Two Presentations of Contact Lens-Induced Papillary Conjunctivitis (CLPC) in Hydrogel Lens Wear: Local and General

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.

Development of an enzymatic method for the evaluation of protein deposition on contact lenses

The aim of this study was to evaluate a new digestion method to quantify protein deposition on contact lenses. Four silicone hydrogel and one hydrogel contact lens material were incubated in lactoferrin, lysozyme, immunoglobulin A, and bovine serum albumin solutions at approximate physiological concentrations and temperature. Immobilized trypsin was used to digest the protein deposits from the contact lens surfaces. The total protein absorbed to lenses was extracted and digested using sequencing grade trypsin. The tryptic peptides were quantified using selected reaction monitoring mass spectrometry. The concentration of surface protein deposits was either lower than or the same as the total protein for all lens types and proteins. Immobilised trypsin can digest protein deposits from the surface of contact lenses. This ability to analyse the amount of protein at a contact lens surface may help in elucidating the effect of surface deposition on clinical outcomes during lens wear.

Lysozyme Deposition on Contact Lenses in an In Vitro Blink-Simulation Eye Model Versus a Static Vial Deposition Model

PURPOSE

To evaluate active lysozyme deposition on daily disposable (DD) contact lenses (CL) using a novel in vitro blink model.

METHODS

Three conventional hydrogel DD CL materials (etafilcon A, omafilcon A, nelfilcon A) and three silicone hydrogel DD CL materials (delefilcon A, senofilcon A, somofilcon A) were tested. The device blink rate was set to 6 blinks/min with a tear flow rate of 1 μL/min using an artificial tear solution (ATS) containing lysozyme and other typical tear film components. After incubation at 2, 4, or 8 hr, lenses were removed, and lysozyme activity was measured. A separate experiment was conducted with lenses incubated in a static vial containing 480 μL of ATS.

RESULTS

Etafilcon A deposited significantly higher amounts of active lysozyme (402±102 μg/lens) than other lens materials after 8 hr (P<0.0001). Etafilcon A had a higher amount of active lysozyme using the blink model compared with the static vial (P=0.0435), whereas somofilcon A (P=0.0076) and senofilcon A (P=0.0019) had a higher amount of lysozyme activity in the vial compared with the blink model.

CONCLUSION

The blink model can be tuned to provide quantitative data that closely mimics ex vivo studies and can be used to model deposition of lysozyme on CL materials.

The State of the Art about Etiopathogenetic Models on Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL): A Narrative Review

BACKGROUND

Breast-implant-associated anaplastic large cell lymphoma is a rare malignancy linked to texturized breast implants. Although many researchers focus on its etiopathogenesis, this topic is affected by a lack of evidence.

MATERIALS AND METHODS

A literature review about BIA-ALCL was made.

RESULTS AND CONCLUSIONS

Although the incidence is reported between 1:355-1:30,000, there is great attention to BIA-ALCL. The incidence is uncertain due to many reasons. It may well be lower, due to inclusion in multiple databases as pointed out by the FDA and undiagnosed cases. The role of chronic inflammation, bacterial contamination, and mechanical forces was discussed. Clarification is needed to understand the mechanisms underlying the progression of alterations and mutations for BIA-ALCL; new molecular analysis and pathogenetic models should be investigated.

Assessment of a Novel Lens Surface Treatment for Scleral Lens Wearers With Dry Eye

OBJECTIVES

To compare lens comfort and dry eye (DE) symptoms of DE scleral lens (SL) wearers fit with polyethylene glycol (PEG)-based surface-treated and untreated SLs. Dry eye signs, comfortable SL wearing time (WT), vision quality, and lens-related ocular surface changes were also assessed.

METHODS

Twenty-one SL wearers with DE and SL discomfort were enrolled in a double-masked crossover study. Participants were randomized to wear their untreated or PEG (Tangible Hydra-PEG, Tangible Science; Redwood, CA) surface-treated SL of the same parameters first for 30 days. Lens comfort, DE symptoms, and ocular surface assessments were measured at baseline, after the first test period, and after the crossover. Comfortable lens WT and frequency of foggy vision were recorded. Comparisons were assessed using paired t tests or Wilcoxon signed-rank tests.

