Anterior eye surface changes following miniscleral contact lens wear

PurposeTo quantify the effect of short-term miniscleral contact lens wear on the anterior eye surface of healthy eyes, including cornea, corneo-scleral junction and sclero-conjuctival area.MethodsTwelve healthy subjects (29.9 ± 5.7 years) wore a highly gas-permeable miniscleral contact lens of 16.5 mm diameter during a 5-hour period. Corneo-scleral height profilometry was captured before, immediately following lens removal and 3 h after lens removal. Topography based corneo-scleral limbal radius estimates were derived from height measurements. In addition, elevation differences in corneal and scleral region were calculated with custom-written software. Sclero-conjuctival flattening within different sectors was analysed.ResultsShort-term miniscleral lens wear significantly modifies the anterior eye surface. Significant limbal radius increment (mean ± standard deviation) of 146 ± 80 μm, (p = 0.004) and flattening of −122 ± 90 μm in the sclero-conjuctival area, (p << 0.001) were observed immediately following lens removal. These changes did not recede to baseline levels 3 h after lens removal. The greatest anterior eye surface flattening was observed in the superior sector. No statistically significant corneal shape change was observed immediately following lens removal or during the recovery period.ConclusionsShort-term miniscleral contact lens wear in healthy eyes does not produce significant corneal shape changes measured with profilometry but alters sclero-conjuctival topography. In addition, sclero-conjuctival flattening was not uniformly distributed across the anterior eye.     

Long-term changes in straylight induced by corneal refractive therapy: A pilot study

PurposeTo assess long-term intraocular straylight changes induced by corneal refractive therapy (CRT) and to determine whether these changes persist after cessation of CRT lens wear.MethodsA single-center, prospective, longitudinal study was performed in 22 subjects (group 1) undergoing overnight corneal refractive therapy for 1 year. Ten right eyes of 10 subjects (group 2) with emmetropia served as controls. In each subject, high contrast visual acuity (HCVA), manifest refraction and intraocular straylight were determined at several time points during treatment and 1 month after discontinuing treatment. Straylight was measured using the van den Berg straylight meter (third generation). EDTRS charts (logMAR units) were used to assess HCVA. For both groups, only data for the right eyes were analyzed.ResultsStraylight (mean ± standard deviation) significantly fell from baseline (0.98 ± 0.13) to values recorded after 1 month (0.88 ± 0.13, p = 0.011), 3 months (0.88 ± 0.13, p = 0.004), 6 months (0.88 ± 0.13, p = 0.000) and 12 months (0.76 ± 0.12, p = 0.003) of treatment. One month after discontinuing CRT lens wear, straylight was still significantly lower than baseline (0.89 ± 0.13, p = 0.003). No correlations were observed between intraocular straylight and HCVA.ConclusionsGood refractive outcomes and reductions in straylight were observed in response to corneal refractive therapy for myopia. The reduction in straylight observed after discontinuing CRT warrents further investigation.     

Corneal changes following short-term rigid contact lens wear

PurposeThe aim of this cross-over study was to investigate the changes in corneal thickness, anterior and posterior corneal topography, corneal refractive power and ocular wavefront aberrations, following the short term use of rigid contact lenses.MethodFourteen participants wore 4 different types of contact lenses (RGP lenses of 9.5 mm and 10.5 mm diameter, and for comparison a PMMA lens of 9.5 mm diameter and a soft silicone hydrogel lens) on 4 different days for a period of 8 h on each day. Measures were collected before and after contact lens wear and additionally on a baseline day.ResultsAnterior corneal curvature generally showed a flattening with both of the RGP lenses and a steepening with the PMMA lens. A significant negative correlation was found between the change in corneal swelling and central and peripheral posterior corneal curvature (all p ≤ 0.001). RGP contact lenses caused a significant decrease in corneal refractive power (hyperopic shift) of approximately 0.5 D. The PMMA contact lenses caused the greatest corneal swelling in both the central (27.92 ± 15.49 μm, p < 0.001) and peripheral (17.78 ± 12.11 μm, p = 0.001) corneal regions, a significant flattening of the posterior cornea and an increase in ocular aberrations (all p ≤ 0.05).ConclusionThe corneal swelling associated with RGP lenses was relatively minor, but there was slight central corneal flattening and a clinically significant hyperopic change in corneal refractive power after the first day of lens wear. The PMMA contact lenses resulted in significant corneal swelling and reduced optical performance of the cornea.     

