Compliance Factors Associated With Contact Lens-Related Dry Eye

How Can We Better Inform Patients of the Importance of Contact Lens Compliance?: Current Perspectives

Compliance with contact lens care is important for successful contact lens wear and for minimizing the risk of complications related to lens wear. There are many components of overall lens care guidelines that may potentially be disregarded, forgotten, or misunderstood. Literature has reported copious data on rates of poor compliance for separate lens care recommendations. Knowing the areas of contact lens care where lens wearers perform poorly is helpful when creating strategies for improving patient education. As science evolves and new best-practices are determined, eye care providers must be engaged in educating new lens wearers and reeducating existing wearers. It is vital to make wearers mindful of proper lens care and why proper lens care should be important to them. Various educational strategies can help practitioners to communicate with their patients more effectively. The purpose of this narrative review is to discuss studies of noncompliance with contact lens wear; consequences of these noncompliant behaviors; and studies of lens care education which were found with a literature search. The resulting discussion also includes strategies to improve compliance with patient contact lens wear.

Complications and compliance in professionally-managed and self-managed contact lenses compared with non-contact lens wearers

PURPOSE

To test the impact of professional management of soft contact lens wear on symptoms and ocular complications.

METHODS

Subjective symptoms and ocular complications of soft CL users who did not seek professional follow-up care (self-managed, SM), were compared to users who were prescribed CLs and their care professionally managed in optometry practices (PM), and to a control group of non-CL wearers. Habitual visual acuity, subjective dry-eye symptoms, and corneal abnormalities were assessed in all participants. CL wearers filled-out a usage habits questionnaire, and their CL fit was assessed. Outcomes were compared using Kruskal-Wallis and Chi Squared tests.

RESULTS

The SM, PM, and non-CL wearers cohorts included 127 (mean age:24.3±5.1, median:23, range:16-45 years,104 female), 132 (mean age:25.5±6.2, median:23, range:18-43 years,103 female), and 56 (mean age:22.3±3.5, median:21, range:18-39 years,36 female) participants, respectively. Meibomian gland dysfunction grade (p = 0.004, p<0.0001), limbal redness (both p = 0.04), corneal neovascularization (both p = 0.003), and papillary conjunctivitis (p<0.0001,p = 0.005) were significantly worse in SM CL wearers compared with both the non-CL wearers and PM CL wearers, respectively. Conjunctival staining was significantly worse in the SM cohort compared with the PM cohort (p = 0.01). 38.6% of the SM compared with 22.8% of the PM CL wearers, had an inappropriate refractive correction (p = 0.006). SM CL wearers wore CLs significantly more years (mean and median 1 year,p = 0.008), for more daily hours (mean and median of 2 hours,p<0.00001), and tended to nap or sleep with their CLs compared with the PM CL wearers (47 vs. 29,p = 0.02). The cohorts did not differ in their subjective symptoms.

CONCLUSIONS

Complications are significantly more prevalent in SM CL wearers compared with PM CL wearers, and SM CL wearers tend to wear CLs with incorrect powers, and are less compliant with napping or sleeping with the CLs compared with PM CL wearers. These findings emphasize the importance of fitting, patient education and follow-ups in CL wearers.

Solving STODS-Surgical Temporary Ocular Discomfort Syndrome

The term STODS (Surgical Temporary Ocular Discomfort Syndrome) has been coined to describe the ocular surface perturbations induced by surgery. As one of the most important refractive elements of the eye, Guided Ocular Surface and Lid Disease (GOLD) optimization is fundamental to success in achieving refractive outcomes and mitigating STODS. Effective GOLD optimization and the prevention/treatment of STODS requires an understanding of the molecular, cellular, and anatomic factors that influence ocular surface microenvironment and the associated perturbations induced by surgical intervention. By reviewing the current understanding of STODS etiologies, we will attempt to outline a rationale for a tailored GOLD optimization depending on the ocular surgical insult. With a bench-to-bedside approach, we will highlight clinical examples of effective GOLD perioperative optimization that can mitigate STODS' deleterious effect on preoperative imaging and postoperative healing.

