International multi-centre study of potential benefits of ultraviolet radiation protection using contact lenses

PurposeTo examine the effects of long-term ultraviolet radiation (UVR) blocking wearing contact lenses on ocular surface health, eye focus and macular pigment.Method210 pre-presbyopic patients were recruited from Birmingham UK, Brisbane Australia, Hong Kong China, Houston USA and Waterloo Canada (n = 42 at each site). All patients had worn contact lenses for ≥ 5 years, half (test group) of a material incorporating a UVR-blocking filter. Ocular health was assessed using slit-lamp biomicroscopy and UV autofluorescence. Accommodation was measured subjectively with a push-up test and overcoming lens-induced defocus. Objective stimulus response and dynamic measures of the accommodative response were quantified with an open-field aberrometer. Macular pigment optical density (MPOD) was assessed using heterochromatic flicker photometry (MPS II).ResultsThe two groups of participants were matched for age, sex, race, body-mass-index, diet, lifestyle, UVR exposure, refractive error and visual acuity. Limbal (p = 0.035), but not bulbar conjunctival redness (p = 0.903) was lower in eyes that had worn UVR-blocking contact lenses compared to controls. The subjective (8.0 ± 3.7D vs 7.3 ± 3.3D; p = 0.125) and objective (F = 1.255, p = 0.285) accommodative response was higher in the test group, but the differences did not reach significance. However, the accommodative latency was shorter in eyes that had worn UVR-blocking contact lenses (p = 0.003). There was no significant different in MPOD with UVR filtration (p = 0.869).ConclusionsBlocking the transmission of UVR is beneficial in maintaining the eye’s ability to focus, suggesting that presbyopia maybe delayed in long-term UVR-blocking contact lenses wearers. These lenses also provide protection to the critical limbal region.     

The effect of hydroxypropyl-guar nanoemulsion on signs and symptoms of dry eye

PurposeTo examine the effect of hydroxypropyl-guar nanoemulsion (HP-Guar nanoemulsion, Alcon Laboratories Ltd, Fort Worth, TX, USA) versus saline (0.9% sodium chloride; Pfizer Inc., Bentley WA Australia) on the comfort and tear film properties of people with dry eye disease both in the short-term (up to 2 h post-drop instillation) and longer-term (after 4 weeks of 4-times daily use), and to examine the effect on tear inflammatory markers after 4 weeks.MethodsThis was a prospective, investigator-masked, randomised, cross-over dispensing study. Twenty participants with dry eye disease (5 males: 15 females) with average age 46.9 ± 14.4 (range 26 to 70) years were randomized to either HP-Guar nanoemulsion, or saline eye drops. Ocular symptoms, lipid layer thickness, tear evaporation, tear osmolarity and non-invasive break-up time were measured pre-drop instillation, 1 h and 2 h post-eye drop instillation, and after 4-weeks of 4-times daily drop use. Tear inflammatory mediators were measured pre-drop instillation and after 4-weeks. After 4-weeks, patients had a 4-week washout period and then crossed over to the alternate drop.ResultsWith HP-Guar nanoemulsion, participants reported less grittiness/burning/stinging 1 h post eye drop instillation compared to baseline (79.5 ± 23.3 vs. 66.8 ± 27.7, p = 0.02); less dryness 1 h and 2 h post eye drop instillation compared to baseline (77.8 ± 23.0 and 76.2 ± 23.7 vs. 61.0 ± 27.1 respectively, p < 0.01 for both); and greater overall satisfaction 1 h post drop instillation and after 4 weeks of daily use compared to baseline (80.4 ± 21.6 and 83.4 ± 16.6 vs. 68.6 ± 26.0 respectively, p ≤ 0.011 for both). With saline, participants reported less dryness after 4 weeks of daily use compared to baseline (74.2 ± 23.8 vs. 60.2 ± 24.0, p < 0.01). For HP-Guar nanoemulsion, average lipid layer thickness was significantly thicker 2 h post drop-instillation (79.5 ± 21.7 nm) compared to baseline (63.7 ± 18.9 nm) and the 4-week assessment (62.4 ± 23.1 nm, p < 0.01 for both). For saline, average lipid layer thickness was significantly thicker at 1 h and 2 h post eye drop instillation (76.0 ± 23.8 nm and 80.4 ± 24.8 nm) compared to baseline (61.0 ± 15.6 nm, p < 0.01 for both). There was no difference in inflammatory mediators or other tear variables between drops or visits.ConclusionHP-Guar nanoemulsion was more effective for improving a range of subjective dry eye symptoms both in the short and long-term compared to saline. Both HP-Guar nanoemulsion and saline transiently increased lipid layer thickness.     