The influence of soft contact lens wear and two weeks cessation of lens wear on corneal curvature

IntroductionAccurate corneal measurements are crucial in corneal refractive surgery (CRS) to ensure successful outcomes. Soft contact lens (SCL) wear may result in changes to corneal curvature and structure. United States Food and Drug Administration (FDA) pre-operative guidelines recommend that prior to CRS, SCL wearers cease SCL wear for “at least two weeks before examination and treatment” [1]. Corneal curvature changes induced by SCL wear may take longer than two weeks to resolve.PurposeTo examine the effect of SCL wear on corneal curvature before and following two weeks SCL wear cessation. To explore the possible impact of different SCL materials and years of SCL wear.MethodsRetrospective data analysis, between a group of SCL wearers (SCL: n = 45); and a non-contact lens control group (NCL: n = 45). Corneal curvature parameters were measured using the Pentacam (Oculus, Germany), before and following two weeks cessation of SCL wear.ResultsNo significant differences in keratometry or Sagittal radius of curvature between SCL and NCL groups prior to or following SCL cessation. Tangential radius of curvature showed significant inferior steepening for the SCL group prior to SCL cessation (SCL vs. NCL; 7.77 ± 0.30 mm vs. 7.90 ± 0.30 mm; p = 0.04). Following two weeks cessation of SCL wear this appeared to have resolved.ConclusionsTwo weeks cessation of SCL wear appears sufficient for resolution of corneal curvature changes with modern SCL materials and years of SCL wear. However, further studies with longer lens deprivation periods are required to ensure stability for all SCL wearing patients.     

The temporal dynamics of miniscleral contact lenses: Central corneal clearance and centration

Purpose

To examine the time course of the reduction in central corneal clearance and horizontal and vertical lens translation (decentration) during miniscleral contact lens wear and the theoretical influence upon the optics of the post-lens tear layer.

Predicting success with silicone-hydrogel contact lenses in new wearers

Purposeto evaluate changes in tear metrics and ocular signs induced by six months of silicone-hydrogel contact lens wear and the difference in baseline characteristics between those who successfully continued in contact lens wear compared to those that did not.MethodsNon-invasive Keratograph, Tearscope and fluorescein tear break-up times (TBUTs), tear meniscus height, bulbar and limbal hyperaemia, lid-parallel conjunctival folds (LIPCOF), phenol red thread, fluorescein and lissamine-green staining, and lid wiper epitheliopathy were measured on 60 new contact lens wearers fitted with monthly silicone-hydrogels (average age 36 ± 14 years, 40 females). Symptoms were evaluated by the Ocular Surface Disease Index (OSDI). After six months full time contact lens wear the above metrics were re-measured on those patients still in contact lens wear (n = 33). The initial measurements were also compared between the group still wearing lenses after six months and those who had ceased lens wear (n = 27).ResultsThere were significant changes in tear meniscus height (p = 0.031), bulbar hyperaemia (p = 0.011), fluorescein TBUT (p = 0.027), corneal (p = 0.007) and conjunctival (p = 0.009) staining, LIPCOF (p = 0.011) and lid wiper epitheliopathy (p = 0.002) after six months of silicone-hydrogel wear. Successful wearers had a higher non-invasive (17.0 ± 8.2 s vs 12.0 ± 5.6 s; p = 0.001) and fluorescein (10.7 ± 6.4 s vs 7.5 ± 4.7 s; p = 0.001) TBUT than drop-outs, although OSDI (cut-off 4.2) was also a strong predictor of success.ConclusionSilicone-hydrogel lenses induced significant changes in the tear film and ocular surface as well as lid margin staining. Wettability of the ocular surface is the main factor affecting contact lens drop-out.     

