Temporal changes in contact lens comfort over a day of wear.

PURPOSE: Contact lens discomfort continues to be reported as the primary reason for soft lens discontinuation, regardless of new modalities and materials. The purpose of this analysis of comfort related data from a series of clinical studies was to review whether there was a difference between symptomatic and asymptomatic habitual lens wearers' comfort responses over the course of the day. METHODS: Data from five independent non-dispensing clinical studies were pooled and analysed. Participants in these studies were assigned to one of two groups depending on whether they were classified as symptomatic or asymptomatic contact lens wearers according to a modified Subjective Evaluation of Symptoms of Dryness (SESOD) questionnaire. Masked participants were randomised to wear either a hydrogel or a silicone hydrogel contact lens and their ocular comfort was rated using a visual analogue scale on insertion and 2-hourly during an 8-hour period of a single lens wearing day. RESULTS: Data from 103 participants were used, 58 in the symptomatic group and 45 in the asymptomatic group as determined by the SESOD questionnaire. There was no effect of lens material on comfort (p = 0.43). However, there was a significant interaction between symptoms and time. The difference in mean comfort between the symptomatic and asymptomatic group was significant at each time point (p < 0.05). However, comfort did not vary significantly over the day for the asymptomatic group (p = 0.87), whereas, there was a significant decline in mean comfort ratings for the symptomatic group from 84.6 ± 13.2 (S.D.) at insertion to 73.0 ± 18.5 at 8 hours (p < 0.001). CONCLUSIONS: In our study, changes in contact lens comfort over a day were independent of lens material but not symptoms. Symptomatic lens wearers reported a progressive decrease in comfort, whereas asymptomatic wearers did not. Therefore, asymptomatic wearers should not be used when measuring contact lens comfort in clinical studies. The exclusion of asymptomatic lens wearers would likely increase the sensitivity of comfort ratings as a measure in contact lens research.

Psychological and other mechanisms for end-of-day soft lens symptoms.

PURPOSE: To examine psychological factors and other mechanisms for soft contact lens (CL)-related end-of-day symptoms of dryness and associated dropping out from lens wear. METHODS: A PubMed search for articles related to dryness, comfort, and discomfort in CLs was conducted. Comparisons with rigid lens adaptation have been used to construct and examine a hypothesis that high levels of initial soft lens comfort increase expectations of an absence of lens awareness that result in end-of-day symptoms being more difficult to tolerate. RESULTS: Relevant reports were referenced in this review having been located using the 143 listed by PubMed. Contact lens-induced corneal hypoalgesia and the association between the influence on blink function of end-of-day general and ocular fatigue, lens front surface degradation, a dysfunctional pre-lens tear layer, and symptoms of dryness suggest that lid wiper friction has a prime role in determining the level of lens awareness. CONCLUSIONS: Rather than dry eye symptoms, end-of-day discomfort in CL wearers might be more appropriately described as dry lens symptoms. Apart from tear function, lens condition, compliance with lens care instructions, and symptom strength, lens awareness may also be determined by psychological factors such as motivation, high expectations for comfort, and sense of subjective well-being. For example, high levels of comfort experienced on lens insertion may increase expectations of the level of comfort to be experienced at the end of the day. In addition, patient management seems to require a thorough assessment of lens comfort, which may indicate the need to review a patient's understanding of the relation between compliance and other factors, which could influence CL performance negatively. For example, increased use of digital devices, especially in air conditioning, and any associated reduced blink efficiency seem likely to be important contributors to dry lens symptoms.

Influence of the COVID-19 pandemic on contact lens wear in Spain.

