Multicenter Case-Control Study of the Role of Lens Materials and Care Products on the Development of Corneal Infiltrates

Risk Factors for Bacterial Keratitis and Severe Disease in Hydrogel Contact Lens Users: A Multicenter Case-Control Study and Case-Only Analysis

PURPOSE

To assess risk factors for contact lens (CL)-related bacterial keratitis, cases and high-risk controls were enrolled. Using high-risk controls can help elucidate whether certain CL types or modalities are attributable to disease burden if risky wear patterns are similar between the cases and controls. This analysis identified whether such CL factors were associated with the occurrence of bacterial keratitis. In addition, a case-only analysis determined CL factors associated with severe disease.

METHODS

From 2018 to 2021, 158 controls were enrolled at University Hospitals of Cleveland Eye Institute, and 153 bacterial keratitis cases were enrolled across 14 sites in the United States. Cases were soft CL wearers with either culture-proven bacterial keratitis or a corneal infiltrate with an overlying epithelial defect within the central 4 mm of the cornea, uveitis, or significant pain. Fungal, protozoan, or nonsoft CL wear-related microbial keratitis cases were excluded. Controls were recruited from high-risk CL wearers with no history of disease. All participants completed a questionnaire related to demographics, type of CL used, wearing schedule, lens handling practices, and storage case handling. Cases with ulcer/infiltrate size ≥2 mm in size, presence of hypopyon, or had fortified antibiotics prescribed were classified as severe keratitis. Univariate and multivariable logistic regression was used to assess association of CL variables with the occurrence of bacterial keratitis as well as occurrence of severe disease among the cases only.

RESULTS

Compared with the control cohort, cases were older (mean age 45.6 vs. 38.9 years), had more males (42.5% vs. 23.6%), and had more current or former smokers (41.7% vs. 12.9%). There were no significant associations between CL material (silicone hydrogel vs. not) or CL type (daily disposable vs. reusable) and occurrence of bacterial keratitis. More than two-thirds (67.3%) of cases were classified as severe. Among cases only, univariate analyses found current smokers to have increased risk of severe disease (OR=2.87; 95% CI 1.13-7.26, P =0.03). Adjusting for age, sex, and smoking among the cases only, daily disposable lenses were protective against severe disease (OR=0.32; 95% CI 0.11-0.89, P =0.03). Reusable lenses increased risk of severe microbial keratitis between 3.0- and 4.4-fold compared with compliant daily disposability.

DISCUSSION/CONCLUSION

Compared with a high-risk control cohort, no specific lens factors were associated with occurrence of CL-associated bacterial keratitis. Among cases only, current smokers and patients wearing reusable lenses are at increased risk of severe keratitis. Daily disposable lenses were protective even when noncompliance to daily disposability was considered.

Contact lenses as a potential vehicle of Candida transmission

PURPOSE

Contact lenses can be contaminated with various microorganisms, including pathogenic yeasts of the genus Candida, which are known for their ability to adhere to abiotic surfaces, including plastic materials used for various medical purposes. Microbial contamination of the lenses can lead to infection of the wearer's eyes. The purpose of this study was to simulate the contamination of contact lenses with C. albicans and C. parapsilosis, analyze the interaction of the microorganisms with the lens material, and optimize the protocol for PCR-based analysis of the microbial agents responsible for lens contamination.

METHODS

Hilafilcon lenses were exposed to C. albicans and C. parapsilosis cultures, washed, and examined for their ability to further spread the contamination. Scanning electron microscopy was used to analyze the attachment of yeast cells to the lenses. Infrared spectroscopy was used to examine the potential changes in the lens material due to Candida contamination. The protocol for DNA isolation from contaminated lenses was established to enable PCR analysis of microbes attached to the lenses.

RESULTS

Hilafilcon lenses contaminated with Candida were able to spread the contamination even after washing with saline or with a commercial cleaning solution. In the present experimental settings, the yeasts did not grow into the lenses but began to form biofilms on the surface. However, the ability of the lenses to retain water was altered. The PCR-based protocol could be used to help identify the type of contamination of contact lenses.

CONCLUSION

Once contaminated with Candida albicans or Candida parapsilosis, Hilafilcon contact lenses are difficult to clean. Yeasts began to form biofilms on lens surfaces.

BCLA CLEAR Presbyopia: Management with contact lenses and spectacles

This paper seeks to outline the history, market situation, clinical management and product performance related to the correction of presbyopia with both contact lenses and spectacles. The history of the development of various optical forms of presbyopic correction are reviewed, and an overview is presented of the current market status of contact lenses and spectacles. Clinical considerations in the fitting and aftercare of presbyopic contact lens and spectacle lens wearers are presented, with general recommendations for best practice. Current options for contact lens correction of presbyopia include soft simultaneous, rigid translating and rigid simultaneous designs, in addition to monovision. Spectacle options include single vision lenses, bifocal lenses and a range of progressive addition lenses. The comparative performance of both contact lens and spectacle lens options is presented. With a significant proportion of the global population now being presbyopic, this overview is particularly timely and is designed to act as a guide for researchers, industry and eyecare practitioners alike.

Scoping review: Reporting characteristics for the safety of contact lenses in the pediatric population

SIGNIFICANCE

Contact lenses are an increasingly popular option for correcting pediatric refractive error due to increased awareness of interventions to slow myopia progression. With limited information on the safety profiles of contact lenses in children, it is important to characterize the current understanding and promote this device's safe and effective use.

PURPOSE

This scoping review evaluates characteristics of the current literature that have examined the safety of contact lenses in pediatric patients. It provides future directions for systematic reviews and identifies any gaps in the current literature or areas for future research.

METHODS

Literature searches in MEDLINE via PubMed, EMBASE, The Cochrane Library, trial registries, and U.S. Food and Drug Administration clinical trial documentation were performed. Included studies (i.e., experimental and quasi-experimental studies; observational studies including prospective and retrospective cohort, case-control, and analytical cross-sectional studies, and case series of 30 or more participants) reported safety and/or complications of the use of any contact lens for correcting refractive error in children (0 to 18 years). Two independent reviewers first screened the titles and abstracts, and then full-text reports for eligibility. Conflicts in eligibility were resolved by discussions with a third reviewer. Two independent reviewers extracted data, including details about the participants, context, study methods, and key findings relevant to the review question.

RESULTS

This scoping review included 73 studies from 10 countries using different contact lens modalities, primarily orthokeratology and soft contact lenses, in children (6 to 18 years). The most common adverse event reported by the studies was corneal staining (60% orthokeratology, 45% soft contact lens).

CONCLUSIONS

The need for uniform reporting standards for adverse events poses challenges for comprehensive data synthesis. However, this scoping review identified a sufficient number of studies for a future systematic review to quantify the risks associated with orthokeratology and soft contact lens use in children.

International trends in daily disposable contact lens prescribing (2000-2023): An update

PURPOSE

Daily disposable contact lenses offer numerous benefits in terms of ocular health and wearer convenience. The purpose of this work is to update earlier surveys by describing global trends in daily disposable lens fitting between 2000 and 2023.