An acute clinical comparison of corneal staining and comfort associated with contact lens care solutions

PurposeThis study compared the biocompatibility and comfort of 4 lens care solutions currently marketed in France.MethodsThis was a randomized, interventional, double-masked, single-center crossover study assessing balafilcon A silicone hydrogel contact lenses, bilaterally, straight from the blister pack solution (control) and pre-soaked in the following lens care solutions: Regard^® (containing sodium chlorite), ReNu^® (containing a PHMB [polyhexamethylene biguanide] derivative), CyClean™ and MeniCare™ Soft (both containing PHMB). Subjects were randomized to the order of test solution use. For each of the 5 solutions tested, subjects attended a baseline/lens dispensing visit and an intervention visit 2 h later. At both visits, evaluation included slit-lamp examination, corrected-distance visual acuity, corneal staining, and subject-assessed photophobia, ocular comfort, and ocular redness.ResultsThirty subjects were enrolled and 28 were evaluable. Corneal staining severity was significantly worse than baseline after 2 h of wearing lenses soaked in CyClean, MeniCare, or ReNu (P ≤ 0.001). The MeniCare group alone demonstrated a significant improvement in ocular comfort after 2 h of lens wear (P = 0.02). No group demonstrated significant changes in ocular redness or photophobia. Corrected-distance visual acuity was similar between baseline and intervention visits for each test solution. No adverse events were reported during the study.ConclusionsSilicone hydrogel contact lenses presoaked in lens solutions containing PHMB or a PHMB derivative produced an increase in corneal staining after 2 h of lens wear. The higher levels of corneal staining in the 2 solutions did not correlate with increased discomfort within this 2-h timeframe.     

Comparison of corneal hysteresis and corneal resistance factor after small incision lenticule extraction and femtosecond laser-assisted LASIK: A prospective fellow eye study

PurposeTo compare corneal hysteresis (CH) and corneal resistance factor (CRF) between eyes treated with small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (femto-LASIK).SettingBeyoğlu Eye Training and Research Hospital.DesignProspective comparative case series.MethodsSixty eyes from 30 patients with bilateral myopia or myopic astigmatism were studied. Inclusion criteria were spherical equivalent of subjective manifest refraction (SE) <10 diopters (D) and a difference ≤0.50 D between the SEs of both eyes. One eye of each patient was treated with SMILE, and the fellow eye underwent femto-LASIK. Randomization was performed using a sealed envelope system. The main outcome measures were CH and CRF measured preoperatively and postoperatively (1 and 6 months).ResultsPreoperative SE was similar in both groups (p = 0.852). CH and CRF values were reduced postoperatively in both groups compared to their corresponding preoperative values (p < 0.001). At the 6-month follow-up visit, the mean CH values in the SMILE and femto-LASIK groups were 8.95 ± 1.47 and 9.02 ± 1.27, respectively (p = 0.852), and the mean CRF values were 7.77 ± 1.37 and 8.07 ± 1.26, respectively (p = 0.380).ConclusionCH and CRF decreased after SMILE. There were no differences between SMILE and femto-LASIK treatments in postoperative CH or CRF values.     

The time course and nature of corneal oedema during sealed miniscleral contact lens wear

PurposeTo examine the magnitude and time course of central epithelial, stromal and total corneal thickness changes during sealed miniscleral contact lens wear and the influence of initial central corneal clearance upon these thickness changes.MethodsHigh-resolution OCT images were captured over an 8 h period of miniscleral contact lens wear (using a rotationally symmetric 16.5 mm diameter lens) in 15 young, healthy participants with normal corneae. Corneal thickness data were derived from OCT images using semi-automated image processing techniques over the central 4 mm.ResultsChanges in stromal and total corneal thickness followed a similar pattern throughout lens wear with oedema first detected 15 min after lens insertion (0.47 ± 0.09% increase in stromal and total corneal thickness, both p < 0.01) which peaked after 90 min of lens wear (1.36 ± 0.24% increase in stromal and 1.18 ± 0.20% increase in total corneal thickness, both p < 0.01) and gradually decreased thereafter. Epithelial thickness increased slightly during the first 30 min of lens wear (0.56 ± 0.30% increase, p > 0.05), then rapidly decreased reaching a minimum thickness 480 min after lens insertion (2.38 ± 0.70% decrease, p < 0.05). The maximum total corneal oedema, maximum stromal oedema, and maximum epithelial thinning were not associated with the initial central corneal clearance or the extent of lens settling over the 8 h period (all p > 0.05). Greater initial central corneal clearance resulted in less oxygen concentration reaching the cornea (∼2% less) based on previously published data, which manifested as ∼0.5% more central corneal oedema.ConclusionsScleral lens induced corneal oedema is stromal in nature. On average, central stromal and total corneal thickness increased rapidly following lens insertion and peaked after 90 min, while central epithelial thickness gradually decreased throughout lens wear consistent with natural diurnal variation. A greater initial central corneal clearance resulted in reduced oxygen delivery to the cornea, which had minimal short-term impact upon healthy eyes, however, minimising central corneal clearance may be important in eyes with reduced endothelial cell function to minimise hypoxic stress.     

