Lens and solution properties in patients with and without midday fogging.

INTRODUCTION: Midday fogging is a complication of scleral lens (SL) wear that interrupts clear vision during the course of wear. SLs can be made with a variety of gas permeable materials, sizes and surface treatments, and various solutions are available for storing the lenses and for filling them before application on the eye. Many of these factors have been implicated as possible contributors to midday fogging. This study explored the lens and solution properties in habitual SL wearers with and without midday fogging. METHODS: In this prospective study, 48 habitual SL wearers were evaluated and asked to report whether they experienced midday fogging and if they removed their lenses during the day. They completed the Ocular Surface Disease Index (OSDI), which is a validated tool for dry eye assessment. Lens parameters (material, coatings and diameter) and lens storage and filling solutions were documented. Backward elimination of regression terms evaluated the lens and solution properties in those with and without fogging. OSDI scores were compared using the Mann-Whitney analysis. RESULTS: Collectively, the lens properties and solutions accounted for 27.7% of the variance related to midday fogging. None of the factors alone had a significant impact upon midday fogging. The median (interquartile range) OSDI score for those with fogging [37 (35)] was significantly different from those without fogging [10 (15)], with the scores corresponding to severe dry eye and normal eyes, respectively. CONCLUSION: SL wearers with midday fogging exhibited similar symptoms to patients with severe dry eye. Lens and solution characteristics may play a small role in patients with midday fogging, although changing just a single factor is not likely to impact its presence.

Wear Experience with a daily disposable soft contact lens for astigmatism in current wearers of a reusable soft toric contact lens.

Objective: The purpose of this study was to evaluate the wear experience of satisfied wearers of a particular reusable toric soft contact lens when refit into a water surface technology daily disposable toric soft contact lens. Methods: 30 participants completed the study over three visits. At the first visit, subjects were refit into with their habitual reusable toric soft contact lens (comfilcon A) to maximize fit and vision. Subjects returned after one week and were then refit into the study daily disposable soft contact lenses (verofilcon A) and completed surveys of their initial impressions of comfort, vision, and satisfaction. Participants wore the study lenses for two weeks, and then returned for their final visit to complete a vision and ocular health check. At the final visit, subjects also completed surveys to rate their overall and end-of-day comfort, quality of vision, stability of vision, and dryness using a visual analog scale (VAS). Participants also answered questions about their wear experience with the lenses. Overall median and interquartile range (IQR) of all data and surveys was calculated. Results: Initial impressions of the study lenses revealed a median (IQR) score of 85 (28) for vision, 91 (25) for comfort, and 87 (21) for satisfaction. Overall VAS scores after two weeks of wear found median scores of 93 (16) for quality of vision, 88 (28) for stability of vision, and 91 (20) for comfort. End-of-day median scores were 82(27) for quality of vision, 90 (35) for stability of vision, and 80 (38) for comfort. Overall dryness scores were 20(45) and end-of-day dryness was 39 (46). Median(IQR) binocular logMAR visual acuity with the study lenses was -0.16(0.1). Median rotation of the lenses was 0(4.3) degrees. Conclusion: Participants wearing the daily disposable study lenses for astigmatism gave high scores in vision and comfort both at initial fitting and after two weeks of lens wear. Results showed that satisfied wearers of comfilcon A reusable toric soft contact lenses can be successfully refit with verofilcon A daily disposable contact lenses.

EVALUATION OF WEAR EXPERIENCE WITH WATER SURFACE DAILY DISPOSABLE LENSES IN SATISFIED REUSABLE SOFT CONTACT LENS WEARERS.

Introduction: Soft contact lens wearers are often prescribed the same lens material and modality for multiple years if patients express satisfaction and no significant problems with lens fit or ocular health are noted upon evaluation. Despite their satisfaction, it is possible that other lenses exist that could provide additional health or convenience benefits and still provide satisfied lens wear experience. Methods: In this study, wearers of a specific monthly replacement lens brand (comfilcon A) were recruited for an open-label study. The habitual contact lens prescription was optimized for 2 weeks of wear and participants confirmed that they were satisfied with their habitual lenses before being refit with daily disposable lenses (verofilcon A). Participants responded to visual analog scale (VAS) survey about their initial impressions of the lenses. After 2 weeks of lens wear, participants completed a final study visit and completed surveys about lens wear experiences with the daily disposable study lenses. Results: Fifteen male and 15 female participants completed the study. Median (IQR) binocular LogMAR visual acuity was -0.20(0.12), which is equivalent to 10/12.5 Snellen acuity. Initial impression surveys revealed median (interquartile range) of 92.5(22.3) for quality of vision; 95.0(19.3) for comfort; and 91.5(19.3) for satisfaction. At the final visit, median scores for EOD quality of vision was 86.5(24.0); EOD comfort was 84.5(30.3), and EOD dryness 25.5(47.0). Median overall VAS scores were 92.5(16.0) for vision; 88.0(18.3) for comfort, and 17.5(25.8) for dryness. Median satisfaction with the study lenses was scored 9(2.8) on a 1-10 scale. Conclusions: In this study, satisfied wearers of comfilcon A reusable lens were refit with Verofilcon A daily disposable lenses and showed high satisfaction scores with the new lenses, showing that refitting these patients can allow patients to have lenses with more frequent replacement and maintain satisfaction with daily lens wear.

Organ donation after cardiac death in amyotrophic lateral sclerosis.

Patients with amyotrophic lateral sclerosis (ALS) are often told that solid organ donation is not possible following death, although the reasons for exclusion are not evidence based. Because ALS patients typically remain sentient until death, organs may be procured under donation after cardiac death protocols. Anticipating this need, our institution created a process for organ donation in ventilator-dependent ALS patients that was subsequently implemented. To our knowledge, this is the first report of organ donation in a patient with rapidly progressive ventilator-dependent ALS.