RESULTS

Polyethylene glycol-treated SL wear resulted in significantly improved: lens comfort (P=0.003), DE symptoms (P=0.004), corneal sodium fluorescein staining (P=0.01), temporal conjunctival lissamine green staining (P=0.01), lid wiper epitheliopathy (P=0.002), conjunctival papillae (P=0.003), frequency of foggy vision (P=0.002), tear break-up time (TBUT) (P=0.01), and comfortable lens WT (P=0.002) compared with untreated wear. There were no significant changes between treated and untreated lens wear for TBUT over the SL (P=0.14) and nasal conjunctival lissamine green staining (P=0.06).

CONCLUSIONS

Polyethylene glycol surface-treated SLs provided improved comfort, reduced DE symptoms, and reduced ocular surface compromise compared with untreated SLs for participants with DE.

Deposition of Fluorescently Tagged Lysozyme on Contact Lenses in a Physiological Blink Model

PURPOSE

To visualize the deposition of fluorescein isothiocyanate (FITC) lysozyme on daily disposable contact lenses (CLs) using a novel blink model.

METHODS

Three daily disposable conventional hydrogel CLs (etafilcon A, omafilcon A, and nelfilcon A) and three silicone hydrogel CLs (delefilcon A, senofilcon A, and somofilcon A) were evaluated in the study. The CLs were mounted onto a novel blink model and exposed to an artificial tear solution containing FITC lysozyme for 2 and 10 hr. The flow rate and blink speed were set to 1 μL/min and 6 blinks/min, respectively. After the incubation period, a 5-mm-diameter disc was punched out from the center of the lens and mounted on a microscope slide. The slides were imaged using the Zeiss 510 Meta confocal laser scanning microscope, which scanned the lens from the front to the back surface at 5-μm increments.

RESULTS

There was an increase in deposition of FITC lysozyme for all lens types with increasing incubation time (P<0.05), with the exception of somofilcon A, which did not show statistical significance between 2 and 10 hr (P>0.05). The conventional hydrogel CLs deposited higher amounts of FITC lysozyme than the silicone hydrogel CLs (P<0.001), with etafilcon A depositing the highest at all time points (P<0.05). Interestingly, at the 2-hr incubation time, most CLs showed a higher amount of deposition at the front surface than the back surface of the lens. In particular, etafilcon A showed preferred deposition at the front surface at all time points.

CONCLUSION

The results suggest that there is differential deposition at the front surface of the CL, which is exposed to the prelens tear film, compared with the back surface of the CL, which is exposed to the postlens tear film. Therefore, it may be beneficial to design CL materials with differing surface properties for the front and back surfaces of the CL to enhance interactions with the tear film and ocular surface.

Iatrogenic corneal diseases or conditions

Any prescribed or self-administered therapy carries inherent risks of secondary adverse events. While the volume of treatments being administered through healthcare systems has been increasing, scientific advancements in our understanding of the mechanisms of pharmaceutical side effects and complications from procedures now allow us to reduce the risk of non-intentional damage to ocular health. This review summarizes the most common and leading causes of iatrogenic visual impairment, corneal diseases, and conditions that present in a general ophthalmologic practice, including a comprehensive analysis of their pathophysiology and recommendations for management and prophylaxis.Iatrogenic corneal diseases and conditions can arise from topical drugs, contact lens use, eye surgeries and procedures, systemic drugs, non-ophthalmological events, and cosmetic procedures. Topical and systemic drugs may disturb tear film homeostasis or result in ocular surface deposits. The use of ill-fitted contact lenses can trigger eye discomfort and poor hygiene conditions that can predispose to severe infections. Procedures to the eye may result in a variety of anatomical and functional complications that ophthalmologists should be aware of how to avoid or at least be prepared to manage if they occur. Even non-ophthalmological events such as non-invasive ventilation, radiation therapies and, immune-based conditions, or cosmetic procedures such as eyelash growth and fillers, can result in unwanted damage to the ocular surface.