Trans epithelial corneal collagen crosslinking for progressive keratoconus: 6 months follow up

PurposeTo evaluate keratoconus biomechanical changes after transepithelial corneal collagen cross linking (TE CXL) using riboflavin and ultraviolet A (UVA).SettingSecond University of Naples, Naples, Italy.DesignProspective non comparative case series study.MethodsPatients with progressive keratoconus were examined, before and during a 6 months follow up after TE CXL, with a Pentacam, an Ocular Response Analyzer and an IOLMaster.Best corrected visual acuity (BCVA), refraction, corneal thinnest point (CTP), keratometry readings at the keratoconus apex (K_max), axial eye length (AL), corneal volume (CV) anterior chamber volume (ACV), anterior chamber depth (ACD), corneal hysteresis (CH) and corneal resistance factor (CRF) were evaluated.ResultsThirty-six eyes of 36 patients with progressive keratoconus were analyzed. Six months after treatment there was a significant improvement in BCVA (p < 0.01), no significant changes in refraction (p = 0.57), CTP (p = 0.07), K_max (p = 0.88), AL (p = 0.07), CV (p = 0.38), ACV (p = 0.07), ACD (p = 0.7), CH (p = 0.1) and CRF (p = 0.3).ConclusionsAccording to our results TE CXL stabilizes most of the patients with progressive keratoconus, without affecting in negative way the corneal elasticity.     

Assessment of corneal endothelial cell density in patients with keratoconus not using contact lenses

PurposeTo assess the corneal endothelial cell density (ECD) in keratoconus patients with no history of contact lens use.SettingYuzuncu Yil University, School of Medicine and Van Training and Research Hospital, Department of Ophthalmology, Van, Turkey.DesignCross-sectional controlled study.MethodsThe eyes of 65 patients with the diagnosis of keratoconus with no history of contact lens wear and the eyes of 40 healthy controls were prospectively examined using the Heidelberg Retinal Tomography Rostock Cornea Module (HRT3/RCM). The average ECD from the two groups were then compared.ResultsOf the cases with keratoconus, 44 (67.7%) were men and 21 (32.3%) were women. The mean age was 20.9 ± 6.8 (range = 10–41) years. Of the controls, 28 (70%) were men and 12 (30%) were women. The mean age was 23.9 ± 5.8 (range = 14–35) years. Of the 65 eyes with keratoconus, 19 (29.2%) had mild keratoconus, 21 (32.3%) had moderate keratoconus, and 25 (38.5%) had severe keratoconus. The mean ECD was 2731.6 ± 303.2 cells/mm² in cases with keratoconus and 2664.9 ± 319.5 cells/mm² in controls. There was no difference between the densities (unpaired t-test, P = 0.4). No significant relationships were found between the ECD data and central corneal thickness or steepest keratometric.ConclusionsEndothelial cell density was unaltered in keratoconic patients without a history of contact lens use when compared with healthy controls. Change in ECD is independent from the central corneal thickness and the stage of keratoconus.     

Evaluation of central corneal thickness after cataract surgery,penetrating keratoplasty and long-term soft contact lens wear

PurposeThe aim of this study was to compare central corneal thickness (CCT) between corneas of normal healthy eyes (cNHE), corneas of eyes that had undergone cataract surgery by clear corneal phacoemulsification with implantation of an intracapsular intraocular lens (cIOL), corneal grafts after penetrating keratoplasty (gPK) and corneas of long-term soft contact lens wearers (cCL).MethodsThe study design was a consecutive cross-sectional trial. CCT was measured using rotating Scheimpflug camera (Pentacam, software version 1.16r04) in 80 cNHE, 79 cIOL, 46 gPK and 78 cCL. Analysis of variance (one-way ANOVA) was performed to compare differences of mean values between these four groups. Pearson's or Spearman's correlation coefficient (r) was determined between CCT value and age, follow up time after penetrating keratoplasty (timePK) or contact lens wearing time (timeCL).ResultsMeans of CCT measurements were comparable between cNHE (mean CCT ± standard deviation, 554 ± 36 μm), cIOL (551 ± 40 μm) and gPK (534 ± 52 μm) as determined by one-way ANOVA. Mean CCT values in cCL (537 ± 37 μm) were statistically significantly lower in comparison to cNHE (p = 0.026, 95% CI = 1.43–31.44). There was no linear correlation between age and CCT values of cNHE and cIOL (p = 0.841, r = −0.031 and p = 0.931, r = 0.011, respectively). No linear relationship was determined between CCT values of cCL and timeCL (p = 0.315, r = −0.125). CCT values of gPK did not correlate with timePK (p = 0.738, r = 0.054).ConclusionsThe data reported here indicate that in the same statistical model among CCT values of cNHE, cIOL and gPK only long-term soft contact lenses (CL) wearer have significantly lower CCT measurements.     