Effect of large diameter and plasma coating on the initial adaptation of gas permeable contact lens fitting for neophytes

PurposeTo determine whether the adaption of neophytes to rigid gas permeable lenses (GPs) could be accelerated by changing their diameter or surface lubricity.MethodsThis was a 2 part prospective double-masked randomised wear study. An GP lens (Roflufocon D material, 9.6 mm diameter) with and without a Hydrapeg plasma coating surface was worn by 119 neophytes (21.1 ± 3.5 years; 77% female) on separate occasions. A further 114 neophytes (average age 20.1 ± 1.0 years; 72% female) wore the uncoated lens with a 9.6 mm diameter lens in one randomly allocated eye and 10.1 mm (n = 51) or 10.6 mm (n = 63) in the other with a basecurve compensation keeping the fit equivalent. Lens fit and corneal staining was assessed after 20 min, and comfort and bulbar redness were assessed at the time of lens application and after 5, 10, 15, and 20 min. Participants also reported their ease of application and removal on a 5 point scale.ResultsPlasma coated GP lenses or increasing diameter did not improve comfort (p = 0.673, p > 0.05) or bulbar redness (p = 0.805, p > 0.05) during a 20 min adaptation period in neophytes. In both cohorts, comfort improved and bulbar redness reduced with time (p < 0.001). Corneal staining, ease of insertion application and ease of removal did not differ with GP coating application or GP diameter (p > 0.05).ConclusionChanging GP diameter or surface lubricity is not beneficial to the adaption of healthy neophytes     

Assessment of condition-induced changes on the ocular surface using novel methods to assess the tear film dynamics and the lipid layer

ObjectivesTo assess the effects of different condition-induced changes on current and novel ocular surface metrics.MethodsEighty-four healthy volunteers (22.4 ± 2.6 years) participated in this study. The ocular surface and tear film response to (1) computer use, (2) contact lens insertion and (3) tear film instillation during computer use with contact lenses were assessed. Current metrics included the ocular surface disease (OSDI) questionnaire, 5-item dry eye questionnaire (DEQ-5), bulbar redness, tear meniscus height (TMH) and non-invasive keratograph break-up time (NIKBUT). Novel metrics included the lipid layer thickness obtained from the intensity of the reflected Placido disk and the speed of tear film particles post-blink.ResultsHigher dry eye symptoms, TMH and bulbar redness, and lower values in metrics related to the intensity of the Placido disk pattern and to particle speed were found after the computer reading task (p < 0.036). When a contact lens was fitted, lower TMH, NIKBUT and particle speed metrics were obtained (p < 0.044). Mixed ANOVA revealed that artificial tears significantly ameliorated the effect of computer reading on OSDI, DEQ-5, NIKBUT, metrics related to the intensity of the Placido disk pattern and metrics related to particle speed (p < 0.033).ConclusionsComputer use and contact lens wear worsened dry eye signs and symptoms, but artificial tears ameliorated this effect. Newly developed methods can serve as a tool to detect changes in the tear film triggered by different ocular surface-disturbing conditions.     

