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.

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.

Eye care professionals' perceptions of the benefits of daily disposable silicone hydrogel contact lenses.

PURPOSE: To gain a better understanding of eye care professionals' (ECPs) perceptions regarding the benefits of silicone hydrogel (SiH) daily disposable contact lenses (DDCL), particularly with respect to health, comfort and patient satisfaction. METHODS: A survey was conducted with 300 ECPs in the United States, United Kingdom and Japan during November 2017. The survey comprised 34 statements relating to SiH DDCLs, to which the ECPs provided their level of agreement using a 6 point Likert scale. A minimum of 70% agreement was set to define majority agreement. Categories of statements included Health, Comfort, Patient Experience, and Standard of Care. RESULTS: ECPs rated the highest levels of agreement to perceptions within the Patient Experiences and Health categories. The six statements receiving the highest ratings were "Silicone hydrogel 1 day lenses satisfy today's patients' demanding lifestyles" (93% agreement); "Silicone hydrogel 1 day lenses are the best choice to safeguard my patients' eye health related to contact lens wear" (92%); "Silicone hydrogel 1 day lenses provide the best benefits to my patients" (92%); "Silicone hydrogel 1 day lenses provide better long term eye health for my patients than hydrogel 1 day lenses" (91%); "Silicone hydrogel is the healthiest lens material for my daily disposable patients" (90%); and "Silicone hydrogel 1 day lenses provide a better wearing experience for my patients than hydrogel 1 day lenses" (90%). CONCLUSION: ECPs perceive that SiH DDCLs offer long-term eye healthand comfort for the patient and although the ECPs surveyed would not necessarily prescribe SiH DDCLs to all their patients, they would prescribe them to most of their patients. The results support the premise that while ECPs consider SiH 1 day contact lenses as the current "standard of care"; the principal barrier continues to be the perceived higher cost of these lenses.

The Case for Using Hydrogen Peroxide Contact Lens Care Solutions: A Review.

Despite their established disinfection and safety benefits, the use of hydrogen peroxide (H2O2) lens care systems among today's wearers of reusable contact lenses remains low in comparison with multipurpose solution (MPS) use. Multipurpose solution systems, however, present several potential drawbacks that may impact patient outcomes, including the use of chemical preservatives for disinfection, biocompatibility issues, and challenges with respect to lens care compliance. Given their unique composition and mechanism of action, one-step H2O2 systems offer the opportunity to avoid many of the challenges associated with MPS use. This article reviews the evolution of H2O2 lens care systems and examines the current scientific and clinical evidence regarding the relative ease of use, lens and tissue compatibility, disinfection efficacy, and ocular surface safety of H2O2 systems. Evaluation of the available data indicates that in comparison with MPS, one-step H2O2 systems tend to promote more favorable compliance, efficacy, comfort, and ocular surface outcomes for a wide range of contact lens-wearing patients. Based on the current published evidence, the authors recommend that eye care practitioners consider making one-step H2O2 systems their first-line contact lens care recommendation for most wearers of reusable lenses.

Objective Assessment of Ocular Surface Response to Contact Lens Wear in Presbyopic Contact Lens Wearers of Asian Descent.

INTRODUCTION: Contact lens wearers of Asian descent may be predisposed to experience microtrauma of the ocular surface as a result a thinner post-lens tear film and higher eyelid tension, and these effects would be anticipated to be most marked in an older population. The objective of this study was to quantify the mechanical effects of the study contact lenses on the ocular surface in a population of presbyopic contact lens wearers of Asian descent. METHODS: Twenty established presbyopic contact lens wearers (hydrogel n=5, none habitual wearers of etafilcon A lenses; silicone hydrogel n=15) of Asian descent were refitted with etafilcon A multifocal daily disposable contact lenses (1-DAY ACUVUE MOIST MULTIFOCAL) for a period of 1 month of daily lens wear. The habitual modalities of wear were 45% daily disposable and 55% planned replacement. Digital photographs of the upper lid margins, nasal and temporal conjunctiva, and superior cornea were taken after 6 hr of wear of the participants' habitual contact lenses, after 1 day without contact lens wear, and after 6 hr of wear of the study contact lenses at the end of the 1-month period. The photographs were masked according to study visit and the staining extent measured using proprietary software. RESULTS: Lid margin staining was significantly lower with the study contact lenses (2.0±1.0 mm) than with the participants' own contact lenses (3.2±3.0 mm) after 6 hr of wear, representing a mean staining decrease of 38% (P=0.010). Lid margin staining after 6 hr of wear of the study contact lenses was not different from that measured after 1 day without contact lenses (P=0.507). Limbal staining was also significantly less with the study contact lenses than with the participants' own contact lenses after 6 hr of wear (P=0.009). There was minimal upper corneal staining, and the degree was similar with the study and habitual lenses. CONCLUSIONS: Etafilcon A material, worn under a daily disposable modality, was shown to reduce upper lid margin and limbal staining in presbyopic contact lens wearers of Asian descent compared with the wearers' own contact lenses. Because of the high preponderance of dry eye amongst presbyopes, material selection is of importance and consideration should be given to the lens-ocular surface interaction.

