Central corneal thickness in new cases of dry eyes: A case-control study.

SIGNIFICANCE: Loss of homeostasis and chronic inflammation result in ocular surface damage in dry eyes, which is also associated with corneal thinning in established cases. Yet, the correlation between corneal thickness and new cases of dry eyes remains inadequately supported by evidence. PURPOSE: This study aimed to compare the central corneal thickness of new cases of dry eyes to that of age- and gender-matched controls. METHODS: A total of 45 dry eye patients were compared with 61 age- and gender-matched non-dry eye individuals. The Ocular Surface Disease Index (OSDI) questionnaire was used to evaluate symptoms, and the central corneal thickness was measured with a Nidek CEM-530 specular microscope. Patients were grouped based on disease severity (OSDI scores), and the clinical findings were compared between groups for slit-lamp examinations, Schirmer's I test, and tear film breakup time. RESULTS: The median age of patients was 25.0 (interquartile range [IQR], 20.0 to 32.0) and 27.0 (IQR, 20.0 to 32.0) years in the control and dry eye groups, respectively (p=0.63). The median (IQR) values of the OSDI scores, tear film breakup time scores, and Schirmer's test measurements in the control groups were 10.4 (8.3 to 10.4), 12.0 (11.0 to 14.0) seconds, and 16.0 (13.5 to 19.5) mm, respectively, which differed from the dry eye groups (p<0.0001). These values in the dry eye group were 29.1 (25.0 to 39.5), 4.0 (3.0 to 8.0) seconds, and 8.0 (3.5 to 11.0) mm, respectively. Patients with dry eyes had lower central corneal thickness than controls (p<0.01). The mean ± standard deviation central corneal thicknesses in patients with dry eyes and the control group were 520.3 ± 26.8 and 545.3 ± 18.8 µm, respectively. CONCLUSIONS: The central corneal thickness in dry eyes was significantly reduced compared with the control group. These findings may be useful in monitoring and managing dry eyes and should be considered in intraocular pressure measurements and refractive surgical procedures.

Antimicrobial Resistance: Is There a 'Light' at the End of the Tunnel?

In recent years, with the increases in microorganisms that express a multitude of antimicrobial resistance (AMR) mechanisms, the threat of antimicrobial resistance in the global population has reached critical levels. The introduction of the COVID-19 pandemic has further contributed to the influx of infections caused by multidrug-resistant organisms (MDROs), which has placed significant pressure on healthcare systems. For over a century, the potential for light-based approaches targeted at combatting both cancer and infectious diseases has been proposed. They offer effective killing of microbial pathogens, regardless of AMR status, and have not typically been associated with high propensities of resistance development. To that end, the goal of this review is to describe the different mechanisms that drive AMR, including intrinsic, phenotypic, and acquired resistance mechanisms. Additionally, the different light-based approaches, including antimicrobial photodynamic therapy (aPDT), antimicrobial blue light (aBL), and ultraviolet (UV) light, will be discussed as potential alternatives or adjunct therapies with conventional antimicrobials. Lastly, we will evaluate the feasibility and requirements associated with integration of light-based approaches into the clinical pipeline.

Managing Corneal Infections: Out with the old, in with the new?

There have been multiple reports of eye infections caused by antibiotic-resistant bacteria, with increasing evidence of ineffective treatment outcomes from existing therapies. With respect to corneal infections, the most commonly used antibiotics (fluoroquinolones, aminoglycosides, and cephalosporines) are demonstrating reduced efficacy against bacterial keratitis isolates. While traditional methods are losing efficacy, several novel technologies are under investigation, including light-based anti-infective technology with or without chemical substrates, phage therapy, and probiotics. Many of these methods show non-selective antimicrobial activity with potential development as broad-spectrum antimicrobial agents. Multiple preclinical studies and a limited number of clinical case studies have confirmed the efficacy of some of these novel methods. However, given the rapid evolution of corneal infections, their treatment requires rapid institution to limit the impact on vision and prevent complications such as scarring and corneal perforation. Given their rapid effects on microbial viability, light-based technologies seem particularly promising in this regard.

