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Navascues-Cornago M, Guthrie S, Morgan PB, Woods J. Determination of the Minimal Clinically Important Difference (MCID) for Ocular Subjective Responses. Transl Vis Sci Technol 2024; 13:28. [PMID: 39150716 PMCID: PMC11343006 DOI: 10.1167/tvst.13.8.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 07/16/2024] [Indexed: 08/17/2024] Open
Abstract
Purpose To determine the minimal clinically important difference (MCID) for contact lens (CL)-related subjective responses and explore whether MCID values differ between subjective responses and study designs. Methods This was a retrospective analysis of data from seven one-week bilateral crossover studies and 14 one-day contralateral CL studies. For comfort, dryness, vision, or ease of insertion, participants rated on a 0-100 visual analogue scale (VAS) and indicated lens preference on a five-point Likert scale featuring strong, slight, and no preferences. For each criterion, four MCID estimates were calculated and averaged: mean VAS score difference for "slight preference," lower limit of 95% confidence interval VAS score difference for "slight preference," difference in mean VAS score difference between "slight" and "no preference" and 0.5 standard deviation of VAS scores. Results The four calculation methods generated a small range of MCID values. For bilateral studies, the averaged MCID was 7.2 (range 5.4-8.8) for comfort, 8.1 (5.2-10.6) for dryness, 7.1 (5.5-9.3) for vision and 7.6 (6.0-10.5) for ease of insertion. For contralateral studies, the averaged MCID was 6.9 (6.1-7.6) for comfort at insertion and 7.5 (6.8-8.2) for end-of-day comfort. Conclusions This work demonstrated very similar MCID values across subjective responses and study designs, in a population of habitual soft CL wearers. In all cases, MCID values were on average seven units on a 0 to 100 VAS. Translational Relevance This work provides MCID values which are important for interpreting ocular subjective responses and planning clinical studies.
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Affiliation(s)
- Maria Navascues-Cornago
- Eurolens Research, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Sarah Guthrie
- Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Philip B. Morgan
- Eurolens Research, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Jill Woods
- Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, ON, Canada
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VanDerMeid KR, Byrnes MG, Millard K, Scheuer CA, Phatak NR, Reindel W. Comparative Analysis of the Osmoprotective Effects of Daily Disposable Contact Lens Packaging Solutions on Human Corneal Epithelial Cells. Clin Ophthalmol 2024; 18:247-258. [PMID: 38292853 PMCID: PMC10825585 DOI: 10.2147/opth.s437841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/12/2023] [Indexed: 02/01/2024] Open
Abstract
Purpose Contact lens (CL) wear challenges the balance of the ocular surface environment by increasing water evaporation and tear osmolarity. Maintaining ocular surface homeostasis during CL wear remains a goal of lens manufacturers and an important consideration for eye care professionals. The purpose of this study was to measure the metabolic activity and inflammatory responses of a transformed human corneal epithelial cell (THCEpiC) line under hyperosmotic conditions in the presence of CL packaging solutions. Methods CL packaging solutions sampled from seven daily disposable silicone hydrogel CL blister packages were prepared at 25% and made hyperosmolar (400 mOsm/kg) with NaCl. THCEpiCs were incubated with each solution for 24 hr, after which cell culture supernatants were collected. THCEpiC metabolic activity was determined by an alamarBlue assay. Concentrations in cell culture supernatants of inflammatory cytokine (interleukin [IL]-6) and chemokine (IL-8), as well as monocyte chemoattractant protein-1 (MCP-1), were quantitated by specific enzyme-linked immunosorbent assays. Results THCEpiC metabolic activity under hyperosmolar conditions decreased in the presence of somofilcon A and senofilcon A solutions (p=0.04 and 0.004, respectively), but no other solution (all p≥0.09). Concentrations of IL-6 increased in the presence of delefilcon A, somofilcon A, narafilcon A, and senofilcon A solutions (all p≤0.001), but no other solution (all p≥0.08), while those of IL-8 increased in the presence of all solutions (all p≤0.03) but kalifilcon A (p>0.99), and those of MCP-1 increased in the presence of delefilcon A, verofilcon A, somofilcon A, and stenfilcon A solutions (all p<0.0001), but no other solution (all p>0.99). Conclusion CL packaging solutions differ in their capacity to inhibit epithelial inflammation. THCEpiC inflammatory response was less in the presence of a CL packaging solution containing osmoprotectants than in solutions lacking osmoprotectants under moderately hyperosmolar conditions in vitro. Clinical studies are warranted to further substantiate the benefit of osmoprotectants.