TFOS DEWS II Diagnostic Methodology report.

The role of the Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II Diagnostic Methodology Subcommittee was 1) to identify tests used to diagnose and monitor dry eye disease (DED), 2) to identify those most appropriate to fulfil the definition of DED and its sub-classifications, 3) to propose the most appropriate order and technique to conduct these tests in a clinical setting, and 4) to provide a differential diagnosis for DED and distinguish conditions where DED is a comorbidity. Prior to diagnosis, it is important to exclude conditions that can mimic DED with the aid of triaging questions. Symptom screening with the DEQ-5 or OSDI confirms that a patient might have DED and triggers the conduct of diagnostic tests of (ideally non-invasive) breakup time, osmolarity and ocular surface staining with fluorescein and lissamine green (observing the cornea, conjunctiva and eyelid margin). Meibomian gland dysfunction, lipid thickness/dynamics and tear volume assessment and their severity allow sub-classification of DED (as predominantly evaporative or aqueous deficient) which informs the management of DED. Videos of these diagnostic and sub-classification techniques are available on the TFOS website. It is envisaged that the identification of the key tests to diagnose and monitor DED and its sub-classifications will inform future epidemiological studies and management clinical trials, improving comparability, and enabling identification of the sub-classification of DED in which different management strategies are most efficacious.

Clinical performance of three silicone hydrogel daily disposable lenses.

PURPOSE: To determine the clinical performance of DAILIES TOTAL1 (DT1), Clariti 1Day (C1D), and 1-DAY ACUVUE TruEye (AVTE) silicone hydrogel daily disposable contact lenses (SiHy DDCLs). METHODS: Eligible participants, subdivided into asymptomatic and symptomatic groups, wore each SiHy DDCLs for three consecutive days. Each participant attended three visits (on day 1 at 0 hours; on days 1 and 3 after 8 hours of wear) per lens type. The order of lens wear was randomized, with at least 1 day washout between lenses. Lens-related performance was evaluated by assessing lens surface deposits, wettability, pre-lens noninvasive tear breakup time, lens movement, and centration; ocular response assessments included conjunctival redness, corneal staining, and conjunctival staining and indentation. RESULTS: Fifty-one asymptomatic and 53 symptomatic participants completed the study. For all visits, the mean noninvasive tear breakup time was about 1 second longer with DT1 than with C1D and AVTE (p < 0.01). Overall, the wettability of all three lenses was good; however, DT1 was graded marginally better than the other lenses (both p < 0.01). On day 3, eyes wearing AVTE had significantly more dehydration-induced corneal staining compared with DT1 (AVTE, 24%; DT1, 11%; p < 0.01). After 8 hours, conjunctival staining was different between lenses (greatest with C1D and least with DT1; all p < 0.01). Conjunctival indentation was more prevalent with the C1D lenses (n = 70) compared with DT1 (n = 1; p < 0.01) and AVTE (n = 11; p < 0.01). There were no differences between asymptomatic and symptomatic lens wearers for any of the clinical parameters (all p > 0.05). CONCLUSIONS: Each of the three SiHy DDCLs performed well. Noninvasive tear breakup time was longest and wettability was greater with DT1. C1D had the most conjunctival staining conjunctival indentation. There was no difference between asymptomatic and symptomatic wearers with regard to ocular response and contact lens-related parameters. These results suggest that SiHy DDCLs may be an excellent contact lens modality for the symptomatic patient.

Compliance with lens replacement and the interval between eye examinations.