Progression of keratoconus in patients wearing pancorneal toric edge rigid gas-permeable contact lenses

PurposeTo investigate the rate of progression of keratoconus in patients wearing pancorneal toric edge rigid gas-permeable contact lenses (pancorneal RGP-CL) compared to non-pancorneal RGP-CL. We also evaluated alterations in anterior chamber parameters with the progression of keratoconus and investigated the location of the cone in eyes with keratoconus.MethodsThe current study was a retrospective study including patients with clinically evident keratoconus from the outpatient clinic from the Department of Ophthalmology of the Erasmus Medical Center, Rotterdam, the Netherlands. Medical history and contact lens characteristics were documented. All participants underwent ophthalmic examination including corneal topography. Corneal topography was repeated at one of the consecutive visits of the patient. Patients were divided into two groups: those wearing pancorneal RGP-CL and those wearing other contact lens types. As a measure of progression of keratoconus differences in corneal topography parameters between both groups were compared.ResultsA total of 82 patients were included of which 42 had follow-up (mean 17.8 months) data. We found a significant difference in progression between eyes fitted with and without pancorneal RGP-CL (K-flat: p = 0.09, K-steep: p = 0.02, K-mean: p = 0.02, and K-minimum: p = 0.04). Compared with eyes fitted without pancorneal RGP-CL no significant difference in K-values was found for eyes fitted with pancorneal RGP-CL during follow-up. Furthermore, a significant decrease in anterior chamber volume (p < 0.001) and corneal volume (p = 0.008) was found during follow-up. In 86.6% the location of the cone was located infero-temporal.ConclusionsPancorneal RGP-CL have a better effect on stabilizing progression of keratoconus than non-pancorneal RGP-CL. The finding of an infero-temporal location of the cone in keratoconic corneas may improve results of contact lens fitting and surgical management.     

Comparison of conventional method of contact lens fitting and software based contact lens fitting with Medmont corneal topographer in eyes with corneal scar

PurposeTo compare conventional method of contact lens fitting with software based contact lens fitting using Medmont corneal topographer in eyes with nebular and macular corneal scars.MethodsFifteen participants who were diagnosed with nebular and macular scars were fitted with rigid gas permeable lenses using conventional method of contact lens fitting. During the lens dispensing visit, participants underwent Medmont corneal topography. Agreement between the two methods of contact lens fitting was studied.ResultsParameters of contact lenses which were concluded using conventional method was compared to that of software based fitting. Mean difference in base curve of contact lens between the two methods was 0.094 mm ± 0.147 mm (95% CI: +0.383 to −0.194). Mean difference in diameter of contact lens between the two methods was 0.16 mm ± 0.172 mm (95% CI: +0.497 to −0.177). Contact lens parameters that were achieved using two different methods of fitting showed good correlation. Correlation coefficients, as comparison of two methods in base curve and diameter were 0.96 (P < 0.05) and 0.94 (P < 0.05), respectively.ConclusionSoftware based contact lens fitting would be useful for contact lens practitioners to predict initial base curve of contact lens in corneal scars.     

A pilot study investigating the effect of extended contact lens wear on limbal and central corneal morphology

PurposeTo investigate the effect of long-term extended soft contact lens wear on limbal and central corneal cell morphology, and limbal architecture.MethodsEach participant attended a study visit involving in vivo confocal microscopy of central corneal and limbal epithelium. Scans were graded by five masked graders for three features: central epithelial irregularity, limbal epithelial irregularity and the prominence of palisades of Vogt. The variability of grades between different graders and the difference of grades between extended wearers and daily soft/non-contact lens wearers were assessed.ResultsNineteen participants (9 extended soft contact lens wearers and 10 daily soft/non-contact lens wearers) aged 31–65 years were enrolled in this study. Scans from 37 eyes were included in the analysis. Agreement between graders for each feature was moderate to good with inter class correlation >0.7. While there were no significant differences in central epithelial cell irregularity (p = 0.527) and the prominence of palisade of Vogt (p = 0.182) between extended or daily soft/non-contact lens wearers, limbal epithelial cell irregularity showed a trend with increased irregularity in extended soft contact lens wearers (p = 0.091).ConclusionsWhile no differences in limbal cell morphology and structure or central epithelial cell was found in this subjective grading study of extended wearers compared to daily soft/non-contact lens wearers, further studies using a larger sample size or a longitudinal study design are warranted.     