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Influence of Selected Ophthalmic Fluids on the Wettability and Hydration of Hydrogel and Silicone Hydrogel Contact Lenses—In Vitro Study. MATERIALS 2022; 15:ma15030930. [PMID: 35160876 PMCID: PMC8839750 DOI: 10.3390/ma15030930] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/11/2022] [Accepted: 01/20/2022] [Indexed: 11/16/2022]
Abstract
This study attempts to evaluate the effect of incubation in selected ophthalmic fluids on contact lenses (Etafilcon A, Omafilcon A, Narafilcon A, Senofilcon A). Four research groups differing in the incubation environment were created: (1) initial state, (2) contact lens solution (CLS), (3) contact lens solution and eye drops (ED) and (4) eye drops. Dehydration by gravimetric method and the contact angle (CA) by the sessile drop method were tested. The surface free energy (SFE) was also calculated with the use of several methods: Owens–Wendt, Wu, Neumann, and Neumann–Kwok. The greatest changes in the dehydration profile were observed for contact lenses incubated in ED. The most noticeable changes in CA values were observed for contact lenses incubated in ED, in which it was not possible to settle water drop after incubation. On the basis of SFE analysis, higher values were found for hydrogel contact lenses, e.g., according to the Owens–Wendt method, they ranged from 54.45 ± 6.56 mJ/m2 to 58.09 ± 4.86 mJ/m2, while in the case of silicone-hydrogel contact lenses, they ranged from 32.86 ± 3.47 mJ/m2 to 35.33 ± 6.56 mJ/m2. Incubation in all tested environments decreased the SFE values, but the differences were in most cases statistically insignificant. Calculating the SFE may be a useful method as it can be used to estimate the possibility of bacteria adhering to contact lens surfaces.
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CLEAR - Contact lens complications. Cont Lens Anterior Eye 2021; 44:330-367. [DOI: 10.1016/j.clae.2021.02.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
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Pena-Verdeal H, Garcia-Queiruga J, García-Resúa C, Yebra-Pimentel E, Giráldez MJ. Osmolality and pH of commercially available contact lens care solutions and eye drops. Cont Lens Anterior Eye 2020; 44:101379. [PMID: 33187860 DOI: 10.1016/j.clae.2020.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 10/18/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The physical properties of contact lens care solutions and Eye Drops (ED) may affect initial comfort and dry eye symptomatology in contact lens wearers, although these properties are not always provided by manufacturers. The present study aimed to measure and compare the osmolality and pH of commercially available contact lens care solutions and ED. METHODS Forty-four solutions were tested (17 lens care solutions and 27 ED) and classified by the presence and/or combination of the viscosity/lubrication-enhancing ingredients. Solution osmolality was obtained with the Fiske 110 osmometer and pH was measured with a micro-pH 2000. Each measurement was taken ten times, following the manufacturer's instructions, while controlling for room temperature and humidity. Differences between the values of the physical properties of the solutions were analysed by type and viscosity/lubrication-enhancing agent subclassification. RESULTS Osmolality ranged from 192.6 ± 2.17 to 364.6 ± 2.88 mOsm/Kg, while pH ranged from 6.35 [6.35-6.26] to 7.99 [7.99-8.00]. A significant difference in the osmolality and pH values of contact lens care solutions and ED was found when classified by type or viscosity/lubrication-enhancing agent (ANOVA and Kruskal-Wallis respectively, both p < 0.001). CONCLUSIONS The physical properties of some contact lens care solutions and ED are not readily available. The osmolality and pH values of various commercially available lens care solutions and ED vary significantly both by type and viscosity/lubrication-enhancing ingredients.
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Affiliation(s)
- Hugo Pena-Verdeal
- Departamento de Física Aplicada (Area de Optometría), Universidade de Santiago de Compostela, Santiago de Compostela (Galicia), Spain.
