Peripheral Defocus, Pupil Size, and Axial Eye Growth in Children Wearing Soft Multifocal Contact Lenses in the BLINK Study.

Purpose: The purpose of this study was to evaluate the relationship between peripheral defocus and pupil size on axial growth in children randomly assigned to wear either single vision contact lenses, +1.50 diopter (D), or +2.50 D addition multifocal contact lenses (MFCLs). Methods: Children 7 to 11 years old with myopia (-0.75 to -5.00 D; spherical component) and ≤1.00 D astigmatism were enrolled. Autorefraction (horizontal meridian; right eye) was measured annually wearing contact lenses centrally and ±20 degrees, ±30 degrees, and ±40 degrees from the line of sight at near and distance. Photopic and mesopic pupil size were measured. The effects of peripheral defocus, treatment group, and pupil size on the 3-year change in axial length were modeled using multiple variables that evaluated defocus across the retina. Results: Although several peripheral defocus variables were associated with slower axial growth with MFCLs, they were either no longer significant or not meaningfully associated with eye growth after the treatment group was included in the model. The treatment group assignment better explained the slower eye growth with +2.50 MFCLs than peripheral defocus. Photopic and mesopic pupil size did not modify eye growth with the +2.50 MFCL (all P ≥ 0.37). Conclusions: The optical signal causing slower axial elongation with +2.50 MFCLs is better explained by the lens type worn than by peripheral defocus. The signal might be something other than peripheral defocus, or there is not a linear dose-response relationship within treatment groups. We found no evidence to support pupil size as a criterion when deciding which myopic children to treat with MFCLs.

Quality of life after wearing multifocal contact lenses for myopia control for 2 weeks in the BLINK Study.

PURPOSE: To validate Pediatric Refractive Error Profile 2 (PREP2) subscales that can be used to evaluate contact lens wearers and compare vision-specific quality of life measurements between children wearing multifocal and single vision contact lenses for 2 weeks. METHODS: Two hundred and ninety-four myopic children aged 7-11 years (inclusive) were enrolled in the 3-year, double-masked Bifocal Lenses In Nearsighted Kids (BLINK) Study. Participants completed the PREP2 survey after having worn contact lenses for 2 weeks. The Vision, Symptoms, Activities and Overall PREP2 subscales were used to compare participants' subjective assessment while wearing +1.50 or +2.50 D add multifocal or single vision contact lenses. Rasch analysis was used to validate each subscale and to compare participants' subjective assessment of contact lens wear. RESULTS: Item fit to the Rasch model was good for all scales, with no individual items having infit mean square statistics outside the recommended range (0.7-1.3). Response category function was acceptable for all subscales, with ordered category thresholds. Measurement precision, assessed by the Rasch person reliability statistic, was less than ideal (≥0.8) for three of the subscales, but met the minimum acceptable standard of 0.5. Scores for the Vision subscale differed by treatment assignment (p = 0.03), indicating that participants with the highest add power reported statistically worse quality of vision, although the difference was only 3.9 units on a scale of 1-100. Girls reported fewer symptoms than boys (p = 0.006), but there were no other differences between boys and girls. CONCLUSIONS: Rasch analysis demonstrates that the PREP2 survey is a valid instrument for assessing refractive error-specific quality of life. These results suggest that vision-related quality of life is not meaningfully affected by 2 weeks of soft multifocal contact lens wear for myopia control.

A comparison of subjective and objective conjunctival hyperaemia grading with AOS® Anterior software.

CLINICAL RELEVANCE: This study evaluates a commercially available conjunctival hyperaemia grading system, providing validation of an important tool for ocular surface research and clinical trials. BACKGROUND: Bulbar conjunctival hyperaemia is a sign of ocular surface inflammation, and proper measurement is essential to clinical care and trials. The aim of this study was to assess the validity and repeatability of an objective grading system in comparison with subjective grading. METHODS: This study was a retrospective, randomised analysis of 300 bulbar conjunctival images that were collected at an academic institution. The images used were de-identified and collected from the Keratograph K5 and Haag-Streit slitlamp. Six investigators graded the images with either a 0.1 or 0.5 unit scaling using a 0-4 Efron grading scale. Three of the investigators also imported the images into the AOS ® Anterior software and graded them objectively. All measurement techniques were assessed for repeatability and comparability to each other. RESULTS: Mean hyperaemia with the objective system (1.1 ± 0.7) was significantly less than the subjective grading (2.0 ± 0.8) (P < 0.001). Both inter- and intra-subject repeatability of the objective system (0.15) was better than the subjective methods (1.70). CONCLUSION: The results showed excellent repeatability of the AOS ® Anterior objective conjunctival hyperaemia grading software, although they were not found to be interchangeable with subjective scores. This system has value in monitoring levels of hyperaemia in contact lens wearers and patients in clinical care and research trials.