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

PurposeTo investigate the differences of functional visual acuity (FVA) and high order aberrations (HOAs) in relation to tinted and clear hydrogel soft contact lens (SCL) wear.MethodsA prospective comparative study was performed in 16 eyes of 16 healthy volunteers. Dynamic visual acuity (using a FVA measurement system) and higher-order aberrations (using a wavefront sensor) were compared in subjects wearing two types of soft contact lenses: 1-day Acuvue^® (Vistakon, Jacksonville, FL) clear and the 1-day Acuvue^® Define^TM (Vistakon, Jacksonville, FL) tinted lens. The blink rates were recorded during FVA testing. The correlation between the difference of HOAs and differences in FVA values was analyzed.ResultsThe mean LogMAR FVA scores with clear and tinted SCLs were 0.07 ± 0.13 and 0.14 ± 0.17 (P < 0.05). The mean blink frequencies with clear and tinted SCL wear were 18.4 ± 8.3 and 25.3 ± 4.7 blinks/min (P < 0.05). Both 3rd-order aberrations and total HOAs showed statistically significant differences between the two types of soft contact lenses for 6 mm pupil measurements (P < 0.05). A significant positive linear correlation was observed between ΔHOAs and ΔLogMAR FVA for 6 mm pupil measurements (R = 0.53, P = 0.04).ConclusionsTinted contact lens wear appears to induce a reduction in optical quality. Functional visual acuity measurement is a useful procedure to study the changes of visual performance and quality in tinted contact lens wear.     

Changes in tear film,corneal topography,and refractive status in premenopausal women during menstrual cycle

PurposeTo investigate the changes in a questionnaire based subjective symptomatology, tear film break-up time, tear volume, corneal topography, and refractive status in premenopausal women during menstrual cycle.MethodsSeventeen premenopausal females and 15 healthy males were enrolled in this prospective study. After routine ophthalmologic examination, an ocular surface disease index questionnaire was administered, tear film break-up time (TBUT), and Schirmer I tests were performed. Keratometry readings and refractive status were also obtained. All examinations were repeated at day 21, day 12 and day 2.ResultsOSDI score in day 21 was significantly lower than that in day 12 (p = 0.004) and day 2 (p = 0.01) in the female patients; however, no significant change was found in the male subjects (p > 0.05). No statistically significant difference was found in TBUT and Schirmer I tests, keratometry, and refraction results in both of the female and male subjects at all of the test points (p > 0.05). There was a significant correlation between OSDI score and TBUT (p = 0.02, p = 0.03, respectively), and Schirmer I test at day 12 (p = 0.004, p = 0.008, respectively). A significant negative correlation was found between oestrogen level and horizontal keratometry values at day 21 (r = −0.5, p = 0.03; r = −0.4, p = 0.04, respectively) for the right and left eyes in the female subjects.ConclusionOur study confirms that fluctuations in the blood levels of oestrogen produce alterations in ocular surface equilibrium during the menstrual cycle and consequently affect the subjective dry eye symptoms in female patients. However, no ocular surface parameter changes were observed.     

