The influence of the tear film on the intraocular pressure and the corneal biomechanical properties analyzed with the Ocular Response Analyzer / La influencia de la película lagrimal sobre la presión intraocular y las propiedades biomecánicas corneales analizadas con el Analizador de Respuesta Ocular

Purpose: As ocular dryness and glaucoma are more prevalent with increasing age, understanding how the tear film affects tonometry is important. The present study aims to understand the impact that changes in the tear film have on intraocular pressure (IOP), corneal hysteresis, and corneal resistance factor measurements. Methods: Cross-sectional research was conducted and 37 patients were assessed. The tear film lipid layer and the non-invasive break-up time (NIBUT) were evaluated using the Tearscope Plus (Keeler, Windsor, UK). Dry eye symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. IOP was measured using rebound tonometry and the Ocular Response Analyzer (ORA, Reichert). Corneal biomechanical properties were measured using ORA. Results: It was found that an increase in the IOP measured with the iCare was directly correlated with the subclass that evaluated symptomatology associated with environmental factors (r = 0.414, p<0.05, Spearman). Goldmann-correlated IOP (IOPg) and Corneal-compensated IOP (IOPcc) values were statistically significantly different between the various interferometric patterns (p<0.05). It was also found that an increase in the corneal biomechanical properties measured with ORA was directly correlated with the overall scores obtained when using the OSDI and some of its subclasses. Conclusions: Tear film interferometric patterns were shown to have some impact on the IOP measured using ORA. The IOP measured with iCare seems to be related to the symptomatology obtained from OSDI. Corneal biomechanical properties were related to the OSDI total score and some of its subclasses. An increase in symptomatology was associated with an increase in the measured biomechanical properties of the cornea.(AU)

The influence of the tear film on the intraocular pressure and the corneal biomechanical properties analyzed with the Ocular Response Analyzer.

PURPOSE: As ocular dryness and glaucoma are more prevalent with increasing age, understanding how the tear film affects tonometry is important. The present study aims to understand the impact that changes in the tear film have on intraocular pressure (IOP), corneal hysteresis, and corneal resistance factor measurements. METHODS: Cross-sectional research was conducted and 37 patients were assessed. The tear film lipid layer and the non-invasive break-up time (NIBUT) were evaluated using the Tearscope Plus (Keeler, Windsor, UK). Dry eye symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. IOP was measured using rebound tonometry and the Ocular Response Analyzer (ORA, Reichert). Corneal biomechanical properties were measured using ORA. RESULTS: It was found that an increase in the IOP measured with the iCare was directly correlated with the subclass that evaluated symptomatology associated with environmental factors (r = 0.414, p<0.05, Spearman). Goldmann-correlated IOP (IOPg) and Corneal-compensated IOP (IOPcc) values were statistically significantly different between the various interferometric patterns (p<0.05). It was also found that an increase in the corneal biomechanical properties measured with ORA was directly correlated with the overall scores obtained when using the OSDI and some of its subclasses. CONCLUSIONS: Tear film interferometric patterns were shown to have some impact on the IOP measured using ORA. The IOP measured with iCare seems to be related to the symptomatology obtained from OSDI. Corneal biomechanical properties were related to the OSDI total score and some of its subclasses. An increase in symptomatology was associated with an increase in the measured biomechanical properties of the cornea.

Evidence for commonly used teaching, learning and assessment methods in contact lens clinical skills education.