Evaluation of Serratia marcescens Adherence to Contact Lens Materials

Bacterial keratitis is a risk associated with the use of contact lenses for cosmetic purposes or vision correction. In this in vitro experimental study, we examined the ability of the ocular pathogen Serratia marcescens to adhere to monthly or biweekly replacement contact lenses. We performed quantitative adhesion assays to evaluate the adherence of S. marcescens to seven contact lens materials: comfilcon A, senofilcon A, omafilcon B, fanfilcon A, balafilcon A, senofilcon C, and lehfilcon A. Lehfilcon A is a newly marketed silicon hydrogel contact lens with a surface modification of poly-(2-methacryloyloxyethyl phosphorylcholine) (PMPC). PMPC has previously been demonstrated to be an effective anti-biofouling treatment for numerous surfaces. We observed low S. marcescens adherence to lehfilcon A compared to other materials. We demonstrate the use of the fluorescent dye 5(6)-Carboxytetramethylrhodamine succinimidyl ester to covalently stain live cells prior to material adhesion studies.

Are Patients Sufficiently Informed about Contact Lens Wear and Care?

SIGNIFICANCE

Frequent and effective patient-practitioner communication is essential to ensure that instructions regarding contact lens use, care, and maintenance are understood and followed. Given the relevance of good patient compliance, the responsibility of practitioners to provide adequate information may not be neglected.

PURPOSE

This study aimed to determine the content and type of information licensed optometrists in Spain provide their patients during the first contact lens fitting and at follow-up visits.

METHODS

A self-reported ad hoc survey was distributed to licensed optometrists in Spain to investigate, among other factors, whether practitioners provided information on several aspects of contact lens use and maintenance, how was this information provided, and whether in-office practical demonstrations were conducted at all contact lens appointments.

RESULTS

Respondents of 321 surveys had a median of 20 years of contact lens fitting experience and worked on independent practices (67.6%), and national (29.0%) and regional chains (3.4%). Type of practice influenced continuous education habits ( P = .03). Overall, 28.0% of participants did not always instruct patients on the need to rub contact lenses, 34.3% did not always address contact lens replacement, and 6.8% did not always explain storage case hygiene and replacement. At the follow-up visit, only 8.4% of respondents asked their patients to demonstrate their care routines. Information was mostly oral (48.6%) or oral and written (43.0%). Contact lens-related complications were reported more frequently by participants with less continuous education training ( P = .01), by those not always recommending rubbing ( P = .002), and by those not providing written information about storage case hygiene and replacement ( P = .002).

CONCLUSIONS

Patient-practitioner communication was good, albeit several areas were identified where information was insufficient or not provided in a correct and timely format. Precise, written information on rubbing and storage case hygiene and replacement may improve compliance and assist in avoiding complications and dropout.

Effectiveness of Commonly Used Contact Lens Disinfectants Against SARS-CoV-2

OBJECTIVE

To assess the effect of commonly used contact lens disinfectants against severe acute respiratory syndrome corona virus 2 (SARS-CoV-2).

METHODS

The efficacy of five disinfectant solutions against SARS-CoV-2 was tested in the presence and absence of contact lenses (CLs). Three types of unused CLs (hard gas permeable, soft hydrogel, and soft silicone hydrogel) and worn silicone hydrogel CLs were tested. Contact lenses were infected with SARS-CoV-2 and disinfected at various times, with and without rubbing and rinsing, as per manufacturer's instructions. Reverse-transcriptase polymerase chain reaction (RT-PCR) and viability polymerase chain reaction (PCR) were applied to detect SARS-CoV-2 RNA and viral infectivity of SARS-CoV-2, respectively.

RESULTS

In the presence of SARS-CoV-2-infected CLs, no SARS-CoV-2 RNA could be detected when disinfectant solutions were used according to the manufacturer's instructions. When SARS-Co-V2-infected CLs were disinfected without the rub-and-rinse step, SARS-CoV-2 RNA was detected at almost each time interval with each disinfecting solution tested for both new and worn CLs. In the absence of CLs, viable SARS-CoV-2 was detected with all disinfectant solutions except Menicon Progent at all time points.

CONCLUSIONS

Disinfectant solutions effectively disinfect CLs from SARS-CoV-2 if manufacturer's instructions are followed. The rub-and-rinse regimen is mainly responsible for disinfection. The viability PCR may be useful to indicate potential infectiousness.

Comparison of compliance with care procedures performed by orthokeratology wearers and their parents and factors affecting compliance

PURPOSE

To compare the levels of compliance with care routines of orthokeratology (ortho-k) wearers and their parents and to identify factors affecting compliance in a hospital setting in Chengdu, China.

