Randomized Crossover Trial Evaluating the Impact of Senofilcon A Photochromic Lens on Driving Performance

Effects on Wavefront Aberration after Short-term Wear of Senofilcon A Photochromic Contact Lens

BACKGROUND

To assess the variability in wavefront aberrations with short-term wear of photochromic senofilcon A contact lenses in both its activated and inactive states.

METHODS AND MATERIAL

In this cross-sectional study, 20 participants who had previously used soft contact lenses were enrolled. Corneal aberrometry measurements were performed on each subject, without contact lenses, using Sirius Scheimpflug-Placido topography. The photochromic lenses were illuminated using a blue-violet light (λ max = 420 nm) so as to provoke an activated state, and measurements were taken with the lenses inserted, in both states. The root mean square (RMS) of the aberrations was calculated, and the higher- and lower-order aberrations, astigmatism, coma, spherical aberration, and trefoil measurements were evaluated using a 5.0-mm pupil diameter.

RESULTS

The average contact lens sphere power was - 2.33 ± 1.07 D. The mean refractive errors with contact lens wear were 0.07 ± 0.18 D for the sphere and - 0.26 ± 0.15 D for the cylinder. The mean RMS values for all the corneal aberrations showed no statistically significant differences with and without contact lenses (p > 0.05). In a bivariate correlation analysis, there was a positive correlation between contact lens sphere power and coma (vertical and horizontal) in the activated state (r = 0.455, p = 0.44 and r = 0.495, p = 0.27, respectively).

CONCLUSION

The photochromic contact lenses did not influence ocular aberration during short-term wear, even when the photochromatic additive was activated. This property may help to provide more comfortable vision with lens wear. This finding needs to be verified by further studies.

Impact of presbyopia treatment pilocarpine hydrochloride 1.25% on night-driving performance

CLINICAL RELEVANCE

Patients prescribed pilocarpine ophthalmic solution are advised to be cautious when driving at night, but studies evaluating the effects of pilocarpine hydrochloride ophthalmic solution 1.25% (pilo), approved to treat presbyopia, on driving at night are lacking.

BACKGROUND

This double-masked, crossover, phase 3b study evaluated night-driving performance with pilo or the placebo once daily.

METHODS

Forty-three adults (40-55 years) with presbyopia impacting daily activities and mesopic, high-contrast, binocular distance-corrected near vision 6/12-6/30 were randomised to bilateral treatment with pilo followed by placebo or placebo followed by pilo (with a ≥7-day washout between interventions). Night-driving performance was evaluated at twilight at a closed-circuit course. Primary efficacy endpoint: overall composite night-driving performance Z score at the end of the 7-14-day intervention period, 1 hour post-instillation. Pilo was considered non-inferior if the lower limit of the 95% confidence interval (CI) for the least squares mean difference (LSMD, pilo minus placebo) was >-0.25. Other efficacy endpoints: individual components of the night-driving performance test (hazard avoidance rate; road sign recognition rate and distance; pedestrians recognition distance; overall driving and lane-keeping times) and night-driving experience questionnaire. Safety included treatment-emergent adverse events (TEAEs).

RESULTS

The mean overall composite Z scores were -0.121 (pilo) and 0.118 (placebo). The LSMD (pilo minus placebo) was -0.224 (95% CI, -0.346, -0.103), with 3 of the 7 individual tasks being significantly better with the placebo. The questionnaire did not reveal significant differences between pilo and the placebo. There were no serious or severe TEAEs and no TEAE-related discontinuations. The most common ocular TEAEs were headache and visual impairment with pilo (both 27.9%), and dry eye (7.0%) with the placebo.

CONCLUSION

The overall performance of night driving was inferior with pilo, compared with placebo. The study findings are consistent with the current class labelling and provide evidence to inform regulators and assist clinicians considering prescribing pilo to adults who seek treatment of presbyopia symptoms and drive at night.ClinicalTrials.gov identifier: NCT04837482.

The Effect of Photochromic Contact Lenses on Pupil Size

Objectives

Photochromic contact lenses (PCL) are designed to increase the comfort of patients, in bright light conditions. The aim of the study was to evaluate the effect of PCL on pupil size.