Microbiome analysis of contact lens care solutions and tear fluids of contact lens wearers: Possible involvement of streptococcal antigens in allergic symptoms related to contact lens wear

The present study elucidated the pathogenesis of allergic symptoms (AS) related to contact lens (CL) wear by assaying CL care solutions in lens storage cases and tears from subjects with AS using molecular biology techniques. A total of 15 CL storage cases were collected from subjects with AS (n=9) and healthy, asymptomatic control CL wearers (n=6). Bacterial populations in CL care solutions and tears were assayed by culture and 16S rDNA sequencing. Histamine levels in tears were measured by high-performance liquid chromatography. Western blot analysis was performed to identify the bacteria recognized by tear IgE from subjects with AS. No significant differences were found in the culture results between the subjects with AS and asymptomatic subjects. Histamine was detected in 2 subjects with AS. Meta-16S rDNA sequencing identified a cluster of 4 subjects with AS that were distinguished from others by principal coordinate analysis. Detailed population analysis revealed that the abundance of Gram-positive bacteria in the microbiomes of CL care solutions used by the subjects with AS were higher than those of asymptomatic subjects (42.24±9.47 vs. 16.85±22.76% abundance). Among these, Streptococcus was the dominant genus (12.1-18.3% abundance). Tear microbiome analysis revealed that the abundance of Streptococcus in the subjects with AS was significantly higher than that in other subjects (19.02±5.50 vs. 3.08±3.35%, P<0.01). Western blot analysis demonstrated that the tear IgE in all subjects with AS reacted with Streptococcus (100%), but not with Staphylococcus. On the whole, these results provide novel insight into the pathogenesis of AS and identify Streptococcus as an important factor in AS associated with CL wear.

Lipid deposition on contact lenses in symptomatic and asymptomatic contact lens wearers

PURPOSE

Lipid deposition on contact lenses (CL) has traditionally been believed to reduce comfort during CL wear. The purpose of this study was to quantify lipid deposition on CL in a group of symptomatic and asymptomatic adapted CL wearers.

METHODS

This was a single-masked, randomized clinical trial. Only confirmed symptomatic (comfortable lens wear time (CWT) < 8 h and a noticeable reduction in comfort over the course of the day) and asymptomatic (CWT > 10 h and minimal reduction in comfort over the course of the day) participants were recruited to participate in the study. Participants wore senofilcon A lenses in combination with a polyquaternium-based care solution (OPTI-FREE Replenish). Worn CL samples were collected on Day 14. Deposited lipid amounts from the lenses (including cholesteryl ester, cholesterol and triolein) were quantified using a liquid chromatography-mass spectrometry technique.

RESULTS

Lipid deposition was significantly higher in CL extracts of asymptomatic wearers compared to the symptomatic wearers for all lipid types quantified, including cholesteryl ester (2.1 ± 0.6 vs 1.6 ± 0.5 log μg/lens), cholesterol (1.5 ± 0.3 vs 1.1 ± 0.3 log μg/lens) and triolein (0.3 ± 0.2 vs 0.1 ± 0.1 log μg/lens) (all p < 0.002). The amount of cholesteryl ester deposited was greatest (p = 0.0001), followed by cholesterol, then triolein, for both the asymptomatic and symptomatic groups (both p = 0.0001).

CONCLUSION

This study demonstrated that the asymptomatic group deposited a significantly greater amount of lipid on their CL. Although lipid levels measured are considered low to trigger any observable clinical deposition, they may influence other clinical outcomes, particularly comfort.

S, Akshara MR, N. K, Zaidi ZS, Iqbal SF, Misra SK. Advances in chemistry and composition of soft materials for drug releasing contact lenses

