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.

Lid Papillae Improvement with Hydrogen Peroxide Lens Care Solution Use.

PURPOSE: To assess changes in lid papillae and symptoms after use of a hydrogen peroxide-containing solution (H2O2) for 3 months by symptomatic contact lens wearers. METHODS: This randomized, controlled, investigator-masked, parallel group study enrolled symptomatic lens wearers with at least mild lid papillae who habitually used a biguanide-preserved multipurpose solution (BMPS). Subjects were randomized to habitual BMPS or H2O2 for 3 months to care for their lenses. Lid papillae severity (0-4) was graded in four zones of each eye at baseline and at 30, 60, and 90 days. Subjects rated frequency and intensity of symptoms and completed the Contact Lens Dry Eye Questionnaire (CLDEQ-8) at the same time points. Lens cases used for 1 month were collected from subjects in the H2O2 group, and residual peroxide concentration was analyzed at disinfection time. RESULTS: In all, 131 subjects were randomized to H2O2 (n = 64) or BMPS (n = 67) and underwent post-baseline assessment. The H2O2 group showed significantly greater improvements in lid papillae from baseline to day 90 than the BMPS group (H2O2, least square mean [LSM] difference [baseline-day 90] in maximum score 0.904 [95% CI 0.744-1.064]; BMPS, LSM difference 0.423 [95% CI 0.271-0.576]; p < 0.001). Frequency and intensity of symptoms, including grittiness, end-of-day dryness, irritation, burning/stinging, itchiness, and blurry vision, were significantly lower for H2O2 than for BMPS at days 30, 60, and 90 (all p ≤ 0.045), as were mean CLDEQ-8 scores (3-mo scores 10.6 ± 6.30 vs.15.0 ± 7.29, p < 0.001). Residual peroxide concentration in 61 used lens cases ranged from 6 to 55 ppm (mean, 15 ± 8 ppm) and 95% of cases had residual peroxide less than 30 ppm. CONCLUSIONS: Symptomatic contact lens wearers using the H2O2 solution showed greater reductions in lid papillae and symptoms at 90 days than did subjects using BMPS. Cases used for 1 month neutralized peroxide at disinfection time to levels below those detectable by ocular tissues.

Dual-Polymer Drops, Contact Lens Comfort, and Lid Wiper Epitheliopathy.

PURPOSE: This study compared a new contact lens rewetting drop containing both carboxymethylcellulose and hyaluronic acid (CMC-HA) with a standard drop containing carboxymethylcellulose only (CMC). Symptoms of discomfort typical in lens wear and lid wiper epitheliopathy (LWE) were assessed over a 3-month period in a diverse sample of contact lens wearers. METHODS: Adapted daily-wear contact lens subjects using hydrogel, silicone hydrogel, or rigid gas permeable lenses were enrolled in this prospective, randomized, double-masked, parallel-group, 90-day study conducted at 15 clinical sites. Subjects were randomized 2:1 to CMC-HA (n = 244) or CMC alone (n = 121) with dosage at least four times per day, along with their habitual lens care system. At baseline and at days 7, 30, 60, and 90, subject-completed questionnaires, bulbar conjunctival staining, LWE, contact lens distance visual acuity (CLDVA), and standard safety measures were assessed. RESULTS: At day 90, CMC-HA performed significantly better than CMC in ocular symptoms including dryness throughout the day (p = 0.006), and burning/stinging throughout the day (p = 0.02) and at the end of the day (p < 0.001). CMC-HA also performed numerically better for dryness at the end of day (p = 0.06). LWE staining was improved in the CMC-HA group at day 90 whereas it increased slightly in the CMC alone group, with a significant between-group difference (p = 0.009). CMC-HA also demonstrated greater reduction in conjunctival staining compared with CMC alone at day 90 (p = 0.08). No differences in CLDVA, contact lens wear time, acceptability, and product use were observed, and safety outcomes were similar between groups. CONCLUSIONS: The addition of HA to a standard CMC rewetting drop improves clinical performance. In this comparison of rewetting drop efficacy in contact lens wearers, LWE was a useful clinical sign for differentiating clinical performance.

Systane® ultra lubricant eye drops for treatment of contact lens-related dryness.

OBJECTIVES: To assess the clinical performance of Systane Ultra lubricant eye drops in daily disposable soft contact lens wearers who experience contact lens-related dryness. METHODS: In this randomized, investigator-masked study, daily disposable lens wearers with symptoms of dryness were randomized to use Systane Ultra lubricant eye drops or to no treatment. The lubricant regimen was applied twice a day, 10 minutes before lens insertion and after lens removal, for the 2-week study period. Subjective comfort, wear time, and visual acuity were assessed at baseline and after 2 weeks. RESULTS: A total of 89 daily disposable lens wearers were randomly assigned to the Systane Ultra group (n=44) or the control group (n=45). Two weeks of Systane Ultra lubricant eye drop use resulted in a significant increase in comfortable lens wear time when compared with baseline assessment (P=0.001) and a trend toward significant improvement compared with the control group (P=0.078). End-of-the-day comfort was significantly improved in the Systane Ultra group compared with the control group (P=0.007). A significant reduction in the overall dryness (P<0.001) and end-of-day dryness (P=0.047) was observed in subjects using the Systane Ultra lubricant eye drops compared with the control group. CONCLUSION: The study demonstrates that Systane Ultra lubricant eye drops applied before and after contact lens wear is an effective artificial tear for alleviating symptoms of contact lens-related dry eye.

