comfort at end of day was 7.2 (95% CI, 7.0 to 7.4). Based on the 28 lens/solution combinations, there was no significant correlation between overall AE rates and comfort on insertion or at end of day (Pearson correlation, -0.34, p = 0.08; and Pearson correlation, -0.23, p = 0.25, respectively). Less than 18% of the combinations tested combined good comfort with low AE rates., Conclusions: Both subjective comfort responses and AE rates varied according to the combination of lens type and care system in use. The combinations with the best comfort ratings did not necessarily have a favorable AE rate. Practitioners can maximize behavior with respect to both these factors by choosing an appropriate care system for the lenses they prescribe.

Contact lens-associated corneal infiltrative events (CIEs) are presumed sterile events that have complicated contact lens wear for more than 30 years. There is consistent evidence that silicone hydrogel soft contact lenses increase CIE risk by twofold compared with low Dk hydrogel materials. The incidence of CIEs during silicone hydrogel extended wear ranges from 2% to 6% for symptomatic events and from 6% to 25% when asymptomatic events are included. For daily wear, with silicone hydrogels, the incidence of CIEs ranges from 2% to 3% for symptomatic events and from 7% to 20% when asymptomatic events are included. Despite the increased rate of CIEs with silicone hydrogels, the benefits of these lenses largely outweigh this risk for many patients. Most risk factors for CIEs observed with silicone hydrogels are consistent with CIE risk factors reported earlier with hydrogel lenses, such as bacterial bioburden on lens surfaces, and young age among others. Limiting the transfer of bacterial bioburden from the skin to lenses, lens cases and eventually to the eye is an obvious step forward for the prevention of CIEs across all lens types.

Silicone hydrogel (SiHy) contact lenses were introduced on the market over 10 years ago, and several multipurpose solutions (MPS) have since been developed for their cleaning and disinfection. Depending on the combination of lens and solution, clinical and retrospective studies have shown that different combinations may be more biocompatible than others. In vivo, sodium fluorescein is used to assess the corneal response, whereas in vitro studies typically investigate MPS toxicity by incubating diluted MPS with cells. This difference between in vivo and in vitro measurements makes it difficult to gain a better understanding of the biocompatibility of SiHy-solution combinations. This review discusses the recent progress in characterizing the interactions between sodium fluorescein and corneal epithelial cells and in vitro MPS cytotoxicity using solution on both monolayer and stratified epithelial models. As interactions between MPS and contact lens materials lead to uptake and release of various solution components, in vitro models that take into account the effect of lens material are also presented. With the improvement of advanced characterization methods and new in vitro models, we are moving in the right direction, but more effort is required to fully elucidate the interactions between contact lens, disinfecting solution, and the cornea.

Daily wear of silicone hydrogel (SiHy) lenses using marketed lens care solutions results in varied levels of anterior eye inflammation. There are several pathways that may lead to corneal and conjunctival inflammation that include mechanical, allergic, and pathogen driven stimuli. The hypotheses and evidence for these various models of inflammation will be discussed in the context of SiHy lens designs and materials and lens care solution components.

The author presents the standards for testing the biocidal effectiveness of combined cleaning disinfection solutions (RDK solutions). By means of literature searches it was investigated whether the updated table of the optometrist Gary Andrasko in the internet is usable with respect to compatibility of combinations of commercially available contact lenses and commonly used RDK solutions by assessment of surface dye affinity. The methods used by Andrasko and the scientific basis of his approach are questioned based on various criteria and the value of the table is negated. The instructions for care given by the manufacturers of contact lenses are recommended.

Purpose: To compare the rates of bacterial contamination in cylindrical and flat contact lens cases of orthokeratology (ortho-k) users and to investigate their preference of lens case design based on ease of use and handling., Methods: Twenty-four children receiving ortho-k treatment were recruited. Each subject was given one cylindrical and one flat lens case, of which one side (50% right, 50% left) was sealed to prevent usage. Subjects were instructed to either rinse the case with water and air dry or rinse with multipurpose solution (MPS) and refill with MPS for storage after lens removal. After 1 month, cases were collected for culture, which was performed on the screw top, inner surface of cases, and also the holder for cylindrical cases. Each subject/parent completed a questionnaire about preference of case design., Results: No significant differences in rates of surfaces contaminated were found between cleaning methods. Overall, 30% of both inner surfaces and screw tops of the cases yielded potentially pathogenic organisms, with significantly higher numbers present on both the inner surfaces (p = 0.003) and the screw tops of the flat cases (p = 0.001). Contamination of the inner surfaces with only normal flora occurred exclusively in the flat cases, but the screw tops of both case types frequently yielded only normal flora. Cylindrical case holder contamination was similar to the inner surface. There was a strong preference (75%) for the cylindrical cases, with subjects/parents citing ease of use and cleaning, good appearance and transparency, and reduced amount of MPS used., Conclusions: Although correct lens case care remains the most important factor in reducing contamination of the case, use of the cylindrical case design, preferred by the majority of subjects/parents, significantly reduced contamination in ortho-k subjects. The method used for cleaning the lens case had no effect on the rates of contamination in this study.

