Strategies and attitudes on the management of myopia in clinical practice in Spain

Objective: In 2019, an international survey was conducted to evaluate strategies and attitudes in the management of myopia in clinical practice worldwide. This study reports on the results found in Spain and how these results compare with those from other regions of the world.MethodsA self-administrated, internet-based questionnaire was distributed to eye care professionals around the world through professional associations. The questions examined were based on the available strategies and their use.ResultsA total of 173 Spanish optometrists, of the 1,336 practitioners from the five different continents who participated in the study, responded to the online survey. Spain, Asia and South America were found among the regions with the highest concern regarding the increased incidence of myopia (p ≤ 0.001). However, in these regions, the prescription of single-vision spectacles and single-vision contact lenses continues to be the main methods of visual correction prescribed to young myopic patients (p ≤ 0.001). Spanish practitioners, like those from other regions, considered orthokeratology to be the most effective treatment to control myopia progression (p ≤ 0.001). The major reasons why Spanish practitioners were not prescribing myopia control strategies were increased cost, inadequate information and unpredictable outcomes (p < 0.05).ConclusionsThe uptake of myopia control methods by Spanish practitioners is relatively low, despite the increase in the prevalence of paediatric myopia as well as increased concern and perceived clinical activity in the area in recent years. (AU)

Clinical evaluation of flat peripheral curve design with aspherical-curve and multi-curve hard contact lenses for keratoconus.

Aspherical- and multi-curve rigid gas-permeable hard contact lenses (HCLs) have a flattened curve in the peripheral zone and are mostly used for patients with keratoconus who cannot wear glasses, soft contact lenses, or spherical HCLs. In this retrospective study, a total of 95 eyes of 77 patients who used aspherical- or multi-curve HCLs (mean age: 40.0 ± 11.0 years) were evaluated. This study examined the types of aspherical- and multi-curve HCLs, best-corrected visual acuity (BCVA) values before and after wearing HCLs, the association with the Amsler-Krumeich classification, duration of wear, corneal/conjunctival disorder, and the frequency of changing HCLs. There were 78 eyes that used aspherical-curve HCLs and 17 that used multi-curve HCLs. BCVA significantly improved from 0.42 logMAR to 0.06 logMAR after wearing either form of HCL. The Amsler-Krumeich classification showed that aspherical-curve HCLs were commonly used for patients with stage 2 keratoconus, and multi-curve HCLs were commonly used for stage 4 patients. The BCVA values were worse when the disease stage was more severe (stages 3 and 4) regardless of HCL type. The mean base curve of the lenses was steeper in multi-curve HCLs than in aspherical-curve HCLs. The more severe the disease stage, the steeper the base curve in both aspherical- and multi-curve HCLs. The duration of wear significantly improved from 2.1 h to 10.2 h, and corneal/conjunctival disorder similarly improved. The mean frequency of changing HCL types was 1.1 times. This study suggests that a flat peripheral curve design with aspherical- and multi-curve HCLs is useful for patients with keratoconus.

Multifocal contact lenses: A bibliometric study

Purpose: To analyze the state of scientific publications in multifocal contact lenses field through a bibliometric study.Methods: The database used to carry out the study was SCOPUS and contained the descriptors “multifocal contact lens”, “bifocal contact lenses”, “progressive contact lenses” and “presbyopia contact lenses”, limited to the fields of title, keywords and abstract. The indicators applied in this research were: doubling time and annual growth rate, Price’s transience index, Lotka’s law of scientific productivity, and Bradford’s zones.Results: A total of 346 articles were published between 1960 and 2019. The growth in the number of publications matches the exponential adjustment slightly better (R = 0.53). The duplication time was 13.2 years. The productivity level is focused on articles with an average number of authors of just 2.06 per article. The Bradford core was formed by two journals, Optometry and Vision Science and Eye and Contact Lens.Conclusions: Research on multifocal contact lenses has exponential growth, without evidence of having reached a saturation point. The main countries in scientific production in this field are the United States and Australia. (AU)

Next-generation contact lenses: Towards bioresponsive drug delivery and smart technologies in ocular therapeutics.

