Wear Experiences with Two Soft Contact Lenses for Astigmatism of Different Modalities.

Introduction: Patients expect to have excellent vision and comfort when wearing soft contact lenses. The purpose of this study was to compare the wear experiences of participants with astigmatism when wearing a daily disposable soft toric lens to an established, commonly used reusable toric lens. Methods: In this crossover study, habitual soft toric lens wearers were fit with a daily replacement soft toric lens (delefilcon A) and a reusable, 1-month replacement soft toric lens (comfilcon A) in a randomized order. After 30 days of wear, Visual analog scale (VAS) surveys were used to assess wear experience, including vision and comfort, for overall wear and end-of-day wear. Scores were compared statistically with mixed-effects linear models. Participants also responded to questions about convenience, ease of use, and satisfaction with both lenses and preference questions based upon comfort, vision, and overall performance. Results: Fifty-nine participants completed the multi-site crossover study. VAS scores [mean(std dev)] for overall quality of vision for the delefilcon A [80.4(16.4)] and comfilcon A [66.8(27.7)] lenses were statistically significant (P=0.002). The difference in the mean overall comfort scores for the delefilcon A lenses [71.6(26.3)] and comfilcon A lenses [63.2(28.9)] was 8.4, which exceeds the establish criteria for clinical significance, although not statistically significant (P=0.08). Overall satisfaction scores were 68.8(26.9) for the delefilcon A and 59.7(30.3) for the comfilcon A lenses (P=0.08). Both lenses provided mean binocular visual acuities better than 20/20 Snellen equivalent. Over half of the participants preferred the delefilcon A lenses based upon comfort, vision, and overall performance. Convenience, ease of use, and satisfaction all scored higher with delefilcon A lenses. Conclusion: The results of this study show that wear experience with delefilcon A lenses for astigmatism can meet or exceed that of comfilcon A toric lenses while also providing healthy, daily disposable lens wear.

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.

Studies of Vision in Cricket-A Narrative Review.

Vision is thought to play a substantial role in hitting and fielding in cricket. An understanding of which visual skills contribute during cricket play could inform future clinical training trials. This paper reviews what has been reported thus far regarding the relationship of visual skills to cricket performance and reviews the results of clinical trials in which the impact of visual skills training on cricket performance has been addressed. Fundamental or low-level visual skills, with the exception of color vision and perhaps near stereopsis and dynamic visual acuity, are similar between cricket players and the general population. Simple reaction time has been found to be shorter in cricket players in some but not all studies. While there is mixed or no evidence that the aforementioned visual skills are superior in cricket players compared to non-players, comparisons of eye and head movements and gaze tracking have revealed consistent differences between elite cricket batters and sub-elite batters. Future training studies could examine whether teaching sub-elite batters to emulate the gaze tracking patterns of elite batters is beneficial for batting. Lastly, clinical trials in which visual skills of cricket players have been trained have in many cases resulted in positive effects on visual skills, or judgments required in cricket, or cricket play. However, clinical trials with larger and more diverse groups of participants and correlations to on-field metrics and on-field performance (i.e., domain-specific assessments) are necessary before conclusions can be drawn regarding the efficacy of vision training.

Novel silicone elastomer contact lenses designed for simultaneous viewing of distance and near eye displays.

SIGNIFICANCE: As technology advances, there is a need for a safe and well-fitting contact lens that can be utilized to carry embedded components without concerns of decreasing oxygen permeability to the eye. PURPOSE: The purpose of this study was to assess fitting characteristics, vision and performance of a novel ultra-high Dk silicone elastomer contact lens having a fully encapsulated two-state polarizing filter and a high-powered central lenslet that allows viewing at distance and viewing of a near eye display, while managing the concomitant high water vapor permeability of the material. METHODS: 15 participants were fit with the silicone elastomer study lenses. Biomicroscopy was conducted before and after lens wear. Visual acuity with manifest refraction and visual acuity with an over-refraction while wearing the plano-powered study lenses were measured. Participants wore spectacles with micro-displays at the focal length of the lenslet on each eye. Lens fit was assessed including ease of lens removal. Subjective assessments of viewing the micro-displays were completed on a 1(unable) to 10(immediate/profound/stable) scale. RESULTS: Biomicroscopy revealed no eyes had moderate or severe corneal staining after study lens wear. Mean (±standard deviation) LogMAR acuity for all eyes was -0.13(0.08) with best corrected refraction and -0.03(0.06) with the study lenses and over-refraction. Mean spherical equivalent of the manifest refraction for both eyes was -3.12 D and was -2.75 D over the plano study lenses. Subjective assessments revealed a mean score of 7.67(1.91) for ease of obtaining fusion; 8.47(1.30) for ease of observing three-dimensional vision, and 8.27(1.49) for stability of the fused binocular display vision. CONCLUSION: The silicone elastomer study lenses with a two-state polarizing filter and central lenslet allow for vision at distance and on spectacle mounted micro-displays.