PURPOSE: To investigate the behaviour of contact lens (CL) wearers in Spain during the COVID-19 pandemic. METHODS: An anonymized web-based questionnaire was used to assess demographics, CL history, and activity, CL wear habits and perceived risk of infection due to CL wear during the COVID-19 pandemic. RESULTS: A total of 737 participants with an average age of 27.4 (±9.3) years completed the online questionnaire. The vast majority of respondents were soft CL wearers and reported at least two years of CL wear. Patients concerns about the increased risk of SARS-CoV-2 infection due to CL wear (40.6 % of participants) were significantly related (χ2(1) = 11.195, p < 0.05) to CL discontinuation (46 % of participants) during the COVID-19 pandemic. This fact joins the significant changes in the frequency of CL wear during the COVID-19 pandemic (χ2(4) = 31.982, p < 0.05), with a tendency to increase occasional CL wear from 29.1 % to 61.8 %. Interestingly, the majority of respondent (87.9 %) indicated that no professional had offered them information related to CL wear and COVID-19, and that they had not sought it on their own (82.2 %). CONCLUSION: There is a relationship between the perceived risk of infection and CL dropout during the COVID-19 pandemic, and a tendency to change the CL frequency of wear, with an increase in occasional CL wear. During the ongoing pandemic, eye care practitioners should reinforce CL patient education to minimize the risk of SARS-CoV-2 infection and CL-related complications requiring clinical care.

Hydro cone lens visual performance and impact on quality of life in irregular corneas.

The aim of this study is to evaluate the visual performance (efficiency) of HydroCone (Toris K) soft silicon hydrogel lenses in patients with irregular corneas.

[Clinical interpretation of the subjective complaint of dryness in contact lens wearers].

PURPOSE: Patients wearing contact lenses who have the feeling of dryness without any objective symptoms of dry eye are sometimes seen in clinics. The purpose of this study was to determine if there was a difference in the clinical signs, personality, and mental condition between a group of contact-lens wearers with no symptoms and a group of contact-lens wearers with subjective symptoms of the feeling of dryness. SUBJECTS AND METHODS: Eighty-two patients who had no trouble with wearing soft contact lenses (SCL) were employed in this study. The patients were asked to fill out a questionnaire and Yatabe Guilford Personality test (Y-G test), and the height of tear meniscus and fluorescein staining were measured. RESULTS: Fifty-three patients (65%) complained of a feeling of dryness. There were no significant differences between the presence of the feeling of dryness and types of SCL, the height of tear meniscus, and the severity of fluorescein staining. On the other hand, there was a significant increase in the scores of positive, subjective, and impulsive personality trais on the Y-G test in the symptomatic group. CONCLUSION: For patients who have subjective symptoms of the feeling of dryness, careful observation of objective symptoms should be carried out, and their personality and mental condition should also be evaluated.

Patient attitudes and behavior regarding hygiene and replacement of soft contact lenses and storage cases.

PURPOSE: To review important aspects of contact lens compliance and to survey contact lens replacement frequency, steps in lens care and hygiene and replacement of the lens storage case via online surveys. METHODS: Random US samples (n=645 and 787) of frequent replacement contact lens wearers answered questions on contact lens wear in online, sponsor-masked surveys. RESULTS: Wearers of lenses prescribed by their practitioner for 2 weekly replacement reported that they replaced lenses as follows: within 2 weeks 45%, within 3 weeks (minor stretching) 68%, within 4 weeks 89%, ≥8 weeks (extreme stretching) 4%, compared to Monthly wearers who reported: within 4 weeks 37%, within 5 weeks (minor stretching) 57%, ≥8 weeks 23% (≥8 weeks extreme stretching, Chi-square p=0.001). Median frequency for cleaning lens storage case was 2-3 times per week, while 33% reported cleaning monthly or less often. Median lens storage case replacement was every 4-6 months, while 48% reported annual replacement or less often. Most patients cleaned their lens case with hot or cold tap water (72%). CONCLUSIONS: These internet surveys revealed significant non-compliance with lens care steps, case hygiene and lens replacement schedule. More than half of the contact lens wearers surveyed were not compliant with their 2-weekly or monthly schedule. Lenses prescribed for longer replacement intervals can lead to more extreme stretching of lens life. To encourage better patient habits, eye care providers should reinforce their recommended frequency of replacement of lenses and storage cases and should reinforce care and hygiene steps at each patient visit.

Ability of patients to recall habitual contact lens products and enhancement of recall using photographic aids.