Purpose: To evaluate the association of symptomatic soft contact lens (SCL)-related corneal infiltrative events (CIEs) with SCL material, lens care products (LCPs), and other risk factors., Methods: Cases with symptomatic CIEs were identified in a retrospective, multicenter case-control study at five academic eye care centers. Each case was matched to three controls each who had received eye care near the time of the case's last full examination at that center but were not matched for demographic or other factors. Infiltrate status was established by an expert panel who were masked to sponsor, SCL, and LCP brand. Stratified analyses were conducted removing all daily disposable (DD) and all extended wear (EW) cases., Results: Clinical records from 166 patients with symptomatic CIEs and known EW status were included. Cases used >50 SCL brands and >10 LCP brands. Increased risk in univariate analysis for LCP was not significant after adjustment for other factors. In the multivariate analysis of all cases, use of reusable SCLs (4.03×; 95% C.I. 1.12 to 14.67) and EW (3.98×; 2.32 to 6.84) increased risk and patient age (per year older) was protective (0.96×; 0.94 to 0.98). Among daily wear cases (n = 102 cases), use of reusable SCLs (12.46×; 1.54 to 100.62) and silicone hydrogel (SiHy) (1.99×; 1.06 to 3.75) and age (0.95×: 0.92 to 0.97) were associated. Without DD cases (n = 162), EW (4.42×; 2.53 to 7.70), SiHy use (1.84×; 1.03 to 3.29), and patient age (0.96× 0.94 to 0.98) were significant factors. No specific SCL or LCP brands were associated with increased risk., Conclusions: In this community-based trial, younger patients were at increased risk of infiltrative events. DD lenses were protective relative to reusable lenses. Overnight use increased risk in all analyses and silicone hydrogels increased risk in daily wearers, regardless of LCP brand. Improvements in lens storage case hygiene and environment may be a mechanism for reducing risk of CIEs related to SCL use.

Objectives: To evaluate the safety and efficacy of a new multipurpose disinfecting solution (MPDS) containing a diblock copolymer, poly(oxyethylene)-poly(oxybutylene), designed to improve the wetting properties of silicone-hydrogel lenses., Methods: This 90-day, randomized, concurrently controlled, double-masked, multisite study involved 573 subjects at 30 investigational sites in the United states. Existing lens wearers were randomly assigned to either regimen 1 (OPTI-FREE PureMoist, a newly developed formulation, Alcon Laboratories Inc., Fort Worth, TX) or regimen 2 (renu fresh, Bausch and Lomb Inc., Rochester, NY). At baseline, days 7, 30, 60, and 90, the subjects recorded subjective evaluations relating to lens acceptability and comfort, wearing time, and rewetting drop frequency, whereas investigators assessed slitlamp findings (including corneal fluorescein staining), lens deposits (modified Rudko), visual acuity, and adverse events. Group IV lenses were collected for ex vivo measurement of lysozyme deposits., Results: Differences favoring regimen 1 were noted on day 90 for subjective evaluations of lens comfort (insertion, removal, overall); lens moisture and freshness; gentle on eye; clear vision; and lens handling (all P<0.004). Corneal fluorescein staining severity and area and lysozyme deposits (group IV lenses) were lower with regimen 1 (P<0.0001)., Conclusions: This 90-day study shows that the new MPDS designed for silicone-hydrogel lenses is safe and effective when used by both silicone-hydrogel and traditional soft lens wearers. By improving comfort and decreasing lysozyme deposits and corneal fluorescein staining, the new MPDS enhances patients' wearing experience and helps maintain optimal lens performance.