Improving ocular surface comfort in contact lens wearers

PurposeContact lens discomfort (CLD) is a major concern that can lead to the decreased or abandoned use of contact lenses. Contact lens users with dry eye disease are more likely to present with CLD. This study was conducted to evaluate the efficacy of a bioprotective preservative free, hypotonic, 0.15% hyaluronic acid (HA)-3% Trehalose artificial tear in managing dry eye symptoms in contact lens wearers.MethodsA prospective, single-arm, observational pilot study to evaluate the effectiveness of treatment with HA-Trehalose artificial tears in contact lens wearers (N = 33) aged 18–45 years with symptoms of ocular discomfort. Participants used a preservative-free, hypotonic HA-Trehalose artificial tear (1 drop/4 times per day) for 84 days. Participants were assessed using Visual Analogue Scale (VAS) for dry eye symptoms (pain, photophobia, dry eye sensation, blurry vision, foreign body sensation, itching, tingling/burning, and sticky eye feeling), Ocular Surface Disease Index (OSDI), Contact Lens Dry Eye questionnaire (CLDEQ-8), Berkley Dry Eye Flow-Chart (DEFC) on Day 0 and Day 84 and tear break-up time (TBUT), ocular surface staining with fluorescein and lissamine green, tear meniscus evaluation, and visual acuity on Day 0, 35, and 84.ResultsAll VAS symptoms (except tingling/burning and sticky eye feeling), OSDI, CLEDQ-8, and DEFC showed statistically significant (p < 0.05) improvement from baseline (Day 0) to Day 84. Similarly, corneal (fluorescein) and conjunctival (lissamine green) quality improved during the study (p < 0.05 at Day 84 versus baseline). Tear break-up time (TBUT), conjunctival (lissamine green) staining, and tear meniscus decreased but the changes were not statistically significant. Visual acuity did not change during the study. There were no ocular or systemic adverse events.ConclusionsThis study showed that the instillation of a preservative-free, hypotonic, HA-Trehalose artificial tear in contact lenses wearers with dry eye syndrome significantly improved symptoms and reduced associated signs such as corneal and conjunctival staining.     

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

BackgroundSince 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.MethodsBaseline 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.ResultsCorneal 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.ConclusionsWhile 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.     

Massive lipid keratopathy after Elizabethkingia meningosepticum keratitis

PurposeTo report the occurrence of massive lipid deposition in the cornea after Elizabethkingia meningoseptica keratitis.MethodsA 52-year-old female presented to the ophthalmology outpatient department of the Hong Kong Eye Hospital in January 2012 with complaints of pain, redness, watering and blurred vision in her left eye for 6 days. Past records showed that the patient underwent radiotherapy for mucoepidermoid carcinoma of the maxillary antrum which was later complicated by radiotherpay associated dry eye syndrome in her left eye. At the time of presentation, her best-corrected visual acuity was 0.7 OD and hand motions close to face OS. Slit lamp examination of the left eye showed a small infiltrate 1.4 mm × 1.2 mm in size with an overlying epithelial defect. Elizabethkingia meningosepticum was isolated on broth. Good clinical response was observed with hourly 5% vancomycin eye drops.ResultsAt the end of 8 weeks, slit lamp examination of the left eye revealed a corneal scar with mild lipid deposition at the site of previous corneal infiltrate. The lipid deposits increased tremendously over the next 4 weeks. The final visual acuity in the right eye dropped down to perception of light. The patient refused any further surgical intervention and is on regular follow-up in our clinic.ConclusionsOur case report highlights the occurrence of post-keratitis lipid keratopathy with E. meningosepticum.     