METHODS

Patients who had worn ortho-k lenses for at least one month were invited to participate in a survey on compliance. Wearers or their parents were required to complete a questionnaire to determine their compliance with hand hygiene, ortho-k lenses and accessory care procedures.

RESULTS

A total of 200 wearers, 78 male wearers and 122 female wearers, median age 12 (range 8-18) years were enrolled. Except for use of lens solution, the percentage of participants reporting total compliance with all procedures did not differ significantly between lens wearers and their parents. However, compliance for some items was significantly higher when performed by parents p < 0.001-0.01). 'Eye care practitioner provided instructions' was a significant protective factor for most procedures (p < 0.001-0.04). Age and sex were significant risk factors for some items (p < 0.001-0.04; p = 0.03-0.04, respectively), with girls having higher compliance than boys. 'Parental supervision' was a significant protective factor for some items (p = 0.02-0.04) when wearers performed the procedures themselves. When parents performed lens care procedures, only 'eye care practitioner provided instructions' was a significant variable (p = 0.001-0.04).

CONCLUSION

Some degree of non-compliance was noted in the majority of ortho-k wearers, particularly for the care of the lens case and suction holder. Compliance with care of some items was higher when performed by parents. Regular reinforcement of care procedures by practitioners is important, especially for older and male lens wearers. Parental supervision is necessary when children perform lens care procedures themselves, even for older wearers.

[Thermal pulsation system (LipiFlow®) for treatment of meibomian gland dysfunction (MGD) from the perspective of an ophthalmologist in private practice]

PURPOSE

Thermal pulsation (LipiFlow®, Johnson&Johnson, Santa Ana, CA, USA) has been advocated for meibomian gland dysfunction (MGD) treatment and was found to be useful in many studies. The aim of this study was to show the efficacy of the method and to compare it to a daily eyelid margin massage in a non-university institution.

METHODS

A non-blinded, single-center interventional study comparing thermal pulsation with eyelid margin massage for the treatment of MDD. In this study 30 patients were recruited during daily office hours. Symptoms (OSDI) and ocular surface (NIK-BUT, tear ferning test, tear meniscus height, LIPCO folds, meibography, meibomian gland evaluator) were assessed before treatment. A total of 15 patients (9 women) underwent thermal pulsation (single session), while 15 patients (8 women) performed eyelid margin massage (once daily) as instructed for 3 months.

RESULTS

Before the two treatment methods, there were no differences in the above parameters, gender and age were also normally distributed. After treatment, both subjective and objective criteria improved in the two groups but significantly more in the thermal pulsation arm. In particular, the limited compliance of 30% in the eyelid margin massage arm should be noted. Safety parameters, such as visual acuity and intraocular pressure (IOP) remained normal in all patients.

CONCLUSION

A single session of thermal pulsation showed significantly better results in the efficacy and safety profile after 3 months compared to eyelid margin massage once daily; however, the high costs for the patients due to the single use mode of the activators must be taken in account.

Determining the information needs of contact lens wearers for better education and more support: a qualitative study

BACKGROUND

Designing educational interventions tailored to the needs of Contact Lens Wearers (CLWs) are important and necessary. The present study aimed to determine the information needs of CLWs to educate and provide information to them to increase their knowledge and reduce complications and non-compliance behaviors.

METHODS

A qualitative approach was applied and semi-structured interviews were conducted in three contact lenses (CL) clinics in Iran among all their practitioners and 24 purposively selected patients. Data were analyzed using the Lundman and Graneheim conventional content analysis.

RESULTS

The qualitative analysis revealed knowledge and skill themes as two main categories. The knowledge category includes five subcategories of basic information for the CLWs, acquaintance with the CL, caring for CL, hygiene and vigilance of CL, and challenges of using CL. The skill category consists of two subcategories, including handling/insertion and removal of the CL, and stabilization of learned information. Moreover, 36 sub-subcategories emerged from these seven subcategories that reflected the information needs of CLWs.

CONCLUSIONS

A clear understanding of CLWs' information needs can help to design and develop appropriate educational approaches to overcome training barriers such as physicians' time constraints and high workload. Moreover, it can help deal with CLWs' insufficient knowledge and provide the required information simply and practically with the possibility of enough repetition.

Inflammatory proteins associated with contact lens-related dry eye

PURPOSE

To evaluate the levels and regulation of tear film inflammatory proteins in contact lens-related dry eye (CLDE).