Assessment of a practitioner's perception of scleral contact lens complications.

PURPOSE: The purpose of this survey was to better understand scleral lens (SL) practitioners' fitting preferences and minor SL complications and their subsequent treatments. METHOD: Practitioners who attended the 2017 Global Specialty Lens Symposium were asked to complete an electronic questionnaire that was created by the investigators, a survey that asked practitioners about their SL fitting experience and preferences, their patients' experience with poor SL wetting, SL fogging, ocular symptoms (redness, pain/discomfort, dryness), and blurred central and side vision, and how the practitioners treated these conditions. RESULTS: This study analyzed data from 164 SL practitioners. The practitioners had been in practice for 16.3 ± 13.4 years, had been fitting SL for 5.5 ± 5.0 years, and fit 7.4 ± 7.1 SL/month. Practitioners preferred a SL with a final central corneal clearance of ∼200 µm and an overall diameter between 15.1 mm to 16.5 mm. Poor SL wetting (90.8% of practitioners documented condition), SL fogging (84.8%), blurred central vision (40.2%), ocular redness (34.8%), ocular dryness (24.4%), ocular pain/discomfort (20.7%), and blurred side vision (12.8%) were encountered by the practitioners. Practitioners preferred treating poor wetting and fogging with lens removal, cleaning, and reapplication, blurred central vision with a lens power change, blurred side (peripheral) vision, ocular redness, and ocular pain with a lens parameter change, and dryness with artificial tears. CONCLUSIONS: Most SL practitioners preferred a SL central corneal clearance of ∼200 µm, and they occasionally encountered SL-related complications in their practice, which they treated similarly to corneal gas permeable CLs.

A Comparison of Three Methods to Increase Scleral Contact Lens On-Eye Stability.

PURPOSE: To quantify on-eye rotational and translational stability of three scleral contact lens stabilization methods and to model the variation in visual acuity when these movements occur in a wavefront-guided correction for highly aberrated eyes. METHODS: Three lens stabilization methods were integrated into the posterior periphery of a scleral contact lens designed at the Visual Optics Institute. For comparison, a lens with no stabilization method (rotationally symmetric posterior periphery) was designed. The lenses were manufactured and lens movements were quantified on 8 eyes as the average SD of the observed translations and rotations over 60 min of wear. In addition, the predicted changes in acuity for five eyes with keratoconus wearing a simulated wavefront-guided correction (full correction through the fifth order) were modeled using the measured movements. RESULTS: For each lens design, no significant differences in the translation and rotation were found between left and right eyes, and lenses behaved similarly on all subjects. All three designs with peripheral stability modifications exhibited no statistically significant differences in translation and rotation distributions of lens movement and were statistically more stable than the spherical lens in rotation. When the measured movements were used to simulate variation in visual performance, the 3 lenses with integrated stability methods showed a predicted average loss in acuity from the perfectly aligned condition of approximately 0.06 logMAR (3 letters), compared with the loss of over 0.14 logMAR (7 letters) for the lens with the spherical periphery. CONCLUSION: All three stabilization methods provided superior stability, as compared with the spherical lens design. Simulations of the optical and visual performance suggest that all three stabilization designs can provide desirable results when used in the delivery of a wavefront-guided correction for a highly aberrated eye.

Wavefront-guided scleral lens correction in keratoconus.