Optimal methodology for lid wiper epitheliopathy identification

PurposeLid wiper epitheliopathy (LWE) is a clinical sign that has been associated with dry eye disease. This study used a semi-automated method to identify the effect of drop instillation and post-dye viewing time on the absorption of lissamine green (LG) and sodium fluorescein (NaFl) on the upper eyelid in order to ascertain the optimal identification for LWE assessment.MethodsIn 37 participants with LWE, 1-drop of 1% LG (10 μL) was applied to the superior bulbar conjunctiva in the right eye, and photographs of the lid margin were taken 1, 3, and 5 min after instillation. Measurements were repeated in the same eye following instillations of 2-drops of 1% LG. The same procedures were followed for application of 2% NaFl (2 μL) to the left eye. Staining area was determined using software to detect and measure dye-stained images. Analysis used a linear mixed model with fixed effects of time, number of drops and their interaction.ResultsFor LG, multivariate analysis showed that time of drop instillation was significant (p = 0.0091) as was the area of staining in the 2-drop versus 1-drop condition (p < 0.0001). For NaFl, there was a significant effect of time (p < 0.0001), drops (p < 0.0001), and a time/drops interaction (p < 0.0134), suggesting that both time and number of drops are important.ConclusionA single drop of dye is insufficient to reveal the full extent of LWE staining. A 2-drop instillation is recommended and observation is recommended between 1 and 5 min (LG) and between 3 and 5 min (NaFl).     

A survey of ocular sports trauma and the role of eye protection

PurposeThe incidence of sports associated ocular injuries presenting to emergency departments is rising. Despite this, eye protection is not widely used in the general population. This survey was conducted to determine the spectrum of ocular sports injuries that presented to the emergency department of an ophthalmic hospital, which serves a large sector of inner city London. The role of eye protection in preventing ocular sports injuries was also investigated.MethodsAll patients who attended the emergency department with sports associated ocular injuries between May and July 2008 were identified. Medical records of these patients were examined.ResultsThere were a total of 16 999 ophthalmic emergency attendances. 48 (0.28%) patients presented with sports related ocular injuries. The outcomes of the consultations were: 13 (27.1%) patients discharged from the emergency department, 17 (35.4%) had reviews arranged in the emergency department, 18 (37.5%) referred to subspecialties. The mean presenting LogMAR visual acuities of patients that were discharged, reviewed in the emergency department, and referred to subspecialties were 0.01 (±0.33), 0.48 (±0.75), and 0.31 (±0.61) respectively. Visual acuities were better by 0.39 (95% CI 0.01–0.77, p = 0.042) in patients who were discharged compared to patients who were reviewed in the emergency department or referred to subspecialties. Evaluation of records revealed that no patients wore eye protection and none were given advice regarding prevention of future injuries.ConclusionResults from this survey show that ocular sports injuries account for a proportion of ophthalmic emergency attendances with a potential impact on service provision. It is essential that ophthalmologists, optometrists and other healthcare professionals are aware of the potential ocular morbidity from sports trauma and the importance of providing advice on the prevention of such injuries.     

Visual function,ocular surface integrity and symptomatology of a new extended depth-of-focus and a conventional multifocal contact lens

PurposeTo evaluate visual function, ocular surface integrity and dry eye symptoms with an extended depth-of-focus (EDOF) design and a conventional multifocal (MF) contact lens (CL) after 15 days of wear.MethodsA crossover single mask randomised clinical trial was conducted including 30 presbyopes who used an EDOF and a conventional MF CL (Biofinity MF) for 15 days each. Defocus curves, depth-of-focus range, contrast sensitivity (CS) under photopic and mesopic conditions (with and without glare) and subjective perception of halos and glare were evaluated. The ocular surface was evaluated through non-invasive Keratograph tear breakup time (NIKBUT), averaged tear breakup time (NIKBUT-avg), tear meniscus height (TMH), bulbar and limbal redness, and conjunctival and corneal staining. Dry eye symptoms were assessed with the OSDI questionnaire.ResultsNo statistically significant differences were found for defocus curves or depth-of-focus between the two CLs (both p > 0.05). Subjective perception of halos and glare was not significantly different between CLs. Statistically significant differences were observed for CS under mesopic conditions for low spatial frequencies (p = 0.008). None of the CL produced significant changes in NIKBUT, NIKBUT-avg, TMH or redness. No change in conjunctival staining was observed in 76.7 % and 73.3 % of participants for EDOF and Biofinity MF, respectively. No change in corneal staining was observed in 86.7 % and 83.3 % of participants for EDOF and Biofinity MF, respectively. No changes were observed in the symptomatology measured with OSDI questionnaire (p > 0.05).ConclusionsBoth CL for presbyopia offer good visual quality, preserve the ocular surface integrity and provide the patient with similar symptomatology levels after 15 days of lens wear.     

