A review of cosmetic contact lens infections

Cosmetic Contact Lenses in the United Kingdom: Assessment of Online Regulation and Quality of Consumer Health Information

OBJECTIVES

To determine the compliance of online vendors to the UK Opticians Act 1989 Section 27 requirements and safety regulations for cosmetic contact lens (CCL) sales and the quality of online CCL health information.

METHODS

The top 50 websites selling CCLs on each three search engines, namely Google, Yahoo, and Bing, were selected. Duplicates were removed, and the remaining websites were systematically analyzed in February 2023. UK legal authorization for CCL sales was assessed using the Opticians Act Section 27 and safety regulations determined by the presence of Conformité Européene (CE) marking. The quality and reliability of online information was graded using the DISCERN (16-80) and JAMA (0-4) scores by two independent reviewers.

RESULTS

Forty-seven eligible websites were analyzed. Only six (12.7%) met the UK legal authorization for CCL sales. Forty-nine different brands of CCLs were sold on these websites, of which 13 (26.5%) had no CE marking. The mean DISCERN and JAMA benchmark scores were 26 ± 12.2 and 1.3 ± 0.6, respectively (intraclass correlation scores: 0.99 for both).

CONCLUSIONS

A significant number of websites provide consumers with easy, unsafe, and unregulated access to CCLs. Most online stores do not meet the requirements set out in the Opticians Act for CCL sales in the United Kingdom. A significant number of CCLs lack CE marking, while the average quality of information on websites selling CCLs is poor. Together, these pose a risk to consumers purchasing CCLs from unregulated websites, and therefore, further stringent regulations on the online sales of these products are needed.

Prognostic indicators of corneal ulcer clinical outcomes at a tertiary care center in the Bronx, New York

PURPOSE

Corneal ulcers frequently result in ocular morbidity and may lead to permanent visual impairment if severe or untreated. This study aims to evaluate the association of patient factors and ocular exam findings on clinical outcomes for patients diagnosed with a corneal ulcer at a tertiary care center in the Bronx, New York.

METHODS

A retrospective chart review was conducted on all ambulatory and admitted patients diagnosed with a corneal ulcer (identified using ICD-10 code H16.0) at Montefiore Medical Center, Bronx, NY between 2016-2022. Patient demographics, presence of known risk factors, characteristics of subsequent clinical course, and microbiological studies were noted. Clinical outcomes following treatment were longitudinally evaluated and categorized based upon the following criteria: 1) 'No Surgical Intervention': No severe complications or surgery required after presentation, 2) 'Surgical Intervention': Decline in BCVA with surgery required for a severe complication.

RESULTS

The search criteria identified 205 patients (205 eyes) with the diagnosis of a corneal ulcer. Mean age was 55.3 ± 21.1 years (mean ± SD). Mean ulcer area at presentation was 7 ± 10.5 mm2. Mean LogMAR at presentation was 1.2 ± 1, and following treatment, improved to 1.0 ± 1. 'Surgical Intervention' outcome was associated with advanced age (p = 0.005), presence of ocular surface disease (p = 0.008), central location of ulcer (p = 0.014), greater ulcer area at presentation (p = 0.003), worse visual acuity at presentation (p < 0.001), and isolation of fungi (p = 0.004).

CONCLUSION

Identification of risk factors associated with a poor clinical prognosis can guide treatment and inform expectations for patients diagnosed with a corneal ulcer. Our study highlights the importance of timely diagnosis, work-up, and initiation of appropriate management, particularly in vulnerable populations where access to specialty care is logistically challenging.