INTRODUCTION: Evidence based practice is now an important part of healthcare education. The aim of this narrative literature review was to determine what evidence exists on the efficacy of commonly used teaching and learning and assessment methods in the realm of contact lens skills education (CLE) in order to provide insights into best practice. A summary of the global regulation and provision of postgraduate learning and continuing professional development in CLE is included. METHOD: An expert panel of educators was recruited and completed a literature review of current evidence of teaching and learning and assessment methods in healthcare training, with an emphasis on health care, general optometry and CLE. RESULTS: No direct evidence of benefit of teaching and learning and assessment methods in CLE were found. There was evidence for the benefit of some teaching and learning and assessment methods in other disciplines that could be transferable to CLE and could help students meet the intended learning outcomes. There was evidence that the following teaching and learning methods helped health-care and general optometry students meet the intended learning outcomes; clinical teaching and learning, flipped classrooms, clinical skills videos and clerkships. For assessment these methods were; essays, case presentations, objective structured clinical examinations, self-assessment and formative assessment. There was no evidence that the following teaching and learning methods helped health-care and general optometry students meet the intended learning outcomes; journal clubs and case discussions. Nor was any evidence found for the following assessment methods; multiple-choice questions, oral examinations, objective structured practical examinations, holistic assessment, and summative assessment. CONCLUSION: Investigation into the efficacy of common teaching and learning and assessment methods in CLE are required and would be beneficial for the entire community of contact lens educators, and other disciplines that wish to adapt this approach of evidence-based teaching.

Eye-LRCN: A Long-Term Recurrent Convolutional Network for Eye Blink Completeness Detection.

Computer vision syndrome causes vision problems and discomfort mainly due to dry eye. Several studies show that dry eye in computer users is caused by a reduction in the blink rate and an increase in the prevalence of incomplete blinks. In this context, this article introduces Eye-LRCN, a new eye blink detection method that also evaluates the completeness of the blink. The method is based on a long-term recurrent convolutional network (LRCN), which combines a convolutional neural network (CNN) for feature extraction with a bidirectional recurrent neural network that performs sequence learning and classifies the blinks. A Siamese architecture is used during CNN training to overcome the high-class imbalance present in blink detection and the limited amount of data available to train blink detection models. The method was evaluated on three different tasks: blink detection, blink completeness detection, and eye state detection. We report superior performance to the state-of-the-art methods in blink detection and blink completeness detection, and remarkable results in eye state detection.

Effects of contact lens wear on tear inflammatory biomarkers.

PURPOSE: This review article intends to critically review the available literature relating to the behavior of tear-borne inflammatory biomarkers during contact lens wear. METHODS: The workflow protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. An exhaustive search was carried out using the PubMed database. The analysis included a list of 34 eligible clinical trials: Thirty addressed the use of soft contact lenses, three focused on rigid gas permeable lenses; and one on scleral lenses. The biomarkers' presence was described as changes in the molecular concentration compared to control groups - non-contact lens wearers - or baseline measurements. RESULTS: Contact lens wear inflates the concentration of several inflammatory molecules in tears. Most relevant changes were found for IL-1ß, IL-6, IL-8, IL-17, LTB4, and MMP-9. The use of rigid gas permeable lenses seems to produce a more robust sub-clinical inflammatory response than soft contact lenses, with significant contributions of IL-8, MMP-9, and EGF. Reusable lenses that are worn continuously or on a daily modality are more likely to raise the expression of biomarkers compared to daily disposables. CONCLUSION: Mechanical trauma, hypoxia, and wearing schedules may be associated with a distinct sub-clinical inflammatory response in contact lens wearers. The relationship between these responses and contact lens-induced discomfort remains unclear, as the existing scientific evidence is still scarce. More clinical studies are still needed to prove the impact of reverse geometry and scleral lens wear on the behavior of tear-borne biomarkers.

Intraocular pressure measurement: A review.

Glaucoma is the leading cause of irreversible blindness, affecting around 80 million people worldwide. Glaucoma is a multifactorial disease of poorly understood pathogenesis, with intraocular pressure being the most significant risk factor. Currently there are different methods of intraocular pressure measurement, based on different physical principles, some of which are continuous measurement methods and others which are only measured in the medical office. The importance of the corneal biomechanical properties in intraocular pressure measurement is becoming increasingly clear. With the development of new instruments that can measure them, it will become possible to obtain more accurate intraocular pressure measurements within a short period of time. In the future, glaucoma patients will be better monitored with instruments capable of measuring intraocular pressure 24 hours a day.