Methods

The study was conducted with 30 patients who were admitted to the contact lens department. Automated pupilography images of the right eyes of patients were obtained without contact lenses (group 1) in scotopic (S: 0.4 lux), mesopic (M: 4.0 lux), and photopic (p=40 lux) conditions. The procedures were repeated with silicone hydrogel contact lenses (Group 2) and with silicon hydrogel PCL (group 3).

Results

Mean age was 23.87±3.27 (17-30) years and male/female ratio was 10/20. The mean spheric equivalent of their right eyes was -3.60±1.73 (-0.50--7.50). Pupil diameters of Group 3, under scotopic conditions, were larger than Group 1 and 2 (p=0.001, p=0.044). There was no difference between groups under mesotopic and photopic conditions. Pupil diameters at the different illumination levels were similar regarding gender.

Conclusion

Similarity in mesotopic and photopic pupil sizes compared to all groups may be a result of insignificant pupil changes of photochromic lenses in indoor conditions or insufficient time for lens activation.

Effect of changing mesopic and photopic light conditions on visual functions

AIM

To determine the effects of change in light conditions on refractive error and visual functions including visual acuity, stereopsis and contrast sensitivity.

METHODS

This cross-sectional study was conducted in the optometry clinic of the Shahid Beheshti School of Rehabilitation on 48 students in 2021-2022. All of them had eye health and normal visual function and could have refractive errors or not. Light intensity of 4 lx was considered equivalent to photopic light condition and light intensity of 1 lx was considered to be equivalent to mesopic light condition. The amount of refractive error was checked by auto refractometer and its changes in mesopic light condition were subjectively measured. Also, visual acuity, stereopsis and contrast sensitivity (in five spatial frequencies of 1.5, 3, 6, 12, and 18 cycles per degree), were measured first in photopic light condition and then in mesopic light condition, by Snellen control vision chart, stereo butterfly test and the M&S technology monitor test respectively.

RESULTS

In the 48 student subjects with an average age of 22.69±3.56y, mean of refractive error as sphere equivalent, visual acuity and stereopsis were -1.25±1.74 diopters, 0 logMAR, 44.37±13.03 seconds of arc, respectively in photopic light condition while in mesopic light was equal to -1.56±1.75 diopters, 0.12±0.09 logMAR and 50.62±33.35 seconds of arc, respectively. The mean of contrast sensitivity measured at spatial frequencies of 1.5, 3, 6, 12, and 18 cycles per degree in photopic condition was equal to 2.38±0.04, 2.37±0.07, 2.04±0.21, 1.27±0.32, 0.82±0.27 logarithm of contrast sensitivity, respectively and in mesopic lighting condition was equal to 2.34±0.12, 2.30±0.16, 1.84±0.28, 1.02±0.28, 0.63±0.24 logarithm of contrast sensitivity, respectively. Statistical analysis showed a significant difference between the two lighting conditions in all evaluated variables [refractive error (P<0.001), visual acuity (P<0.001), stereopsis (P=0.008) and contrast sensitivity (P<0.001)].

CONCLUSION

The refractive error of the student subjects in mesopic light condition change towards myopia, and its amount is clinically significant. Also, the examination and comparison of the factors of visual acuity, stereopsis and contrast sensitivity in these two lighting conditions show that the decrease in brightness level to the mesopic level causes a decrease in the aforementioned visual functions.

Unexpected vision performance with photochromic contact lenses in normal and low light conditions: An analysis of two randomized trials

PURPOSE

Evaluate the performance of a photochromic contact lens in various lighting conditions throughout the day, including those indoor and outdoor environments where the photochromic contact lens is in a less active or inactive state.

METHODS

Data from two clinical trials of a photochromic contact lens were analyzed to evaluate its performance in various light environments. Both studies involved a photochromic test lens (ACUVUE® OASYS with Transitions™ Light Intelligent Technology™) and a similar non-photochromic control lens (ACUVUE® OASYS 2-week with HYDRACLEAR® PLUS). The studies were both multi-visit, multi-site, 2-treatment by 3-period randomized crossover (i.e., Test/Control/Control or Control/Test/Test) dispensing studies, with follow-up visits after each 2-week dispensing period.