TFOS Lifestyle: Impact of contact lenses on the ocular surface

Several lifestyle choices made by contact lens wearers can have adverse consequences on ocular health. These include being non-adherent to contact lens care, sleeping in lenses, ill-advised purchasing options, not seeing an eyecare professional for regular aftercare visits, wearing lenses when feeling unwell, wearing lenses too soon after various forms of ophthalmic surgery, and wearing lenses when engaged in risky behaviors (e.g., when using tobacco, alcohol or recreational drugs). Those with a pre-existing compromised ocular surface may find that contact lens wear exacerbates ocular disease morbidity. Conversely, contact lenses may have various therapeutic benefits. The coronavirus disease-2019 (COVID-19) pandemic impinged upon the lifestyle of contact lens wearers, introducing challenges such as mask-associated dry eye, contact lens discomfort with increased use of digital devices, inadvertent exposure to hand sanitizers, and reduced use of lenses. Wearing contact lenses in challenging environments, such as in the presence of dust and noxious chemicals, or where there is the possibility of ocular trauma (e.g., sport or working with tools) can be problematic, although in some instances lenses can be protective. Contact lenses can be worn for sport, theatre, at high altitude, driving at night, in the military and in space, and special considerations are required when prescribing in such situations to ensure successful outcomes. A systematic review and meta-analysis, incorporated within the review, identified that the influence of lifestyle factors on soft contact lens dropout remains poorly understood, and is an area in need of further research. Overall, this report investigated lifestyle-related choices made by clinicians and contact lens wearers and discovered that when appropriate lifestyle choices are made, contact lens wear can enhance the quality of life of wearers.

Contact Lens Safety for the Correction of Refractive Error in Healthy Eyes

ABSTRACT

Contact lenses are a safe and effective method for correction of refractive error and worn by an estimated 45 million Americans. Because of the widespread availability and commercial popularity of contact lenses, it is not well appreciated by the public that contact lenses are U.S. Food and Drug Administration (FDA)-regulated medical devices. Contact lenses are marketed in numerous hard and soft materials that have been improved over decades, worn in daily or extended wear, and replaced in range of schedules from daily to yearly or longer. Lens materials and wear and care regimens have impact on the risks of contact lens-related corneal inflammatory events and microbial keratitis. This article reviews contact lens safety, with specific focus on the correction of refractive error in healthy eyes.

Gone Viral: A Cross-Sectional Analysis of Contact Lens-Related Videos on TikTok

OBJECTIVES

To evaluate the content, sources, and quality of contact lens (CL)-related videos on TikTok, the fastest growing social media platform worldwide.

METHODS

TikTok was queried on October 25, 2021 for the top 200 posts with the hashtag "#contactlenses." Posts meeting inclusion criteria were characterized and assessed for quality with DISCERN, a validated scoring instrument for the appraisal of consumer health information (score range 1-5 with a higher score indicating a higher quality video).

RESULTS

The included 113 posts showed a mean quality of 1.94±0.44. Content included product displays (42%), patient experiences (23%), educational (22%), and comedy (12%). Most product displays featured decorative lenses (98%). Although videos by eye-care providers (ECPs) accounted for most educational content (52%) and showed significantly higher mean quality compared with posts by non-ECPs (2.57±0.18 vs. 1.85±0.13, P <0.001), they were a minority (12%) and showed poor overall quality. Contact lens representation was greatly skewed toward decorative lenses (74%), whereas only 3.5% of videos promoted seeing an ECP.

CONCLUSIONS

Poor quality and skewed representation of posts indicate that CL-related information on TikTok has serious shortcomings. These findings are particularly concerning given that most TikTok users are adolescents and young adults, the same population who tend to be decorative lens wearers and who are at increased risk of CL-related complications. Eye-care providers, professional organizations, and regulatory agencies should be urged to increase their engagement with the platform, especially regarding educational content creation and CL marketing oversight.

A Review of Contact Lens-Related Risk Factors and Complications

The purpose of this article is to develop a modern strategy for handling difficulties related to contact lenses and their care. A growing number of people throughout the world are currently concerned by eye-related undesirable activities in allergy sufferers and those wearing contact lenses. While many wearers who experience ocular discomfort exhibit dryness as a symptom, many other contact lens-related pain symptoms also include irritation and fatigue, and managing coexisting diseases must be done in accordance with aspects of wearing contact lenses, all of which undoubtedly increase discomfort.

It is typical for contact lens storage containers to have persistent microbial contamination, which has been linked to microbial keratitis (MK) and clear corneal invasion. Contact lens-associated MK is an interesting, potentially sight-threatening complexity arising from wearing soft contact lenses. Estimates show that for every 10,000 persons who wear contact lenses each year, there are 2 to 5 occurrences of MK. Investigating separate determinants for contact lens-associated MK and evaluating their impact on infection load is one of the challenges in their administration. It is hoped that this will offer a useful outline of the complicated issues of contact lens wear that are both infectious and non-infectious. Recent epidemiological studies detailing the risk factors associated with contact lens use, and the effect of pathogen and individual immune profiles on the severity of diseases have enlightened how we might interpret the prophylaxis and prevention of contact lens-related corneal infection. The most dreaded side effect of contact lens use, infectious keratitis linked with contact lenses, will be reviewed, along with the most recent advancements in its diagnosis and treatment.