The use of daily disposable lenses in problematic reusable contact lens wearers

PurposeReplacing soft contact lenses (CLs) on a daily basis brings a number of advantages, most notably, reduced exposure to deposits, disinfectants, allergens, and other contaminants. This retrospective study estimated the prevalence of problems in current wearers of reusable soft CLs and tested the effect of refitting “problem” patients with daily disposable (DD) hydrogel lenses.MethodsPrevalence was estimated from 398 current reusable CL wearers for: frequent/constant discomfort or dryness, ≥2 h of uncomfortable wear, ≥grade 2 conjunctival hyperaemia (0–4), or ≥grade 3 corneal staining (0–15). In the second part of the study, 217 reusable CL wearers classified as problem patients were randomly refitted with DD lenses manufactured from one of two materials: etafilcon A (n = 96) or nelfilcon A (n = 121) and reassessed 1 week later.ResultsThirty-nine percent (154/398) had some qualifying criterion: reduced comfortable wearing time (CWT), 20%; dryness, 20%; irritation, 5%; corneal staining, 8%; and hyperaemia, 7%. After refitting with DDs, the prevalence of reduced CWT was decreased from 65% to 51% (P = 0.0039), dryness from 60% to 41% (P < 0.0001) and corneal staining from 28% to 21% (P = 0.04). There was no significant change in the prevalence of irritation, or hyperaemia. Some differences were noted between the two lens materials.ConclusionsA high proportion of reusable soft lens wearers encounter clinically relevant signs or symptoms with their current CLs. This study provides evidence that refitting with DD lenses is a useful strategy for alleviating some of the common problems of CL wear.     

Efficacy of two silicone-hydrogel contact lenses for bandage use after photorefractive keratectomy

PurposeTo evaluate the efficacy of two silicone hydrogel (SiH) contact lenses, approved for continuous wear for one week, following photorefractive keratectomy (PRK).MethodsForty seven myopic patients (94 eyes) undergone bilateral PRK were enrolled in this prospective, double-masked, comparative study. One eye of each patient was fitted with a Lotrafilcon B lens (Ciba Vision, Duluth, US; 30-day recommended replacement) whereas the fellow eye was fitted with an Asmofilcon A lens (Menicon, Nagoya, Japan; 14-day recommended replacement). Epithelial defect size was assessed using slit lamp biomicroscopy on the day of surgery and at days 1–4 post-operatively. Uncorrected and best-corrected visual acuity and retinal straylight (C-Quant, Oculus Optigerate, Germany) were evaluated pre-operatively and one month post-operatively.ResultsAverage epithelial defect size for Asmofilcon A and Lotrafilcon B was 25.5 ± 11.0 mm² vs. 27.1 ± 9.9 mm² at day 1 (p = 0.007) and 6.3 ± 7.0 mm² vs. 9.2 ± 9.5 mm² at day 2 (p = 0.012) post-operatively. Re-epithelialization at day 3 was completed in 87.2% of the eyes fitted with Asmofilcon A lenses, compared to 74.5% with Lotrafilcon B lenses (p = 0.012). At the 3rd post-operative day 29.8% of re-epithelialized eyes showed irregular suture with Lotrafilcon B, compared to 12.8% eyes with Asmofilcon A lenses (p < 0.001). Finally, no statistically significant differences were found post-operatively between the two lenses retinal straylight (p = 0.98) and best-corrected visual acuity (p = 0.68).ConclusionsSiH lenses can be used as an effective bandage after PRK due to the limited time requested for achieving complete corneal re-epithelialization. Faster and smoother epithelial healing is provided with Asmofilcon A over Lotrafilcon B lenses.     

Ethnic differences in dry eye symptoms: Effects of corneal staining and length of contact lens wear

PurposeTo explore the relationships among length of contact lens (CL) wear, degree of corneal staining and severity of dryness symptoms, and to determine whether these relationships differ between Asians and non-Asians.MethodsAdapted soft CL wearers (n = 395; 180 Asian, 215 non-Asian) were required to discontinue CL wear for at least 24 h and report to the University of California, Berkeley Clinical Research Center (UCB-CRC). Fluorescein corneal staining was graded according to Brien Holden Vision Institute scales. Length of CL wear was reported by subjects and subjective dryness ratings were collected using the UCB-CRC Dry Eye Flow Chart (DEFC).ResultsMore Asian CL wearers exhibited corneal staining compared to non-Asians, and Asian CL wearers had a higher mean grade of corneal staining (p < 0.001), as well as a higher mean DEFC classification (p < 0.001). The difference between Asians and non-Asians in grades of corneal staining extent and depth were significant (p < 0.001). Among non-Asian CL wearers, dryness symptoms decreased with more years of CL wear and increased in the presence of corneal staining, which was not the case for Asian CL wearers.ConclusionsAsian soft CL wearers reported more severe dryness symptoms and demonstrated more severe corneal staining overall compared to non-Asians. Among non-Asians, dryness symptoms were less severe on average with increased years of CL wear and more severe in the presence of corneal staining. Dryness severity does not appear to be related to years of CL wear or corneal staining among Asians.