METHOD

An annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000 and 2023, inclusive. Data relating to 265,106 daily wear soft lens fits undertaken in 20 countries returning reliable longitudinal data were analysed in respect of daily disposable lens fitting.

RESULTS

Overall, daily disposable lens prescribing increased over time, from 17.1 % of daily wear soft lens fits in 2000 to 46.7 % in 2023 (p < 0.0001). There were significant differences between countries in daily disposable lens prescribing (p < 0.0001), and between the percentage of males fitted with daily disposable lenses, as a proportion of all daily wear soft lenses (37.2 %), compared to females (35.2 %) (p < 0.0001). Daily disposable lens wearers are slightly younger at fitting than reusable soft lens wearers (31.0 vs 31.2 years, respectively) (p < 0.0001), although this difference is not clinically meaningful. Analysis of 50,240 daily wear soft lenses fitted recently (2019-2023) were found to be prescribed for the following replacement frequencies: daily - 47 %; monthly - 42 %; 1-2 weekly - 9 %; and ≥3 monthly - 2 %.

CONCLUSION

There has been a substantial increase in daily disposable lens fitting throughout the first 24 years of this century. The gradual nature of this increase is commensurate with the staged introduction of daily disposable lens designs and expanded parameter ranges over the survey period.

Intraocular Straylight and Multifocal Soft Contact Lens Fit With a Myopia Control Approach

OBJECTIVES

Center-distance multifocal contact lenses (MFCLs) are used to slow myopia progression. We examined the effect of two MFCLs on intraocular straylight values in myopic individuals.

METHODS

Twenty-five young myopic adults were enrolled and were fit with three contact lenses (Biofinity sphere, Biofinity Multifocal, and NaturalVue Multifocal) in a random order over two study visits. Pupil size (NeurOptics VIP-300, Laguna Hills, CA) and contact lens centration were measured. Right eye intraocular straylight measurements were collected (OCULUS C-Quant; Wetzlar, Germany) and compared with a spectacle trial lens. Log straylight (LogSL) values and straylight residuals were analyzed using repeated-measures analyses of variance with Tukey-corrected post hoc t -tests.

RESULTS

The mean participant age (±SD) was 24.1±1.5 years, and right eye spherical equivalent refractive error was -3.38±1.53 DS. There was no difference in mesopic pupil size between visits ( P =0.68) and no difference in contact lens centration between lenses ( P =0.99). LogSL values differed by lens type ( P =0.004). LogSL with the spectacle trial lens was significantly greater than with each contact lens type (all P <0.05), but there were no significant differences in LogSL between the three contact lenses (all P >0.05). There was no difference between the three contact lens designs for straylight residuals ( P =0.33).

CONCLUSIONS

Measured intraocular straylight for both MFCLs was not different than with a spherical soft contact lens. A significant increase in intraocular straylight with spectacle trial lens correction was observed compared with all contact lenses.

Wear Experiences with Two Soft Contact Lenses for Astigmatism of Different Modalities

Introduction

Patients expect to have excellent vision and comfort when wearing soft contact lenses. The purpose of this study was to compare the wear experiences of participants with astigmatism when wearing a daily disposable soft toric lens to an established, commonly used reusable toric lens.

Methods

In this crossover study, habitual soft toric lens wearers were fit with a daily replacement soft toric lens (delefilcon A) and a reusable, 1-month replacement soft toric lens (comfilcon A) in a randomized order. After 30 days of wear, Visual analog scale (VAS) surveys were used to assess wear experience, including vision and comfort, for overall wear and end-of-day wear. Scores were compared statistically with mixed-effects linear models. Participants also responded to questions about convenience, ease of use, and satisfaction with both lenses and preference questions based upon comfort, vision, and overall performance.

Results

Fifty-nine participants completed the multi-site crossover study. VAS scores [mean(std dev)] for overall quality of vision for the delefilcon A [80.4(16.4)] and comfilcon A [66.8(27.7)] lenses were statistically significant (P=0.002). The difference in the mean overall comfort scores for the delefilcon A lenses [71.6(26.3)] and comfilcon A lenses [63.2(28.9)] was 8.4, which exceeds the establish criteria for clinical significance, although not statistically significant (P=0.08). Overall satisfaction scores were 68.8(26.9) for the delefilcon A and 59.7(30.3) for the comfilcon A lenses (P=0.08). Both lenses provided mean binocular visual acuities better than 20/20 Snellen equivalent. Over half of the participants preferred the delefilcon A lenses based upon comfort, vision, and overall performance. Convenience, ease of use, and satisfaction all scored higher with delefilcon A lenses.

Conclusion

The results of this study show that wear experience with delefilcon A lenses for astigmatism can meet or exceed that of comfilcon A toric lenses while also providing healthy, daily disposable lens wear.

Anonic Silicon Hydrogels Affect the Concentration of Proteins in Tears during Wear

PURPOSE

The objective of this study was to quantitatively assess the concentration of human tear proteins in patients wearing contact lenses of various ionicities and determine whether differences were related to the incidence of corneal infiltrative events (CIE).

METHODS

24 subjects (samples) were randomly selected for spectral count analysis to obtain protein concentrations using LCMS analysis. The subjects were neophyte and ametropic with ages between 18 and 40; 6 wore control lenses, 8 wore TestLens1, and 10 wore TestLens2. 16 subjects experienced CIEs during the study.

RESULTS

A pairwise multiple hypothesis test identified 7 proteins that significantly differed in concentration between TestLens1 and control, and 11 proteins that differed between TestLens2 and control. Of the 12 unique proteins, 9 were at increased concentration and 3 were at lower concentration in the tears of test lens wearers compared to the control lens group. Bootstrap clustering confirmed these findings, showing 3 similar clusters to the original sample groups which separated people wearing control lenses from those wearing TestLens1 or TestLens2 with 83% accuracy and between TestLens1 and TestLens2 with 45% accuracy. Permutation testing identified 5 proteins that had significantly changed in concentration between people wearing TestLens2 and Control lenses. There was no difference in protein concentrations between those subjects who experienced a CIE and those who did not.

CONCLUSION

Wearing contact lenses of different ionicities can affect the concentration of proteins in the tear film. The current study did not find any associations of the concentration of proteins with CIEs. Future tests with increased sample size are needed to establish any relations between these changes and clinical performance.

A proposed methodology for conducting a remote rigid gas permeable contact lens consultation

PURPOSE

COVID-19 spread to numerous countries, overwhelming healthcare systems and economies worldwide. COVID-19 restrictions have prevented patients from attending consultations in person and led to the further development of telemedicine to provide health care. The situation also applies to contact lens (CL) practitioners and their patients; telemedicine enables practitioners to provide patients with regular and continuing care. This study aimed to investigate available tools to enable continuing care for rigid gas permeable (RGP) CL wearers who are unable to attend face-to-face consultations.

METHODS

The study consists of three components. Firstly, an approach to enable the assessment of a patient's CL fitting and cornea remotely. Secondly, to find an affordable and reliable method to obtain a patient's visual acuity (VA), and thirdly, to develop a questionnaire to provide practitioners with information to deliver optimal patient care.

