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Andrew D Pucker,1 Chris Lievens,2 Gerald McGwin Jr,1 Quentin X Franklin,1 Amy Logan,1 Gregory S Wolfe2,3 1University of Alabama at Birmingham, Birmingham, AL, USA; 2Southern College of Optometry, Memphis, TN, USA; 3Center for Eye and Health Outcomes, Memphis, TN, USACorrespondence: Andrew D Pucker, University of Alabama at Birmingham, School of Optometry, 1716 University Blvd, Birmingham, AL, 35233, Tel +1 (920) 579-2900, Email apucker@uab.eduPurpose: To understand the impact of Systane Hydration PF on dryness symptoms and quality of life in digital device users and to determine if participants prefer either the unit-dose or multi-dose dispensing system of Systane Hydration PF.Materials and Methods: This 2-week, three visit study recruited regular digital device users. Participants were required to score ≤ 80 on the Impact of Dry Eye on Everyday Life (IDEEL) Quality of Life (QoL) Work domain and between 13 and 32 on the Ocular Surface Disease Index (OSDI) questionnaire. Participants were randomized to either Systane Hydration PF unit-dose or multi-dose for 1 week and switched to the alternative dosing system for the second week. Participations were evaluated by completing the full IDEEL-QoL module and OSDI questionnaire at each visit. Likert surveys were completed to probe dispensing system preferences.Results: Thirty participants with a mean ± SD age of 28.6 ± 12.0 years (70% female) were recruited. Participants had significant improvements in all three IDEEL-QoL domains as well as in OSDI scores (all p < 0.0001). Participants had similar preferences for the two dispensing systems, though they were more likely to indicate that they thought that the multi-dose bottle was more environmentally friendly than the unit-dose vials.Conclusion: Digital device users with dry eye symptoms had meaningful improvements in eye comfort and quality of life scores after being treated with Systane Hydration PF for 2 weeks. Participants did not have a clear dispensing system p

Terri Call,1,&ast; Andrew D Pucker,1,&ast; Gerald McGwin Jr,2 Quentin X Franklin,1 Amy Logan1 1Department of Optometry and Vision Science, University of Alabama at Birmingham, Birmingham, AL, USA; 2Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA&ast;These authors contributed equally to this workCorrespondence: Andrew D Pucker, University of Alabama at Birmingham, School of Optometry, 1716 University Blvd, Birmingham, AL, 35233, USA, Tel +1 920 579-2900, Email andrewpucker@hotmail.comPurpose: To map contact lens (CL) comfort over the full wear day and across 1 month’s wear in established, asymptomatic to minimally symptomatic, reusable, soft CL wearers.Methods: Adult, 18- to 45-year-old, participants were recruited and required to have 20/20 best-corrected visual acuity or better and must have been asymptomatic to minimally symptomatic CL wearers. Participants were required to be able to wear TOTAL30® sphere CLs and have minimal astigmatism. Participants were fit in the study CLs and asked to wear these CLs daily for the next month for 16 hours per day each day. Participants were asked to complete a visual analog scale (VAS) survey via text message at time of CL application and after 8, 10, 12, 14, and 16 hours of wear and at CL removal on days 1, 2, 3, 4, and 5 and at 2 weeks and 1 month. The utilized VAS had a ± 50 scale with positive scores being comfortable, negative scores being uncomfortable, and scores of 0 being neutral comfort.Results: Forty-eight participants were recruited who had a mean ± SD age of 26.2 ± 5.2 years (71% female). Mean initial VAS CL comfort scores at initial CL dispense were 45.56 ± 9.20 units. Mean CL wear times for any of the days evaluated were at least 14.80 ± 2.41 hours per day and did not differ across the study (p = 0.77). Mean comfort VAS scores significantly decreased over the wear day (all days p ≤ 0.02), yet there were no significant differences in VAS comfort scores acr