Prevalence of binocular vision dysfunctions in professional football players.

CLINICAL RELEVANCE: The extent of binocular vision dysfunction in elite soccer players needs to be determined as it may impact performance. BACKGROUND: The purpose of the study was to investigate the prevalence of binocular vision dysfunctions in elite soccer players. METHODS: One hundred and seven professional soccer players were evaluated. Refractive error was measured and the following binocular vision parameters were assessed: horizontal and vertical phoria for distance and near vision, the values of break and recovery for negative and positive fusional vergences at distance and near vision, vergence facility at distance and near vision, monocular accommodative facility at near vision, and near point of convergence (break and recovery points). All the athletes were men with a mean age of 24.4 ± 4.8 years. RESULTS: No athlete was diagnosed with divergence excess, divergence insufficiency, or basic exophoria. About 13.0% of the athletes have binocular vision dysfunctions related to esophoria (0.9% with esophoria at near vision and 12.1% with esophoria at distance and near vision). About 10.3% have convergence insufficiency and 2.8% were diagnosed with fusional vergence dysfunction. The only accommodation-related parameter analysed was accommodative infacility, and 6.5% of the athletes had this dysfunction. Vertical phoria was present in 3.7% of the athletes. No statistically significant differences were found based on in athletes with respect to ethnicity, position occupied on the field, age, ametropia or laterality. CONCLUSION: The overall prevalence of binocular vision dysfunction in elite soccer players was 36.4%. The most prevalent dysfunctions are related to the presence of esophoria (13.0%). The values found point out the need to include binocular vision assessment protocols in the visual assessment routine for athletes.

Interactions between contact lenses and lens care solutions: Influence in optical properties.

PURPOSE: Investigate changes in optical properties of contact lenses materials (transmittance and reflectance) and lens care solutions (absorption and fluorescence) resulting from its interaction. METHODS: From an experimental study, triplicate measurements of transmittance and reflectance of five contact lenses (Senofilcon A, Lotrafilcon B, Balafilcon A, Comfilcon A, and Omafilcon A), as well as UV-vis absorption and fluorescence of four lens care solutions (LCS) (ReNu MultiPlus, Biotrue, OPTI-FREE PureMoist, and AOSept Plus), were evaluated before and after 8 h, one day and one week in storage. The outcomes were provided by Shimadzu UV3101-PC UV-vis-NIR spectrophotometer equipped with an integrating sphere, between 200-700 nm, and SPEX-Fluorolog 2 FL3-22 spectrofluorometer. RESULTS: All variables exhibited statistically significant differences over time. Comfilcon A showed the lowest ultraviolet radiation (UVR) A & B attenuation. Balafilcon A and Lotrafilcon B displayed a slight suppression of UVR. Senofilcon A was effective in UVR protection and showed less effect on the fluorescence of lens care solutions. Overall, the reflectance decreased after storage (p < 0.05). AOSept Plus absorbance and fluorescence demonstrated lower interactions than multipurpose solutions (MPS), and Lotrafilcon B induced more remarkable changes in optical properties of LCS than the other materials. CONCLUSION: The findings suggest that optical variables of lens care solutions and contact lenses changed mutually after storage, probably associated with biochemical and biophysical interactions between components and the release of some polymer compounds. These findings can provide additional information about the interaction of CL materials and LCS in clinical behavior.

Acanthamoeba keratitis: a review of biology, pathophysiology and epidemiology.