RESULTS

The use of a macro lens, smartphone, and auxiliary materials enables high-quality images of the anterior eye and RGP CL to be obtained. Two free and validated smartphone applications (apps) for VA measurements were identified which are available on Android and iOS systems. Two questionnaires were also developed to enable practitioners to obtain additional patient information to facilitate optimal patient care.

CONCLUSION

This study has developed the components of a remote CL consultation to enable patients who cannot attend scheduled appointments to receive care and advice to ensure the safety of their RGP CL wear. The tools involved in this study are low-cost, affordable, and an adjunct, not a substitute, for face-to-face consultations.

Incidence of Corneal Adverse Events in Children Wearing Soft Contact Lenses

OBJECTIVES

There is increasing interest in fitting children with soft contact lenses, in part due to the increase in prescribing of designs to slow the progression of myopia. This literature review summarizes large prospective and retrospective studies that include data on the incidence of microbial keratitis and corneal infiltrative events (CIEs) in children wearing soft contact lenses.

METHODS

Peer-reviewed prospective and retrospective studies that report contact lens-related complications in children with at least one year of wear and at least 100 patient years of wear were identified.

RESULTS

Seven prospective studies published between 2004 and 2022 were identified representing 3,752 patient years of wear in 1,756 children, nearly all of whom were fitted at age 12 years or younger. Collectively, they report one case of microbial keratitis and 53 CIEs, of which 16 were classified as symptomatic. The overall incidence of microbial keratitis was 2.7 per 10,000 patient years (95% CI: 0.5-15), and the incidence of symptomatic CIEs was 42 per 10,000 patient years (95% CI: 26-69). Two retrospective studies were identified representing 2,545 patient years of wear in 1,025 children, fitted at age 12 years or younger. One study reports two cases of microbial keratitis giving an incidence of 9.4 per 10,000 patient years (95% CI: 0.5-15).

CONCLUSIONS

Accurate classification of CIEs is challenging, particularly in retrospective studies. The incidence of microbial keratitis in children wearing soft lenses is no higher than in adults, and the incidence of CIEs seems to be markedly lower.

Challenges to the new soft contact lens wearer and strategies for clinical management

Soft contact lens discontinuations have a dramatic impact on the overall success of this form of vision correction, and evidence suggests that the reasons for contact lens cessation are different for new wearers than for established lens users. In descending order, these relate to vision, discomfort, handling, inconvenience/loss of interest, ocular health and cost. This paper considers the background and underlying evidence for these causes of soft lens discontinuation in new wearers, and presents clinical management strategies to minimise this phenomenon. Such measures can reasonably be expected to significantly reduce the number of contact lens discontinuations leading to happier patients, increased satisfaction for eye care professionals (ECPs), and greater success for both individual practices and the contact lens industry more broadly.

Examining daily disposable soft contact lens wearers' attitudes and beliefs using the Health Belief Model

PURPOSE

To use the Health Belief Model (HBM) to understand daily disposable (DD) soft contact lens (SCL) wearers' attitudes and beliefs.

METHODS

A convenience sample of DD SCL wearers (18-33 years) was enrolled at two sites. Participants were queried about demographics, SCL wear and HBM constructs. Rasch analysis was used to assess the psychometric properties of the survey instrument and generate scores for each HBM subscale. ANOVA was used to determine relationships among HBM constructs, subject demographics and DD SCL-related health behaviours.

RESULTS

One hundred people participated (mean ± SD), age = 24.2 ± 3.9 years, 76% female. Thirty-seven percent reported sleeping in DD SCLs and 25% reported reusing DD SCLs. Self-report of reusing DD SCLs was associated with scores on the benefits: reuse (p = 0.02) and barriers (p = 0.007) subscales, and sleeping in lenses was associated with scores on the susceptibility (p = 0.05), benefits: wear behaviours (p = 0.006) and barriers (p = 0.01) subscales. Rasch analysis showed some subscales demonstrated multidimensionality.

CONCLUSIONS

Selected health belief constructs were associated with DD SCL-related behaviours including reusing and overnight wear. Increased understanding of SCL attitudes and beliefs could inform patient education and interventions to decrease risks associated with improper SCL wear.

Compliance of Soft Contact Lens Care and Bacterial Contamination Among University Students in Palestine

PURPOSE

This study investigated the contact lens care compliance, noncompliance reasons, bacterial contamination rate, and the behaviors associated with contamination among university students in Palestine.

PATIENTS AND METHODS

133 Habitual soft contact lens wearers were recruited in this study and interviewed using a face-to-face questionnaire, to obtain data on demographics, contact lenses, modifiable lens care behaviors and the reasons for non-compliance. High, moderate, and low lens care behaviors were identified. Additionally, a sample of the participant's storage cases was collected for bacterial contamination testing.

RESULTS

The participants' mean age was 22.4±4.4, with female predominance (62.4%). The average compliance rate was 76.8%. Total CL care compliance (100%) was found in filling the case with adequate solution, not sharing the lenses or storage case with others, while the poorest compliance (>40%) was found in attending after-care visits, checking the solution's expiry, and re-disinfecting the lenses with a fresh solution before insertion after prolonged storage. Poor understanding of the instructions contributed significantly to a low level of compliance (P≤0.05). Gram-positive and gram-negative bacteria were detected in 19.55% of the participants' cases. Poor hand and case hygiene, no replacement of lens cases (monthly), and water exposure were linked to bacterial contamination of storage cases.

CONCLUSION

This study indicated moderate to high compliance in CL care, averaging 76.8%. Poor compliance was found in attending after-care visits, checking the solution's expiry, and re-disinfecting the lenses with a fresh solution after an extended storage interval. 19.55% of the cases had bacterial contamination, with Staphylococcus Aureus being the most common. Poor hand and lens case hygiene and water exposure are found to be associated with lens case contamination. These findings emphasize the importance of patient education on safer lens wear modalities, proper wearing schedules, and hygiene regimens to reduce the risks of developing contact lens complications.

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.

Topical Review: Contact Lens Eye Health and Safety Considerations in Government Policy Development

SIGNIFICANCE

As new federal or state policies are introduced in the United States to shape the evolving contact lens market, it has never been more important to amplify the importance of patient health and safety during contact lens wear and promote the value of the eye care professional-patient relationship.Within the United States, contact lenses are regulated by the Food and Drug Administration as class II or III medical devices that require additional regulatory and professional oversight to keep consumers safe. The contact lens market and broader eye health landscape are rapidly changing. Recently, the U.S. Federal Trade Commission finalized its 10-year review of the Contact Lens Rule, implementing new policies that will shape the contact lens market in the United States for years to come. The purpose of this clinical perspective was to compile and review key data regarding contact lens-related adverse events, including their economic impact on the health care system, to inform government policy development. Although contact lenses provide many benefits to the wearer, a variety of complications can occur ranging from asymptomatic events or mild discomfort to severe sight-threatening adverse events such as microbial keratitis. Patients who do not routinely visit their eye care professional or do not receive the lenses prescribed to them are at a greater risk of contact lens-related adverse events. Nearly 1 million people in the United States experience ocular infections or inflammation annually, resulting in significant health care costs. The economic burden of contact lens-related microbial keratitis in the United States has been estimated to be approximately $175 million annually. The importance of eye care professional oversight of contact lens wear cannot be emphasized enough to key stakeholders, including lawmakers, government regulators, contact lens manufacturers and distributors, and the broader eye health community.