PURPOSE: Eye care practitioners (ECPs) acknowledge that their patients do not always follow recommendations for lens replacement, but many may not realize the possible implications for their offices. The study was conducted to investigate whether there is a relationship between contact lens compliance and the interval between full eye examinations (IEE). METHODS: The study was conducted in ECP offices in the United States. Eye care practitioners and patients independently completed linked questionnaires, evaluating their contact lens wear and care. Patients were required to be current wearers of daily disposable (DD) lenses or reusable silicone hydrogel lenses with a manufacturer-recommended replacement frequency (MRRF) of 2 weeks (2WR) or 1 month (1MR). RESULTS: A total of 2147 questionnaires from 141 offices were eligible. Fifty-four percent of patients were wearing 2WR, 37% 1MR, and 9% DD lenses. Wearers of 2WR lenses were significantly less compliant with replacement than wearers of both DD and 1MR lenses (34% vs. 74% and 67%, both p < 0.001); patients purchasing an annual supply were more compliant (55% vs. 45%, p < 0.001). The mean IEE was 16 months and was longer for wearers who were noncompliant with the MRRF (17.4 months vs. 14.5 months, p < 0.001). Other factors affecting IEE were household income (p = 0.030), insurance (p < 0.001), purchase source (p < 0.001), and sex (p = 0.007). CONCLUSIONS: Patients who were not compliant with the MRRF had longer IEEs and were less likely to purchase an annual supply of lenses. Patients who purchased lenses from their ECP, had a higher household income, had eye examination insurance, and were female had shorter IEEs. Patients failing to replace their lenses when scheduled were also found to be less compliant with lens care procedures. Eye care practitioners should reinforce the importance of all aspects of lens wear and care with their patients, with the overall aim of reducing possible complications and retaining successful contact lens wearers in their offices.

The impact of contemporary contact lenses on contact lens discontinuation.

OBJECTIVES: Discontinuation or "dropout" from contact lens (CL) wear continues to afflict the CL industry. This study was conducted to determine whether the advent of new CL materials and designs has impacted the dropout rate and the reasons for discontinuation. METHODS: Current and lapsed CL wearers residing in Canada were recruited using Facebook to take part in an on line survey investigating CL wearing experiences during 2008 to 2010 and to establish the percentage of participants who temporarily and permanently discontinued CL wear during the period surveyed. RESULTS: Four thousand two hundred seven eligible surveys were received (64% female; median age 27 years). Forty percent had lapsed from lens wear for at least 4 months; however, 62% of the lapsed wearers (LWs) resumed wear. There were no differences between LWs and nonlapsed wearers (NLWs) with respect to gender; however, LWs were older, started lens wear when older, and had not worn lenses for as long as NLWs (all P<0.001). More NLWs than LWs wore silicone hydrogel CLs (49% vs. 38%, P<0.001) and more LWs than NLWs wore daily disposable lenses and hydrogel CLs (24% vs. 19% and 22% vs. 18%, respectively, P≤0.001). Primary reasons for discontinuation were discomfort (24%), dryness (20%), red eyes (7%), and expense (7%). Compliance with lens replacement was no different between LWs and NLWs (48% vs. 45%). CONCLUSIONS: About 23% of those surveyed had discontinued CL wear permanently. The primary reasons for dropping out continue to be discomfort and dryness. Dropout rates were lower in silicone hydrogel wearers.

Patient and practitioner compliance with silicone hydrogel and daily disposable lens replacement in the United States.

OBJECTIVE: The objectives of this study were to assess current recommendations for replacement frequency (RF) of silicone hydrogel (SH) and daily disposable (DD) lenses, to determine compliance with these recommendations, and to investigate the reasons given for noncompliance. METHODS: A package containing 20 patient surveys was sent to 309 eye care practitioners (ECPs) in the United States who had agreed to participate in the study. One thousand eight hundred fifty-nine completed surveys were received from 158 ECPs and 1,654 surveys were eligible for analysis. Questions related to patient demographics, lens type, lens wearing patterns, the ECP instructions for RF, and the actual patient reported RF. ECPs were asked to provide lens information and their recommendation for RF after the surveys had been completed and sealed in envelopes. All responses were anonymous. RESULTS: Sixty-six percent of patients were women and their mean age was 34 +/- 12 years. Eighty-eight percent of lenses were worn for daily wear, 12.8 +/- 3.2 hours a day, 6.2 +/- 1.5 days a week. Lens type distribution was 16% DD, 45% 2 week (2W) SH, and 39% 1 month (1M) SH. ECP recommendations for RF varied according to the lens type; 1% of 1M (95% CI 0.2-1.7), 4% of DD (95% CI 2.1-7.2), and 18% of 2W (95% CI 15.1-20.7) patients were given instructions that did not conform to the manufacturers' recommended RF (MRRF). When considering only those patients who were given the correct instructions for RF, 38% were not compliant with the MRRF; noncompliance rates varied according to the lens type and were 12% for DD (95% CI 8.6-17.2), 28% for 1M (95% CI 24.9-32.1), and 52% for 2W (95% CI 47.8-55.8). The most frequent reasons for over wearing lenses were "forgetting which day to replace lenses" (51%) and "to save money" (26%). Fifty-three percent believed that a reminder system would aid compliance; the most popular methods being a cell phone reminder or text message (29%) and a nominated day each week or month (26%). Discussions between the ECPs and the patients were more extensive for patients who were compliant with the MRRF. CONCLUSIONS: ECPs recommended RFs more frequently with DD and 1M SH lenses than with 2W SH lenses, consistent with manufacturers' recommendations. Patients were less compliant with RF than ECPs for all lens types investigated. Patients were most compliant with RF when wearing DD lenses and least compliant when wearing 2W SH lenses. Better communication facilitated greater compliance with RF. More than half of those not replacing lenses, when recommended, reported that this was because they forgot which day to replace their lenses.