Acanthamoeba keratitis is an infection caused by a unicellular protozoan of the genus Acanthamoeba that is universally widespread. Until now, most cases were reported in contact lens wearers, although it is also a reality for non-wearers, mostly connected to corneal trauma. There is also a variation in incidence regarding the aetiology of the disease between developed and developing countries. PURPOSE: This work is based on a literature review, and the main goal is to deepen the knowledge about Acanthamoeba keratitis, presenting the main risk factors and focusing on prevention actions for this type of corneal infection since the treatments are not always effective. It targets specialists in visual health to strengthen their knowledge in this area, as well as to allow them to better inform their patients about hygiene care, appropriate measures of disinfection and ways to minimise the risk of infection. At this stage, it is important to highlight the essential role that practitioners play in fitting, monitoring and following-up patients to minimise the danger of infection. RECENT FINDINGS: It is well recognised that corneal trauma facilitates invasion by leaving an open door for microorganisms to penetrate the cornea. In addition to trauma, risk factors are mostly associated with patients' behaviours, such as interaction of contact lenses with contaminated water in the shower, swimming pools and beaches, etc., lack of hygiene habits with contact lenses and respective cases, and the use of ineffective disinfecting solutions. The fact that a disinfecting solution is not completely effective against trophozoites and/or cysts, both forms of Acanthamoeba's lifecycle, can cause the infection since one cyst alone leads to the emergence of a whole new population of Acanthamoeba. SUMMARY: It is necessary to reduce the risk of infection and, beyond the need to promote patient education to encourage correct CL hygiene behaviours, it should also be highlighted that there is an urgent need to enhance the efficacy of CL disinfection systems against all strains and both stages of Acanthamoeba through the creation of standardised methods. The ease of purchasing CLs without any supervision must also be considered a concern, and, in the near future, it is also important to develop and implement effective diagnostic methods and treatments for Acanthamoeba keratitis.

Contrast sensitivity function with soft contact lens wear / Función de sensibilidad al contraste con el uso de lentes de contacto blandas

PURPOSES: To compare contrast sensitivity function (CSF) with soft contact lens (SCL) and spectacles wear. To investigate the effect of a three-month period of SCL wear on CSF. METHODS: Forty-seven myopic subjects with no history of contact lens (CL) wear were included in this longitudinal prospective study. CSF was measured with spectacles using the CSV-1000 (VectorVision, Greenvile, OH). Subsequently, subjects were fitted with a daily disposable lens (Nelfilcon-A, Stenofilcon-A or Nesofilcon-A) in one eye and a monthly disposable lens (Lotrafilcon-B, Comfilcon-A or Balafilcon-A) in the other eye and wore the same type of CLs for three months. CSF was measured again on the same day and after three months wearing CLs. Differences in CSF with spectacles and CLs on baseline and changes to CSF after three months of CLs wear were assessed. The effect of lens materials and wearing modality on CSF change was also investigated. RESULTS: CSF was higher with CLs in comparison to the values with spectacles for spatial frequencies of 3, 6 and 12 cycles per degree (cpd) (p < 0.05) while there was no difference for spatial frequency of 18 cpd (p = 0.114). No significant difference was found in the CSF with CLs between baseline and after three months of lens wear (p > 0.05). There was no difference in CSF between hydrogel and silicone CLs as well as when comparing daily with monthly wear CLs (p > 0.05). CONCLUSIÓN: CSF is better with CLs than with spectacles. CSF values with CL are similar between baseline and after 3 months of lens wear