Long Day Wear Experience with Water Surface Daily Disposable Contact Lenses

OBJECTIVE

The purpose of this study was to assess the wear experience of silicone hydrogel daily disposable contact lenses with water surface technology over a long day of lens wear.

METHODS

Thirty-five soft contact lens wearers were refit with the daily disposable study lenses and participants scored their initial impressions of comfort, vision and satisfaction using a visual analog scale (VAS). Participants used their smart phones to complete surveys of comfort and vision on a scale of 1-10 at 10, 12, 14, and 16 hours of lens wear on 5 weeknights. A participant score for each time point was calculated by averaging the evening responses. End of study VAS surveys of symptoms were also completed.

RESULTS

Median (Interquartile Range) VAS initial impression scores were 99.00 (12.00) for quality of vision, 98.00 (16.00) for comfort, and 100.00 (13.00) for satisfaction. The end of study surveys found end of day median VAS scores of 87.00 (19.00) for end of day quality of vision and 75.00 (24.50) for end of day comfort. The median score for overall quality of vision was 93.00 (14.00) and for overall comfort was 93.00 (16.50). The median score for end of day dryness was 37.00 (55.00) and overall dryness was 13.00 (34.00).

CONCLUSION

The daily disposable lenses with water surface treatment used in this study maintained high median scores for comfort and quality of vision for up to 16 hours of wear.

OSDI Questions on Daily Life Activities Allow to Detect Subclinical Dry Eye in Young Contact Lens Users

Dry eye disease (DED) is difficult to detect in young contact lens (CL) wearers, who usually have no signs, mild symptoms and an ocular surface disease index (OSDI) below the DED diagnosis values (OSDI ≥ 13). We investigate if some of the 12 OSDI questions (OSDI A—ocular symptoms; OSDI B—vision-related functionality; OSDI C—environmental triggers) contribute the most to classify young CL as symptomatic. TBUT and tear volume are also measured. Age, gender and refraction error-matched eye glasses (EG) wearers participated as the control. CL and EG data were compared with t-test and z-test. Confusion matrices and logistic correlation analyses were performed to define the contribution of each OSDI question to classify symptomatic subjects. OSDI classified symptomatic CL better than the tear volume or TBUT values. In CL, only OSDI B and C values were significantly higher in symptomatic vs. asymptomatic subjects (p < 0.001), while values of all twelve OSDI questions were significantly higher in symptomatic vs. asymptomatic EG (p < 0.05−0.001). All OSDI questions contribute equally to identify symptomatic EG, while only OSDI B questions on daily life visual functions are significant to classify symptomatic CL wearers at risk to develop DED or at a subclinical stage. CL wearers scoring ≥ 2 on the OSDI B questions should be considered for preventive treatments, even if their clinical sings are scarce or absent.

In Vivo Confocal Microscopy in Different Types of Dry Eye and Meibomian Gland Dysfunction

In vivo confocal microscopy (IVCM) imaging is increasingly popular in ocular surface disease diagnosis and management. We conducted a systematic review to update the use of IVCM in the diagnosis and treatment of dry eye and meibomian gland dysfunction (MGD). A literature review was conducted on IVCM studies in MGD, dry eye disease, systemic disease causing dry eye, dry eye in glaucoma patients, contact lens-associated ocular conditions, graft-versus-host disease, and Sjogren’s syndrome-related dry eye. The articles were identified through PubMed and a total number of 63 eligible publications were analyzed in detail. All primary research studies on confocal microscopy on dry eye and related conditions from 2017 onwards were included. The reports were reviewed for their contribution to the existing literature as well as potential biases and drawbacks. Despite limitations such as small field of view, lack of population-based norms, and lack of standardization of image acquisition, interpretation, and quantification, IVCM is useful as a complementary technique for clinical diagnosis in various ocular surface disorders related to dry eye. With advances in hardware and software in the near future, it has the potential for further practical impact.

Wear Experience of a Water Surface Daily Disposable Contact Lens in Existing Silicone Hydrogel Planned Replacement Lens Wearers

PURPOSE

The health benefits of silicone hydrogel lens materials and a daily replacement modality have been demonstrated in previous studies; however, existing planned replacement lens wearers may resist changing to a new lens replacement schedule. The purpose of this study is to evaluate the wear experience of satisfied planned replacement silicone hydrogel wearers when refit into a silicone hydrogel daily disposable lens.

PATIENTS AND METHODS

In this open-label, non-comparison study, satisfied wearers of two week planned replacement contact lenses were evaluated for inclusion criteria and refit with optimized prescriptions in their habitual lenses. At a follow-up visit one week later, participants were refit with the study daily disposable lenses and completed visual analog scale (VAS) surveys of initial quality of vision, comfort, and satisfaction. Participants returned for a final visit after two weeks of wearing the study daily disposable lenses. At the final visit, VAS surveys for both overall and end of day (EOD) vision, comfort, and dryness were completed. Overall median and interquartile range (IQR) were assessed for all surveys in the study.

RESULTS

Thirty individuals completed the study (29.1 ± 7.8 years old; 19 female). Median (IQR) results for the initial impression VAS surveys were 92.50(11.75) for quality of vision, 92.50(18.00) for comfort, and 93.00(18.00) for satisfaction. Final VAS survey results revealed median scores of 87.50(25.00) for EOD quality of vision and 82.50(51.25) for EOD comfort. The median overall quality of vision was 91.00(17.00) and overall comfort was 93.00(28.50). Median (IQR) overall dryness was 28.50(49.00) and median EOD dryness was 30.50(64.25).

CONCLUSION

The findings of this study suggest that providers can successfully refit satisfied wearers of early generation silicone hydrogel planned replacement lenses into a new generation silicone hydrogel daily disposable lens while maintaining satisfaction.

Addressing common myths and misconceptions in soft contact lens practice

Advances in contact lens technology over the past 50 years since the commercialisation of the first soft lenses in 1971 have been incredible, with significant changes in contact lens materials, frequency of replacement, care systems and lens designs occurring. However, despite the widespread availability of contact lenses, penetration rates for those who need vision correction remain in the low single digits and many practitioners seem to hold on to concepts around the potential value of contact lenses that appear based in the dim and distant past and are certainly no longer valid today. This review addresses 10 common 'myths and misconceptions' around soft contact lenses using an evidence-based approach that can hopefully dispel some of these incorrect assumptions.

Review of 20 years of soft contact lens wearer ocular physiology data

BACKGROUND

Since the introduction of Silicone hydrogel (SiHy) contact lenses 20 years ago, industry has continued to modify lens materials, designs, lens care products and manufacturing processes, striving to improve contact lens physiological performance, comfort, and convenience for wearers. The purpose of this study was to investigate whether the ocular health of habitual soft contact lens wearers today is better than it was in previous decades.