Kenneth Sall,1 Gary N Foulks,2 Andrew D Pucker,1 Karen L Ice,1 Richard C Zink,1 George Magrath1 1Lexitas Pharma Services, Inc, Durham, NC, USA; 2University of Louisville (Retired), Louisville, KY, USACorrespondence: Kenneth Sall, Lexitas Pharma Services, Inc, 313 Foster St, Durham, NC, 27701, USA, Tel +1 919 205-0012, Email drsall@sallresearch.comPurpose: Validation of the novel Lexitas modified NEI scale for use in assessment of corneal fluorescein staining.Patients and Methods: A series of 18 illustrations and 14 clinical photographs depicting varying severity levels of corneal fluorescein staining were assessed by 3 independent examiners. Regions of the cornea were graded for staining severity based on 3 different grading scales: the original NEI staining scale (density-based scoring; 0– 3 scale), a structured version of the NEI scale (dot-count scoring; 0– 3 scale), and the Lexitas modified NEI staining scale (0– 4 scale with half-point increments). Kappa statistics (simple and weighted) were computed to determine intra-examiner image grading repeatability for each examiner over 2 separate assessments. Inter-examiner assessment reliability utilized the scores from the first read of each examiner, and pairs of examiners to compute kappa statistics.Results: Data was analyzed from the scores provided by the examiners from each gradable corneal region on 32 images (18 illustrations and 14 photographs) for a total of 154 corneal regions across the 3 grading scales for each validation run. The mean intra-examiner simple/weighted kappa values using the NEI density, NEI dot count, and the Lexitas modified NEI staining scales were 0.67/0.72, 0.91/0.94, 0.80/0.92 for the graded illustrations, and 0.83/0.88, 0.76/0.85, 0.77/0.88 for the graded photographs, respectively. The mean inter-examiner simple/weighted kappa values using the NEI density, NEI dot count, and the Lexitas modified NEI staining scales were 0.59/0.65, 0.86/0.90, and 0.78/0.91 for the graded illustra

Chelsea S Bradley,1 Lindsay A Sicks,1 Andrew D Pucker2 1Illinois College of Optometry, Chicago, IL, USA; 2School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USACorrespondence: Andrew D Pucker Email apucker@uab.edu View the original paper by Dr Bradley and colleagues This is in response to the Letter to the Editor

Chelsea S Bradley, 1 Lindsay A Sicks, 1 Andrew D Pucker 2 1Illinois College of Optometry, Chicago, IL, USA; 2School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USACorrespondence: Andrew D Pucker Email apucker@uab.eduPurpose: Preservatives are essential for preventing contact lens (CL)-related microbial keratitis (MK). The purpose of this review is to summarize the current knowledge related to the use of common ophthalmic preservatives in CL care products with respect to both safety and efficacy.Methods: Manuscripts written in English were obtained by searching PubMed.gov with the term contact lens plus antimicrobial, benzalkonium chloride, biguanide, Aldox, polyquaternium, preservative, thimerosal, EDTA (ethylenediaminetetraacetic acid), chlorhexidine, or blister pack.Results: This review found that first-generation preservatives are no longer used in CL multipurpose solutions (MPS) due to their high levels of ocular toxicity. Modern, high-molecular-weight preservatives, including polyquaternium-1 (PQ-1) and biguanides (PHMB), are generally effective against bacteria, minimally effective against fungi, and not effective against Acanthamoeba. PQ-1 and PHMB are likely safe when used with CLs, but they may cause ocular adverse events, with roughly equal risk between the two preservatives. Some CL MPS contain both PQ-1 and PHMB, but no increased risk of adverse events has been reported when combining the two. Hydrogen-peroxide (H 2O 2) solutions are effective against all common ocular microbes, including Acanthamoeba, and they have been proven safe with proper compliance. Povidone-iodine (P-I) solutions are not currently commercially available in North America, but they have been shown in other countries to be safe and effective.Conclusion: Patients should be monitored when using PQ-1 or PHMB-containing solutions since they have been associated with ocular adverse events. If events are detected, patients should be switched to an alternative soluti