Prevalence of refractive errors in Nepalese children and adults: a systematic review with meta-analysis.

CLINICAL RELEVANCE: Country-specific estimates of the prevalence of refractive errors are important to formulate national eye health policies for refractive care services. BACKGROUND: The purpose of this study was to systematically synthesise available literature and estimate the prevalence of refractive errors in the Nepalese population. METHODS: PubMed, Scopus, and Web of Science databases were systematically searched for articles on refractive errors and presbyopia published in English language until 27 September 2022. Population and school-based quantitative, cross-sectional prevalence studies and Rapid Assessment of Avoidable Blindness survey repository data were included. The quality of the included studies was assessed using the Newcastle Ottawa scale adapted for cross-sectional studies. Data extraction was performed with consensus among the reviewers. Meta-analysis of the prevalence was performed using the Random effects model to estimate the pooled proportions. RESULTS: A total of 38 studies with 101 701 participants were included: 18 studies in children (n = 31 596) and 20 in adults (n = 70 105). In children, the estimated pooled prevalence of overall refractive errors was 8.4% (95% CI: 4.8 to 12.9) with myopia, hypermetropia and astigmatism prevalent in 7.1% (95% CI: 3.7 to 11.4), 1.0% (95% CI: 0.7 to 1.3) and 2.2% (95% CI: 0.9 to 3.9), respectively. In adults, the prevalence of refractive errors, uncorrected refractive errors, and uncorrected presbyopia were 11.2% (95% CI: 8.0 to 14.9), 7.3% (95% CI: 5.4 to 9.5) and 78.9% (95% CI: 69.1 to 87.3), respectively. CONCLUSIONS: The pooled prevalence of refractive errors is relatively low while uncorrected refractive errors and presbyopia are high in Nepalese population suggesting a need for better access to refractive care services in the country. The paucity of quality evidence on prevalence of refractive errors, particularly in children, indicates a need for a well-designed population-based study to accurately estimate the current prevalence of refractive errors.

Preclinical confirmation of UVC efficacy in treating infectious keratitis.

PURPOSE: Preclinical evaluation of the therapeutic potential of antimicrobial 265 nm UVC for infectious keratitis. METHODS: Four experiments explored UVC: 1) impact on bacterial and fungal lawns on agar, in individual or mixed culture, 2) bacterial inactivation dose in an in vitro deep corneal infection model, 3) dose validation in an ex vivo porcine keratitis model and 4) efficacy in a masked, randomised, controlled murine keratitis trial using bioluminescent Pseudomonas aeruginosa. RESULTS: Minimum effective UVC exposures ranged between 2 s and 5 s for lawn bacteria and fungi in individual or mixed culture. Significant P. aeruginosa growth inhibition in the in vitro infection model was achieved with 15 s UVC, that resulted in a >3.5 log10 reduction of bacteria in a subsequent ex vivo keratitis model (p < 0.05). Bioluminescence fell below baseline levels in all treated animals, within 8 h of treatment (p < 0.05), in the in vivo study. Re-epithelialisation with corneal clarity occurred within 24 h in 75% of UVC-treated cases, with no relapse at 48 h. On plating, bacteria were recovered only from untreated controls. CONCLUSIONS: UVC inhibited all tested bacteria and fungi, including mixed culture and strains linked to antibiotic resistance, in vitro, with exposures of ≤ 5 s. In vitro and ex vivo testing confirmed therapeutic potential of 15 s UVC. In vivo, 15 s UVC administered in two doses, 4 h apart, proved effective in treating murine bacterial keratitis.

Can microorganisms develop resistance against light based anti-infective agents?