METHODS

Baseline ocular physiology data for 3624 participants from a The Brien Holden Vision Institute clinical trials database were retrospectively reviewed. Records were grouped into 3 time periods; A: >2 decades ago (1997-1999), B: one decade ago (2009-2014) and C: recent years (since 2015). Physiology data for both neophytes and habitual contact lens wearers included; bulbar, limbal and upper palpebral conjunctival redness, corneal and conjunctival staining and conjunctival indentation from contact lenses.

RESULTS

Corneal staining levels are similar between neophytes and contact lens wearers at time points A and C but worse for contact lens wearers at time point B. Limbal redness was greater in contact lens wearers than in neophytes at time point A but at time points B and C they are not different to the non-contact lens wearing population. In recent years, most ocular physiological variables in habitual contact lens wearers are similar to neophytes.

CONCLUSIONS

While there have been changes over the past two decades in ocular physiological responses to contact lens wear, it appears that ocular health with current day contact lens wear is similar to no lens wear in most respects.

All soft contact lenses are not created equal

Soft contact lenses that have been prescribed by eye care practitioners are sometimes substituted for alternative lenses by unqualified, unregulated and sometimes even fully regulated lens suppliers, in the mistaken belief that there is essentially no difference between different soft lens types. This review considers the implications of inappropriately substituting soft contact lens types in terms of (a) lens properties: surface treatment, internal wetting agents, material, total diameter, back optic zone radius, thickness, edge profile, back surface design, optical design, power, colour (tint) and ultraviolet protection; and (b) lens usage: wearing modality (daily versus overnight wear) and replacement frequency. Potential aspects of patient dissatisfaction and adverse events when prescribed soft lenses are substituted for lenses with different properties or intended usage are considered. Substitution of 15 of the 16 lens properties considered (i.e. except for back surface design) was found to be related to at least one - and as many as six - potential sources of patient dissatisfaction and adverse ocular events. Contact lens are medical devices which are prescribed and fitted; they should never be substituted for another lens type in the absence of a new prescription further to a full finalised fitting, for the simple reason that all soft contact lenses are not created equal. A substituted lens may have properties that results in undesirable consequences in respect of vision, ocular health, comfort and cosmetic appearance, and may be incompatible with the lifestyle of the patient.

Effect of material and care system combination on subclinical inflammation of the ocular surface in soft contact lens wear

PURPOSE

To investigate the ocular subclinical inflammatory response in two soft contact lens materials when used in combination with two different care systems ('solutions').

METHODS

Fifteen established soft contact lens wearers wore each of two lenses: Acuvue® 2 (CH) and Acuvue® Oasys® (SiH) or no lenses in random sequence for one week. Two care systems were used: a peroxide system: Oxysept 1 Step® (P) for the right lens and Opti-Free® Replenish® (MPS) for the left lens. After one week of lens/no lens wear, in vivo confocal microscopy (IVCM) of corneal and conjunctival regions was carried out. Density of presumed dendritic cells (DC) and 'white spots' (WS) were quantified. Impression cytology of the bulbar and upper eyelid margin conjunctivae was carried out and samples were analysed for CD45+, CD3+ and CD11c+ cells.

RESULTS

The SiH + MPS combination showed a greater inflammatory response compared to SiH + P in seven out of 12 parameters investigated (p < 0.05). The remaining five were not statistically different between the two solutions. The converse was found for the CH lens, with four of the 12 parameters showing a greater response with the P solution compared to the MPS (p < 0.05).

CONCLUSION

This study suggests that the SiH lens investigated demonstrated an upregulated response when used with a MPS compared to a P solution whereas the converse is true for the CH lens which showed a reduced response when used with a MPS compared to a P solution. This finding aids in the understanding of the biological underpinnings of manifest corneal inflammatory events during contact lens wear.

Contact lens procurement and usage habits among adults in Sudan

Objective

The study aimed to assess contact lens (CL) wear and care habits among adults in Sudan.

Design

An observational, non-interventional, multi-center, cross-sectional study was conducted in the CL departments of all the eye hospitals and centers, and optical centers in the Khartoum State, Sudan.

Participants

Established CL wearers residing in Khartoum State, Sudan.

Main outcomes and measures

CL wear profile, CL usage habits, hand and CL hygiene habits were assessed using an interviewer-administered questionnaire.

Results

The average age of the 442 participants was 24.57 (± 4.87) years. Women comprised 92% of the sample. Smoking was reported by 15.8% of the sample. 81.9% wore soft spherical CL, with 43.4% of the participants were prescribed CL on a yearly replacement schedule. Only 68.3% were prescribed CL by an eye care practitioner. Multipurpose solutions were used by 78.8% of the sample to clean CL, and by 52% to clean the lens case. Compliance rate for CL wear and care among participants was 81.1%. None of the participants reported sharing CL or CL case and rinsing the case with tap water. High compliance level was observed for overnight wear; swimming and showering with CL; handwashing before CL insertion; and cleaning of CL. Moderate compliance rates were recorded for cleaning and replacing lens case, and topping up or sharing solution. Low compliance was noted for attending after care visits.

Conclusions and relevance

CL wearers in Sudan exhibit high to moderate levels of compliance to most contact lens wear and care aspects, except for attending aftercare visits. CL practitioners in Sudan are encouraged to prescribe CL appropriate to the lifestyle and economic situation of patients and actively recommend care products. In addition, practitioners need to follow up with patients to attend aftercare appointments, where hygienic wear and care habits should be emphasized.

Uptake and Release of a Multipurpose Solution Biocide (MAP-D) From Hydrogel and Silicone Hydrogel Contact Lenses Using a Radiolabel Methodology

PURPOSE

The purpose of this study was to evaluate the uptake and release of radiolabelled myristamidopropyl dimethylamine (MAP-D) on reusable daily wear contact lenses (CLs) over 7 days.

METHODS

Three silicone hydrogel (SH) CL materials (lotrafilcon B, balafilcon A, senofilcon A) and two conventional hydrogel (CH) materials (etafilcon A, omafilcon A) were tested. A short-term (experiment 1, N=4) and a longer-term (experiment 2, N=3) study was conducted. In experiment 1, the CLs were incubated in 2 mL of phosphate buffered solution (PBS) containing 14C MAP-D (5 μg/mL) for 8 hrs. The release of 14C MAP-D was measured at t=0.25, 0.5, 1, 2, 4, 8, and 24 hr in PBS. In experiment 2, the CLs were incubated in the 14C MAP-D solution for 8 hrs followed by a 16-hr release in PBS. This cycle was repeated daily for 7 days. At the end of both experiments, lenses were extracted to determine the total uptake of MAP-D. The radioactivity was measured using a beta scintillation counter.

RESULTS

In experiment 1, all three SH lenses sorbed similar amounts of MAP-D (P=0.99), all of which were higher than the two CH materials (P<0.01). However, the CH materials released a greater amount of MAP-D than the SH materials (P<0.01). In experiment 2, the uptake of MAP-D in SH materials increased over 7 days, whereas the amount of MAP-D remained constant in the CH materials (P=0.99). Similar to experiment 1, the CH lenses released more MAP-D than SH lenses after 7 days (P<0.01).