| | - Jacobo Garcia-Queiruga
- Departamento de Física Aplicada (Area de Optometría), Universidade de Santiago de Compostela, Santiago de Compostela (Galicia), Spain
| | - Carlos García-Resúa
- Departamento de Física Aplicada (Area de Optometría), Universidade de Santiago de Compostela, Santiago de Compostela (Galicia), Spain
| | - Eva Yebra-Pimentel
- Departamento de Física Aplicada (Area de Optometría), Universidade de Santiago de Compostela, Santiago de Compostela (Galicia), Spain
| | - María J Giráldez
- Departamento de Física Aplicada (Area de Optometría), Universidade de Santiago de Compostela, Santiago de Compostela (Galicia), Spain
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6
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Evaluation of Systane Complete for the Treatment of Contact Lens Discomfort. Cont Lens Anterior Eye 2020; 43:441-447. [DOI: 10.1016/j.clae.2019.10.141] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 01/25/2023]
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Pucker AD. A Review of the Compatibility of Topical Artificial Tears and Rewetting Drops with Contact Lenses. Cont Lens Anterior Eye 2020; 43:426-432. [DOI: 10.1016/j.clae.2020.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 11/27/2022]
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Umar AK, Wathoni N, Hasanah AN, Kurniawansyah IS, Abdassah M. Kahar Method: A Novel Calculation Method of Tonicity Adjustment. J Pharm Bioallied Sci 2020; 11:S635-S649. [PMID: 32148375 PMCID: PMC7020836 DOI: 10.4103/jpbs.jpbs_210_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/01/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Hypertonic and hypotonic conditions in pharmaceutical preparations decrease the drug’s absorption and bioavailability. In addition, it can cause tissue damage. There are several calculation methods to regulate hypotonic preparations. However, there are no methods that can be used to regulate hypertonic preparations without causing dose-dividing problem. Objective: This study aimed to develop a new calculation using basic principle of freezing point depression method (cryoscopic) that can solve hypotonic and hypertonic problems, especially for hypertonic preparations through reducing the levels of additional ingredients. Methods: The calculation of Kahar method was successfully obtained by substitution and simplification in the basic principle equation of cryoscopic method, and then evaluated by resolving the problems in 42 sterile formula preparations and compared with White–Vincent method, cryoscopic method, equivalent NaCl method, and milliequivalent method through the analysis of its similarity and reliability. Results: The results of similarity analysis between Kahar method and other methods showed good similarity values with more than 0.880. Kahar method and cryoscopic method have the highest similarity of the calculation result with a similarity value of 1. The reliability analysis obtained very good result with Cronbach α = 0.990. Conclusions: These results suggest that Kahar method provides reliable equation with complete and efficient solution to hypotonic and hypertonic problems.
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Affiliation(s)
- Abd K Umar
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
| | - Nasrul Wathoni
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
| | - Aliya N Hasanah
- Department of Pharmaceutical Analysis and Medicinal Chemistry, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
| | - Insan S Kurniawansyah
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
| | - Marline Abdassah
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
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Willcox MD. Tear film, contact lenses and tear biomarkers. Clin Exp Optom 2019; 102:350-363. [PMID: 31119796 DOI: 10.1111/cxo.12918] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/30/2019] [Accepted: 04/05/2019] [Indexed: 01/09/2023] Open
Abstract
This article summarises research undertaken since 1993 in the Willcox laboratory at the University of New South Wales, Sydney on the tear film, its interactions with contact lenses, and the use of tears as a source of biomarkers for ocular and non-ocular diseases. The proteome, lipidome and glycome of tears all contribute to important aspects of the tear film, including its structure, its ability to defend the ocular surface against microbes and to help heal ocular surface injuries. The tear film interacts with contact lenses in vivo and interactions between tears and lenses can affect the biocompatibility of lenses, and may be important in mediating discomfort responses during lens wear. Suggestions are made for follow-up research.
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Affiliation(s)
- Mark Dp Willcox
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
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10
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Kwon MY, Park DJ. The Clinical Result of Extended Wear of Therapeutic Contact Lenses and 5% NaCl for Traumatic Recurrent Corneal Erosion. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.1.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Mi Young Kwon
- Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea
| | - Dae Jin Park
- Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea
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12
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Asharlous A, Mirzajani A, Jafarzadehpur E, KhabazKhoob M, Ostadimoghaddam H. Objective and subjective assessing efficacy of a lubricating drop in eyes wearing silicone hydrogel contact lenses. J Curr Ophthalmol 2016; 28:69-74. [PMID: 27331150 PMCID: PMC4909696 DOI: 10.1016/j.joco.2016.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the effect of a lubricating drop on optical quality, tear film stability, and subjective symptoms in individuals wearing silicone hydrogel contact lens. Methods In this one-day, prospective single-center clinical study, Pre-lens Tear Deformation Time (PL-TDT), Root-Mean-Square (RMS) of Low Order Aberrations (LOA) and High Order Aberrations (HOA), individual twelve Zernike coefficients, and subjective symptoms were assessed in 43 volunteers (mean age 19.58 ± 1.63, 86 eyes) at 6 h after inserting the contact lens and then at 60 min after instilling a lubricating drop (Comfort drops, Avizor, Madrid-Spain). Results PL-TDT, LOA-RMS, and HOA-RMS values measured before drop instillation were not significantly different with those measured after drop. None of the Zernike coefficients were significantly different after instilling lubricating drop. Statistically significant decrement in both frequency and severity values in blurry vision, dryness, discomfort, burning, itching, foreign body sensation, excessive blinking, and lacrimation were seen after drop instillation (all P < 0.05). Conclusion Our results showed that although the lubricating drop did not improve the tear film stability and optical quality in the silicone hydrogel contact lens wearers, subjects experienced a subjective improvement.