Recently, there have been increasing numbers of publications illustrating the potential of light-based antimicrobial therapies to combat antimicrobial resistance. Several modalities, in particular, which have proven antimicrobial efficacy against a wide range of pathogenic microbes include: photodynamic therapy (PDT), ultraviolet light (UVA, UVB and UVC), and antimicrobial blue light (aBL). Using these techniques, microbial cells can be inactivated rapidly, either by inducing reactive oxygen species that are deleterious to the microbial cells (PDT, aBL and UVA) or by causing irreversible DNA damage via direct absorption (UVB and UVC). Given the multi-targeted nature of light-based antimicrobial modalities, it has been hypothesised that resistance development to these approaches is highly unlikely. Furthermore, with the exception of a small number of studies, it has been found that resistance to light based anti-infective agents appears unlikely, irrespective of the modality in question. The concurrent literature however stipulates, that further studies should incorporate standardised microbial tolerance assessments for light-based therapies to better assess the reproducibility of these observations.

Safety and efficacy of UV application for superficial infections in humans: A systematic review and meta-analysis.

BACKGROUND: Ultraviolet (UV) light is naturally antimicrobial, but risks associated with UV overexposure have limited its clinical application. This systematic review evaluates the safety and efficacy of UV light treatment of superficial human infections. METHODS: MEDLINE, Embase, Cochrane CENTRAL, ANZCTR and US National Library of Medicine were searched (March 25, 2020). Clinical studies applying UV light (200-400 nm) for superficial infections and non-clinical studies evaluating the antimicrobial effects of UV light on human samples were included. Randomised controlled trials (RCTs) and non- RCTs were appraised using the Cochrane risk of bias and the ROBINS-I tools, respectively. RESULTS: Eleven RCTs, seven non-RCTs, 24 case studies, and 11 in vitro studies were included. Most clinical studies (34/42) evaluated UVA treatment for microbial keratitis (MK) using cross-linking (UVA-CXL) methods. Six clinical studies assessed UVC; one, UVB; and one, broadband UV for chronic skin infections. Pooled data analysis showed no difference in the time to wound resolution with UVA-CXL relative to standard treatment (mean difference [MD]: -18.20 [95% CI: -39.04 to 2.65] days; p = 0.09). Adverse event incidence was similar to control for UVA-CXL in MK (RR: 0.70 [95%CI: 0.32-1.79]; 5 RCTs) and UVC in skin infections (RR: 0.63 [95%CI: 0.25-1.54]; 2 RCTs). CONCLUSION: Alone or as an adjunct to standard therapy, UV light shows promise as a safe and effective treatment for a wide range of infections. Applications of UV light as an anti-infective agent are deserving of further evaluation, especially in the context of growing antibiotic resistance. REGISTRATION: PROSPERO registration number CRD42020176510.

Spectacle non-tolerance in clinical practice - a systematic review with meta-analysis.

PURPOSE: Spectacle non-tolerance or adverse events to spectacle wear are serious concerns for both patients and practitioners. Non-tolerance may contribute to a negative impact on the practitioner's ability and practice. Therefore, a detailed understanding of frequency and causes of spectacle non-tolerance in clinical ophthalmic practice is essential. This review aimed to determine the prevalence and causes of non-tolerance to spectacles prescribed and dispensed in clinical practice. METHOD: The current systematic review included quantitative studies published in the English language that reported spectacle non-tolerance in clinical practice. A comprehensive search was conducted in PubMed, Scopus and the Web of Science database for studies published until 13 July 2020. An adapted version of the Newcastle-Ottawa Scale (NOS) modified for cross-sectional studies was used to assess the quality of each included study. Five investigations with 205,478 study participants were included in the review. The prevalence of spectacle non-tolerance from individual studies was pooled using MetaXL software. The pooled prevalence of spectacle non-tolerance was 2.1% (95% CI: 1.6-2.7) ranging from 1.6% to 3.0%. The papers were also reviewed to identify the potential causes of non-tolerances. Nearly half reported that non-tolerance (47.4%) was due to an error in refraction. Other causes identified were errors related to communication (16.3%), dispensing (13.5%), non-adaptation (9.7%), data entry (8.7%), binocular vision (7.4%) and ocular pathology (6.4%). SUMMARY: This review improves our understanding of spectacle non-tolerance in clinical practice. This is important because non-tolerance may lead to spectacle wear discontinuation, which may deprive patients of optimal vision. Increased non-tolerance in clinical practice may affect a clinician's reputation and incur additional costs associated with reassessments and replacements. Spectacle non-tolerance occurred due to a multitude of factors related to optical dispensing and wearer adaptation. Therefore, there is a need for vigilance while prescribing spectacles. The limited evidence highlights the need for more studies, especially in limited-resource settings, to improve the quality of refractive error services.