CONCLUSION

The SH materials absorbed greater amounts of MAP-D compared to CH materials. However, the CH materials released the greatest amount of MAP-D. Radioactive labelling of MAP-D offers a highly sensitive method of assessing the uptake and release profiles of biocides to CL materials.

Quarter of a century of contact lens prescribing trends in the United Kingdom (1996 - 2020)

PURPOSE

To document contact lens prescribing trends in the United Kingdom over the past quarter of a century.

METHODS

An annual survey of contact lens prescribing was conducted each year from 1996 to 2020, inclusive, by asking a random selection of optometrists and contact lens opticians to provide information relating to 10 consecutive contact lens fits between January and March.

RESULTS

Over the 25 year survey period, 2,671 practitioners returned survey forms, reporting a total of 25,575 contact lens fits. The mean (± standard deviation) age of lens wearers was 35 ± 15 years, of which 64 % were female. Over the survey period, rigid lens new fits decreased from 22 % to 2%. The prescribing of silicone hydrogel lenses has increased steadily since their introduction towards the end of the 1990s, and now represent 80 % of soft lens fits. Soft toric lens prescribing has gradually increased to 47 % - a value at which astigmatism ≥ 0.75DC is theoretically corrected in all contact lens wearers. Daily disposable prescribing increased steadily over the survey period and now represents 63 % of lenses prescribed. Extended wear fits remain at very low levels, except for some prescribing for overnight orthokeratology. Multi-purpose lens care solutions are ubiquitous; peroxide and other systems are now seldom prescribed. Rigid lenses and monthly replacement soft lenses are predominantly worn on a full time basis, whereas daily disposable soft lenses are mainly worn part time.

CONCLUSIONS

This report documents the evolution of contact lens fitting in the United Kingdom over the past 25 years. The most likely lens fit is a spherical design silicone hydrogel daily disposable contact lens prescribed for a 35 year old female and worn on a part-time basis.

In vitro analysis of the interaction of tear film inflammatory markers with contemporary contact lens materials

PURPOSE

Several clinical studies have suggested that reusable silicone hydrogel contact lens materials exhibit a two-times increased rate of corneal infiltrative events compared to reusable hydrogels. One potential factor contributing to this complication relates to the differential uptake of tear film-based pro-inflammatory cytokines. The purpose of this study was to use an in vitro assay to investigate whether four pro-inflammatory cytokines differed in their uptake onto six contemporary contact lens materials.

METHODS

Conventional hydrogel (etafilcon A, omafilcon A) and silicone hydrogel (balafilcon A, comfilcon A, senofilcon A, somofilcon A) contact lens materials were soaked in solutions containing pro-inflammatory cytokines IL-1β, IL-6, IL-8 and TNF-α. Samples of the soaking solutions were collected over various time points and analyzed using the Meso Scale Discovery system, which served as a measurement of cytokine uptake onto the contact lens materials.

RESULTS

Both conventional hydrogels (etafilcon A, omafilcon A) and two of the four silicone hydrogels tested (balafilcon A, comfilcon A), exhibited some uptake of IL-1β, IL-8 or TNF-α (p < 0.05). Senofilcon A and somofilcon A did not exhibit uptake of any of these cytokines (p > 0.05). There was no uptake of IL-6 onto any of the contact lens materials investigated (p > 0.05).

CONCLUSION

The contact lens materials tested did not exhibit any uptake of IL-6 and furthermore, did not exhibit more than 10 ± 3 % to 25 ± 12 % uptake of IL-1β, IL-8 or TNF-α. Numerous factors could contribute to the reported increase in corneal infiltrative events with reusable silicone hydrogel materials, however, based on these results, it appears that uptake of these four cytokines are unlikely to contribute to this finding.

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.

An investigation into disposal and recycling options for daily disposable and monthly replacement soft contact lens modalities

PURPOSE

To examine the annualised waste and end-of-life disposal options with two representative soft contact lens (CL) modalities.

METHODS

The component parts of two representative soft CL modalities were catalogued, separated, weighed and inspected for material identification: somofilcon A soft CLs (clariti elite, CooperVision Inc.) used with multi-purpose solution (MPS) (All in one Light, CooperVision Inc.) and somofilcon A CLs (clariti 1 day, CooperVision Inc). Using a model that assumed compliant wear and care of CLs, the mass of material solid waste generated by CL use over a year was calculated. Disposal options were explored using household and specialist recycling streams in order to develop recommendations for responsible disposal of CL waste.

RESULTS

Full-time daily disposable (DD) CL wear generates 1.06 kg of waste annually compared to 0.83 kg generated by reusable-monthly replacement daily wear ('reusable') CLs. Plastic was the dominant material in both modalities. With full-time use of DD CLs, 64% of waste by mass was plastic blister trays. For full-time use of reusable CLs, where figures from lens and MPS packaging are combined, plastics accounted for 67% of waste by mass. MPS bottles alone made up almost half the waste (45%) associated with full-time reusable CL wear.

CONCLUSION

Full-time DD wear generates 27% more waste annually than full-time reusable lens wear. Reusable CL wearers can recycle 78% of waste at home. DD lens wearers have access to recycling options that allow them to recycle 100% of CL related waste. Full-time CL lens wear represents just 0.20-0.26% of the 412 kg of household waste generated per person, per year in the United Kingdom. Worn CLs should never be disposed of down the sink or lavatory. CL wearers should be aware of responsible end-of-life recycling and disposal options for all CL waste.

Current understanding and therapeutic management of contact lens associated sterile corneal infiltrates and microbial keratitis

Contact lenses are widely prescribed in clinical practice with multiple applications and advantages. However, contact lenses can be associated with various complications which range from innocuous to severe. Clinicians thus not only need to possess the ability to prescribe the most appropriate contact lenses for each individual patient but also be able to recognise and manage any associated complications. This review examines the existing literature on the management of corneal infiltrative events associated with soft contact lenses, including microbial keratitis, particularly in the context of practising in Australia. The definitions and diagnosis of corneal infiltrative events, as well as the current understanding of their aetiologies, will be explored. The various aspects of a successful management will be discussed, including the applications of therapeutic agents such as antimicrobial and anti-inflammatory agents, the role of microbiological investigations, and strategies to improve long-term prognosis. The currently available evidence supporting management options will be presented, highlighting the relative abundance of high-level evidence on management protocols, antimicrobial selection and treatment duration for microbial keratitis; and the relative paucity of studies and trials for sterile corneal infiltrative events, despite this condition being much more commonly encountered in clinical practice.

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.

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.