In contrast to the conventional ocular formulations, contact lenses are well known for their diverse applications ranging from bio-sensing, prevention of myopia, cosmetics, and drug delivery. With a tremendous change in the lifestyle, contact lenses for therapeutic purposes have increased several fold. Contact lenses as medicated lenses suffer from several disadvantages, and to overcome the same numerous approaches have been explored. Researches worldwide have come a long way from cyclodextrin-based and vitamin E-based modified contact lenses to bioinspired approaches to enhance the effectiveness of the drug-eluting contact lenses. The bioinspired approach exploits bioinspired polymeric systems to enhance biocompatibility, specific molecule recognition technique by molecular imprinting, or stimuli-responsive system to improve the biocompatibility, drug loading, and drug delivery efficacy of the drug-eluting contact lenses. Moreover, recent innovations in ocular therapeutics such as nanowafers and microneedle contact lenses, and ocular patches have gained tremendous attention in ocular therapeutics. Another potential application of the contact lenses are smart lenses applied in the biosensing and diagnosis of various ocular disorders. The review summarizes and discusses the widespread therapeutic applications of next-generation contact lenses and various fabrication approaches, including its clinical implications, efforts taken by researchers in exploring the novel materials and diverse forms of the lenses, mechanisms of drug release, clinical trials, and their toxicity and safety concerns.

The COVID-19 pandemic: Important considerations for contact lens practitioners.

A novel coronavirus (CoV), the Severe Acute Respiratory Syndrome Coronavirus - 2 (SARS-CoV-2), results in the coronavirus disease 2019 (COVID-19). As information concerning the COVID-19 disease continues to evolve, patients look to their eye care practitioners for accurate eye health guidance. There is currently no evidence to suggest an increased risk of contracting COVID-19 through contact lens (CL) wear compared to spectacle lens wear and no scientific evidence that wearing standard prescription spectacles provides protection against COVID-19 or other viral transmissions. During the pandemic there will potentially be significant changes in access to local eyecare. Thus, it is imperative CL wearers are reminded of the steps they should follow to minimise their risk of complications, to reduce their need to leave isolation and seek care. Management of adverse events should be retained within optometric systems if possible, to minimise the impact on the wider healthcare service, which will be stretched. Optimal CL care behaviours should be the same as those under normal circumstances, which include appropriate hand washing (thoroughly with soap and water) and drying (with paper towels) before both CL application and removal. Daily CL cleaning and correct case care for reusable CL should be followed according to appropriate guidelines, and CL exposure to water must be avoided. Where the availability of local clinical care is restricted, practitioners could consider advising patients to reduce or eliminate sleeping in their CL (where patients have the appropriate knowledge about correct daily care and access to suitable lens-care products) or consider the option of moving patients to daily disposable lenses (where patients have appropriate lens supplies available). Patients should also avoid touching their face, including their eyes, nose and mouth, with unwashed hands and avoid CL wear altogether if unwell (particularly with any cold or flu-like symptoms).

Could telehealth help eye care practitioners adapt contact lens services during the COVID-19 pandemic?

The COVID-19 pandemic has necessitated government-imposed restrictions on social interactions and travel. For many, the guidance has led to new ways of working, most notably a shift towards working remotely. While eye care practitioners (ECPs) may continue to provide urgent or emergency eye care, in many cases the travel restrictions present a unique challenge by preventing conventional face-to-face examination. Telephone triage provides a useful starting point for establishing at-risk and emergency patients; but patient examination is central to contact lens patient care. The indeterminate period over which conventional practice will be suspended, and the risk that resumption of 'normal' practice could be impeded by a potential secondary peak in COVID-19 cases, hastens the need for practitioners to adapt their delivery of eyecare. Specifically, it is prudent to reflect upon supportive evidence for more comprehensive approaches to teleoptometry in contact lens practice. Smartphone based ocular imaging is an area which has seen considerable growth, particularly for imaging the posterior eye. Smartphone imaging of the anterior eye requires additional specialised instrumentation unlikely to be available to patients at home. Further, there is only limited evidence for self-administered image capture. In general, digital photographs, are useful for detection of gross anterior eye changes, but subtle changes are less discernible. For the assessment of visual acuity, many electronic test charts have been validated for use by practitioners. Research into self-administered visual acuity measures remains limited. The absence of a comprehensive evidence base for teleoptometry limits ECPs, particularly during this pandemic. Knowledge gaps ought to be addressed to facilitate development of optometry specific evidence-based guidance for telecare. In particular, advances in ocular self-imaging could help move this field forwards.