OBJETIVOS: Comparar la función de sensibilidad al contraste (CSF) con el uso de lentillas blandas y gafas. Investigar el efecto en la CSF de un periodo de uso de lentillas blandas de tres meses. MÉTODOS: En este estudio longitudinal prospectivo incluimos a cuarenta y siete sujetos miopes sin antecedentes de uso de lentillas. La CSF se midió con gafas, utilizando el sistema CSV-1000 (VectorVision, Greenvile, OH). A continuación, se proporcionaron a los sujetos lentillas diarias desechables (Nelfilcon-A, Stenofilcon-A o Nesofilcon-A) en un ojo, y lentillas mensuales desechables (Lotrafilcon-B, Comfilcon-A or Balafilcon-A) en el otro ojo, utilizándose el mismo tipo de lentillas durante tres meses. Se volvió a medir la CSF el mismo día, y transcurridos tres meses de uso de lentillas. Se evaluaron las diferencias en cuanto a CSF con gafas y lentillas al inicio, y los cambios de CSF transcurridos tres meses de uso de lentillas. También se investigó el efecto en el cambio de CSF de las modalidades de las lentillas y la modalidad de uso. RESULTADOS: La CSF fue más alta con el uso de lentillas, en comparación con el uso de gafas para las frecuencias espaciales de 3, 6 y 12 ciclos por grado (cpg) (p < 0,05), mientras que no se produjo diferencia para la frecuencia espacial de 18 cpg (p = 0,114). No se encontró diferencia significativa de CSF entre el valor basal y transcurridos tres meses de uso de lentillas (p > 0,05). No se encontró diferencia de CSF entre las lentillas de hidrogel y silicona, ni al comparar el uso de lentillas diarias y mensuales (p > 0,05). CONCLUSIÓN: La CSF es mejor con lentillas que con gafas. Los valores de CSF con el uso de lentillas son similares entre el valor basal y transcurridos tres meses de uso de lentillas

Physicochemical stability of contact lenses materials for biomedical applications / Estabilidad fisicoquímica de los materiales de las lentes de contacto, para aplicaciones biomédicas

PURPOSE: The physicochemical stability, thermal and water plasticizing effect on transport properties of contact lenses (CL) were analyzed to verify its capacity to maintain the original properties after being dehydrated and rehydrated. METHODS: Two daily disposable (nesofilcon A and delefilcon A) and two monthly CL (comfilcon A and lotrafilcon B) were used. Measurements of refractive index (RI), water content (WC), chemical structure and thermal properties were taken: new (N), after dehydration (D) and rehydrated (R). RI and WC were accessed using a digital automated refractometer (CLR-12-70). Chemical structure was evaluated by a Fourier Transformed Infrared Spectroscopy (FTIR-ATR) and Differential Scanning Calorimetry (DSC) with a calorimeter (Mettler Toledo DSC-821). RESULTS: The FTIR spectrum of N, D and R was quite similar for all CL, with higher differences observed in the transmission between 3500-3000cm−1 due to the hydroxyl group (OH). After dehydration and rehydration, there were no significant changes in the chemical structure. RI and WC of the CL rehydrated did not vary significantly from the initial CL (p > 0.05) and thermal properties also confirm that the behavior did not change. It was observed that the glass-transition temperature decrease with increased WC. CONCLUSIÓN: No significant alterations were observed in the physicochemical structure of the materials after dehydration and rehydration showing a good stability of their components. The strong water plasticizing effect in the silicone hydrogel lens materials improves flexibility and chain mobility and may should be considered for other biomedical applications

OBJETIVO: Se analizaron la estabilidad fisicoquímica, las propiedades térmicas y el efecto plastificante en las propiedades de transporte de las lentes de contacto (LC), para verificar su capacidad de mantener sus propiedades originales tras la deshidratación y rehidratación. MÉTODOS: Se utilizaron dos lentes de contacto desechables diarias (nesofilcon A y delefilcon A) y dos mensuales (comfilcon A y lotrafilcon B). Se realizaron medidas del índice de refracción (IR), contenido de agua (CA), estructura química y propiedades térmicas: nuevas (N), tras la deshidratación (D) y tras la rehidratación (R). Se accedió a IR y CA utilizando un refractómetro digital automatizado (CLR-12-70). La estructura química se evaluó mediante Espectroscopía de infrarrojos con transformada de Fourier (FTIR-ATR) y Calorimetría diferencial de barrido (DSC) con un calorímetro (Mettler Toledo DSC-821). RESULTADOS: El espectro FTIR de N, D y R fue bastante similar para todas las LC, observándose mayores diferencias en la transmisión entre 3500-3000cm−1 debido al grupo hidroxilo (OH). Tras la deshidratación y rehidratación no se produjeron cambios significativos en la estructura química. Los valores IR y CA de las LC rehidratadas no variaron significativamente con respecto a la LC inicial (p > 0,05), y las propiedades térmicas confirmaron también que el comportamiento no experimentó cambio alguno. Se observó que la temperatura vidrio-transición disminuía al incrementarse WC. CONCLUSIÓN: No se observaron alteraciones significativas en la estructura fisicoquímica de los materiales tras la deshidratación y rehidratación, reflejando una buena estabilidad de sus componentes. El fuerte efecto plastificante del agua en los materiales de las lentes de hidrogel de silicona mejora la flexibilidad y la movilidad de la cadena, debiendo considerarse esta circunstancia para otras aplicaciones biomédicas