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 Soft Daily Disposable Lenses for Astigmatism over 16 Hours of Wear.

Objective: The purpose of this study was to assess the wear experience of participants while wearing a toric daily disposable contact lens with water surface technology over long days of lens wear. Methods: Existing soft toric contact lens wearers were fit with the daily disposable study lenses. Participants assessed their initial comfort, vision, and satisfaction with the lenses by visual analog scale (VAS) survey. After a successful 1-week follow-up visit, participants were scheduled for 5 survey days, in which surveys were deployed to their smartphones for immediate assessments of comfort and quality of vision on a 1-10 scale at 10, 12, 14, and 16 hours of lens wear on 5 subsequent weeknights. The final study visit assessed visual acuity, and overall lens wear experience surveys were completed with VAS surveys. The overall median and interquartile (IQR) range of all surveys were calculated. Results: Thirty bilateral toric lens wearers completed the study. Median (IQR) initial impression VAS scores were 97(12) for quality of vision, 100(9) for comfort, and 96(10) for satisfaction. Median evening surveys resulted in comfort scores of 10(1) at 10 hours, 9(2) at 12 hours, 9(2) at 14 hours, and 8(2) at 16 hours of wear. Median evening surveys resulted in quality of vision scores of 10(1) at 10 hours, 10(2) at 12 hours, 9(2) at 14 hours, and 9(3) at 16 hours of wear. VAS scores for overall experience were 97(9) for comfort, 95(13) for vision, and 8(31) for dryness. End-of-day VAS scores were 93(21) for comfort, 90(15) for vision, and 21(38) for dryness. Mean (±standard deviation) OU LogMAR visual acuity with the study lenses was -0.19(0.06). Conclusion: Surveys of wear experience resulted in high scores for comfort and vision over the course of a long day of wear with the daily disposable study lenses in this population of patients with astigmatism.

Long Day Wear Experience with Water Surface Daily Disposable Contact Lenses.

Objective: The purpose of this study was to assess the wear experience of silicone hydrogel daily disposable contact lenses with water surface technology over a long day of lens wear. Methods: Thirty-five soft contact lens wearers were refit with the daily disposable study lenses and participants scored their initial impressions of comfort, vision and satisfaction using a visual analog scale (VAS). Participants used their smart phones to complete surveys of comfort and vision on a scale of 1-10 at 10, 12, 14, and 16 hours of lens wear on 5 weeknights. A participant score for each time point was calculated by averaging the evening responses. End of study VAS surveys of symptoms were also completed. Results: Median (Interquartile Range) VAS initial impression scores were 99.00 (12.00) for quality of vision, 98.00 (16.00) for comfort, and 100.00 (13.00) for satisfaction. The end of study surveys found end of day median VAS scores of 87.00 (19.00) for end of day quality of vision and 75.00 (24.50) for end of day comfort. The median score for overall quality of vision was 93.00 (14.00) and for overall comfort was 93.00 (16.50). The median score for end of day dryness was 37.00 (55.00) and overall dryness was 13.00 (34.00). Conclusion: The daily disposable lenses with water surface treatment used in this study maintained high median scores for comfort and quality of vision for up to 16 hours of wear.

Wear Experience of a Water Surface Daily Disposable Contact Lens in Existing Silicone Hydrogel Planned Replacement Lens Wearers.

Purpose: The health benefits of silicone hydrogel lens materials and a daily replacement modality have been demonstrated in previous studies; however, existing planned replacement lens wearers may resist changing to a new lens replacement schedule. The purpose of this study is to evaluate the wear experience of satisfied planned replacement silicone hydrogel wearers when refit into a silicone hydrogel daily disposable lens. Patients and Methods: In this open-label, non-comparison study, satisfied wearers of two week planned replacement contact lenses were evaluated for inclusion criteria and refit with optimized prescriptions in their habitual lenses. At a follow-up visit one week later, participants were refit with the study daily disposable lenses and completed visual analog scale (VAS) surveys of initial quality of vision, comfort, and satisfaction. Participants returned for a final visit after two weeks of wearing the study daily disposable lenses. At the final visit, VAS surveys for both overall and end of day (EOD) vision, comfort, and dryness were completed. Overall median and interquartile range (IQR) were assessed for all surveys in the study. Results: Thirty individuals completed the study (29.1 ± 7.8 years old; 19 female). Median (IQR) results for the initial impression VAS surveys were 92.50(11.75) for quality of vision, 92.50(18.00) for comfort, and 93.00(18.00) for satisfaction. Final VAS survey results revealed median scores of 87.50(25.00) for EOD quality of vision and 82.50(51.25) for EOD comfort. The median overall quality of vision was 91.00(17.00) and overall comfort was 93.00(28.50). Median (IQR) overall dryness was 28.50(49.00) and median EOD dryness was 30.50(64.25). Conclusion: The findings of this study suggest that providers can successfully refit satisfied wearers of early generation silicone hydrogel planned replacement lenses into a new generation silicone hydrogel daily disposable lens while maintaining satisfaction.