Application of systane complete for the treatment of contact lens discomfort

PurposeTo understand the safety of treating contact lens (CL) discomfort with a new artificial tear when it is directly applied to a CL-wearing eye.MethodsThis was a two-week, two-visit, double-masked study that randomized participants with CL discomfort to use Systane Complete (artificial tear), Sensitive Eyes (rewetting drop), or no treatment. Drops were applied before, twice during, and after CL use each day. Corneal staining served as the primary safety metric. Conjunctival staining, tear break-up time, Schirmer’s test, CL comfort (Contact Lens Dry Eye Questionnaire-8 [CLDEQ-8]), and dry eye symptoms (Standardized Patient Evaluation of Eye Dryness [SPEED]) were also evaluated.ResultsThis study recruited 73 participants with a mean age of 30.3 ± 11.5 years; 18 % of the participants were male. There were no significant changes in ocular surface signs from baseline or between the artificial tear and rewetting drop groups after two weeks (p ≥ 0.05). Participants in the artificial tear and rewetting drop groups had significant improvements in CLDEQ-8 scores after two weeks of treatment compared with baseline (p < 0.0001), though scores for this test were not significantly different between these groups after two weeks (p = 0.94). CLDEQ-8 scores were significantly better in the artificial tear and rewetting drop groups compared with no treatment after two weeks (p < 0.0001).ConclusionsBoth drops were found to be safe for use with CLs while also significantly improving ocular symptoms compared to no treatment after two weeks of use.     

A preliminary investigation into the effects of ocular lubricants on higher order aberrations in normal and dry eye subjects

PurposeTo study the effects of ocular lubricants on higher order aberrations in normal and self-diagnosed dry eyes.MethodsUnpreserved hypromellose drops, Tears Again™ liposome spray and a combination of both were administered to the right eye of 24 normal and 24 dry eye subjects following classification according to a 5 point questionnaire. Total ocular higher order aberrations, coma, spherical aberration and Strehl ratios for higher order aberrations were measured using the Nidek OPD-Scan III (Nidek Technologies, Gamagori, Japan) at baseline, immediately after application and after 60 min. The aberration data were analyzed over a 5 mm natural pupil using Zernike polynomials. Each intervention was assessed on a separate day and comfort levels were recorded before and after application. Corneal staining was assessed and product preference recorded after the final measurement for each intervention.ResultsHypromellose drops caused an increase in total higher order aberrations (p = <0.01 in normal and dry eyes) and a reduction in Strehl ratio (normal eyes: p = <0.01, dry eyes p = 0.01) immediately after instillation. There were no significant differences between normal and self-diagnosed dry eyes for response to intervention and no improvement in visual quality or reduction in higher order aberrations after 60 min. Differences in comfort levels failed to reach statistical significance.ConclusionCombining treatments does not offer any benefit over individual treatments in self-diagnosed dry eyes and no individual intervention reached statistical significance. Symptomatic subjects with dry eye and no corneal staining reported an improvement in comfort after using lubricants.     