PURPOSE: To examine the performance of state-of-the-art wavefront-guided scleral contact lenses (wfgSCLs) on a sample of keratoconic eyes, with emphasis on performance quantified with visual quality metrics, and to provide a detailed discussion of the process used to design, manufacture, and evaluate wfgSCLs. METHODS: Fourteen eyes of seven subjects with keratoconus were enrolled and a wfgSCL was designed for each eye. High-contrast visual acuity and visual quality metrics were used to assess the on-eye performance of the lenses. RESULTS: The wfgSCL provided statistically lower levels of both lower-order root mean square (RMS) (p < 0.001) and higher-order RMS (HORMS) (p < 0.02) than an intermediate spherical equivalent scleral contact lens. The wfgSCL provided lower levels of lower-order RMS than a normal group of well-corrected observers (p << 0.001). However, the wfgSCL does not provide less HORMS than the normal group (p = 0.41). Of the 14 eyes studied, 10 successfully reached the exit criteria, achieving residual HORMS wavefront error less than or within 1 SD of the levels experienced by normal, age-matched subjects. In addition, measures of visual image quality (logVSX, logNS, and logLIB) for the 10 eyes were well distributed within the range of values seen in normal eyes. However, visual performance as measured by high-contrast acuity did not reach normal, age-matched levels, which is in agreement with prior results associated with the acute application of wavefront correction to keratoconic eyes. CONCLUSIONS: Wavefront-guided scleral contact lenses are capable of optically compensating for the deleterious effects of higher-order aberration concomitant with the disease and can provide visual image quality equivalent to that seen in normal eyes. Longer-duration studies are needed to assess whether the visual system of the highly aberrated eye wearing a wfgSCL is capable of producing visual performance levels typical of the normal population.

Peripheral optics with bifocal soft and corneal reshaping contact lenses.

PURPOSE: To determine whether bifocal soft contact lenses with a distance center design provide myopic defocus to the peripheral retina similar to corneal reshaping contact lenses. METHODS: Myopic subjects underwent five cycloplegic autorefraction readings centrally and at 10, 20, and 30 degrees temporally, nasally, superiorly, and inferiorly while wearing Proclear Multifocal "D" contact lenses with a +2.00-diopter add power (CooperVision, Fairport, NY) and after wearing Corneal Refractive Therapy (Paragon Vision Sciences, Mesa, AZ) contact lenses for 2 weeks. RESULTS: Fourteen subjects completed the study. Nine (64%) were female, and 12 (86%) were white. The average (± SD) spherical equivalent noncycloplegic manifest refraction for the right eye was -2.84 ± 1.29 diopters. The average logMAR best-corrected, binocular, high-contrast visual acuity was -0.17 ± 0.15 while wearing the bifocal soft contact lenses and -0.09 ± 0.16 after corneal reshaping contact lens wear (analysis of variance, p = 0.27). The orthokeratology contact lens yielded a more myopic peripheral optical profile than the soft bifocal contact lens at 20 and 30 degrees eccentricity (except inferior at 20 degrees); the two modalities were similar at 10 degrees eccentricity. CONCLUSIONS: Our data suggest that the two modalities are dissimilar despite the statistical similarities. The corneal reshaping contact lens shows an increase in relative peripheral myopic refraction, a pattern achieved by other studies, but the bifocal lens does not exhibit such a pattern. The low statistical power of the study could be a reason for lack of providing statistical difference in other positions of gaze, but the graphical representation of the data shows a marked difference in the peripheral optical profile between the two modalities. More sophisticated methods of measuring the peripheral optical profile may be necessary to accurately compare the two modalities and to determine the true optical effect of the bifocal soft contact lens on the peripheral retina.

What do kids think about kids in eyeglasses?

PURPOSE: Previous studies have examined how people feel about others who wear glasses, but no studies of children have been published on the subject. We conducted the Children's Attitudes about Kids in Eyeglasses (CAKE) study to determine how children feel about other children who wear glasses. METHODS: Subjects compared a series of 24 picture pairs and answered six questions regarding which child ...he or she would rather play with, looks better at playing sports, appears smarter (more intelligent), appears nicer, looks more shy and looks more honest. The children in each pair of pictures differed by gender, ethnicity and spectacle wear. Logistic regression was performed to determine the probability and confidence interval that a subject would pick a particular child. RESULTS: Eighty subjects between the ages of 6 and 10 years participated. The average (+/-SD) age of the subjects was 8.3 +/- 1.3 years, 42 (53%) were females, 51 (64%) were whites, 21 (26%) were blacks, and 30 (38%) wore glasses. The spectacle wearer appeared smarter (0.66, CI = 0.60-0.71) and more honest (0.57, CI = 0.50-0.64), and children who wore glasses looked smarter regardless of whether the child picking wore glasses. Both boys (0.66, CI = 0.68-0.79) and girls (0.77, CI = 0.71-0.82) thought that boys looked better at playing sports. DISCUSSION: The old adage 'Boys never make passes at lasses who wear glasses' may be outmoded, but glasses may tend to make children look smarter and slightly more honest to their peers.