Driving performance and road sign identification by multifocal contact lens wearers in a driving simulator.

PURPOSE: The purpose of this study was to compare sign identification distances and driving performance metrics in presbyopic participants while wearing multifocal contact lenses (MFCL) and while wearing progressive addition lens (PAL) spectacles. METHODS: 19 presbyopic participants completed PAL spectacle assessments and contact lens fitting and follow up visits before driving assessments began. These assessments occurred in a simulator equipped with a full-sized sedan on a motion platform and a 260 degree screen. Participants completed the driving task with PAL and with MFCL. Participants followed a lead car and identified signs at various distances from the road. For the two wearing conditions, comparisons of the distance along the road at which signs were identified were made using repeated measures ANOVA. Paired t-tests were used to compare driving performance for the two conditions. RESULTS: There was no statistical difference in sign identification distance between PAL and MFLC for signs 32.0 m from the road side of the road (182 ± 46 m for MFCL; 205 ± 45 m for PAL; P = 0.07) or 51.4 m from the side of the road (204 ± 43 m for MFCL; 216 ± 36 m for PAL; P = 0.3). Only signs 70.2 m from the roadside showed a significant difference (207 ± 42 m with MFCL; 232 ± 39 m with PAL; P = 0.01), All distances were greater than those required to safely stop a vehicle. There were no significant differences in the driving performance metrics between the refractive corrections. CONCLUSION: Driving performance metrics were similar for MFCL and PAL spectacles. Sign identification distances with both eyewear types were well within the distances required for safe vehicle stopping.

Visual performance with multifocal contact lenses and progressive addition spectacles.

PURPOSE: As presbyopia occurs, new visual demands create a need for clear vision at multiple distances. Many spectacle wearers adapt into progressive addition lenses (PAL) in order to see clearly at distance, intermediate, and near. A multifocal contact lens provides the ability to see at these same distances without the prismatic effects of a spectacle lens or the peripheral obstruction of a spectacle frame. No studies have been done to date comparing the effect of these types of presbyopic vision correction on a variety of tests of visual performance representative of everyday tasks. METHODS: A battery of visual performance tasks were completed by subjects while wearing their habitual PAL spectacles. These subjects were then fit with a multifocal contact lens and wore lenses for 2 weeks or more before completing the tasks again. These functional vision tests included assessments of coincidence anticipation timing, peripheral search and hand-eye coordination, and dynamic visual acuity. Following functional vision testing, subjects completed a preference survey comparing both types of refractive correction while performing common activities of daily living. RESULTS: Performance on the majority of the tests of visual performance were equivalent (P < 0.05) when comparing PAL spectacles and multifocal contact lenses. Survey results demonstrated a preference for multifocal contact lenses overall. CONCLUSION: PAL spectacles are widely prescribed for presbyopic patients. The findings of this study suggest that in addition to providing excellent vision, multifocal contact lenses provide functional vision performance equal to PAL spectacle wear and patients may prefer them over PAL spectacles.

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.

Visual and Ocular Characteristics of eSports Participants.

SIGNIFICANCE: The popularity of competitive video game play is growing rapidly. Little is known about the ocular characteristics of esports participants. Refractive error and binocular measures in young adult gamers were similar to population norms. However, tear breakup time was lower, and accommodative lag was higher. PURPOSE: In a recent report, very young video game players were found to have greater levels of refractive error and heterophoria and reduced stereopsis. The purpose of this study was to assess the visual and ocular characteristics of a group of recreational esports athletes to determine if the findings in young children were similar to findings in a group of young adult video game players. METHODS: Vision tests were performed on 36 college students during a video game combine event. Testing included high- and low-contrast visual acuity, autorefraction at distance and at 33 cm, stereoacuity, near heterophoria, and tear breakup time. Participants also indicated their level or rank in the game Overwatch. RESULTS: Fifteen participants were myopic, and 21 did not wear vision correction. The mean local stereopsis was 31.9 seconds. The mean of the esophoric value was 3.2 prism diopters, and the mean of the exophoric value was 5.7 prism diopters. The mean lag of accommodation was 0.81 D. The mean tear breakup time was 5.8 seconds. Average hours of play did not differ between those who wore vision correction and those who did not. There were no significant relationships between the hours of play and the ocular findings. CONCLUSIONS: The prevalence of refractive error and the mean heterophoria were similar to population norms, and the mean stereoacuity was normal. However, accommodative lag was slightly higher, and the tear breakup time was lower than expected. Differences in these latter values were also noted between high- and low-level Overwatch players.