RESULTS

A total of 250 subjects were dispensed lenses across both studies, of which 237 total subjects completed. In situations where exposure to an activating light source is common (e.g., outdoors), the Test lens was preferred nearly 6:1 over the control lens. In situations where exposure to an activating light source is less common - indoors, driving at night, using digital devices -, the Test lens was still preferred over the control lens by margins of 4:1, nearly 4:1, and over 3:1 respectively. The Test lens was superior with respect to quality of vision, ability to see comfortably, clarity of vision, reduction of squinting while using computers and reduction of bright light while driving at night.

CONCLUSION

The photochromic test contact lens was rated superior to a non-photochromic control lens in environmental situations where the lens is in a less active or inactive state.

Effect of Photochromic Contact Lens Wear on Indoor Visual Performance and Patient Satisfaction

INTRODUCTION

To quantitatively assess visual performance and patient satisfaction during photochromic contact lens (CL) wear in an indoor environment.

METHODS

This observational study comprised 82 eyes of 41 healthy subjects (mean age ± standard deviation, 21.7 ± 0.7 years) who had no ophthalmic diseases except for refractive errors at Kitasato University in 2021. We prospectively compared visual acuity, kinetic visual acuity, functional (time-dependent) visual acuity, the maintaining rate of visual acuity, the response time, contrast sensitivity function, higher-order aberrations, and patient satisfaction score for overall vision in such subjects during photochromic and non-photochromic CL wear in such an environment.

RESULTS

The kinetic visual acuity at 30 km/h was 0.32 ± 0.21 and 0.41 ± 0.24 in the photochromic and non-photochromic CL groups, respectively (p = 0.008). The kinetic visual acuity at 60 km/h was 0.32 ± 0.21 and 0.41 ± 0.24, respectively (p = 0.034). The functional visual acuity was 0.00 ± 0.21 and 0.05 ± 0.25, respectively (p = 0.030). The average response time was 1.19 ± 0.15 s and 1.23 ± 0.15 s, respectively (p = 0.029). The patient satisfaction score for overall visual performance was 4.22 ± 0.11 and 3.59 ± 0.68, respectively (p < 0.001). Otherwise, we found no significant differences in visual acuity, the maintaining rate, higher-order aberrations, or contrast sensitivity function (p = 0.116, p = 0.053, p = 0.371, or p = 0.943). We found no apparent complications such as ocular discomfort, superficial punctate keratitis, conjunctival injection, or infectious keratitis during the observation period.

CONCLUSIONS

According to our experience, the photochromic CL showed good visual quality, especially in terms of kinetic and functional visual acuities and subsequent high patient satisfaction, even in an indoor environment, suggesting its viability of visual correction not only in daily activities but also in indoor sports activities.

CLEAR - Contact lens technologies of the future

Contact lenses in the future will likely have functions other than correction of refractive error. Lenses designed to control the development of myopia are already commercially available. Contact lenses as drug delivery devices and powered through advancements in nanotechnology will open up further opportunities for unique uses of contact lenses. This review examines the use, or potential use, of contact lenses aside from their role to correct refractive error. Contact lenses can be used to detect systemic and ocular surface diseases, treat and manage various ocular conditions and as devices that can correct presbyopia, control the development of myopia or be used for augmented vision. There is also discussion of new developments in contact lens packaging and storage cases. The use of contact lenses as devices to detect systemic disease has mostly focussed on detecting changes to glucose levels in tears for monitoring diabetic control. Glucose can be detected using changes in colour, fluorescence or generation of electric signals by embedded sensors such as boronic acid, concanavalin A or glucose oxidase. Contact lenses that have gained regulatory approval can measure changes in intraocular pressure to monitor glaucoma by measuring small changes in corneal shape. Challenges include integrating sensors into contact lenses and detecting the signals generated. Various techniques are used to optimise uptake and release of the drugs to the ocular surface to treat diseases such as dry eye, glaucoma, infection and allergy. Contact lenses that either mechanically or electronically change their shape are being investigated for the management of presbyopia. Contact lenses that slow the development of myopia are based upon incorporating concentric rings of plus power, peripheral optical zone(s) with add power or non-monotonic variations in power. Various forms of these lenses have shown a reduction in myopia in clinical trials and are available in various markets.