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Affiliation(s)
- Amir Asharlous
- Optometry Department, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Mirzajani
- Optometry Department, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mehdi KhabazKhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadi Ostadimoghaddam
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
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Aslan Bayhan S, Bayhan HA, Muhafız E, Bekdemir Ş, Gürdal C. Effects of osmoprotective eye drops on tear osmolarity in contact lens wearers. Can J Ophthalmol 2016; 50:283-9. [PMID: 26257222 DOI: 10.1016/j.jcjo.2015.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 02/21/2015] [Accepted: 03/16/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the impact of osmoprotective eye drops on tear osmolarity and patient comfort, and to compare its efficacy with a commercially available lubricant in contact lens (CL) wearers. DESIGN Prospective, cross-sectional study. PARTICIPANTS Forty eyes of 20 first-time CL wearers were included. METHODS Tear osmolarity measurements using TearLab osmolarity system were performed in each eye of subjects at 8 am, and 2, 4, and 8 h after that on the first and second days, and at 12:00 on the third day and eighth days. On the second day and afterward, all eyes were fitted Purevision 2 (Bausch & Lomb) soft CLs. Subjects instilled Optive (Allergan) osmoprotective eye drops into their 1 eye (group 1) and Refresh tears (Allergan) eye drops into their other eyes (group 2) after 2 hours of CL wear on the third day and afterward. Ocular comfort with eye drops was also assessed. RESULTS There were no significant differences between the tear osmolarity measurements of the groups on the first day. On the second day, osmolarity significantly increased from baseline after 4 h of CL wear (p < 0.05) but returned to baseline after 8 h of CL wear (p > 0.05) in both groups. Tear osmolarity measurements of group 1 were significantly lower than those of group 2 on the third and eighth days (both p < 0.05). The mean comfort scores were significantly higher in group 1. CONCLUSIONS Tear osmolarity increases within the first hours of CL wear, and instillation of osmoprotective eye drops prevents this increment in patients wearing CLs.
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Affiliation(s)
- Seray Aslan Bayhan
- Bozok University Faculty of Medicine, Ophthalmology Department, Yozgat, Turkey.
| | - Hasan Ali Bayhan
- Bozok University Faculty of Medicine, Ophthalmology Department, Yozgat, Turkey
| | - Ersin Muhafız
- Bozok University Faculty of Medicine, Ophthalmology Department, Yozgat, Turkey
| | - Şükran Bekdemir
- Bozok University Faculty of Medicine, Ophthalmology Department, Yozgat, Turkey
| | - Canan Gürdal
- Bozok University Faculty of Medicine, Ophthalmology Department, Yozgat, Turkey
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Dutescu RM, Panfil C, Schrage N. Osmolarity of prevalent eye drops, side effects, and therapeutic approaches. Cornea 2015; 34:560-6. [PMID: 25789693 DOI: 10.1097/ico.0000000000000368] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Little is known about how the osmolarity of ophthalmic formulations affects the ocular surface. Because hyperosmolar eye drops could be therapeutic for treating corneal edema, this article presents an ex vivo model of corneal edema for testing ophthalmic drugs based on their osmolarity. The respective osmolarity of common eye drops found in the German market is also analyzed here. METHODS For modeling corneal edema, an Ex Vivo Eye Irritation Test was used to simulate an ocular anterior chamber with a physiological corneal barrier. To induce corneal edema, the anterior chamber was supplied with a hypoosmolar medium (148 mOsm/L) for 24 hours. Preserved and preservative-free 5% sodium chloride (hyperosmolar Omnisorb and Ocusalin 5% UD) were used for 1 hour, on 5 corneas each, to test their efficiency to reduce corneal edema in this model. Corneal thickness was determined by optical coherence tomography. Osmolarity of 87 common eye drops was measured by freezing point osmometry. RESULTS Ex vivo, the tested hypoosmolar condition induced corneal edema from 450 μm (±50 μm) at baseline to 851 μm (±94 μm, P < 0.0001). Omnisorb and Ocusalin 5% UD significantly reduced the corneal thickness by 279 μm (±28 μm, P < 0.001) for Omnisorb and 258 μm (±29 μm, P < 0.001) for Ocusalin 5% UD. Forty-three (49%) of the tested products had an osmolarity below and 44 (51%) above the physiological tear osmolarity of 289 mOsm/L. Osmolarity values of less than 200 mOsm/L were found in lubricant drops. The highest osmolarity was detected in Omnisorb (1955 mOsm/L). CONCLUSIONS The Ex Vivo Eye Irritation Test has proven to be a reliable novel model of corneal edema for evaluating osmotic eye drops. Osmolarity measurements revealed a wide range from hypotonic to hypertonic formulations for commonly marketed ophthalmic drugs.