International survey of contact lens fitting for myopia control in children.

PURPOSE: To determine the extent of contact lens fitting for myopia control (MC) in children (defined as ≤ 17 years of age) worldwide and to characterize the associated demographics and fitting patterns. METHODS: Survey forms were sent to contact lens fitters in 66 countries between January and March every year for eight consecutive years (2011-2018, inclusive). Practitioners were asked to record data relating to the first 10 contact lens fits performed after receiving the survey form. Data were analysed for those countries reporting ≥ 100 contact lens fits to children. RESULTS: Data were analysed for 535 MC fits and 23,295 other (non-MC) lens fits undertaken in 31 countries reporting ≥ 100 contact lens fits to children, with 52.1% of MC fits and 12.0% of non-MC fits being with rigid lenses (p < 0.0001). Overall, MC lenses represented 2.3% of all contact lens fits to children, with significant differences between nations (p < 0.0001), ranging from no MC fits recorded in the Czech Republic, Greece, Japan, South Korea and Puerto Rico, to 24.9% in Austria. There has been an increase in contact lens fitting for MC over the survey period (p < 0.0001). MC contact lenses were fitted to younger children compared to non-MC lenses (MC, median 13 years vs. non-MC, median 15 years) (p < 0.0001). There was no sex bias in the fitting of MC lenses (p = 0.89). CONCLUSIONS: MC lenses are currently being prescribed for younger children in equal measure in terms of soft vs. rigid lenses and males vs. females. The extent of MC fitting is low and varies between nations. The gradual increase in MC fitting throughout the survey period perhaps reflects growing concerns among practitioners over the myopia epidemic.

Recent Trends in Advanced Contact Lenses.

Exploiting contact lenses for ocular drug delivery is an emerging field in the area of biomedical engineering and advanced healthcare materials. Despite all the research conducted in this area, still, new technologies are in their early stages of the development, and more work must be done in terms of clinical trials to commercialize these technologies. A great challenge in using contact lenses for drug delivery is to achieve a prolonged drug release profile within the therapeutic range for various eye-related problems and diseases. In general, desired release kinetics to avoid the initial burst release is the zero-order kinetics within the therapeutic range. This review highlights the new technologies developed to achieve efficient and extended drug delivery. It also provides an overview of the materials and methods for fabrication of contact lenses and their mechanical and optical properties.

Trends in contact lens microbial keratitis 1999 to 2015: a retrospective clinical review.

IMPORTANCE: Contact lens microbial keratitis (CLMK) is the most common cause of microbial keratitis in our community. BACKGROUND: Define the trend in rate of CLMK and define patient demographics/culture results that may have a predictive value in patients with CLMK. DESIGN: Retrospective review of clinical records of patients with MK. PARTICIPANTS: All patients with positive corneal scraping between 1999 and 2015 at the Princess Alexandra Hospital, Brisbane, Queensland identified through local microbiology database. METHODS: Trend in CLMK tested with chi-squared test of peak 3 years vs other years and Poisson regression of interrupted time series. Patient characteristics predictive of CLMK were defined by creating a polynomial regression model by stepwise variable selection. MAIN OUTCOME MEASURES: Yearly rate of CLMK. RESULTS: Records of 895 episodes of MK were included. The most common: risk factor was contact lens wear (324, 36.2%), isolated organism was Pseudomonas aeruginosa (P. aeruginosa 181, 55.9%) and treatment was monotherapy with a fluoroquinolone 172, 53%). CLMK was most common between 2009 and 2011 (49.5% vs other years 32%, P < 0.001). Poisson regression of the interrupted time series showed there was a significant decrease in the rate over time after 2010 (P < 0.001). Independent factors predictive of CLMK in multivariate regression were young age (15-49 years) and corneal culture positive for P. aeruginosa CONCLUSIONS AND RELEVANCE: The rate of CLMK in our community ranged between 32% and 50% and the rate of disease appears to have peaked during 2009 to 2011 and subsequently declined.

Contact lens trends over three decades in a hospital-based practice in India.