Impact of Improper Approach to Identify Lid Wiper Epitheliopathy (LWE).

PURPOSE: Variability in the use of ophthalmic dyes to diagnose lid wiper epitheliopathy (LWE) has led to division in the literature and clinical practice. The principal aim of this study was to evaluate whether the use of a non-optimal methodology to identify LWE had a potential for false negatives; in which LWE was overlooked. PATIENTS AND METHODS: A total of 20 participants were initially categorized to not have LWE and were enrolled in this study. The protocol examined whether or not LWE would later be revealed through the use of optimized methodology. Semi-automated analysis was performed of images taken after two different drop instillations with varying post-dye viewing times for both lissamine green (LG) and sodium fluorescein (NaFl). RESULTS: There was a significant increase in area of staining revealed when an optimal methodology for LWE identification was used. Comparisons for every non-optimal condition were statistically significantly different against the optimal condition (all p<0.01). The use of a non-optimal methodology resulted in a 70% false-negative rate when using LG and a 95% false-negative rate when using NaFl. CONCLUSION: The study demonstrated that using a double instillation of dye was statistically different from a single-dose, even with extended wait time for clinical observation. A single instillation did not offer adequate volume of dye for adequate lid margin uptake. A careful adherence to volume as well as a repeat administration is key to revealing the full area of LWE. A non-optimal approach to diagnose LWE can lead to false negatives.

Accuracy, speed and repeatability of the voice assisted subjective refractor (VASR).

PURPOSE: To compare the accuracy, speed and repeatability of the voice assisted subjective refractor (VASR) to traditional refractive methods. METHODS: Fifty healthy adult subjects were examined by autorefractor, followed by subjective phoropter refinement. Subjects were then evaluated using the VASR (Vmax Vision) to obtain an objective and subjective result. Three total assessments were performed for each subject using each of the methods described. Corrected visual acuity was recorded for each eye after each procedure. The total time was measured for both the traditional and VASR refraction. RESULTS: A comparison of the results obtained by traditional refraction and VASR revealed no statistically significant difference from the mean in equivalent sphere measurements (P=0.1383), and the datasets were highly correlated (r=0.993). The data comparisons for cylinder power and axis were similar (cylinder: P=0.6377, r=0.864) (axis: P=0.6991, r=0.738). VASR, on average, required 71 additional seconds to complete when compared to traditional phoropter refraction. In terms of repeatability, the average difference noted upon repeat of equivalent sphere power was 0.01 D for the phoropter (P=0.98) and 0.10 D for the VASR (P=0.23). For sphere power, the average difference was 0.02 D for the phoropter (P=0.55) and 0.07 D for the VASR (P=0.58). For cylinder power, the average difference was 0.02 D for the phoropter (P=0.11) and 0.03 D for the VASR (P=0.39). For all refractive methods, the differences between measurements amounted to ≤0.10 diopters, which is neither clinically nor statistically significant. CONCLUSION: Refractive error results obtained with the VASR were not statistically different from those achieved using traditional phoropter methods. Time elapsed for the VASR was slightly longer than a more traditional refractive sequence. The VASR demonstrated clinically and statistically significant repeatability of measurement, consistent with traditional refraction.

Evaluation of some factors affecting the agreement between the Proview Eye Pressure Monitor and the Goldmann applanation tonometer measurements.

BACKGROUND: Our aim was to examine whether training level and ocular factors could account for part of the difference in intraocular pressure (IOP) measured using the Goldmann applanation tonometer (GAT) and Proview Eye Pressure Monitor (PPT). METHODS: One hundred and nineteen individuals (238 eyes) were enrolled in the study. The mean age was 35.8 years (range 21 to 79). All study participants obtained IOP measurements using the PPT after hearing instructions on how to perform PPT. Glaucoma patients obtained additional IOP measurements using PPT after viewing an instructional video and after 30 days of home use. IOP was also measured using the GAT at each experimental session. RESULTS: The difference in IOP measured by the GAT and the PPT was 0.55 +/- 3.38 mmHg, 0.17 +/- 3.79 mmHg and -1.30 +/- 3.79 mmHg for myopic, emmetropic and hypermetropic groups, respectively, which were statistically significant (ANCOVA; p = 0.014). The difference in IOP between GAT and PPT was not significantly different for measurements obtained after verbal instructions, instructional video or after 30 days of home use (Repeated-ANCOVA; p = 0.30). The overall agreement between the GAT and the PPT was poor. Intra-class correlation coefficient was 0.575, and the 95% confidence interval (CI) of agreement was -6.93 to +6.73 mmHg. CONCLUSION: There was a small systematic difference in IOP measured by the GAT and PPT when comparing the different refraction groups; however, this level of difference between the groups is unlikely to be of clinical significance. The level of training in using the PPT did not influence its measurements. The limits of agreement between the PPT and the GAT were wide and long-term use of PPT did not improve its agreement.