Contrast sensitivity function with soft contact lens wear.

PURPOSES: To compare contrast sensitivity function (CSF) with soft contact lens (SCL) and spectacles wear. To investigate the effect of a three-month period of SCL wear on CSF. METHODS: Forty-seven myopic subjects with no history of contact lens (CL) wear were included in this longitudinal prospective study. CSF was measured with spectacles using the CSV-1000 (VectorVision, Greenvile, OH). Subsequently, subjects were fitted with a daily disposable lens (Nelfilcon-A, Stenofilcon-A or Nesofilcon-A) in one eye and a monthly disposable lens (Lotrafilcon-B, Comfilcon-A or Balafilcon-A) in the other eye and wore the same type of CLs for three months. CSF was measured again on the same day and after three months wearing CLs. Differences in CSF with spectacles and CLs on baseline and changes to CSF after three months of CLs wear were assessed. The effect of lens materials and wearing modality on CSF change was also investigated. RESULTS: CSF was higher with CLs in comparison to the values with spectacles for spatial frequencies of 3, 6 and 12 cycles per degree (cpd) (p<0.05) while there was no difference for spatial frequency of 18 cpd (p=0.114). No significant difference was found in the CSF with CLs between baseline and after three months of lens wear (p>0.05). There was no difference in CSF between hydrogel and silicone CLs as well as when comparing daily with monthly wear CLs (p>0.05). CONCLUSION: CSF is better with CLs than with spectacles. CSF values with CL are similar between baseline and after 3 months of lens wear.

Physicochemical stability of contact lenses materials for biomedical applications.

PURPOSE: The physicochemical stability, thermal and water plasticizing effect on transport properties of contact lenses (CL) were analyzed to verify its capacity to maintain the original properties after being dehydrated and rehydrated. METHODS: Two daily disposable (nesofilcon A and delefilcon A) and two monthly CL (comfilcon A and lotrafilcon B) were used. Measurements of refractive index (RI), water content (WC), chemical structure and thermal properties were taken: new (N), after dehydration (D) and rehydrated (R). RI and WC were accessed using a digital automated refractometer (CLR-12-70). Chemical structure was evaluated by a Fourier Transformed Infrared Spectroscopy (FTIR-ATR) and Differential Scanning Calorimetry (DSC) with a calorimeter (Mettler Toledo DSC-821). RESULTS: The FTIR spectrum of N, D and R was quite similar for all CL, with higher differences observed in the transmission between 3500-3000cm-1 due to the hydroxyl group (OH). After dehydration and rehydration, there were no significant changes in the chemical structure. RI and WC of the CL rehydrated did not vary significantly from the initial CL (p>0.05) and thermal properties also confirm that the behavior did not change. It was observed that the glass-transition temperature decrease with increased WC. CONCLUSION: No significant alterations were observed in the physicochemical structure of the materials after dehydration and rehydration showing a good stability of their components. The strong water plasticizing effect in the silicone hydrogel lens materials improves flexibility and chain mobility and may should be considered for other biomedical applications.

Daily versus monthly disposable contact lens: Which is better for ocular surface physiology and comfort?