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Affiliation(s)
- Ralf M Dutescu
- *Aachen Centre of Technology Transfer in Ophthalmology (ACTO e.V.), An-Institute, RWTH Aachen University, Aachen, Germany; and †Department of Ophthalmology, RWTH Aachen University, Aachen, Germany
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Moisseiev E, Loberman D, Zunz E, Kesler A, Loewenstein A, Mandelblum J. Pupil dilation using drops vs gel: a comparative study. Eye (Lond) 2015; 29:815-9. [PMID: 25857606 PMCID: PMC4469672 DOI: 10.1038/eye.2015.47] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/23/2015] [Indexed: 12/25/2022] Open
Abstract
Purpose To compare the efficacy in pupil dilation and degree of discomfort between topical instillation of mydriatic drops and gel. Methods The study included 60 patients with no previous ocular history of trauma and surgery. One eye was dilated with two drops (tropicamide 0.5% and phenylephrine 10%), and the other with one drop of gel (tropicamide 0.5%+phenylephrine 5%). Pupil size was measured by a Colvard pupillometer at baseline and 5, 15, 30, and 45 min following instillation. Pain upon instillation was measured by visual analog scale (VAS). Results There was no difference in pupil size at baseline. Use of the gel achieved greater mydriasis than drops (P=0.01), and was also associated with lower pain scores (P=0.003). In diabetic patients, pupil size was smaller at baseline and following instillation of drops and gel. Use of the gel achieved an even greater degree of pupil dilation in this subset of patients than drops (P=0.019). Conclusions Gel formulation achieved significantly greater pupil dilation than drops, despite a lower concentration of phenylephrine, and was also associated with significantly lower patient discomfort. This study is the first report of improved mydriatic efficacy in diabetic patients.
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Affiliation(s)
- E Moisseiev
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Loberman
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Zunz
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Kesler
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Loewenstein
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Mandelblum
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lombardo M, Rosati M, Pileri M, Schiano-Lomoriello D, Serrao S. Evaluation of corneal optical properties in subjects wearing hydrogel etafilcon A contact lenses and the effect of administering mannitol-enriched sodium hyaluronate ophthalmic solution. Clin Ophthalmol 2014; 8:2347-54. [PMID: 25473260 PMCID: PMC4247147 DOI: 10.2147/opth.s71944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of daily administration of mannitol-enriched sodium hyaluronate ophthalmic solution on the corneal optical properties of subjects wearing low Dk hydrogel (etafilcon A) contact lenses (CLs). METHODS Forty-five subjects wearing etafilcon A CLs daily for more than 6 months were recruited into this pilot study. Fifteen of the subjects administered a 10% mannitol-enriched 0.05% sodium hyaluronate solution (study group) once daily and 30 subjects did not administer any ophthalmic solution (control group). The subjects were examined at baseline and one month after recruitment. Changes in central corneal thickness (CCT) and corneal light backscatter were evaluated by Scheimpflug imaging (Pentacam HR). Changes in corneal total high-order aberration, corneal spherical aberration, coma, and trefoil were evaluated using the OPD scan II. RESULTS At one month, corneal light backscatter decreased significantly in the study group (≤18.30 arbitrary units; P<0.05) and this was highly correlated with a decrease in CCT (R=0.81; P=0.04). The decrease in corneal total high-order aberration, spherical aberration, and coma was significantly higher in the study group than in the control group (P<0.05). No changes in corneal light backscatter or CCT were found in the control group during follow-up. CONCLUSION Once-daily administration of a mannitol-enriched lubricant ophthalmic solution was effective for improving the corneal optical quality and reducing corneal swelling in subjects wearing low Dk hydrogel (etafilcon A) CLs during one month follow-up.