Ocular drug delivery has always been a challenging feat to achieve in the field of medical sciences. One of the existing methods of non-invasive ocular drug delivery is the use of eye drops. However, drugs administered through these formulations have low bioavailability in the ocular system. This limitation can been overcome by using contact lenses as drug delivery vehicles. According to USA FDA definitions they can be categorized into two main categories-hard and soft contact lenses. Based on the material properties, hard contact lenses are mostly produced from polymers of acrylate monomers such as MMA (methyl methacrylate). These have the least water retention capacity, thereby, having minimal ability to diffuse oxygen into the corneal layer and are not ideal for long term use. Soft material contact lenses are flexible and are mainly hydrogel based. They have higher water retention capacities as compared to rigid contact lenses, which gives them the ability to transmit oxygen to the corneal layer. These hydrogel based soft materials are mainly produced from polymers of acrylate monomers such as HEMA (hydroxyethyl methacrylate) and found to be better for drug delivery contact lenses. These polymer-based soft materials have been efficiently modified in terms of their chemistry to achieve diverse physicochemical properties to produce efficient ocular drug delivery systems. However, complications such as drug leaching during storage and distribution, sterilisation, preservation of integrity of the lens and the possibility of surface roughness due to the incorporated drug molecules still need to be optimised. This review highlights the chemistries of various polymeric molecules through which physicochemical properties can be modified to achieve optimum drug loading and sustained release of the drug for application in the ocular system.

Contact lens as controllable route for ocular drug delivery.

Effects of lysosomal deposition on the friction coefficient of hydrogel contact lenses

When a contact lens is in contact with the eyelid and the cornea, tear proteins start to be accumulated on the lens and may subsequently undergo conformational changes. Protein adsorption or conformational changes on the lens may lead to discomfort, red eye, or even inflammatory reactions. Although measuring the friction coefficient of contact lens has been linked to comfort degree in vivo, there is not much research about the effects of tear protein deposition on the friction coefficient of the contact lens. Therefore, we investigated the friction coefficient of three distinct materials of contact lenses in two different lysosomal concentrations. We also studied lysozyme deposition on the lens without the influence of friction. The results demonstrated that although the amount of lysozyme deposition was high on all the materials we tested, it was not corresponded to higher friction coefficient. In addition, we investigated the effect of the contact lens care solution we developed on friction coefficient and lysozyme deposition of three different materials of contact lenses. The results showed that the care solution could reduce the increased friction coefficient caused by high lysosomal concentration. Therefore, we proposed a potential mechanism of why lysosomal deposition may result in high friction coefficient for certain types of hydrogel contact lenses.

Review of Contact Lens-Related Complications

The purpose of this article is to provide a review of existing literature describing complications with contemporary contact lenses and their management. It is envisioned that this will serve as a useful summary of noninfectious and infectious complications associated with contact lens wear.

The characteristics of a preservative-free contact lens care solution on lysozyme adsorption and interfacial friction behavior

The population of soft contact lens wearers is increasing, thus the issues of feeling comfortable and contact lens-induced clinical symptoms are concerned. Both lysozyme deposition and mechanical friction among contact lens and the eye can induce discomfort and eye conditions. Therefore, we characterized our developed preservative-free contact lens care solution on lysozyme adsorption and lubrication. Two distinct lens materials were washed with the care solution after being soaked in lysozyme, as well as were rubbed against the glass in the presence of lysozyme and the care solution for measuring the friction coefficient. Our results demonstrated that the preservative-free contact lens care solution can be applied as a potential lubricant for a specific type of soft contact lenses.

Biological and Clinical Implications of Lysozyme Deposition on Soft Contact Lenses

Within a few minutes of wear, contact lenses become rapidly coated with a variety of tear film components, including proteins, lipids, and mucins. Tears have a rich and complex composition, allowing a wide range of interactions and competitive processes, with the first event observed at the interface between a contact lens and tear fluid being protein adsorption. Protein adsorption on hydrogel contact lenses is a complex process involving a variety of factors relating to both the protein in question and the lens material. Among tear proteins, lysozyme is a major protein that has both antibacterial and anti-inflammatory functions. Contact lens materials that have high ionicity and high water content have an increased affinity to accumulate lysozyme during wear, when compared with other soft lens materials, notably silicone hydrogel lenses. This review provides an overview of tear film proteins, with a specific focus on lysozyme, and examines various factors that influence protein deposition on contact lenses. In addition, the impact of lysozyme deposition on various ocular physiological responses and bacterial adhesion to lenses and the interaction of lysozyme with other tear proteins are reviewed. This comprehensive review suggests that deposition of lysozyme on contact lens materials may provide a number of beneficial effects during contact lens wear.