PURPOSE: To investigate the effect of soft contact lenses (SCL) wearing modality and lens materials on the changes in conjunctival bulbar and limbal redness and conjunctival and corneal staining after two months of SCL wear. Comfort level was also analyzed. METHODS: In this longitudinal clinical trial, forty-seven neophyte myopic subjects were fitted with a monthly disposable lens (lotrafilcon-B or comfilcon-A or balafilcon-A) in one eye and a daily disposable lens (nelfilcon-A or stenofilcon-A or nesofilcon-A) in the other eye, randomly selected. Conjunctival bulbar and limbal redness and conjunctival and corneal staining were evaluated before and after lens wear. Effect of lens wearing modality and lens materials on these changes was also determined. Level of comfort was evaluated subjectively twice per day. Comfort level and reduction in end-of-day comfort were compared between different lens wearing modalities and materials. RESULTS: Bulbar and limbal redness and conjunctival and corneal staining were increased (p<0.001) after lens wear, and changes were similar with daily and monthly disposable lens wear (p>0.05). Limbal redness was associated with lens materials, and lotrafilcon-B induced the least among the studied lenses (p<0.05). There was no significant association between the wearing modality and the average comfort level and reduction of end-of-day comfort (p>0.05). CONCLUSION: Two months of SCL wear increased conjunctival redness, conjunctival and corneal staining, which were not associated with the lens wearing modality. There was a reduction in end-of-day comfort, similar to daily and monthly lenses. The change in limbal redness and reduction in end-of-day comfort were associated with the characteristics of the lens material.

Comfort, Ocular Dryness, and Equilibrium Water Content Changes of Daily Disposable Contact Lenses.

OBJECTIVES: The objective of this investigation was to evaluate the level of comfort and ocular dryness during wear with six daily disposable contact lenses (DDCL) and also determine the changes in contact lens equilibrium water content (EWC) resulting from their wear. METHODS: In this contralateral open trial, 27 subjects were randomly fitted with six DDCL (stenfilcon A, delefilcon A, nelfilcon A, narafilcon A, nesofilcon A, and omafilcon A). The evaluation of comfort and ocular dryness sensation was recorded by the participants at two moments of the day (11 AM and 5 PM) over a period of 10 days of contact lens wear. The assessment was made with the aid of visual analogue scales (0-10). The refractive index of 54 contact lenses was accessed by a single operator using a digital automated refractometer (CLR 12-70; Index Instruments). The EWC of the lenses was estimated based on its refractive index values. RESULTS: Comfort ratings were slightly higher for delefilcon A (9.56±0.67, P=0.01) and narafilcon A (9.40±0.93, P=0.01) and these lenses wearers also reported less ocular dryness. The results revealed a pronounced water content reduction for omafilcon A (P=0.002), narafilcon A (P=0.008), and nesofilcon A (P=0.003). CONCLUSION: Although changes in subjective responses and EWC were distinct among the materials analyzed, all the contact lenses performed well during the 10 days of wear.

Effect of Lens Care Systems on Silicone Hydrogel Contact Lens Hydrophobicity.