PURPOSE: To determine the proportion of soft contact lens (CL) wearers who are able to recall their habitual products (lenses and care system) correctly from memory, and to evaluate the value of using photographic aids (PAs) to improve recall. METHODS: 103 soft lens wearers attended 2 visits to investigate their habitual CL product use. At the first visit they were asked to recall which products they were using and then to identify their products from PAs. They returned for a second visit with their products for confirmation. RESULTS: 51% correctly reported their lens brands from memory alone, which improved to 87% with the use of the PAs (p<0.001). 41% correctly reported their habitual care system from memory alone, which improved to 80% with the use of PAs (p<0.001). Females were better at recalling care system brand names than males (49% versus 27% correct, p=0.040) and wearers with more than 1 year experience with their habitual CLs had better recall than those with up to 1 year experience (63% versus 27%, p=0.014). CONCLUSION: Less than 50% of contact lens wearers were able to recall the names of their habitual lens and lens care products correctly from memory. PAs improved this recall significantly for both contact lenses and contact lens care systems.

Pre-operative Quality of Life and psychological factors that influence patient decision making in LASIK.

PURPOSE: To assess pre-operative visual function, psychological factors, personality traits and satisfaction in myopic patients seeking laser-assisted in situ keratomileusis (LASIK). METHODS: Eligible patients seeking LASIK (n=183) and successful contact lens wearers (n=23) not interested in LASIK completed the Institute for Eye Research Quality of Life (QOL) Scale. Of the 183 patients seeking LASIK who completed the QOL instrument before LASIK, 30 declined the procedure and 153 underwent LASIK. One hundred and two patients who underwent LASIK attended their 3-month post-operative follow-up appointment and 51 patients failed to present for their post-operative follow-up appointment. Multiple comparisons (One-way Analysis of Variance (ANOVA)) were conducted to determine differences in visual function, psychological factors, personality traits and satisfaction between patient groups. RESULTS: Successful soft contact lens (SCL) wearers reported better functional vision (P=0.001), felt more attractive (P=0.007), had a lower frequency of disturbing visual and ocular symptoms (P=0.027) and higher overall satisfaction with their current optical correction (P<0.001) than patients seeking LASIK. LASIK patients lost to follow-up showed higher self-efficacy, adaptability and well-being than the patients who completed their appointments and those who declined surgery (P<0.05). CONCLUSIONS: Psychological characteristics, the perception of visual and ocular symptoms and satisfaction with the current method of optical correction play an important role in the decision to undergo LASIK. The IER QOL Scale is a valid and reliable instrument able to discriminate between different groups seeking choices for myopic correction. Psychological factors may influence the level of satisfaction with LASIK.

Concurrent acanthamoeba and Fusarium keratitis with silicone hydrogel contact lens use.

PURPOSE: To report a case of simultaneous Acanthamoeba and Fusarium keratitis associated with no-rub multipurpose contact lens solution and silicone hydrogel contact lens use. METHOD: Observational case report. RESULTS: A 39-year-old woman was referred for worsening of a presumed bacterial corneal ulcer in the setting of silicone hydrogellens wear with occasional overnight wear, no-rub multipurpose contact lens solution use, and combined topical antibiotic/corticosteroid treatment. Initial corneal scrapings and culture confirmed Acanthamoeba and Fusarium solani, corroborated by in vivo confocal microscopy findings, yet despite topical chlorhexidine 0.02%, propamidine 1%,neomycin/polymyxin B ointment, and natamycin 5% along with oral itraconazole, the ulcer worsened. Four days after amoebic and fungal therapy initiation, it was discovered that the pharmacy accidentally dispensed neomycin/polymyxin B/dexamethasone, and despite immediate discontinuation, therapeutic penetrating keratoplasty from corneal melting was ultimately required. Corneal histopathology confirmed the presence of amoebic cysts and fungal elements. CONCLUSIONS: Coexisting infection with Acanthamoeba and Fusarium species can occur in contact lens wear. Atypical infection must be considered in patients with corneal ulcers demonstrating poor therapeutic response in the setting of contact lens wear. Corticosteroids should be used with extreme caution in contact lens­related corneal infections, especially when the diagnosis remains unknown because they can lead to acceleration of active infection and keratolysis.

Synergeyes versus soft toric lenses: vision-related quality of life.