Optical coherence tomography to evaluate the interaction of different edge designs of four different silicone hydrogel lenses with the ocular surface

Purpose

To evaluate the lens edge interaction with the ocular surface with different edge designs using optical coherence tomography and to examine the effect of lens power on the lens edge interactions.

Methods

Four types of silicone hydrogel lenses with different edge designs (round-, semi-round-, chisel-, and knife-edged) at six different powers (+5.0, +3.0, +1.0, −1.0, −3.0, and −5.0 diopters) were fitted to both eyes of 20 healthy volunteers. Optical coherence tomography images were taken at the corneal center and at the limbus within 15–30 minutes after insertion. The images were evaluated with respect to two parameters: conjunctival indentation exerted by the lens edge; and the tear film gaps between the posterior surface of the lens and the ocular surface. The amount of conjunctival indentation was measured with the distortion angle of the conjunctiva at the lens edge.

Results

The degree of conjunctival indentation was highest with the chisel-edged design followed by the semi-round design (P<0.0001). Knife- and round-edged lenses exerted similar levels of conjunctival indentation that was significantly lower compared to chisel-edged lens (P<0.001). For each one of the tested lens edge designs, no significant difference was observed in the conjunctival indentation with respect to lens power. The chisel-edged lens produced the highest amount of conjunctival indentation for each one of the six lens powers (P<0.0001). Post-lens tear film gaps at the limbus were observed at most in the round-edge design (P=0.001).

Conclusion

The fitting properties of contact lenses may be influenced by their edge design but not by their lens power.

Risk factors for contact lens-induced papillary conjunctivitis associated with silicone hydrogel contact lens wear

BACKGROUND

Contact lens-induced papillary conjunctivitis (CLPC) continues to be a major cause of dropout during extended wear of contact lenses. This retrospective study explores risk factors for the development of CLPC during extended wear of silicone hydrogel lenses.

METHODS

Data from 205 subjects enrolled in the Longitudinal Analysis of Silicone Hydrogel Contact Lens study wearing lotrafilcon A silicone hydrogel lenses for up to 30 days of continuous wear were used to determine risk factors for CLPC in this secondary analysis of the main cohort. The main covariates of interest included substantial lens-associated bacterial bioburden and topographically determined lens base curve-to-cornea fitting relationships. Additional covariates of interest included history of adverse events, time of year, race, education level, gender, and other subject demographics. Statistical analyses included univariate logistic regression to assess the impact of potential risk factors on the binary CLPC outcome and Cox proportional hazards regression to describe the impact of those factors on time-to-CLPC diagnosis.

RESULTS

Across 12 months of follow-up, 52 subjects (25%) experienced CLPC. No associations were found between the CLPC development and the presence of bacterial bioburden, lens-to-cornea fitting relationships, history of adverse events, gender, or race. Contact lens-induced papillary conjunctivitis development followed the same seasonal trends as the local peaks in environmental allergens.

CONCLUSIONS

Lens fit and biodeposits, in the form of lens-associated bacterial bioburden, were not associated with the development of CLPC during extended wear with lotrafilcon A silicone hydrogel lenses.

The effect of tinted soft contact lens wear on functional visual acuity and higher-order aberrations

PURPOSE

To investigate the differences of functional visual acuity (FVA) and high order aberrations (HOAs) in relation to tinted and clear hydrogel soft contact lens (SCL) wear.

METHODS

A prospective comparative study was performed in 16 eyes of 16 healthy volunteers. Dynamic visual acuity (using a FVA measurement system) and higher-order aberrations (using a wavefront sensor) were compared in subjects wearing two types of soft contact lenses: 1-day Acuvue(®) (Vistakon, Jacksonville, FL) clear and the 1-day Acuvue(®) Define(TM) (Vistakon, Jacksonville, FL) tinted lens. The blink rates were recorded during FVA testing. The correlation between the difference of HOAs and differences in FVA values was analyzed.