Lipopolysaccharide Enhances Genotoxicity by Activating GADD45G and NF-κB in Human Corneal Epithelial Cells

As the prevalence of microbial keratitis increases, it creates an environment conducive to genotoxicity response. A potential connection between growth arrest and DNA-damage-inducible 45 gamma (GADD45G) gene expression has not been proven in the corneal epithelial cells. The aim of this study was to determine whether lipopolysaccharide (LPS) enhances genotoxicity, DNA damage, and inflammatory responses in human corneal epithelial cells (HCECs) in vitro. In a set of parameters, cytotoxicity, reactive oxygen species, mitochondrial membrane potential, DNA damage, inflammatory response, and apoptosis were assessed. LPS (1, 5, and 10 μg/mL) treated HCECs were increased reactive oxygen species formation, mitochondrial membrane depolarization, and genotoxicity in a concentration-dependent manner. Similarly, NF-κB, PARP1, and TP53 were also overexpressed in the LPS treated HCECs. 24 hours after LPS induction, micronucleus scoring, and proapoptotic factors were also increased. Among them, the GADD45G, NF-κB, and γH2AX were overexpressed both on the mRNA and protein levels in LPS (10 μg/mL) treated HCECs. In our study, we show that the GADD45G signaling can trigger genotoxic instability in HCECs exposed to LPS. Therefore, understanding the factors contributing to infectious keratitis, such as GADD45G, NF-κB, and γH2AX signaling, may help to develop antigenotoxic and anti-inflammatory therapies for corneal dystrophy and epithelial cell remodeling.

A web-based survey of contact lens-related adverse events among the Japanese female population

To assess the safety of cosmetic contact lenses and to identify other factors of contact lens (CL)-related complications for Japanese females. A web-based, cross-sectional, observational survey of complications related to CL use was performed. The frequencies of complications were compared between transparent and cosmetic CLs. Besides lens pigmentation, age, replacement schedule, total experience, daily wear time, location of purchase, stacking of CLs, CL exchange with friends, compliance to hygiene procedure, replacement of CLs at intervals longer than recommended, and CL wear overnight were considered as risk factors. Logistic regression analyses were performed to calculate the odds ratios. A total of 3803 Japanese females were analyzed. The frequency of adverse events was 33.4% (95%CI 31.3-35.4%) and 35.7% (95%CI 33.5-38.0%) for transparent and cosmetic CLs, respectively. In a multivariate model, statistically significant factors associated with complications included the following: quarterly schedule lenses, replacement at intervals longer than recommended, compliance to hygiene procedure, overnight wearing, purchase at physical shops and on the internet, and longer daily wearing time. Most of the risk-increasing behaviors are preventable. The role of public health ophthalmology is to increase awareness and to improve CL use behaviors.

Use of Soft Contact Lens for Esthetic and Functional Rehabilitation

OBJECTIVE

To report the outcomes and complications of colored soft contact lenses (SCLs) to improve esthetic or eye function in visually impaired (VI) or blind patients.

METHODS

This retrospective study enrolled consecutive patients with unilateral or bilateral VI or blindness who had received colored SCLs to improve appearance or ocular function. Data were collected on demographics, complaints, complete ophthalmological examinations, types of SCL, follow-ups, and complications.

RESULTS

The study sample was comprised of 109 patients (ages 4-80 years). Eighty-six patients (78.89%) had unilateral blindness, and 14 patients (12.84%) had functional disorder. Most of the patients presenting for improved esthetic had anterior segment pathology (74/67.88%), mainly secondary to trauma (55/50.5%) resulting in leukoma (73/66.97%). Patients with functional VI (19/17.43%) received filtered SCLs for color blindness (7/6.42%), diplopia (7/6.42%), or photophobia (5/4.58%). No serious complications were observed in any cases, and 94.49% of patients were satisfied with the SCLs.

CONCLUSION

Colored SCLs can cover ocular surface imperfections in VI or blind eyes of patients who are seeking better cosmesis or improvement functional VI. Soft contact lenses with only one filter can cover imperfections of the ocular surface and improve vision in functional VI. Appropriate follow-up of these patients can reduce complication rates, resulting in good cosmesis and patient satisfaction with a positive impact on the lives of patients suffering from functional VI or blindness.