Multifocal contact lens vision simulated with a clinical binocular simulator

PurposeThe purpose of this study is to compare the binocular visual perception of participants wearing multifocal contact lenses and these same lens designs viewed through a temporal multiplexing visual simulator.MethodsVisual performance and perceived visual quality at various distances were obtained in 37 participants wearing soft M?CLs and through the SimVis Gekko programmed with the same lenses. In a pilot study (n = 10) visual performance was measured in terms of LogMAR visual acuity (VA) at far (4 m), intermediate (64 cm) and near (40 cm) distances and through-focus VA (TFVA) curves with the simulated M?CLs. In the follow-up study (n = 27), LogMAR VA at far, intermediate and near distances were measured both with the actual and simulated M?CLs. Perceived visual quality was measured in both studies using the Multifocal Acceptance Score (MAS-2EV), and a Participants Reported Outcomes Vision questionnaire. Differences between the metrics obtained with simulated and actual lenses were obtained.ResultsBoth actual and simulated M?CLs increased depth-of-focus by a similar amount. Mean LogMAR VA differences with actual and simulated M?CLs ranged between 4 and 6 letters (0.08 ± 0.01, 0.12 ± 0.01 and 0.10 ± 0.01, for far, intermediate and near distances, respectively). MAS-2EV average score differences with actual and simulated M?CLs ranged between ?1.00 and + 4.25. Average MAS-2EV scores were not correlated significantly with VA. However, MAS-2EV (average and individual scores) were highly correlated to visual quality questionnaire responses (p < 0.005).ConclusionsA simultaneous vision simulator accurately represented vision with M?CLs both VA at various distances and perceived visual quality, as measured in a clinical setting. The MAS-2EV metric accurately captured participant reported outcomes of standard vision questionnaires. The combination of SimVis Gekko and MAS-2EV has the potential to largely reduce chair time in M?CLs fitting.     

0.1% Nepafenac reduces pain and increases patient comfort during cataract surgery

Purpose

To evaluates analgesic effectiveness of 0.1% nepafenac during cataract surgery.

Innovative bulls eye drop applicator for self-instillation of eye drops

PurposeTo report the role of Bulls eye drop applicator device in self-instillation of eye drops and in prevention of wastage of medicine.MethodsA small pocket sized device “Bulls eye drop applicator” was developed, which is a simple, handy, mirror-based attachment which can be attached to any eye drop bottle to help in accurate self-instillation of the drops in the eye. The prototype of this device was tried in ten volunteer subjects (Group 1) and 15 patients (Group 2); they were asked to use lubricating eye drops (5 ml bottle) in one eye without the device (N) and in the other eye with the device (M). The numbers of attempts for the application of eye drops were noted and the residual eye drops in the returned bottles were measured for quantitative assessment.ResultsTen volunteers and 11/15 patients completed the study. At the completion of the study, there were a total of 232 applications of eye drops in the Group 1 N (without device) and 1 M (with device). To achieve these 232 applications, there were 330 attempts without the device and 266 attempts of instillation were needed with the device (P < 0.0001). In Group 2, there were a total of 544 applications of eye drops; to achieve this, there were 879 attempts in Group 2 N and 685 attempts of instillation in Group 2 M (p < 0.0001). The cumulative quantity of residual drops in the returned bottles collected from Group 2 N was 5.1 ml and it was 19.7 ml in Group 2 M (p = 0.001).ConclusionsThe number of attempts of instillation reduced significantly with the use of the eye drop applicator device. The use of eye drops applicator device reduced the wastage of drops from 42.2% to 14.6% in Group 1 N Vs Group 1 M and saving of about 35.7 % in Group 2 M compared to Group 2 N.     

Randomized crossover trial of silicone hydrogel contact lenses

PurposeThe aim of the current study is to assess, using new technologies, the interaction of four monthly silicone hydrogel contact lenses on the ocular surface and the comfort over 15 days of use.MethodsProspective cross-over, randomized and double-masked study including four materials (lotrafilcon-B, samfilcon-A , comfilcon-A and filcom-V3). Clinical examination was performed in the following order: tear meniscus height, first break-up of the tear film, the average time of all tear film breakup incidents, bulbar redness, limbal redness (Keratograph 5M ,Oculus, Germany); central corneal thickness (Pentacam, Oculus, Germany), thermography values (FLIR A325; FLIR Systems Inc., USA), and slit-lamp evaluations, including ocular surface staining. Finally, subjective comfort was obtained from Contact Lens Dry Eye Questionnaire-8.ResultsThe impact of contact lens wear on the ocular surface didn’t show statistically significant changes over time except for corneal and conjunctival staining grades on day 15 compared to day 1 for the comfilcon A group (P = .003 and P = .01, respectively). Contact lens stability and impact on the ocular surface during contact lens wear didn’t show statistically significant changes over time except in the case of the comfilcon A material with respect to the irritation item (P = .01).ConclusionsThese results suggest that the impact of monthly silicone hydrogel contact lens materials on the ocular surface after and during contact lens wear, contact lens stability over time, and subjective comfort did not reveal any significant changes over 15 days of use for any of the materials.     