An investigation of the efficacy of a novel ocular lubricant.

OBJECTIVE: To investigate the efficacy of a novel ocular lubricant compared with a commercially marketed ocular lubricant in a group of noncontact lens wearers currently using over-the-counter products for the management of symptoms of moderate to severe dry eye. METHODS: This was a prospective, double-masked study that randomized 110 subjects in a ratio of 1:1 to receive a novel ocular lubricant (test group) or a marketed ocular lubricant (control group). Subjects were instructed to instill the lubricant eye drops at least three times daily. After enrollment, subjects were evaluated at baseline and at 7 and 30 days. They were also required to complete a series of home-based subjective questionnaires after 15 days. Main outcomes were subjective symptoms and objective clinical assessment at 7 and 30 days. RESULTS: The test group had higher overall comfort ratings than the control group (P = 0.012). Seventy-one percent of the test group and 57% of the control group said the drops used "somewhat" or "definitely" improved ocular comfort; 62% of the test group had greater end-of-day comfort compared with 45% of the control group (P = 0.015). There were no between-group differences in visual acuity, tear quality or quantity, corneal staining, conjunctival staining, or bulbar and limbal conjunctival hyperemia. CONCLUSIONS: The novel ocular lubricant offers equivalent or superior comfort compared with a marketed lubricant eye drop. Objective clinical outcomes were not statistically significantly different between the two groups.

Noninflammatory silicone hydrogel contact lens complications.

High Dk silicone hydrogel lenses have overcome many of the hypoxic problems associated with traditional extended wear, and the popularity of continuous wear with these lens types is increasing. Despite the elimination of hypoxia, several noninflammatory clinical complications have been reported to occur as a result of mechanical disturbances or trauma when wearing silicone hydrogel lenses. This article reviews the origin and presentation of mucin balls, superior epithelial arcuate lesions, contact lens papillary conjunctivitis, and corneal erosions in silicone hydrogel lens wearers. A number of management strategies and approaches to minimize the occurrence of these clinical complications are also discussed.

Adverse events with silicone hydrogel continuous wear.

High Dk silicone hydrogel lenses have overcome many of the hypoxic problems associated with traditional extended wear and the popularity of continuous wear (up to 30 nights) with these lens types is increasing. Results from clinical trials indicate that the typical physiological changes associated with edema from conventional extended wear of low Dk/t lenses do not occur with continuous wear of silicone hydrogel lenses. These changes include neovascularization, striae, microcysts and an increase in bulbar and limbal hyperemia. It is perhaps not surprising though that a number of adverse events do still occur with silicone hydrogel lenses when they are worn on a continuous wear basis. These include inflammatory conditions such as contact lens-induced peripheral ulcers (CLPU), contact lens-induced acute red eye (CLARE), infiltrative keratitis (IK) and contact lens papillary conjunctivitis (CLPC). Other events such as superior epithelial arcuate lesions (SEAL) and localised CLPC may be due to mechanical influences. While these conditions are not sight threatening, they may be painful and are certainly inconvenient to both the patient and the practitioner. It is therefore very important that the signs and symptoms associated with these events be recognised in order that they may be accurately identified and appropriately managed. The purpose of this review article is to describe the pathophysiology, etiology, and clinical presentation of these adverse events when observed with continuous wear contact lenses and to discuss their associated risk factors and incidence. Clear management and treatment strategies are also presented and a number of approaches to minimize adverse events with continuous wear of silicone hydrogel contact lenses are suggested.