Understanding clinical and immunological features associated with Pseudomonas and Staphylococcus keratitis

Pseudomonas aeruginosa and Staphylococcus aureus are the two dominant Gram-negative and -positive species, respectively, isolated from patients with contact lens-related bacterial keratitis. The clinical features of bacterial keratitis vary, such that timely differential diagnosis can be challenging, which may cause a delay in diagnosis resulting in poorer outcome. This review aims to explore the current understanding of clinical and immunological features associated with contact lens-related P. aeruginosa and S. aureus keratitis based on currently available evidence. Firstly, the review characterises contact lens-related P. aeruginosa and S. aureus keratitis, based on clinical features and prognostic factors. Secondly, the review describes the primary immune response associated with a bacterial infection in in-vivo non-scratch contact lens-wearing animal models, colonised by bacteria on contact lens and topical administration of bacteria on the cornea. Finally, the review discusses the role of macrophage inflammatory protein-2 (MIP-2) and intercellular adhesion molecule (ICAM-1) in neutrophil recruitment based on both in-vivo scratch models of bacterial keratitis and bacterial challenged in cell culture models.

The contact Lens risk survey to assess risk of soft contact lens-related inflammatory events

PURPOSE

To test the Contact Lens Assessment in Youth Contact Lens Risk Survey (CLRS) scoring algorithm in soft contact lens (SCL) wearers presenting with SCL-related adverse events and healthy matched controls.

METHODS

This prospective case-control study compared CLRS responses in SCL wearers presenting with symptomatic red eyes (Cases) with age-, sex- and site-matched healthy SCL wearers (Controls) at six locations across North America. Responses to individual questions from Cases and Controls were analyzed using either the Pearson, Mantel-Haenszel chi-square, or Fisher's exact test. Differences in the CLRS scores were compared using t-tests.

RESULTS

A total of 171 SCL wearers were enrolled (n = 57 Cases, 114 Controls). Cases were adjudicated to consensus and classified as contact lens-related serious and significant (S&S) or non-serious events. S&S Cases scored significantly higher on the CLRS (56.1 ± 11.1) than either their matched Controls (44.3 ± 11.1) (P <  0.001) or the non-Serious Cases (44.8± 12.8 P =  0.002). Scores of non-serious Cases were not significantly different than scores of their Controls (43.4 ± 10.7, P = 0.33) CONCLUSIONS: The CLRS scoring algorithm discriminated between SCL wearers presenting with S&S CL-related adverse events from healthy SCL wearers and those with non-serious events. This survey and scoring system could help practitioners identify patients at greatest risk for CL-related adverse events and support targeted interventions aimed at reducing risk behaviors.

Development of a contact Lens risk survey

PURPOSE

To describe the development and report psychometric properties of the Contact Lens Risk Survey (CLRS) to identify patients at risk for soft contact lens-related complications.

METHODS

Psychometric properties of the CLRS, a web-based survey with branching logic, were determined using data from 5 multi-site fieldings (n = 1059), including re-fielding to sub groups. Responses from participants with and without an active red eye were used to identify risk factors of a red eye event and calculate an overall risk score. A 6th fielding of the CLRS (n = 171) was used to assess discriminate validity.

RESULTS

Participants needed 11-12 min to complete the survey with a negligible difference by age. Internal consistency was excellent (Cronbach's α ≥ 0.70) for 3 of the 5 constructs identified by factor analysis. Twelve of the 17 survey items exhibited excellent within-subject repeatability (Kappa ≥ 0.61). Between-subject agreement, assessed in 18-25 year olds, was high for the majority of items, suggesting good generalizability across different populations of SCL wearers. The ability of the model using individual items of the CLRS to discriminate Controls and participants with a red eye was good with an area under the curve of 0.779.

CONCLUSION

The CLRS tool is a repeatable and valid instrument to standardize documentation of demographic, behavior, and exposure factors which appear to drive the greatest risk of a contact lens related red eye event.

Adverse event rates in the retrospective cohort study of safety of paediatric soft contact lens wear: the ReCSS study

Purpose

To ascertain the safety of soft contact lens (SCL) wear in children through a retrospective chart review including real‐world clinical practice settings.

Methods

The study reviewed clinical charts from 963 children: 782 patients in 7 US eye care clinics and 181 subjects from 2 international randomised clinical trials (RCTs). Subjects were first fitted while 8–12 years old with various SCL designs, prescriptions and replacement schedules, and observed through to age 16. Clinical records from visits with potential adverse events (AEs) were electronically scanned and reviewed to consensus by an Adjudication Panel.

Results

The study encompassed 2713 years‐of‐wear and 4611 contact lens visits. The cohort was 46% male, 60% were first fitted with daily disposable SCLs, the average age at first fitting was 10.5 years old, with a mean of 2.8 ± 1.5 years‐of‐wear of follow‐up observed. There were 122 potential ocular AEs observed from 118/963 (12.2%) subjects; the annualised rate of non‐infectious inflammatory AEs was 0.66%/year (95% CI 0.39–1.05) and 0.48%/year (0.25–0.82) for contact lens papillary conjunctivitis. After adjudication, two presumed or probable microbial keratitis (MK) cases were identified, a rate of 7.4/10 000 years‐of‐wear (95% CI 1.8–29.6). Both were in teenage boys and one resulted in a small scar without loss of visual acuity.

Conclusion

This study estimated the MK rate and the rate of other inflammatory AEs in a cohort of SCL wearers from 8 through to 16 years of age. Both rates are comparable to established rates among adults wearing SCLs.

The COVID-19 pandemic: Important considerations for contact lens practitioners

A novel coronavirus (CoV), the Severe Acute Respiratory Syndrome Coronavirus - 2 (SARS-CoV-2), results in the coronavirus disease 2019 (COVID-19). As information concerning the COVID-19 disease continues to evolve, patients look to their eye care practitioners for accurate eye health guidance. There is currently no evidence to suggest an increased risk of contracting COVID-19 through contact lens (CL) wear compared to spectacle lens wear and no scientific evidence that wearing standard prescription spectacles provides protection against COVID-19 or other viral transmissions. During the pandemic there will potentially be significant changes in access to local eyecare. Thus, it is imperative CL wearers are reminded of the steps they should follow to minimise their risk of complications, to reduce their need to leave isolation and seek care. Management of adverse events should be retained within optometric systems if possible, to minimise the impact on the wider healthcare service, which will be stretched. Optimal CL care behaviours should be the same as those under normal circumstances, which include appropriate hand washing (thoroughly with soap and water) and drying (with paper towels) before both CL application and removal. Daily CL cleaning and correct case care for reusable CL should be followed according to appropriate guidelines, and CL exposure to water must be avoided. Where the availability of local clinical care is restricted, practitioners could consider advising patients to reduce or eliminate sleeping in their CL (where patients have the appropriate knowledge about correct daily care and access to suitable lens-care products) or consider the option of moving patients to daily disposable lenses (where patients have appropriate lens supplies available). Patients should also avoid touching their face, including their eyes, nose and mouth, with unwashed hands and avoid CL wear altogether if unwell (particularly with any cold or flu-like symptoms).

Safety of soft contact lenses in children: retrospective review of six randomized controlled trials of myopia control

PURPOSE

To examine the rate and types of ocular adverse events among children wearing soft contact lenses.

METHODS

This study is a retrospective review of ocular adverse event data from six randomized controlled trials among a total of 581 myopic children (aged 7-15 years at baseline) administered daily disposable hydrogel contact lenses (etafilcon A).