Safety and efficacy of lotilaner ophthalmic solution, 0.25% for the treatment of blepharitis due to demodex infestation: A randomized,controlled, double-masked clinical trial

PurposeTo evaluate the safety and efficacy of lotilaner ophthalmic solution, 0.25% for the treatment of blepharitis due to Demodex infestation compared to vehicle control.MethodsIn this phase II, randomized, controlled, double-masked clinical trial, 60 eligible participants with Demodex blepharitis were randomly assigned in a 1:1 ratio to receive either topical lotilaner ophthalmic solution, 0.25% (Tarsus Pharmaceuticals, Inc., Irvine, CA) (study group) or the vehicle without lotilaner (control group) bilaterally twice a day for 28 days. Participants were followed at Days 7, 14, 28, 60 and 90. The efficacy parameters were change in collarette grade and Demodex density at Day 28. Safety parameters were adverse events, changes in corrected distance visual acuity (CDVA), intraocular pressure (IOP) and slit-lamp biomicroscopy.ResultsThe study group showed a statistically significant decrease in collarette grade compared to the control group beginning at Day 14 (p = 0.003) in the upper eyelid and at Day 28 (p = 0.003) in the lower eyelid. Decreases in both lids were maintained through Day 90 (p < 0.001). At Day 28, mite eradication was achieved in 66.7% and 25.9% of eyes in the study and control group (p = 0.005); at Day 90, these proportions were 68.2% and 18.5% (p = 0.001), respectively. No serious adverse events or clinically significant changes in CDVA and IOP were observed.ConclusionFor Demodex blepharitis, treatment with lotilaner ophthalmic solution, 0.25% for 4 weeks is safe and effective. The improvement in collarette grade and mite density observed during the treatment period persisted for at least two months following treatment cessation.     

Natural course of lid wiper epitheliopathy (LWE) in symptomatic contact lens wearers

PurposeTo establish the time course of lid wiper epitheliopathy (LWE) in established CL wearers after a single day (6–10 h) of daily disposable contact lens (CL) wear, the following day post-CL removal and 1-week after CL discontinuation.MethodsTwenty-one symptomatic (CLDEQ-8 score ≥ 12) habitual wearers of MyDay® silicone hydrogel daily disposable were included. LWE staining was assessed prior to CL wear (Visit 1, V1) using semi-automated analysis after instillation of two drops of 1 % lissamine green (10 μL) that were applied to the superior bulbar conjunctiva. LWE measurements were repeated after 6–10 h of continuous CL wear (Visit 2, V2), post-CL removal the following day (Visit 3, V3) and after 1-week CL discontinuation (Visit 4, V4). At each visit, ocular symptoms were evaluated using the SPEED-8 questionnaire and set of 0–100 visual analogue scales (VAS).ResultsLWE showed no significant changes after 6–10 h of continuous CL wear (p = 0.536), post-CL removal the following day (p = 0.677) or following 1-week of CL discontinuation (p = 0.478). Analysis revealed a significant improvement in symptomatology between V1 and V2 (SPEED-8, p < 0.01) and also improvements in the 0–100 VAS scores between V2 and V4 for average daily dryness (p < 0.01), end-of-day dryness (p < 0.01) and frequency of end-of-day dryness (p < 0.05).ConclusionThe present data suggest that the etiology of LWE is multifactorial and the sole intervention of temporarily discontinuing CL wear does not lead to resolution of these clinical signs.     

Daily versus monthly disposable contact lens: Which is better for ocular surface physiology and comfort?

Purpose

To investigate the effect of soft contact lenses (SCL) wearing modality and lens materials on the changes in conjunctival bulbar and limbal redness and conjunctival and corneal staining after two months of SCL wear. Comfort level was also analyzed.