CLEAR - Contact lens complications.

Contact lens-related complications are common, affecting around one third of wearers, although most are mild and easily managed. Contact lenses have well-defined anatomical and physiological effects on the ocular surface and can result in other consequences due to the presence of a biologically active material. A contact lens interacts with the tear film, ocular surface, skin, endogenous and environmental microorganisms, components of care solutions and other antigens which may result in disease specific to contact lens wear, such as metabolic or hypersensitivity disorders. Contact lens wear may also modify the epidemiology or pathophysiology of recognised conditions, such as papillary conjunctivitis or microbial keratitis. Wearers may also present with intercurrent disease, meaning concomitant or pre-existing conditions unrelated to contact lens wear, such as allergic eye disease or blepharitis, which may complicate the diagnosis and management of contact lens-related disease. Complications can be grouped into corneal infection (microbial keratitis), corneal inflammation (sterile keratitis), metabolic conditions (epithelial: microcysts, vacuoles, bullae, tight lens syndrome, epithelial oedema; stromal: superficial and deep neovascularisation, stromal oedema [striae/folds], endothelial: blebs, polymegethism/ pleomorphism), mechanical (corneal abrasion, corneal erosion, lens binding, warpage/refractive error changes; superior epithelial arcuate lesion, mucin balls, conjunctival epithelial flaps, ptosis, discomfort), toxic and allergic disorders (papillary conjunctivitis, solution-induced corneal staining, incomplete neutralisation of peroxide, Limbal Stem Cell Deficiency), tear resurfacing disorders/dry eye (contact lens-induced dry eye, Meibomian gland dysfunction, lid wiper epitheliopathy, lid parallel conjunctival folds, inferior closure stain, 3 and 9 o'clock stain, dellen, dimple veil) or contact lens discomfort. This report summarises the best available evidence for the classification, epidemiology, pathophysiology, management and prevention of contact lens-related complications in addition to presenting strategies for optimising contact lens wear.

Effect of therapeutic UVC on corneal DNA: Safety assessment for potential keratitis treatment.

PURPOSE: Antimicrobial ultraviolet C (UVC) has proven efficacy in vitro against keratitis isolates and has potential to treat corneal infection if safety can be confirmed. METHOD: Safety of 265 nm, 1.93 mW/cm2 intensity UVC (15-300 s exposures) was investigated in vitro via cyclobutane pyrimidine dimer (CPD) formation in DNA of human cultured corneal epithelial cells; ex vivo, by evaluating UVC transmissibility as a function of porcine corneal thickness; and in vivo, by evaluating CPD induction in the mouse cornea following UVC exposure. RESULTS: A single exposure of 15 s UVC did not induce significant CPD formation (0.92 ± 1.45%) in vitro relative to untreated control (p = 0.93) whereas 300 s exposure caused extensive CPD formation (86.8 ± 13.73%; p < 0.0001). Cumulative exposure to 15 s UVC daily for 3 days induced more CPD (14.6 ± 8.2%) than a single equivalent 45 s exposure (8.3 ± 4.0%) (p < 0.001) but levels returned to baseline within 72 h (p = 0.29), indicating highly efficient DNA repair. Ex vivo, UVC transmission decreased sharply with increasing corneal thickness, confirming UVC effects are limited to the superficial corneal layers. In vivo evaluations demonstrated no detectable CPD after three consecutive daily 15 s UVC exposures, whereas a single 300 s exposure induced extensive CPD formation in superficial corneal epithelium. CONCLUSION: Up to three daily doses of 15 s UVC, in vivo, appear safe with respect to CPD formation. Ongoing research exploring UVC as a possible treatment for microbial keratitis is warranted.