Contact lens care tips for patients: an optometrist's perspective.

Contact lens (CL) wear has been a viable alternative to spectacle wear for several decades. The interest and desire to wear CLs have been stable in recent years, evidenced by the consistency of new wearers into this category of refractive correction. CLs have become one of the most commonly used medical devices in the market, with more than 40 million wearers in the US. There are many activities in which patients report a preference of CL wear over spectacles (athletics for example). Nearly all patients (even presbyopic patients) have the option of contact lenses today given the expansion of powers and parameters in recent years. Patients eyes are getting dryer as factors of age and the environment. CL materials have improved in recent years in an attempt to meet the challenges of dryer eyes. Despite the improvements in CLs and their care, challenges persist. Patient education, handwashing, compliance with care, and wearing schedule are some of the challenges that providers face in the care of CL patients even today.

Effect of Proview self-tonometry on pharmaceutical compliance.

AIM: To evaluate changes in patient compliance with medical treatment while using the Proview Eye Pressure Monitor. METHODS: A crossover study design was used to compare the compliance of patients with established use of topical medication to lower intraocular pressure in the treatment of primary open-angle glaucoma. Thirty-two patients currently managed with latanoprost 0.005%, brimonidine 0.15%, travoprost 0.004% or bimatoprost 0.03% as monotherapy or in combination were randomly assigned to two study groups. Group 1 was instructed in the use of Proview Eye Pressure Monitor three times daily for 30 days as an adjunct to the glaucoma regimen. Group 2 was observed with no change in the patients' treatment regimen during this phase of study. A crossover occurred at 30 days. Compliance was monitored by assigning new bottles of topical medication during each phase of study. Bottles were weighed with a Mettler balance (Mettler Toledo Co.) at the initiation and completion of each phase. The changes in bottle-weight determined the amount of medication consumed by each patient for each phase of the study. The weights were analysed to estimate changes in compliance. RESULTS: A paired samples Student t-test compared the consumed bottle weights with and without Proview Eye Pressure Monitor usage. No statistical significance or trend was identifiable (p = 0.98). Use of the Proview Eye Pressure Monitor did not significantly change compliance with adjunct eye drop medication. CONCLUSION: The use of the Proview Eye Pressure Monitor use did not improve but appeared to hinder compliance with glaucoma treatment in this study.

The effect of multipurpose solutions on the ocular surface.

PURPOSE: We aimed to determine if multipurpose contact lens solutions could solely contribute to adverse ocular surface effects. Three specific multipurpose solutions were evaluated: Bausch & Lomb ReNu MultiPlus (ReNu with MoistureLoc was not evaluated in this study), Alcon No Rub Opti-Free Express, and Advanced Medical Optics Complete Moisture Plus. The impact that solutions have on the ocular surface, if negative, could be adverse. Nearly all recent studies examine the effects of solutions through the contact lens as a vehicle for delivery. The lens itself cannot be completely ruled out as a causal factor. METHODS: 21 subjects were randomized to one of the three solution groups. Subjects self-administered a solution to their treatment eye four times daily, with the fellow eye serving as the control. Solutions and the test eye were masked to the subject and examiner. A battery of ocular surface testing was conducted at the baseline examination and at every week interval by masked examiner. RESULTS: Non-parametric data was analyzed by Friedman 1-way ANOVA and parametric data by the 1-way repeated measures ANOVA. A reduction in tear breakup time was found to be statistically significant for the ReNu group (P < 0.05). CONCLUSIONS: ReNu has frequently been cited as being more cytotoxic. We propose that when used at a high frequency, ReNu preservatives and additives are adverse. Contact lens dropout and/or clinical signs noted by the examiner may be linked to the use of ReNu.

Comparing goblet cell densities in patients wearing disposable hydrogel contact lenses versus silicone hydrogel contact lenses in an extended-wear modality.

PURPOSE: The current study evaluates the response of the ocular surface to extended contact lens wear by comparing a new silicone hydrogel lens to an ACUVUE 2 lens. METHODS: Twenty subjects with an average age of 28 years were randomly assigned to a fitting with ACUVUE 2 or PureVision lenses. Ocular surface assessment by impression cytology was performed at baseline and for the 6 months after initiation of lens wear. RESULTS: Although goblet cell density significantly increased with wear time, no statistically significant difference was observed between the contact lens groups. The average baseline goblet cell percentages were as follows: ACUVUE 2 group, 1.44; PureVision group, 1.11. The 6-month averages were as follows: ACUVUE 2 group, 3.16; PureVision group, 2.22. CONCLUSIONS: It appears that silicone hydrogel lenses may be slightly less irritating to the ocular surface than lenses not containing silicone. This could be a promising indicator for successful 30-day continuous wear.