Midday Fogging of Scleral Contact Lenses: Current Perspectives.

Midday fogging is a common problem in scleral lens wear, as particles accumulate in the tear reservoir between the posterior surface of the lens and the front of the ocular surface during wear. As particulate waste collects, symptoms of blurred vision and discomfort arise, typically leading patients to remove their lenses for cleaning, refilling with fresh solution, and reinsertion into the eye. The appearance of the particulate can vary, likely due to different causes for midday fogging. Studies which attempted to identify the particulate have given some insight into some of the causes, but larger studies are needed to identify this debris. Research on lens solutions used for filling the lens reservoir and of various aspects of scleral lens fits have also begun to culminate in the concept that midday fogging may ultimately be related to inflammation. Since scleral lens wearers can have varied and multiple sources of inflammation, strategies in minimizing midday fogging can differ between patients.

Comparison of Pneumatonometry and Transpalpebral Tonometry Measurements of Intraocular Pressure during Scleral Lens Wear.

SIGNIFICANCE: As scleral lens wear becomes more common, understanding the impact of these lenses upon ocular physiology is critically important. Studies on the effect of scleral lens wear upon intraocular pressure (IOP) have used different instruments and have reported conflicting results. PURPOSE: The purpose of this study was to compare assessment of IOP during scleral lens wear using pneumatonometry and transpalpebral tonometry. METHODS: Twenty healthy subjects wore a small-diameter (15.2 mm) and a large-diameter (18.0 mm) scleral lens on the right eye, each for 1 hour in randomized order. IOP was assessed with pneumatonometry and transpalpebral tonometry on both eyes before lens application, immediately after lens application, after 1 hour of lens wear, and immediately after lens removal. Paired t test compared mean IOP in the study eye to the control eye. Repeated-measures ANOVA was performed to take instrumentation, lens diameter, and their interaction into account in an analysis of the change in IOP in the study eye. RESULTS: Mean peripheral IOP measured with pneumatonometry was not significantly different from baseline at any subsequent measurement. Measurements with transpalpebral tonometry, however, were significantly different during scleral lens wear immediately after application and after 1 hour of wear with both diameter lenses (P < .005), but were not significantly different after either sized lens was removed. Repeated-measures ANOVA revealed that the instrument used to measure IOP was a significant factor in IOP changes found during lens wear (P ≤ .001). CONCLUSIONS: Assessment of IOP during scleral lens wear varies based upon the instrument that is used. Although further studies are clearly needed to further elucidate this issue, clinicians should continue to monitor optic nerve structure and function in scleral lens wearers, as they do in all patients.

Changes in Symptoms of Midday Fogging with a Novel Scleral Contact Lens Filling Solution.

SIGNIFICANCE: Midday fogging of scleral contact lenses requires frequent lens removal and reapplication for a large portion of lens wearers. Using a lens filling solution that mimics the composition of tears is hypothesized to have an impact on the production of material trapped under a scleral lens. PURPOSE: The purposes of this open-label study were to assess the safety of a scleral lens filling solution, which closely approximates the ionic concentration and pH of human tears, and to assess signs and symptoms of midday fogging with this formulation and with subjects' habitual sodium chloride solutions. METHODS: Existing scleral lens wearers with midday fogging (N = 22) were examined and completed surveys of symptoms. Subjects filled the concavity of their current lenses with test solution and were assessed immediately and approximately 4 hours later for safety monitoring. Test solution was dispensed and used for 5 to 9 days when subjects were reexamined and repeated the surveys. Biomicroscopy and anterior optical coherence tomography images were used to assess midday fogging objectively. RESULTS: The median (interquartile range) Ocular Surface Disease Index score decreased from 27.1 (21.7) U when using habitual filling solution to 9.1 (20.1) U when using the test solution (P = .006). Current Symptoms Survey findings with the test solution compared with habitual solution resulted in statistically significant decreases in burning/stinging (P = .04), grittiness/foreign body sensation (P = .01), dryness (P = .002), blurry/fluctuating vision (P = .002), and overall pain/discomfort (P = .006). Objective assessment of corneal staining and fogging revealed decreases that were not statistically significant in this small sample size. CONCLUSIONS: This study establishes the safety and subject tolerance of a scleral lens filling solution that mimics the ionic composition of human tears. Significant improvements in subjective ratings, although likely biased in this unmasked trial, suggest that further studies of the effectiveness of this solution in reducing midday fogging are warranted.