RESULTS

The mean LogMAR FVA scores with clear and tinted SCLs were 0.07 ± 0.13 and 0.14 ± 0.17 (P<0.05). The mean blink frequencies with clear and tinted SCL wear were 18.4 ± 8.3 and 25.3 ± 4.7 blinks/min (P<0.05). Both 3rd-order aberrations and total HOAs showed statistically significant differences between the two types of soft contact lenses for 6mm pupil measurements (P<0.05). A significant positive linear correlation was observed between ΔHOAs and ΔLogMAR FVA for 6mm pupil measurements (R=0.53, P=0.04).

CONCLUSIONS

Tinted contact lens wear appears to induce a reduction in optical quality. Functional visual acuity measurement is a useful procedure to study the changes of visual performance and quality in tinted contact lens wear.

Adverse events during 2 years of daily wear of silicone hydrogels in children

PURPOSE

Type and incidence of adverse events and rate of discontinuations for 2 years of daily wear with silicone hydrogel contact lenses in Chinese children with myopia.

METHODS

Two hundred forty children aged 7 to 14 years were enrolled in a prospective randomized clinical trial from November 2008 to April 2009. Children with myopia of up to -3.50 diopters (D) spherical equivalent with astigmatism less than or equal to -0.75 D were randomized to one commercial and three experimental lens designs of Lotrafilcon B silicone hydrogel lenses (four groups) used bilaterally on a daily wear, monthly replacement schedule. The main outcome measures were incidence per 100 patient-years (incidence, in percentage) of adverse events and rate of discontinuations.

RESULTS

There were no events of microbial keratitis. Fifty-five adverse events (incidence, 14.2%) were seen. There were also 12 recurrent events. The type and incidence percentage were contact lens papillary conjunctivitis (16 events, 4.1%), superior epithelial arcuate lesions (SEALs, six events, 1.5%), corneal erosions (eight events, 2.1%), infiltrative keratitis (five events, 1.3%), asymptomatic infiltrative keratitis (seven events, 1.8%), and asymptomatic infiltrates (13 events, 3.42%). There were differences in the incidence of SEALs between groups (p = 0.023), with the incidence of SEALs being greater with one of the experimental designs. No event resulted in any vision loss. Seventy participants (29.2%) discontinued, with one-third (26 participants, 10.8%) occurring in the first month of lens wear. Discomfort and non-lens-related reasons such as safety concern and disinterest were frequently cited reasons for discontinuations.

CONCLUSIONS

Adverse events with daily wear of silicone hydrogels in children were mainly mechanical in nature, and significant infiltrative events were few. The large number of dropouts in the early days of lens wear and their reasons for discontinuation suggest that adaptation and patient motivation are critical for survival in lens wear.

Optimization of a fluorescence-based lysozyme activity assay for contact lens studies

PURPOSE

To optimize a fluorescence-based lysozyme activity assay to investigate the conformational state of lysozyme in solution and to determine the impact of extraction and evaporation procedures and the possible interference of contact lens materials on lysozyme activity.

METHODS

The fluorescence-based lysozyme activity assay, Enzchek (Molecular Probes Inc, Eugene, OR) which utilizes fluorescently quenched Micrococcus lysodeikticus, was compared to the gold standard, classical lysozyme turbidity assay, using four differently concentrated lysozyme samples (20, 10, 5.0 and 2.0 ng/µL). Furthermore, six differently concentrated lysozyme samples (2.0, 1.0, 0.5, 0.25, 0.125 and 0.01 µg/µL) were quantified using the fluorescence-based assay in the presence of extraction solvents consisting of 0.2% and 0.02% trifluroacetic acid/acetonitrile and following evaporation procedures.

RESULTS

A standard curve was generated by the fluorescence-based assay ranging from 2 to 150 ng. The total active lysozyme quantified in the four lysozyme samples was not significantly different between the two assays (p > 0.05) and the concordance correlation coefficient was determined to be 0.995. However an average discrepancy between the two assays was found to be 0.474 ng, with the turbidity assay typically reporting higher active lysozyme measurements. The sensitivity of the fluorescence-based assay was higher than the classical turbidity assay when quantifying 20 ng or less active lysozyme. Following the extraction and evaporation procedures and the addition of lens extracts, the total active lysozyme recovered was 95% or greater.