METHODS

One hundred healthy, daily wear (non-overnight), experienced soft contact lens wearers were classified into normal (n = 50) and CLDE (n = 50) groups based on Contact Lens and Dry Eye Questionnaire scores, tear break-up times, and comfort (a two-hour difference between total and comfortable daily lens wear hours). Tear samples (up to 5 μL) were collected by capillary extraction from the inferior meniscus of each eye, and pooled tear samples (10 per group) were tested using a customized Quantibody array. Mann Whitney tests with the Benjamini-Hochberg procedure with a 5% false discovery rate were used to compare the normal and CLDE groups.

RESULTS

Relative to the normal group, the CLDE group showed a significantly increased tear concentration of several inflammatory mediators, including interleukin (IL)-7 (p = 0.001), IL-8 (p = 0.001), IL-13 (p = 0.001), IL-15 (p = 0.001), IL-12 p70 (p = 0.002), growth-related oncogene-alpha/ chemokine (CXC motif) ligand 1 (p = 0.003), granulocyte-colony stimulating factor (p = 0.005), IL-11 (p = 0.008), epidermal growth factor receptor (p = 0.01), IL-1 receptor antagonist (RA) (p = 0.013), macrophage colony-stimulating factor (p = 0.013), Eotaxin/CC motif chemokine ligand 11 (CCL11) (p = 0.016), and IL-2 (p = 0.016). The following cytokines were increased three-fold or more in the CLDE group: IL-13 (p = 0.001), Eotaxin/CCL11 (p = 0.016), and IL-1RA (p = 0.013).

CONCLUSIONS

Several inflammatory markers, including interleukins, were increased in tears of subjects with CLDE. These results support a growing body of evidence that suggests a potential role of inflammation in CLDE.

CLEAR - Evidence-based contact lens practice

Evidence-based contact lens -->practice involves finding, appraising and applying research findings as the basis for patient management decisions. These decisions should be informed by the strength of the research study designs that address the question, as well as by the experience of the practitioner and the preferences and environment of the patient. This reports reviews and summarises the published research evidence that is available to inform soft and rigid contact lens history and symptoms taking, anterior eye health examination (including the optimised use of ophthalmic dyes, grading scales, imaging techniques and lid eversion), considerations for contact lens selection (including the ocular surface measurements required to select the most appropriate lens parameter, lens modality and material selection), evaluation of lens fit, prescribing (teaching self-application and removal, adaptation, care regimen and cleaning instructions, as well as -->minimising risks of lens wear through encouraging compliance) and an aftercare routine.

The impact of patient behaviour and care system compliance on reusable soft contact lens complications

Reusable soft daily wear contact lenses (CLs) remain popular and were fit to just over half of all wearers in the most recent international CL prescribing survey. Unlike daily disposable CLs, reusables require cleaning and disinfecting after every use, along with storage in a CL case. These additional requirements add a number of steps to the daily wear and care routine, increasing the opportunities for CL wearers to exhibit non-compliant behaviour. The impact of non-compliance ranges from poor lens comfort through to potentially sight-threatening infective keratitis. The coronavirus pandemic has refocused the profession on the importance of hand hygiene in particular, and the need for promoting safe CL wear in general. This review summarises typical non-compliant behaviour related to reusable CLs, and examines strategies and opportunities to better support wearers. Patient education has a central role in encouraging compliant behaviour, although patient recall of information is low, and personal belief systems may result in continuation of non-compliant behaviour despite awareness of the risks. CL care solutions are required for the daily disinfection of lenses, however misuse of multipurpose solutions (MPS) and hydrogen peroxide (H₂O₂)-based care systems can challenge their ability to be fully efficacious. Standard efficacy testing is reviewed, with consideration of how well current protocols model real-world use of CL solutions. Although some recommendations are in place for the inclusion of additional variables such as lens cases, CL materials, organic soil and efficacy against Acanthamoeba, opportunity still exists to reevaluate global standards to ensure consistency of testing in all markets. Finally, potential future innovations are discussed which may further support increased safety in reusable lens wear through novel antimicrobial additions to both CL materials and cases.