RESULTS

During 816 patient years of contact lens wear, no significant or serious ocular adverse events were reported. A total of 86 non-significant ocular adverse events occurred in 53 children. The crude rate of ocular adverse events was 10.6 per 100 patient years with the estimated pooled incidence being 8.9 per 100 patient years (95% CI: 4.5-17.4). Two asymptomatic corneal infiltrative events were reported (both non-significant), which is an incidence of 0.3 (95% CI: 0.1-0.9) per 100 patient years. The most common ocular adverse events (n) were slit-lamp findings of Grade 2 or less requiring treatment (26), unspecified conjunctivitis (14), and allergic conjunctivitis (13). No cases of microbial keratitis were observed. Of the 86 adverse events, 37 were classified as highly likely or possibly lens-related, giving a crude incidence of 4.5 per 100 patient years for contact lens-related events. The crude incidence of ocular adverse events among spectacle wearers was 1.8 per 100 patient years.

CONCLUSION

These data suggest that daily disposable soft contact lenses can be safely worn by children. Additional studies will be needed to precisely quantify the adverse event rate of soft contact lenses in normal clinical practice.

Thirty years of 'quiet eye' with etafilcon A contact lenses

Frequent replacement contact lenses made from the etafilcon A hydrogel lens material were introduced onto the market over 30 years ago, and etafilcon A remains the most widely used hydrogel lens material today. Although the prescribing of silicone hydrogel lenses is increasing, millions of lens wearers globally have been wearing hydrogel lenses for many years and exhibit a physiologically-stable 'quiet eye', with a low profile of adverse events. Hydrogel lenses are demonstrated to maintain a low inflammatory response and infection risk profile during daily wear, which in the case of etafilcon A, may be related to its low modulus, and the naturally-protective, anti-microbial, non-denatured lysozyme absorbed into the lens from the tear fluid. Although improved corneal physiology from decreased hypoxia with silicone hydrogel lenses is well accepted, equivalent levels of corneal oxygenation are maintained during daily wear of low to medium powered hydrogel lenses, which do not impede the daily corneal de-swelling process, and do not induce clinically significant changes in ocular health. Therefore, hydrogel lenses remain an important alternative for daily wear in modern contact lens practice.

Silicone hydrogel daily disposable benefits: The evidence

Daily disposable (DD) contact lenses first came to the market approximately 25 years ago and eye care professionals (ECPs) started prescribing silicone hydrogel (SiH) contact lenses, primarily for extended or continuous wear, approximately 20 years ago. It has now been over ten years since SiH DD contact lenses have been available, and while SiH materials are routinely prescribed by ECPs for reusable daily wear, hydrogel materials are still frequently selected for the DD modality of contact lens wear. This article reviews the evidence to support the benefits of both a DD modality and SiH materials and how patients' needs may be met with SiH DD contact lenses, with respect to clinical performance, health outcomes, satisfaction, compliance and convenience. Factors which may enable or constrain ECPs from prescribing SiH DD contact lenses, as opposed to hydrogel DD and reusable contact lenses, for more of their patients are discussed with the objective of providing ECPs with a greater understanding of the advantages that can be afforded by prescribing SiH DD contact lenses to both their new and existing contact lens wearers.

A Survey of Contact Lens Wearers and Eye Care Professionals on Satisfaction with a New Smart-Surface Silicone Hydrogel Daily Disposable Contact Lens

PURPOSE

To assess the patient and ECP preference of verofilcon A lenses over approximately a one-week period when worn on a daily wear, daily disposable (DD) basis by current DD contact lens wearers (CLWs) and new CLWs. ECPs assessed the lens fit, performance on eye and lens preference (to habitual DD lens) for current wearers.

METHODS

A total of 218 current DD CLWs and 129 new CLWs aged >18 years participated in the survey. Baseline demographics and one-week data were obtained by 31 ECPs after fitting up to 10 current and 10 new wearers each. The survey was conducted online for both the participants and the ECPs. The survey took place in Australia and New Zealand from April to May 2019.

RESULTS

For new wearers, the surveyed results demonstrated strong wearer preference for the verofilcon A lens with quality of life as a main driver. For current wearers, comfort was the main driver for verofilcon A preference. Post survey, 73% of ECPs stated they would most likely continue to fit verofilcon A lenses.

Visual Performance of Daily-disposable Multifocal Soft Contact Lenses: A Randomized, Double-blind Clinical Trial

SIGNIFICANCE

The present study highlights the differences between modern daily-disposable multifocal soft contact lenses to assist eye care practitioners in fitting presbyopic contact lens wearers.

PURPOSE

The purpose of this study was to compare visual performance of three daily-disposable multifocal contact lenses.

METHODS

Presbyopes (n = 72) wore 1-Day Acuvue Moist Multifocal, BioTrue ONEday for Presbyopia, and Dailies AquaComfort Plus Multifocal for 1 week in a prospective, randomized, double-blind, crossover clinical trial. After 1 week, high- and low-contrast visual acuities (HCVA, LCVA) were measured between 6 m and 40 cm and stereopsis at 40 cm. Subjective performance was assessed with 1- to 10-point rating scales for clarity, ghosting, driving vision, vision stability, ease of focusing, overall vision satisfaction, and ocular comfort. Willingness to purchase was reported with categorical responses. Linear mixed models and χ tests were used for analysis, and level of significance was set at 5%.

RESULTS

BioTrue provided better HCVA and LCVA at distance than did Acuvue Moist (P ≤ .03). Subjectively, Acuvue Moist was rated lowest for distance clarity, distance ghosting, and driving vision (P ≤ .05). Acuvue Moist provided better HCVA at 70 to 40 cm and LCVA at 1 m to 40 cm than did BioTrue (P ≤ .01) and better LCVA at 1 m to 50 cm than did AquaComfort Plus (P ≤ .02). AquaComfort Plus also provided better HCVA and LCVA at 50 and 40 cm than did BioTrue (P ≤ .03). Acuvue Moist provided better stereopsis than did BioTrue (P = .02). Subjectively, BioTrue was rated lowest for near clarity (P ≤ .007) and lower than Acuvue Moist for intermediate clarity and near ghosting (P ≤ .04). No other differences were found between lenses (P > .05).

CONCLUSIONS

BioTrue had better distance performance compared with near, whereas Acuvue Moist performed conversely. AquaComfort Plus performed reasonably overall.

The Development of an Antimicrobial Contact Lens - From the Laboratory to the Clinic

Contact lens wear is generally safe and provides excellent vision. However, contact lens wear is often associated with the risk of developing ocular surface infection and inflammation, and in severe cases, the infection can result in loss of vision. Antimicrobial peptide-coated contact lenses have been made to help reduce the incidence of infection and inflammation. This paper reviews the research progress from conception, through the laboratory and preclinical tests to the latest information on clinical testing of an antimicrobial contact lens. We provide insights into the pathways followed and pitfalls that have been encountered. The journey has not always been linear or smooth, but has resulted in some of the first published clinical testing of antimicrobial peptide-coated contact lenses in humans. We hope this may help lead to the development and commercialisation of antimicrobial contact lenses in the future.