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Affiliation(s)
- Marco Lombardo
- Fondazione G.B. Bietti IRCCS, Rome, Italy ; Vision Engineering Italy Srl, Rome, Italy
| | | | - Marco Pileri
- Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy
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Brjesky VV, Maychuk YF, Petrayevsky AV, Nagorsky PG. Use of preservative-free hyaluronic acid (Hylabak(®)) for a range of patients with dry eye syndrome: experience in Russia. Clin Ophthalmol 2014; 8:1169-77. [PMID: 24970995 PMCID: PMC4069143 DOI: 10.2147/opth.s47713] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Artificial tear preparations are important in the management of dry eye syndrome. We present the findings from four recently published studies conducted in Russia assessing Hylabak(®) (marketed as Hyabak(®) in Europe), a preservative-free hyaluronic acid preparation, for the treatment of dry eye syndrome. All studies had an open, noncomparative design, but one compared the findings with those from 25 patients treated with Tear Naturale(®) in previous studies. A total of 134 children and adults were enrolled, and the etiologies of dry eye syndrome included contact lens use, intensive office work, adenovirus eye infection, postmenopausal status, persistent meibomian blepharitis, Sjögren's syndrome, phacoemulsification with intraocular lens implantation, and refractive surgery. The patients were treated with Hylabak for 2 weeks to 2 months. All studies showed that Hylabak resulted in marked improvement as assessed by subjective sensations/complaints, Schirmer's test, Norn's test, impression cytology and biomicroscopy, staining, and tear osmolarity. Greater benefits were also reported compared with Tear Naturale, including a faster onset of action. Hylabak was well tolerated. In conclusion, Hylabak provided rapid and safe relief from the signs and symptoms of dry eye syndrome, as well as improvement in objective measures, in a wide range of patients.
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Affiliation(s)
| | | | | | - Peter Gerrievich Nagorsky
- Novosibirsk Branch of the Federal State Institute MNTK Eye Microsurgery, Novosibirsk, Russian Federation, Russia
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Overview of factors that affect comfort with modern soft contact lenses. Cont Lens Anterior Eye 2014; 37:65-76. [DOI: 10.1016/j.clae.2013.08.154] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 07/31/2013] [Accepted: 08/13/2013] [Indexed: 11/21/2022]
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Bron AJ, Tomlinson A, Foulks GN, Pepose JS, Baudouin C, Geerling G, Nichols KK, Lemp MA. Rethinking dry eye disease: a perspective on clinical implications. Ocul Surf 2014; 12:S1-31. [PMID: 24725379 DOI: 10.1016/j.jtos.2014.02.002] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 02/07/2014] [Accepted: 02/01/2014] [Indexed: 01/18/2023]
Abstract
Publication of the DEWS report in 2007 established the state of the science of dry eye disease (DED). Since that time, new evidence suggests that a rethinking of traditional concepts of dry eye disease is in order. Specifically, new evidence on the epidemiology of the disease, as well as strategies for diagnosis, have changed the understanding of DED, which is a heterogeneous disease associated with considerable variability in presentation. These advances, along with implications for clinical care, are summarized herein. The most widely used signs of DED are poorly correlated with each other and with symptoms. While symptoms are thought to be characteristic of DED, recent studies have shown that less than 60% of subjects with other objective evidence of DED are symptomatic. Thus the use of symptoms alone in diagnosis will likely result in missing a significant percentage of DED patients, particularly with early/mild disease. This could have considerable impact in patients undergoing cataract or refractive surgery as patients with DED have less than optimal visual results. The most widely used objective signs for diagnosing DED all show greater variability between eyes and in the same eye over time compared with normal subjects. This variability is thought to be a manifestation of tear film instability which results in rapid breakup of the tearfilm between blinks and is an identifier of patients with DED. This feature emphasizes the bilateral nature of the disease in most subjects not suffering from unilateral lid or other unilateral destabilizing surface disorders. Instability of the composition of the tears also occurs in dry eye disease and shows the same variance between eyes. Finally, elevated tear osmolarity has been reported to be a global marker (present in both subtypes of the disease- aqueous-deficient dry eye and evaporative dry eye). Clinically, osmolarity has been shown to be the best single metric for diagnosis of DED and is directly related to increasing severity of disease. Clinical examination and other assessments differentiate which subtype of disease is present. With effective treatment, the tear osmolarity returns to normal, and its variability between eyes and with time disappears. Other promising markers include objective measures of visual deficits, proinflammatory molecular markers and other molecular markers, specific to each disease subtype, and panels of tear proteins. As yet, however, no single protein or panel of markers has been shown to discriminate between the major forms of DED. With the advent of new tests and technology, improved endpoints for clinical trials may be established, which in turn may allow new therapeutic agents to emerge in the foreseeable future. Accurate recognition of disease is now possible and successful management of DED appears to be within our grasp, for a majority of our patients.