Survey of hygiene, behaviours, and awareness regarding contact lens wear with conventional and novel questions

Clinical relevance: Contact lens (CL) compliance studies are beneficial to identify potential risks, take necessary measures, and issue warnings on time.Background: Understanding CL compliance is crucial to ensure that individuals maintain healthy and appropriate CL wear. The present study aims to assess knowledge and awareness about soft CLs; the degree of non-compliance among soft CL wearers; and the associations of these with demographic features.Methods: A comprehensive questionnaire composed of 44 questions was used to assess the demographic characteristics, hygiene care, habits, knowledge, opinions, awareness and experiences of 109 soft CL wearers. The survey was conducted between September 2019 and March 2020.Results: The mean non-compliance rates were: 35.4% and 11.2% for hand-washing and hand-drying; 77.8% for rubbing/rinsing of the CLs; and 37.0%, 50.5%, and 31.6% for swimming, showering, and overnight sleeping with the CLs in, respectively. Women were more compliant in manual cleaning and rinsing of the CL storage cases with lens solution (p = 0.037). Swimming behaviour with inserted CLs was significantly high among CL users with over 5 years of experience (p = 0.03). Additionally, 85% of the wearers generally found the soft CLs comfortable, and 69.8% found the cost of the soft CLs reasonable. Over 90% of the wearers spent between 0 to 5 min per day to insert and remove the soft CLs.Conclusion: Women presented with more frequent CL use, and were significantly more compliant in terms of cleaning the CL storage cases. Regardless of gender, the non-compliance of swimming with inserted CLs was significantly high among CL wearers with over five years of experience. A majority of the results of the investigated non-compliances did not depend on gender, income level, age-group, duration of CL use, and education level.

Clinical Performance of Samfilcon A, a Unique Silicone Hydrogel Lens, on a 7-Day Extended Wear Basis

Purpose

The objective of this study was to evaluate and compare the clinical performance of samfilcon A, a unique, polyvinylpyrrolidone (PVP)-containing, silicone hydrogel contact lens with that of the balafilcon A silicone hydrogel contact lens when worn on a 7-day extended wear basis.

Subjects and Methods

A total of 669 subjects completed this 12-month, controlled, parallel group, masked, randomized study; of these, 340 wore samfilcon A lenses and 329 balafilcon A lenses. Subjects wore their respective assigned lenses bilaterally on a 7-day extended wear basis. On the seventh night of each wearing week, lenses were removed, cleaned, and disinfected using Biotrue multi-purpose solution (MPS), then re-inserted the following morning. Lenses were replaced with new lenses monthly. At each follow-up visit, investigators completed a slit lamp evaluation, and subjects rated lenses based upon a predefined set of performance criteria.

Results

The samfilcon A lens performed comparably to the balafilcon A lens in terms of most graded and ungraded slit lamp findings, differing significantly only for corneal staining Grade 2 or greater, which favored samfilcon A, and anterior segment abnormalities, which favored balafilcon A. Subjects rated both lenses highly when queried about various lens-wearing characteristics. When comparing the number of subjects with findings on either eye on at least one follow-up visit, the two lenses were comparable in many aspects but favored samfilcon A with respect to cleanliness upon removal, overall comfort, comfort at end of day, dryness, vision, vision in low light, vision at end of day, and overall impression (all p < 0.05).

Conclusion

While subjects rated both highly, samfilcon A lenses worn for 7-day extended wear and replaced on a monthly basis performed comparably to or better than balafilcon A lenses when worn for the same 7-day wear time and replacement cycle.

Contact lens trends over three decades in a hospital-based practice in India

BACKGROUND

Contact lens fittings in a hospital-based practice are different from those in private practices because of specialised conditions. Few studies have been published on material preferences of such wearers, especially in long-term wearers. The aim of this study is to document contact lens prescribing trends in a hospital-based practice among long-term lens wearers and to identify their demographic profile.

METHODS

Subjects reporting to a contact lens clinic of a tertiary eye-care centre in India from 1 January 2014 to 31 December 2014, with a minimum of five years of lens wear, were included in the study. Data were collected retrospectively from the electronic medical charts of these subjects.

RESULTS

Three hundred and sixty subjects were included in the study. The average duration of contact lens wear among the subjects was 9 ± 5 years (range: 5-35 years). The average age of the subjects was 31.38 ± 11.75 years (age range: 5-78 years). Hydrogel material and soft spherical type were preferred by most of the soft lens wearers (53 per cent). Eighty per cent of subjects followed hand hygiene and cleaning regimen practices.

CONCLUSION

The preference for monthly replacement lenses and silicone hydrogel material increased over the years. Regular after-care consultations could enforce the need for compliance with hand hygiene and cleaning regimens among lens wearers.