Purpose: To determine the impact of incubation solution composition on protein deposition to silicone hydrogel (SH) contact lenses using a simplistic and a complex model of the tear film., Methods: Three SH materials--senofilcon A (SA), lotrafilcon B (LB), and balafilcon A (BA)--were incubated in two different solutions; Solution A was a simplistic augmented buffered saline solution containing a single protein, whereas Solution B was a complex artificial tear solution (ATS), containing the augmented buffered saline solution in addition to proteins, lipids, and mucins (pH=7.4). The proteins of interest (lysozyme, lactoferrin, albumin) were radiolabeled with Iodine-125 (2% protein of interest) and the accumulation of the conjugated protein to the lens materials was determined after 1, 7, 14, and 28 days of incubation. Protein deposition was measured using a gamma counter and the raw data were translated into absolute amounts (µg/lens) via extrapolation from standards., Results: After 28 days, lysozyme uptake was significantly lower on BA lenses when incubated in Solution A (33.7 μg) compared to Solution B (56.2 μg), p<0.001. SA lenses deposited similar amounts of lysozyme when incubated in either Solution A (2.6 μg) or Solution B (4.1 μg), p>0.05. LB lenses also deposited similar amounts of lysozyme for both solutions (Solution A: 5.0 μg, Solution B: 4.7 μg, p>0.05). After 28 days, BA lenses accumulated approximately twice the amount of lactoferrin than the other lens materials, with 30.3 μg depositing when exposed to Solution A and 22.0 μg with Solution B. The difference between the two solutions was statistically significant (p<0.001). LB materials deposited significantly greater amounts of lactoferrin when incubated in Solution A (16.6 μg) compared to Solution B (10.3 μg), p<0.001. Similar amounts of lactoferrin were accumulated onto SA lenses regardless of incubation solution composition (Solution A: 8.2 μg, Solution B: 11.2 μg, p>0.05). After 28 days, albumin deposition onto BA lenses was significantly greater when lenses were incubated in Solution B (1.7 μg) compared to Solution A (0.9 μg), p<0.001. Similar amounts of albumin were deposited on SA lenses when incubated in either solution (0.6 μg versus 0.7 μg, p>0.05). LB lenses incubated in Solution A deposited more albumin compared to Solution B (0.9 μg versus 0.6 μg), p=0.003., Discussion: Protein deposition onto SH materials varied when contact lenses were incubated in either a complex ATS compared to a single protein solution. More lysozyme accumulated onto BA lenses incubated in a complex analog of the human tear film, whereas lactoferrin deposited onto SA lenses independent of incubation solution composition. To better mimic the ex vivo environment, future studies should use more appropriate analogs of the tear film.

Purpose: The study purpose was to evaluate corneal barrier function and staining relative to potential bioincompatibilities., Methods: This was a randomized double-masked study (n = 25 subjects). Three lens material-care solution combinations were tested: (1) lotrafilcon B/polyhexamethylene biguanide (PHMB)-based multipurpose (MPS) solution (MPS-1); (2) lotrafilcon B/polyquaternium-1 and myristamidopropyl dimethylamine-based solution (MPS-2); and (3) lotrafilcon B and another PHMB-based solution (MPS-3). Saline served as the control. New lenses were soaked in the preserved solutions or saline and then worn for 2 hours before corneal measurements. Barrier function was characterized by the fluorescein penetration rate, corneal amount, both measured with an objective scanning fluorometer. The dye penetration rate ratio, test to control; amount ratio, test to control, and corneal staining were evaluated., Results: The mean rate ratios (± SD) for the combinations were 2.98 (± 3.04), 1.23 (± 1.01), and 1.83 (± 1.77) for MPS-1, MPS-2, and MPS-3 solutions, respectively. Significant ratio differences were found across regimens (P = 0.007); for MPS-1 compared with baseline (P = 0.031) and for MPS-1 compared with MPS-2 (P = 0.007). The statistical results for staining were similar., Conclusions: Use of an objective quantitative physiological method suggests that significant differences in lens solution bioincompatibilities occur that mirror corneal staining data relative to corneal compromise.