Prophylactic action of lipid and non-lipid tear supplements in adverse environmental conditions: A randomised crossover trial.

PURPOSE: To evaluate the prophylactic benefits of lipid-based and non-lipid-based artificial tear lubricants, in dry eye disease, after adverse environmental exposure. METHODS: Twenty-eight participants with dry eye disease were recruited in a prospective, double-masked, randomised crossover trial. On separate days, participants were randomised to receive a single application of a lipid-containing tear supplement (Systane Complete) to one eye, and a non-lipid containing eye drop (Systane Ultra) to the contralateral eye. Participants were then exposed to a previously validated simulated adverse environment. Symptoms, non-invasive tear film breakup time, lipid layer grade, and tear meniscus height were assessed at three time points; baseline, following eye drop instillation, and after exposure to the adverse environment. RESULTS: Both treatments effected improvements in symptoms and non-invasive tear film stability following instillation (all p < 0.05), although an improvement in lipid layer quality was limited to the lipid-containing nano-emulsion tear supplement (p = 0.003). Although protective effects were conferred by both treatments following exposure to the simulated adverse environment, more favourable symptomology scores, non-invasive tear film stability, and lipid layer quality were observed in the lipid-containing tear supplement group (all p < 0.05). No significant changes were observed in tear meniscus height in both treatment groups (all p > 0.05). CONCLUSIONS: Both the lipid and non-lipid-based artificial tear supplement demonstrated prophylactic benefits in a simulated adverse environment. However, the ability to preserve tear film quality and reduce dry eye symptomology was greater with the lipid-containing eye drop. TRIAL REGISTRATION NUMBER: ACTRN12619000361101.

Pattern of astigmatism in a clinical setting in Maldives / Patrón del astigmatismo en un centro clínico de Maldivas

Background: Patterns of refractive errors have never been reported in Maldives. This study aims to dissect astigmatism and provide a general view in context of this island country. Methods: A clinic based cross sectional study was designed with 277 patients, aged ≥3.5 years and with a primary astigmatism of ≥−1.00 diopters (D). They underwent complete eye examination and a vector analysis was done. Results: Mean age was 28.58 (SD 19.15) years. Astigmatic magnitude depended on age (p<0.05) but not on gender (p>0.05). Severity of visual impairment after refractive correction was very less, with only 2.2% having visual acuity ≤6/60. Mean spherical, spherical equivalent and astigmatic refraction were −1.35 (SD 2.94D), −2.40 (SD 3.04) and −2.12 (SD 1.11D), respectively. Between fellow eyes, refractive and corneal astigmatism highly correlated (0.83 and 0.73). Fifty eyes (18.1%) had an astigmatic error of ≥−3.00D which peaked in the second and third decades of life (p<0.0001) and was corneal in origin (p<0.0001). Internal J45 and J0 tended to be more negative with increasing age, showing a trend toward against the rule astigmatism. Correlation between corneal and refractive J0 and J45 were 0.88 and 0.62 (p<0.0001). With the rule astigmatism was more common followed by against the rule and oblique. Conclusion: In conclusion, this study inferred that among patients with relatively higher magnitude of astigmatism attending to the clinics in Maldives, younger patients are affected more, which could possibly link to the environment, genetics and nutrition. The probable association between nutrition and astigmatism needs to be investigated to fill the gap in literature (AU)