Lens fitting and subjective acceptance of senofilcon A with photochromic additive on a neophyte population

PURPOSE

To determine the proportion of contact lens neophytes that can be successfully fitted with a photochromic contact lens, and to survey subjective performance outcomes compared to habitual spectacles. It was hypothesized that at least 50 % of lens fits would be successful.

METHODS

Eleven sites enrolled contact lens neophytes with up-to-date spectacles. Subjects were fitted bilaterally with a photochromic Test contact lens (ACUVUE® OASYS with Transitions™) for one month of daily, reusable wear. Follow-up visits occurred at 1 week, 2 weeks (lenses replaced), and at 4 weeks after initial dispensing. The investigator judged lens fitting success based on overall assessment of physiology, mechanical fitting, comfort, vision, and handling at the 4-week visit. Following this visit, subjects returned to wearing habitual spectacles for one week and evaluated the performance of the study lens compared to their spectacles.

RESULTS

From a total of 127 subjects who were dispensed contact lenses, 105 completed the study per protocol (mean age: 25.5 ± 5.9 years; 57 % female; 80.0 % Caucasian; 71 % with dark iris color). Investigators judged that 97 % of the contact lenses were fitted successfully after 4 weeks of wear; thus, the primary hypothesis was met. Among per-protocol subjects, 60 % reported better vision outdoors, 53 % better vision in changing lighting conditions, 62 % less squinting, and 66 % being less often bothered by bright light. Additionally, 95 % would recommend the lens to others, and 71 % would recommend their eye care practitioner if offered the lens.

CONCLUSION

Greater than 95 % of subjects were successfully fitted with the photochromic contact lens based on professional judgement of physiology, mechanical fitting, comfort, vision, and handling. Subjects new to contact lens wear expressed positive opinions for the study contact lenses compared to their up-to-date spectacles.

The Effect of a Photochromic Contact Lens on Visual Function Indoors: A Randomized, Controlled Trial

SIGNIFICANCE

Photochromic soft contact lenses contain light-sensitive additives that allow them to darken when exposed to ultraviolet or violet light. One question, however, is whether the lenses influence vision indoors (minimally activated). In this study, we found that the minimally activated lenses improved many aspects of visual function under bright light.

PURPOSE

Photochromic contact lenses were designed to darken when exposed to outdoor sunlight. The filtering that results improves visual function under bright light conditions. Not all bright light exposures occur outdoors. In this study, we tested whether a photochromic contact lens improved visual function under conditions where the lens was minimally activated (i.e., no more than it normally would be in an indoor environment).

METHODS

A subject-masked contralateral design was used comparing a photochromic contact lens randomized to one eye against a nonphotochromic contact in the other eye of the same subject. Sixty subjects (mean = 34.90 ± 11.24 years) were tested. The primary endpoints consisted of four visual function outcomes: photostress recovery, glare disability, glare discomfort, and chromatic contrast. Photostress recovery was quantified by measuring the time needed to recover visual acquisition of a grating target after 5 seconds of an intense xenon white flash exposure; glare disability was evaluated as the energy in a surrounding xenon white annulus necessary to veil a central grating target; and glare discomfort was assessed using bioimaging of the squint response. Chromatic contrast was measured as thresholds for a green-yellow (580 nm) grating target superposed on a blue (460 nm) background.

RESULTS

The minimally activated photochromic contact demonstrated improved visual performance compared with the nonphotochromic control across all visual functions tested (P < .01).

CONCLUSIONS

Even under conditions of exiguous activation (e.g., as would be expected indoors or while driving at night), a photochromic contact will improve many of the more deleterious aspects of bright light.