Purpose: To evaluate the safety, physiological performance, and effect on ocular tissues of a new multipurpose disinfecting solution (MPDS) specifically formulated for use with silicone hydrogel (SH) contact lenses (CL)., Methods: Two MPDS [solution A (Solo-care Aqua(®), Ciba-Vision) and solution B (Hidro Health(®), Disop)] were randomly assigned and prescribed in a clinical trial in a crossover clinical trial (Registered #293/07/EC; Spanish National Health Department). Only lotrafilcon B CL daily wearers were included. After each solution was used, a masked investigator assessed the slit-lamp findings (SL9, Topcon Inc.), lens deposits, and wettability according to the Guidance for clinical investigation (ISO 11980). CL daily wearing time (hours per day and days per week) were recorded., Results: Fifty-four daily wearers were included. Average CL wear time was 8.3 ± 2.3 (CI95% 7.9-8.7) hours per day (8.5 ± 2.7 at baseline visit, 8.2 ± 1.9 with solution A, and 8.4 ± 2.2 with solution B). The average number of days per week of CL wear was 5.9 ± 1.3 (CI95% 5.6-6.1) (5.4 ± 1.6 at baseline visit, 6.1 ± 0.9 with solution A, and 6.0 ± 1.1 with solution B). Non-adverse slit-lamp findings were recorded (higher than 2 points). No statistical difference (P>0.05 Friedman test) in CL wearing time, number of days of CL wears and slit-lamp findings were found between the two solutions., Conclusions: This clinical trial shows that the new formulation of Hidro Health(®) MPDS is safe when used for the care of daily-wear lotrafilcon B CL. This new solution has no clinical significance on ocular tissues, according to the Guidance for clinical investigation (ISO 11980)., (Copyright © 2010 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose:   The aim of this study was to determine current approaches adopted by optometrists to the recording of corneal staining following fluorescein instillation., Methods:   An anonymous 'record-keeping task' was sent to all 756 practitioners who are members of the Queensland Division of Optometrists Association Australia. This task comprised a form on which appeared a colour photograph depicting contact lens solution-induced corneal staining. Next to the photograph was an empty box, in which practitioners were asked to record their observations. Practitioners were also asked to indicate the level of severity of the condition at which treatment would be instigated., Results:   Completed task forms were returned by 228 optometrists, representing a 30 per cent response rate. Ninety-two per cent of respondents offered a diagnosis. The most commonly used descriptive terms were 'superficial punctate keratitis' (36 per cent of respondents) and 'punctate staining' (29 per cent). The level of severity and location of corneal staining were noted by 69 and 68 per cent of respondents, respectively. A numerical grade was assigned by 44 per cent of respondents. Only three per cent nominated the grading scale used. The standard deviation of assigned grades was ± 0.6. The condition was sketched by 35 per cent of respondents and two per cent stated that they would take a photograph of the eye. Ten per cent noted the eye in which the condition was being observed. Opinions of the level of severity at which treatment for corneal staining should be instigated varied considerably between practitioners, ranging from 'any sign of corneal staining' to 'grade 4 staining'., Conclusion:   Although most practitioners made a sensible note of the condition and properly recorded the location of corneal staining, serious deficiencies were evident regarding other aspects of record-keeping. Ongoing programs of professional optometric education should reinforce good practice in relation to clinical record-keeping., (© 2010 The Authors. Clinical and Experimental Optometry © 2010 Optometrists Association Australia.)

Propylene glycol used as an ophthalmic demulcent in certain contact-lens care systems has been included recently among factors responsible for increasing Acanthamoeba keratitis. In this study, we provide evidence that propylene glycol as well as examined contact-lens solutions containing it induce rapid differentiation of acanthamoebae into pseudocysts. The partial resistance of the pseudocysts and their reversibility to viable trophozoites even after 24-h exposure to the contact-lens solutions indicate a potential risk of infection to contact-lens users., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Objectives: To describe the type of complications related to contact lens wear seen in a hospital setting in Singapore., Methods: Data were collated over a 2-year period from April 1999 to March 2001, from all public hospitals in Singapore. A standardized clinical record form was completed by the attending doctor when a patient presented for contact lens-related complications., Results: Nine hundred and fifty-three contact lens-related complications were recorded. The mean age of presentation was 26.4 years. Women made up the majority n=491 (68%). Most patients were Chinese (555, 77%). Six hundred and seventy-six (93.7%) patients were soft contact lens wearers. Most patients, 585 patients (85.2%) wore their lenses on a daily basis. Two hundred and forty-four cases (25.6%) of infective keratitis were seen, with 55 patients requiring hospital admission for management of the infection. Soft disposable contact lens wear was associated with the majority of the infective keratitis (178, 73%). Epithelial keratitis occurred in 229 patients (24.0%) with punctuate epithelial erosions being the commonest presentation in 139 (14.6%). Allergic conjunctivitis occurred in 179 (18.8%) of the cases with giant papillary conjunctivitis accounting for 147 (15.4%) of them. Dry eyes (77, 8.1%), sterile infiltrates (71, 7.5%) and neovascularization of the cornea (75, 7.9%) were the next commonest complications seen. Corneal edema, solution- and lens-related complications occurred in small numbers, accounting for less than 5% of the complications reported., Conclusion: Infective keratitis secondary to soft lens wear was the most common complication, followed by epithelial keratitis and allergic conjunctivitis seen in public hospitals in Singapore.