PURPOSE: To analyze changes in wettability of hydrogel and silicone hydrogel contact lenses (CLs) when preserved in different lens care systems. METHODS: In this research, four silicone hydrogel CLs (senofilcon A, balafilcon A, comfilcon A, and lotrafilcon B) and one conventional CL (etafilcon A) and appropriate lens care solutions (ReNu MultiPlus, Biotrue, OPTI-FREE PureMoist, and AOSept Plus) were used. Lenses were immersed in each lens care system for 12 hr and then CL hydrophobicity was determined through water contact angle (CA) measurements using the OCA 20 instrument (DataPhysics). RESULTS: Mean CA values obtained when CLs were removed from blisters (baseline value) were lower for etafilcon A (49.6°±3.0°) and comfilcon A (48.0°±2.8°) and higher for senofilcon A (78.9°±2.5°), lotrafilcon B (82.6°±1.7°), and balafilcon A (91.5°±0.7°). Depending on CL and lens care combination, it was detected a statistically significant reduction by 70% of the 20 combinations studied and any significant increase in the CA. When compared to baseline values, CA varied between etafilcon A: 2° and 11°, comfilcon A: 1° and 7°, senofilcon A: 2° and 28°, lotrafilcon B: 14° and 31°, and balafilcon A: 18° and 29°. Comfilcon A was the most stable lens material presenting only one significant decrease in CA. CONCLUSIONS: This study reveals the existence of interactions between CL material and lens solutions that can play an important role in CL surface wettability. The major changes were obtained in lenses with higher baseline CA, which showed significant changes with each of the solutions. These differences can be positive, because in almost all of the combinations, the lenses became more wettable.

iDEAS: A web-based system for dry eye assessment.

BACKGROUND AND OBJECTIVES: Dry eye disease is a public health problem, whose multifactorial etiology challenges clinicians and researchers making necessary the collaboration between different experts and centers. The evaluation of the interference patterns observed in the tear film lipid layer is a common clinical test used for dry eye diagnosis. However, it is a time-consuming task with a high degree of intra- as well as inter-observer variability, which makes the use of a computer-based analysis system highly desirable. This work introduces iDEAS (Dry Eye Assessment System), a web-based application to support dry eye diagnosis. METHODS: iDEAS provides a framework for eye care experts to collaboratively work using image-based services in a distributed environment. It is composed of three main components: the web client for user interaction, the web application server for request processing, and the service module for image analysis. Specifically, this manuscript presents two automatic services: tear film classification, which classifies an image into one interference pattern; and tear film map, which illustrates the distribution of the patterns over the entire tear film. RESULTS: iDEAS has been evaluated by specialists from different institutions to test its performance. Both services have been evaluated in terms of a set of performance metrics using the annotations of different experts. Note that the processing time of both services has been also measured for efficiency purposes. CONCLUSIONS: iDEAS is a web-based application which provides a fast, reliable environment for dry eye assessment. The system allows practitioners to share images, clinical information and automatic assessments between remote computers. Additionally, it save time for experts, diminish the inter-expert variability and can be used in both clinical and research settings.

Effect of three months of soft contact lens wear on conjunctival cytology.

BACKGROUND: The purpose of this study was to investigate the effect of three months of soft contact lens wear on conjunctival goblet cell density and epithelial cell morphology. METHODS: This was a longitudinal clinical trial. Conjunctival impression cytology was performed on the superior palpebral conjunctiva in fifty-four eyes of twenty-seven neophyte contact lens wearers before and after three months of contact lens wear. Goblet cell density was determined by optical microscopy and epithelial cell morphology was classified according to the Tseng classification. Changes in goblet cell density as well as epithelial cell grading were determined. The effects of lens material and wearing modality on cytological changes were also investigated. RESULTS: Goblet cell density reduced significantly by 85 ± 151 cells/mm(2) (p < 0.001) after three months of contact lens wear. Reduction in goblet cell density was associated with lens materials; it was higher in conventional hydrogel lenses in comparison to silicone-hydrogel lenses (p = 0.008). The highest reduction in goblet cell density was found with Nelfilcon A lens wear (p = 0.002) and the lowest with Comfilcon A lens wear (p = 0.414). There was no statistically significant difference in grading of epithelial metaplasia before and after three months of contact lens wear (p = 0.075). Age was not correlated with the reduction in goblet cell density (r = -0.196, p = 0.160) but it was associated with the change in epithelial cell morphology (p = 0.036). CONCLUSION: Three months of soft contact lens wear statistically significantly reduced goblet cell density; however, no significant changes were found in the grading of epithelial metaplasia. Contact lenses with lower oxygen permeability, higher Young modulus and higher thickness highly affected the conjunctival cytology.