CONCLUSIONS

In comparison to the classical turbidity assay, the fluorescence-based assay is a very sensitive method, making it a favorable technique, particularly when studying contact lens materials that deposit relatively low levels of lysozyme.

Prevalence of papillary changes and folliculosis of the palpebral conjunctiva in asymptomatic Chinese children

PURPOSE

To determine the prevalence of papillary changes of the upper palpebral conjunctiva and folliculosis of the lower palpebral conjunctiva in Chinese children with no history of contact lens wear.

METHOD

Ninety-nine subjects (aged 6-15 years old) who were interested in a myopia control study were screened for papillary changes and folliculosis of the palpebral conjunctiva. Photodocumentation was performed under white and blue light (after the application of fluorescein) with a yellow filter and the photographs were graded by a group of practitioners according to a pre-set grading scale. Analysis was performed with the subjects divided into groups according to gender and age.

RESULTS

More than 48% of the subjects had clinically significant (≥Grade 3) papillary changes in the upper palpebral conjunctiva. The prevalence of significant folliculosis in the lower lid was about 33%. The prevalence of significant papillary changes and folliculosis were similar between genders. No differences were observed between younger (age≤10 years old) and older (age>10 years old) in papillary changes but younger subjects showed a higher prevalence of folliculosis.

CONCLUSIONS

The prevalences of clinically significant papillary changes and folliculosis of unknown aetiology are high in Chinese children.

Comparison of tacrolimus, fluorometholone, and saline in mild-to-moderate contact lens-induced papillary conjunctivitis

INTRODUCTION

The purpose of this study was to compare the efficacy of tacrolimus, fluorometholone, and saline in the treatment of mild to moderate contact lens-induced papillary conjunctivitis (CLPC).

METHODS

This was a double-masked, randomized pilot study. A total of 18 soft contact lens users (n = 36 eyes) with mild to moderate papillary conjunctivitis were enrolled. Subjects were randomly assigned into three groups to receive tacrolimus 0.05%, fluorometholone 0.1%, or saline (sodium chloride 0.9%). Drugs were prescribed at the baseline visit (visit 1) and instilled twice daily for 4 weeks. Follow-up visits were taken at week 1 (visit 2), week 2 (visit 3), week 4 (visit 4, drug usage suspended at this visit), and week 6 (visit 5, 2 weeks after interrupting eye drops). Contact lens use was discontinued during the 6 weeks of the study, and variables assessed were symptoms and signs, tear film status, and intraocular pressures. Conjunctival impression cytology was performed at baseline and visit 5 to assess ocular surface status.

RESULTS

Mean roughness and redness scores decreased significantly from visit 1 to visit 5, but the variation tendency was comparable in all groups (P = 0.180 and 0.889, respectively). Subjective symptom parameters were improved in all CLPC patients at visit 5, and there was no remarkable difference in symptom reduction in three groups. The mean Schirmer value and mean break-up time (BUT) did not change significantly in the three groups during the study. Ocular surface findings by impression cytology improved significantly after three treatments. Intraocular pressure fluctuation from baseline to 6-week follow-up was not statistically significant in all subjects. No adverse treatment-related event was observed in any study group.

CONCLUSIONS

Tacrolimus 0.05% may be a safe and effective treatment for mild to moderate CLPC and is comparable with fluorometholone 0.1% in efficacy. Contact lens cessation accompanied with saline may also be effective in treating mild to moderate CLPC.

Quantification of non-polar lipid deposits on senofilcon a contact lenses

PURPOSE

To quantify non-polar lipids deposited on senofilcon A silicone hydrogel contact lenses (J&J Acuvue OASYS) when disinfected with a no-rub one-step hydrogen peroxide system (CIBA Vision ClearCare) and a care system preserved with Polyquad & Aldox (Alcon OPTI-FREE RepleniSH).