Purpose: To investigate whether the inclusion of a rub and rinse step before contact lens disinfection has an impact on solution-induced corneal staining., Methods: This was a prospective, double-masked, single investigator study. Twenty participants were recruited for two visits, where balafilcon-A lenses were worn bilaterally for 2 h. Each pair of lenses was prepared using two different methodologies. The "control" lens was transferred from the blister pack directly into a storage case containing polyhexamethylene biguanide-based lens care solution. The contralateral "test" lens was rubbed and simultaneously rinsed using the same polyhexamethylene biguanide-based care solution, for either 60 s (visit 1) or 20 s (visit 2). Both lenses were then soaked in the solution overnight. After baseline corneal staining assessments, the lenses were inserted following a randomized contralateral model. After 2 h, lenses were removed, corneal staining was regraded, and comfort scores were obtained., Results: Rubbed and rinsed test lenses induced significantly less corneal staining than control lenses for all participants during visit 1 (mean ± SD: 516 ± 843 vs. 2170 ± 902; p < 0.001) and visit 2 (522 ± 417 vs. 2091 ± 965; p < 0.001). There was no significant difference between the test lenses during visits 1 and 2 (p = 0.72) or controls (p = 0.50). Comfort scores did not differ between eyes (p > 0.05)., Conclusions: Corneal staining induced after 2 h of lens wear with the combination of balafilcon-A and polyhexamethylene biguanide-based lens care solution can be significantly reduced by including a rub and rinse step before overnight soaking. Further work is required to establish the longevity of this effect during the monthly wearing cycle.

Multipurpose solutions (MPS) often contain low concentrations of boric acid as a buffering agent. Limited published literature has suggested that boric acid and borate-buffered MPS may alter the corneal epithelium; an effect attributed to cytotoxicity induced by boric acid. However, this claim has not been substantiated. We investigated the effect of treating cells with relevant concentrations of boric acid using two cytotoxicity assays, and also assessed the impact of boric acid on corneal epithelial barrier function by measuring TEER and immunostaining for tight junction protein ZO-1 in human corneal epithelial cells. Boric acid was also assessed in an in vivo ocular model when administered for 28 days. Additionally, we evaluated Biotrue multi-purpose solution, a novel borate-buffered MPS, alone and with contact lenses for ocular compatibility in vitro and in vivo. Boric acid passed both cytotoxicity assays and did not alter ZO-1 distribution or corneal TEER. Furthermore, boric acid was well-tolerated on-eye following repeated administration in a rabbit model. Finally, Biotrue multi-purpose solution demonstrated good ocular biocompatibility both in vitro and in vivo. This MPS was not cytotoxic and was compatible with the eye when administered alone and when evaluated with contact lenses. We demonstrate that boric acid and a borate-buffered MPS is compatible with the ocular environment. Our findings provide evidence that ocular effects reported for some borate-buffered MPS may be incorrectly attributed to boric acid and are more likely a function of the unique combination of ingredients in the MPS formulation tested., (Copyright © 2010 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To examine the public health implications of 2 recent outbreaks of atypical contact lens-related infectious keratitis., Design: Perspective based on the literature and authors' experience., Results: The contact lens-related Fusarium and Acanthamoeba keratitis outbreaks were each detected by dramatic rises seen in tertiary care centers in Singapore and the United States, respectively. Case-control studies of both outbreaks were able to identify a strong association with the use of different contact lens disinfection solutions. Their respective recalls resulted in a steep decline of Fusarium keratitis, but not of Acanthamoeba keratitis. Early investigations into each solution association implicated components not directly related to their primary disinfectant, but the true pathogenesis remains unknown. However, the number of Acanthamoeba cases individually attributed to each of almost all available disinfection systems exceeds the previously understood total United States incidence, suggesting other risk factors. Current standards do not require demonstration of anti-acanthamoebal activity. Yet, despite the inclusion of Fusarium in mandatory testing for solutions, current premarket testing was not predictive of the outbreak., Conclusions: The 2 recent outbreaks of atypical contact lens-related keratitis have reinforced the value of tertiary care eye care centers in detecting early rises in rare infections and the power of adaptable, well-designed epidemiologic investigations. Although Fusarium keratitis has declined significantly with the recall of Renu with MoistureLoc (Bausch & Lomb Inc.), the persistence of Acanthamoeba keratitis demands fundamental changes in contact lens hygiene practices, inclusion of Acanthamoeba as a test organism, and contact lens disinfectant test regimens for all contact lens-related pathogens that are verifiably reflective of end user contact lens wear complications., (Copyright © 2010 Elsevier Inc. All rights reserved.)