PURPOSE: The purpose of this study is to contrast the clinical and vision-related quality of life outcomes between Synergeyes, a hybrid contact lens, and Bausch & Lomb Soflens 66 Toric contact lenses in a cross-over design. Also, to determine subject preference of one mode of lens wear over the other. METHODS: The Synergeyes lens has a central rigid gas permeable portion made of Paragon HDS100 material (paflufocon D) bonded to the nonionic hydrophilic skirt material of 27% water (PolyHEMA hem-iberfilcon A). The Soflens 66 Toric lens is made of a nonionic hydrophilic 66% water (alphafilcon A) material. Subjects age 18 years and older with spherical refractive error between -0.50 and -8.00 D and astigmatism correction of -0.75 to -3.50 D were randomly assigned to wear one mode of contact lens for 1 month then wear the alternate mode for 1 month. Follow-up visits were done at 1 and 4 weeks. Data gathered at these visits included high-contrast log MAR distance visual acuity, average wearing time, comfortable wearing time, over-refraction, and slit lamp observations for corneal edema, conjunctival hyperemia, and corneal staining. At each visit, subjects were asked to rate overall comfort, dryness, and comfortable wearing time. Subjects were asked to complete the NEI-RQL-42 questionnaire at the end of each lens wearing period. Upon completion of both lens wearing modes, subjects were asked to choose their preferred mode. RESULTS: Fifty subjects completed the study; 22 (44%) preferred the Synergeyes lenses, and 28 (56%) preferred the Soflens 66 Toric soft lenses. Measured visual acuity was significantly better with the Synergeyes lenses. Of the 13 attributes analyzed in the RQL-42, a statistically significant difference between the two modes was found in only one category, "symptoms." In that category, subjects indicated fewer symptoms when wearing soft lenses. The subjects' ratings also showed significantly more comfort while wearing the soft toric lenses. CONCLUSIONS: Bausch & Lomb Soflens 66 Toric lenses were more comfortable and were perceived to produce less symptoms of dryness, itchiness, and lens awareness than Synergeyes lenses. Synergeyes lenses gave better visual acuity than the soft toric lenses.

A multi-centre study of lapsed contact lens wearers.

PURPOSE: Discontinuation from contact lens wear has been identified as a contributing factor in the lack of growth of contact lens use in Europe. The purpose of this study was to determine the proportion of lapsed contact lens wearers that can be refitted successfully with contact lenses and to evaluate the reasons for discontinuation from contact lens wear. METHODS: This was a multi-site clinical study involving 15 UK investigators and 236 lapsed contact lens wearers who had previously tried contact lenses and discontinued. The reasons for discontinuation were assessed by subjects, who were then refitted with contact lenses. Investigators subsequently evaluated factors associated with their initial discontinuation. Short-term success was defined as the successful completion of 1 month of contact lens wear with absence of complications that would prevent further wear. Subjects were interviewed by telephone 6 months after being refitted to determine whether they were still wearing contact lenses. Those who were not wearing lenses were questioned about the reasons for discontinuation and their likelihood of resuming lens wear. RESULTS: A majority of subjects (51%) cited discomfort as the principal reason for having previously given up contact lens wear. Problems with vision were the second most common reason (13%), either with reading (6%) or general vision (7%). The most common type of discomfort was dryness (40%). In almost all cases (97%), the investigator's assessment of the reasons for discontinuation agreed with the subject's own assessment but investigators also cited product-related and practitioner-related factors as contributing to previous failure. The short-term success rate for refitting lapsed wearers was found to be 77% (Cl: 70-82%). The highest short-term success rates were for 2-weekly/monthly soft spherical lenses (91%) and daily disposable lenses (89%). Lower success rates were found for soft toric (69%) and soft bifocal (53%) lenses. At the 6-month stage, 73% of those who continued in lenses after the 1-month visit were still wearing contact lenses and a further 18% indicated that they were either 'very likely' or 'likely' to resume lens wear. CONCLUSIONS: A high proportion of lapsed contact lens wearers can be successfully refitted with contact lenses. The prime reason for previous discontinuation from contact lenses is discomfort and, in particular, dryness-related discomfort. In many cases, previous contact lens failure is product or practitioner-related rather than because of patient-specific problems. Once refitted with contact lenses, lapsed wearers cite vision problems rather than discomfort as the most common reason for discontinuing. This finding suggests that recent advances in contact lens material, design, replacement frequencies and care systems have improved the prospects for avoiding lens-related discomfort and for continuing contact lens wear.