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Affiliation(s)
- Anthony J Bron
- Professor emeritus - University of Oxford, Nuffield Laboratory of Ophthalmology, Nuffield Dept of Clinical Neurosciences, UK.
| | - Alan Tomlinson
- Professor of Vision Sciences, Glasgow Caledonian University, Scotland
| | - Gary N Foulks
- Emeritus Professor of Ophthalmology, University of Louisville; Editor-in-Chief, The Ocular Surface, USA
| | - Jay S Pepose
- Professor of Clinical Ophthalmology and Visual Sciences, Washington University School of Medicine, Director, Pepose Vision Institute, St. Louis, Missouri, USA
| | - Christophe Baudouin
- Quinze-Vingts National Ophthalmology Hospital, and Vision Institute, University Paris 6, Paris, France
| | - Gerd Geerling
- Professor and Chair, Department of Ophthalmology, Heinrich-Heine-University Moorenstr. 5 40225 Düsseldorf, Germany
| | - Kelly K Nichols
- FERV Professor (Foundation for Education and Research in Vision), The Ocular Surface Institute, University of Houston, College of Optometry, Houston, Texas, USA
| | - Michael A Lemp
- Clinical Professor of Ophthalmology, Georgetown University, Washington DC and George Washington University, Washington DC, USA
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Stapleton F, Marfurt C, Golebiowski B, Rosenblatt M, Bereiter D, Begley C, Dartt D, Gallar J, Belmonte C, Hamrah P, Willcox M. The TFOS International Workshop on Contact Lens Discomfort: report of the subcommittee on neurobiology. Invest Ophthalmol Vis Sci 2013; 54:TFOS71-97. [PMID: 24058137 PMCID: PMC5963174 DOI: 10.1167/iovs.13-13226] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 09/10/2013] [Indexed: 12/26/2022] Open
Abstract
This report characterizes the neurobiology of the ocular surface and highlights relevant mechanisms that may underpin contact lens-related discomfort. While there is limited evidence for the mechanisms involved in contact lens-related discomfort, neurobiological mechanisms in dry eye disease, the inflammatory pathway, the effect of hyperosmolarity on ocular surface nociceptors, and subsequent sensory processing of ocular pain and discomfort have been at least partly elucidated and are presented herein to provide insight in this new arena. The stimulus to the ocular surface from a contact lens is likely to be complex and multifactorial, including components of osmolarity, solution effects, desiccation, thermal effects, inflammation, friction, and mechanical stimulation. Sensory input will arise from stimulation of the lid margin, palpebral and bulbar conjunctiva, and the cornea.
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Affiliation(s)
- Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Carl Marfurt
- Indiana University School of Medicine–Northwest, Gary, Indiana
| | - Blanka Golebiowski
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Mark Rosenblatt
- Weill Cornell Medical College, Cornell University, Ithaca, New York
| | - David Bereiter
- University of Minnesota School of Dentistry, Minneapolis, Minnesota
| | - Carolyn Begley
- Indiana University School of Optometry, Bloomington, Indiana
| | - Darlene Dartt
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Juana Gallar
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernandez–Consejo Superior de Investigaciones Cientificas, Alicante, Spain
| | - Carlos Belmonte
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernandez–Consejo Superior de Investigaciones Cientificas, Alicante, Spain
| | - Pedram Hamrah
- Massachusetts Eye and Ear Infirmary, Stoneham, Massachusetts
| | - Mark Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Çömez AT, Tufan HA, Kocabıyık Ö, Gencer B. Effects of Lubricating Agents with Different Osmolalities on Tear Osmolarity and Other Tear Function Tests in Patients with Dry Eye. Curr Eye Res 2013; 38:1095-103. [DOI: 10.3109/02713683.2013.806670] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
The current literature review was intended to investigate whether the use of silicone hydrogel contact lenses has resulted in improved comfort compared with that of hydrogel contact lenses when both are used for daily wear. The conclusion reached is that silicone hydrogel contact lenses, which were initially developed to eliminate hypoxia during overnight wear, have not significantly improved comfort compared with the comfort achieved with hydrogel contact lenses when worn on a daily wear basis, even though a body of the published literature would suggest to the contrary. A careful review and consideration of the literature demonstrates that the relative comfort achieved with the two types of contact lenses is in fact highly dependent on the study methodology: Although refitting studies have concluded enhanced comfort with silicone hydrogels, the more robust study designs involving concurrent controls and masking were not able to show a difference, and some even concluded an inferior performance. Evidence-based review has however clearly demonstrated that comfort cannot be considered in isolation but is contact lens specific and depends on the material surface and bulk properties, lens design characteristics, and modality of use of the contact lens, and may also be significantly influenced by the replacement frequency and interaction with any lens care system that may be used.