Realisation and assessment of a low-cost LED device for contact lens disinfection by visible violet light

This study presents a device for efficient, low-cost and eye-friendly overnight disinfection of contact lenses by visible violet light as an alternative to disinfection with biocide-containing solutions. Bacterial solutions with one Pseudomonas and one Staphylococcus strain each were irradiated for up to 8 h in commercial transparent contact lens cases by the presented light-emitting diode (LED) device. Samples were taken at different intervals and distributed on agar plates. The surviving bacteria were determined by counting of colony-forming units and compared to the specific requirements of the stand-alone test for contact lens disinfection of the hygiene standard ISO 14729. The concentration of both microorganisms was reduced by three orders of magnitude after less than 4 h of irradiation. The LED current and intensity have not yet been at maximum and could be further increased if necessary for other microorganisms. The presented device fulfils the requirement of the stand-alone test of the contact lens hygienic standard ISO 14729 for the tested Pseudomonas and Staphylococcus strains. According to literature data, the inactivation of Serratia marcescens, Candida albicans and Fusarium solani seems also possible, but may require increased LED current and intensity.

American Academy of Optometry Microbial Keratitis Think Tank

SIGNIFICANCE

Think Tank 2019 affirmed that the rate of infection associated with contact lenses has not changed in several decades. Also, there is a trend toward more serious infections associated with Acanthamoeba and fungi. The growing use of contact lenses in children demands our attention with surveillance and case-control studies.

PURPOSE

The American Academy of Optometry (AAO) gathered researchers and key opinion leaders from around the world to discuss contact lens-associated microbial keratitis at the 2019 AAO Annual Meeting.

METHODS

Experts presented within four sessions. Session 1 covered the epidemiology of microbial keratitis, pathogenesis of Pseudomonas aeruginosa, and the role of lens care systems and storage cases in corneal disease. Session 2 covered nonbacterial forms of keratitis in contact lens wearers. Session 3 covered future needs, challenges, and research questions in relation to microbial keratitis in youth and myopia control, microbiome, antimicrobial surfaces, and genetic susceptibility. Session 4 covered compliance and communication imperatives.

RESULTS

The absolute rate of microbial keratitis has remained very consistent for three decades despite new technologies, and extended wear significantly increases the risk. Improved oxygen delivery afforded by silicone hydrogel lenses has not impacted the rates, and although the introduction of daily disposable lenses has minimized the risk of severe disease, there is no consistent evidence that they have altered the overall rate of microbial keratitis. Overnight orthokeratology lenses may increase the risk of microbial keratitis, especially secondary to Acanthamoeba, in children. Compliance remains a concern and a significant risk factor for disease. New insights into host microbiome and genetic susceptibility may uncover new theories. More studies such as case-control designs suited for rare diseases and registries are needed.

CONCLUSIONS

The first annual AAO Think Tank acknowledged that the risk of microbial keratitis has not decreased over decades, despite innovation. Important questions and research directions remain.

ToF-SIMS and AFM Characterization of Brown Cosmetic Contact Lenses: From Structural Analysis to the Identification of Pigments

Over the years, soft contact lenses for vision correction and cosmetic and therapeutic purposes have been greatly improved. For cosmetic contact lenses, the pigments need to be nontoxic, and the position of the pigment layer is particularly important because of the risks posed by pigment elution and the roughness of the lens surface. In this paper, we characterized the properties of brown cosmetic contact lenses made by three different manufacturers using surface analytical techniques. The surface topographies of the noncolored and colored parts were obtained by atomic force microscopy (AFM), and the position and composition of the pigment layer were determined by analyzing the cross section of the contact lenses using scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM-EDX). The influence of pigment location on surface roughness was also examined. In addition, to find the method of the evaluation for the risk of surface elution of the pigments in the colored parts, the mass spectra and ion images of the surfaces were obtained by time-of-flight secondary ion mass spectrometry (ToF-SIMS) with a new sample preparation. From the ToF-SIMS spectra, we observed specific fragment ions of the poly(hydroxyethyl methacrylate) (PHEMA) polymer and found differences in the composition of the pigment layer depending on the manufacturers. The cross-sectioned image and 3D chemical characterizations of metallic and specific ions in the brown cosmetic contact lenses clearly indicated the spatial distribution and location of the pigment layer that can be used for the evaluation of pigment elution.