METHODS

Thirty existing soft lens wearers symptomatic of dryness were enrolled into a 4-week prospective, randomized, bilateral eye (lens type), cross-over (care regimen), daily wear, double masked study. Subjects were refitted with senofilcon A lenses, which were replaced biweekly. During each period of wear, participants used either the peroxide or preserved system. After each period of wear, lenses were collected and lipid was extracted using 1.5 ml of a 2:1 chloroform:methanol solution for 3 h at 37 °C. Lens extracts were analyzed for non-polar lipids [cholesterol oleate (CO), cholesterol, oleic acid (OA), triolein, and OA methyl ester] using normal phase high-performance liquid chromatography.

RESULTS

The total lipid (sum of CO and cholesterol) detected was 34 ± 28 μg/lens for the peroxide-based system and 22 ± 21 μg/lens for the system preserved with Polyquad and Aldox (p = 0.029). Although there was no difference between products for cholesterol (1.4 vs. 1.3 μg/lens; p = 0.50), use of a system preserved with Polyquad and Aldox resulted in significantly less deposited CO (33 ± 28 vs. 21 ± 20 μg/lens; p = 0.033). Approximately, 95% of the detectable lipid deposited on the material was CO, followed by cholesterol. OA and triolein contributed <1% of the total lipid and no OA methyl ester was found on any of the lenses.

CONCLUSIONS

A care system preserved with Polyquad and Aldox removed higher amounts of CO from senofilcon A contact lenses used for 2 weeks than a peroxide-based system, in soft lens wearers who were symptomatic of dry eye.

Quantification of protein deposits on silicone hydrogel materials using stable-isotopic labeling and multiple reaction monitoring

This study was designed to use multiple reaction monitoring (MRM) for accurate quantification of contact lens protein deposits. Worn lenses used with a multipurpose disinfecting solution were collected after wear. Individual contact lenses were extracted and then digested with trypsin. MRM in conjunction with stable-isotope-labeled peptide standards was used for protein quantification. The results show that lysozyme was the major protein detected from both lens types. The amount of protein extracted from contact lenses was affected by the lens material. Except for keratin-1 (0.83 ± 0.61 vs 0.77 ± 0.20, p = 0.81) or proline rich protein-4 (0.11 ± 0.04 vs 0.15 ± 0.12, p = 0.97), the amounts of lysozyme, lactoferrin, or lipocalin-1 extracted from balafilcon A lenses (12.9 ± 9.01, 0.84 ± 0.50 or 2.06 ± 1.6, respectively) were significantly higher than that extracted from senofilcon A lenses (0.88 ± 0.13, 0.50 ± 0.10 or 0.27 ± 0.23, respectively) (p < 0.05). The amount of protein extracted from contact lenses was dependent on both the individual wearer and the contact lens material. This may have implications for the development of clinical responses during lens wear for different people and with different types of contact lenses. The use of MRM-MS is a powerful analytical tool for the quantification of specific proteins from single contact lenses after wear.

Drug-induced ocular side-effects with isotretinoin

Whereas there are numerous reported ocular side-effects from isotretinoin medication, we present the first case report of corneal steepening after systemic treatment with isotretinoin for seven and a half weeks. The case was associated with a significant drop in visual acuity which could not be explained from the refractive error change. All signs and symptoms were absent seven and a half weeks after the medication was withdrawn. The case indicates that eye care professionals need to be vigilant about the possibility of adverse ocular manifestations associated with the use of systemic medications.

Giant papillary conjunctivitis

PURPOSE OF REVIEW

Despite shorter replacement intervals and new lens materials, giant papillary conjunctivitis still limits the ability of some patients to wear contact lenses.

RECENT FINDINGS

Recent research has elucidated many new mediators of inflammation. The presence of chemokines and cytokines such as IL-8, IL-6, IL-11, macrophage inflammatory protein-delta, tissue inhibitor of metalloproteinases-2 macrophage-colony stimulating factor and monokine-induced gamma interferon, eotaxin, pulmonary and activation-regulated CC chemokines have been shown to be elevated in patients with giant papillary conjunctivitis. In addition, M cells and B lymphocytes have been hypothesized to play a role in the pathogenesis of giant papillary conjunctivitis.

SUMMARY

The pathophysiology of giant papillary conjunctivitis is complicated with both immune and mechanical mechanisms playing a role in the development of this condition; understanding these mechanisms is important in both treatment and prevention of giant papillary conjunctivitis.