Antecedentes: Los patrones de los errores refractivos no han sido reportados nunca en Maldivas. Este estudio trata de analizar minuciosamente el astigmatismo, así como aportar una visión genérica en el contexto de este país insular. Métodos: Se diseñó un estudio clínico transversal que incluyó a 277 pacientes, de edades ≥3,5 años y con astigmatismo primario de ≥-1,00 Dioptrías (D). Se les realizó un examen visual completo y un análisis vectorial. Resultados: La edad media fue de 28,58 años (DE 19,15). La magnitud astigmática dependió de la edad (p<0,05) pero no del sexo (p>0,05). La severidad de la discapacidad visual tras la corrección refractiva fue muy baja, y únicamente el 2.2% reflejó una agudeza visual ≤6/60. La media del defecto esférico, el equivalente esférico y la refracción astigmática fueron de -1,35 (DE 2,94D), -2,40 (DE 3,04) y -2,12 (DE 1,11D), respectivamente. El astigmatismo refractivo y el corneal guardaron una amplia correlación entre ambos ojos (0,83 y 0,73). Cincuenta sujetos (18,1%) reflejaron un valor de error astigmático ≥-3,00D, que se incrementó en la veintena y la treintena (p<0,0001), siendo corneal en origen (p<0,0001). Los vectores J45 y J0 internos tendieron a ser más negativos conforme aumentaba la edad, mostrando tendencias de astigmatismo en contra de la regla. La correlación entre los vectores J0 y J45 corneal y refractivo fue de 0,88 y 0,62 (p<0,0001). El astigmatismo a favor de la regla fue el más común, seguido del astigmatismo contra la regla y el oblicuo. Conclusión: En conclusión, este estudio concluyó que de entre los pacientes astigmáticos de magnitud relativamente mayor que se presentaron en la clínica de Maldivas, los pacientes más jóvenes estaban más afectados, lo que podría estar ligado al entorno, los factores genéticos y la nutrición. Debe investigarse la posible asociación entre la alimentación y el astigmatismo, para llenar el vacío en la literatura al respecto (AU)

Pattern of astigmatism in a clinical setting in Maldives.

BACKGROUND: Patterns of refractive errors have never been reported in Maldives. This study aims to dissect astigmatism and provide a general view in context of this island country. METHODS: A clinic based cross sectional study was designed with 277 patients, aged ≥3.5 years and with a primary astigmatism of ≥-1.00 diopters (D). They underwent complete eye examination and a vector analysis was done. RESULTS: Mean age was 28.58 (SD 19.15) years. Astigmatic magnitude depended on age (p<0.05) but not on gender (p>0.05). Severity of visual impairment after refractive correction was very less, with only 2.2% having visual acuity ≤6/60. Mean spherical, spherical equivalent and astigmatic refraction were -1.35 (SD 2.94 D), -2.40 (SD 3.04) and -2.12 (SD 1.11 D), respectively. Between fellow eyes, refractive and corneal astigmatism highly correlated (0.83 and 0.73). Fifty eyes (18.1%) had an astigmatic error of ≥-3.00 D which peaked in the second and third decades of life (p<0.0001) and was corneal in origin (p<0.0001). Internal J45 and J0 tended to be more negative with increasing age, showing a trend toward against the rule astigmatism. Correlation between corneal and refractive J0 and J45 were 0.88 and 0.62 (p<0.0001). With the rule astigmatism was more common followed by against the rule and oblique. CONCLUSION: In conclusion, this study inferred that among patients with relatively higher magnitude of astigmatism attending to the clinics in Maldives, younger patients are affected more, which could possibly link to the environment, genetics and nutrition. The probable association between nutrition and astigmatism needs to be investigated to fill the gap in literature.

Visual profile of students in integrated schools in Malawi.