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Safety and efficacy of topical azithromycin ophthalmic solution 1.0% in the treatment of contact lens-related dry eye. Eye Contact Lens 2012; 38:73-9. [PMID: 22157392 DOI: 10.1097/icl.0b013e31823ff229] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this pilot study was to evaluate the safety and efficacy of azithromycin ophthalmic solution 1% in patients with contact lens-related dry eye (CLDE). METHODS This was a 4-week, single-center, open-label clinical trial in patients diagnosed with CLDE using the Contact Lens Dry Eye Questionnaire (CLDEQ). Fifty patients were enrolled in this study. The patients were randomized to 1 of 2 treatment groups: azithromycin ophthalmic solution administered bid on days 1 and 2 and on days 3 to 29±1 or Visine for Contacts rewetting drops administered qid on days 1 to 29±1. The patient diaries were used daily to collect data on comfortable and total contact lens wear time and ocular dryness throughout the treatment period. Tear osmolarity, fluorescein corneal staining, and visual acuity were also assessed during clinic visits. RESULTS Fifty patients were enrolled, and 44 completed the study. One patient discontinued in the azithromycin group, and five patients discontinued in the rewetting drops group because of adverse events. A statistically significant increase in mean comfortable contact lens wear time from baseline was observed for the subjects treated with azithromycin ophthalmic solution as compared with the subjects treated with rewetting drops at week 4 (P=0.004; primary endpoint), in addition to weeks 2 and 3. The improvement in the mean comfortable wear time for the patients in the azithromycin treatment group exceeded 2 hrs throughout the treatment period (weeks 1-4). No significant differences were observed between the groups for total wear time, low contrast visual acuity, or tear osmolarity. Subject-rated ocular dryness (PM time assessments) was significantly improved from baseline in the subjects treated with azithromycin ophthalmic solution as compared with those treated with rewetting drops at weeks 2 and 3 endpoints (P=0.015 for each week). Additionally, a statistical difference was observed in favor of the azithromycin treatment group at week 2 for the subjects reclassifying as nondry eye as determined by the CLDEQ (P=0.05). CONCLUSIONS Treatment with topical azithromycin ophthalmic solution was well tolerated and resulted in a significant improvement in comfortable contact lens wear time in the patients with CLDE.
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Tong L, Petznick A, Lee SY, Tan J. Assessment and Management of Dry Eye Patients for Non-Ophthalmic Healthcare Practitioners. PROCEEDINGS OF SINGAPORE HEALTHCARE 2012. [DOI: 10.1177/201010581202100104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dry eye is a very common condition in many parts of the world. Both ophthalmologists and other healthcare professionals, such as optometrists and general practitioners, are often involved in the care of these patients. The main thrust of dry eye management is over-the-counter tear lubricants. There is a wide range of tear lubricants available today. These lubricants vary in viscosity, duration of action, type of preservatives, osmolarity/osmolality and pH. This article aims to educate healthcare professionals on 1) how to assess and manage patients with mild to moderate dry eyes and 2) how to identify patients who may need a referral to an ophthalmologist. Strategies on the use of available treatments and their limitations, as well as factors that may affect patient compliance will be discussed.
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Affiliation(s)
- Louis Tong
- Department of Cornea and External Eye Disease, Singapore National Eye Centre
- Office of Clinical Sciences, Duke-NUS Graduate Medical School
- Singapore Eye Research Institute, Singapore National Eye Centre
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore
| | - Andrea Petznick
- Singapore Eye Research Institute, Singapore National Eye Centre
| | - Sze Yee Lee
- Singapore Eye Research Institute, Singapore National Eye Centre
| | - Jeremy Tan
- Faith Medical Group
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore
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Wolkoff P. Ocular discomfort by environmental and personal risk factors altering the precorneal tear film. Toxicol Lett 2010; 199:203-12. [DOI: 10.1016/j.toxlet.2010.09.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 09/01/2010] [Accepted: 09/03/2010] [Indexed: 02/06/2023]
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