BACKGROUND: Blindness and visual impairment are very common in African countries and are often loosely linked to inadequate resources. We designed this study to assess clinical visual and ocular characteristics of children in three integrated schools in Malawi, so that students needing low vision services or those with correctable refractive error will be identified. METHODS: We included 95 students, who underwent a detailed optometric examination. The assessment included distance visual acuity measurement in logMAR notation, near visual acuity, oculo-motor assessment, pupillary assessment and anterior as well as posterior segment evaluation. Non-cycloplegic refraction was done in all the participants. RESULTS: Mean age of students was 13.84 ±4.61 years. Almost 90 per cent of students had presenting visual acuity worse than logMAR 0.54. Visual acuity improved significantly after refractive correction by more than two logMAR lines in 31.8 per cent (p < 0.0001). Refractive error was very common (36.5 per cent) and the most common causes of visual impairment were lenticular (21.2 per cent), corneal (20.0 per cent) and albinism (15.3 per cent). One-tenth (10.5 per cent) of the students were wrongly enrolled in the schools, even though they did not have visual impairment. The compliance to spectacles wear was very poor (37 per cent). An adequate refractive correction improved visual acuity in more than a third (36.5 per cent) of the students. Students benefited from spectacle magnifiers (18.8 per cent), handheld magnifiers (4.7 per cent) and telescopes (5.9 per cent). Mobility canes were advised for 36.5 per cent of the students. CONCLUSION: Nine out of ten students in three integrated schools in Malawi had visual impairment and 41 per cent had low vision. Inappropriate placement in the integrated schools and poor spectacle compliance are very common. Well accepted optical and non-optical devices could improve visual performance in visually disabled children, for which public awareness and parental education is important.

Compliance and hygiene behaviour among soft contact lens wearers in the Maldives.

BACKGROUND: Significant levels of non-compliance and poor hygiene among contact lens wearers have been reported previously from different parts of the world. This survey aimed at identifying the scope of hygiene and non-compliant behaviour of soft contact lens wearers in the Maldives. METHODS: Established soft lens wearers attending two eye clinics in Male' city, were interviewed in office or via telephone. A set of interviewer-administered questions was used to access the subjective response on compliance and hygiene behaviour (hand and lens case hygiene, water exposure, adherence to lens replacement schedule, dozing and overnight wear, awareness of aftercare visits and reuse of disinfecting solution). Participants were also asked to rate themselves as a contact lens user based on their perceived compliance and hygiene practices. RESULTS: Out of 107 participants, 79 (74.8 per cent) were interviewed in the office and the rest via telephone. The majority of lens wearers were female, office workers and students, with a mean age of 20.64 ± 4.4 years. Mean duration of lens wear was 28.04 ± 8.36 months. Most of them were using spherical lenses (86.9 per cent) on a daily wear basis (96.3 per cent). Major reported forms of non-compliance were poor hand hygiene (60.7 per cent), lack of aftercare awareness (39.3 per cent), water exposure (35.5 per cent) and over-use of lenses (24.3 per cent). While females were more likely to overuse their lenses than males (p < 0.005), other socio-demographic factors were not associated with reported non-compliance. Although around 90 per cent of the participants considered themselves average or good contact lens wearers, most exhibited some form of non-compliant and poor hygienic behaviour. CONCLUSION: A significant number of Maldivian contact lens wearers exhibited poor levels of hygiene and compliance with contact lenses and lens care systems. An effective educational reinforcement strategy needs to be developed to modify lens wearers' non-compliance.

Methanol poisoning: ocular and neurological manifestations.

PURPOSE: The purpose of this study was to examine the effectiveness of ethanol and high-dose intravenous steroid for preserving vision in acute methanol poisoning. METHODS: Eight cases of acute methanol poisoning presented to the emergency department. Detailed physical examination including neurological assessment was performed. Detailed ocular examinations were performed including visually evoked potential and electroretinography in indicated cases. All patients had visual symptoms. Pupillary abnormality was observed in all. Edema of the optic disc and nerve fiber layer were common fundus findings. The majority of cases were treated with methylprednisolone intravenously. Ethanol was given intravenously in four cases who presented within 48 h. Hemodialysis was performed in two cases having neurological manifestations and metabolic acidosis. Sodium bicarbonate was given to four patients. Folinic acid and multivitamins were also given to all the patients based on neurological advice. RESULTS: Most of the patients showed a good response to the treatment. In 87.5% of the cases, improvements in visual acuity of at least two lines were noted in follow-up visits. CONCLUSIONS: Early presentation with prompt treatment has a significant role in preserving and improving visual acuity. Ethanol and high-dose intravenous methylprednisolone can be an alternative treatment with better visual outcome where fomepizole is unavailable.