BACKGROUND: Contact lens fittings in a hospital-based practice are different from those in private practices because of specialised conditions. Few studies have been published on material preferences of such wearers, especially in long-term wearers. The aim of this study is to document contact lens prescribing trends in a hospital-based practice among long-term lens wearers and to identify their demographic profile. METHODS: Subjects reporting to a contact lens clinic of a tertiary eye-care centre in India from 1 January 2014 to 31 December 2014, with a minimum of five years of lens wear, were included in the study. Data were collected retrospectively from the electronic medical charts of these subjects. RESULTS: Three hundred and sixty subjects were included in the study. The average duration of contact lens wear among the subjects was 9 ± 5 years (range: 5-35 years). The average age of the subjects was 31.38 ± 11.75 years (age range: 5-78 years). Hydrogel material and soft spherical type were preferred by most of the soft lens wearers (53 per cent). Eighty per cent of subjects followed hand hygiene and cleaning regimen practices. CONCLUSION: The preference for monthly replacement lenses and silicone hydrogel material increased over the years. Regular after-care consultations could enforce the need for compliance with hand hygiene and cleaning regimens among lens wearers.

On the power profiles of contact lenses measured with NIMO TR1504 / Perfiles de potencia de las lentes de contacto medidas con NIMO TR1504

No disponible

Contact lens technology to 2020 and beyond: a review of recent patent literature.

Contact lenses have been a common means of vision correction for more than half a century. Recent developments raise the possibility that the next several years will see the range of applications in which they are used broaden considerably, with an associated expansion in both the number and type of individuals who consider them to be a valuable option. To describe this new landscape, a review of recent patent submissions covering the period 1 January 2014 to 1 February 2017 was undertaken. The results show that in the main, areas where contact lenses will be applied include drug delivery, visual augmentation and biosensing.

Efeito de diferentes tratamentos de superfície na resistência de união, ângulo de contato, morfologia e análise da distribuição de tensão de laminados ultrafinos de cerâmica reforçada por dissilicato de lítio / Effect of different surface treatments on bond strength, contact angle, morphology and analysis of stress distribution in ultrathin lithium disilicate ceramic laminate veneers

Laminados cerâmicos são utilizados em tratamentos conservadores para restabelecer estética e função com mínimo desgaste da estrutura dental. O objetivo deste estudo foi avaliar, in vitro, o efeito de dois tratamentos de superfície em espécimes cerâmicos ultrafinos de dissilicato de lítio na resistência de união com o cimento resinoso. Laminas ultrafinas de cerâmica (14 X 12 X 0,3 mm) foram distribuídas aleatoriamente em dois grupos (n=20) de acordo com o tratamento de superfície: ácido hidrofluorídrico 5% durante 20 s e silano (HF) e Monobond Etch & Prime (Ivoclar, Vivadent) por 60 s (MEP). Dois cilindros de cimento resinoso foram confeccionados utilizando matrizes cilíndricas. Após 24 h de armazenamento, os espécimes foram submetidos ao ensaio mecânico de microcisalhamento (1 mm/min) e o modo de falha foi estabelecido. Dados de resistência de união foram analisados pelo teste t de Student (α=0.05). O ângulo de contato foi determinado. Análise morfológica das superfícies cerâmicas por meio de microscopia de força atômica e eletrônica de varredura foi realizada. Através de análise por elementos finitos foi estudada a distribuição de tensão em incisivos centrais superiores restaurados com laminados cerâmicos ultrafinos de dissilicato de lítio (0,3 mm). O modelo tridimensional foi elaborado no software Rhinoceros e exportado para software de análise Ansys. Foram modelados e analisados 04 grupos sob duas condições: desgaste ou não de esmalte e tipo de preparo. Foi aplicada uma carga de 100 N e a tensão gerada analisada pelo critério de Tensão Máxima Principal. Não houve diferença estatística nos valores de resistência de união entre o grupo HF e MEP (p=0,117). O ângulo de contato foi influenciado pelo tratamento de superfície (p=0,001); espécimes sem tratamento de superfície tiveram o maior ângulo de contato (65, 37˚) entanto que o grupo HF exibiu o menor ângulo de contato (33,80˚). A análise morfológica mostrou que o condicionamento da superfície com HF foi mais obvio mostrando poros, irregularidades e maior rugosidade em comparação com o condicionamento com MEP. A análise por elementos finitos mostrou que o grupo com laminado cerâmico cimentado sobre o esmalte sem preparo apresentou as menores concentrações de tensão tanto no esmalte como no laminado. Laminados cimentados sobre esmalte preparado mostraram concentração de tensão na interface dente/laminado. O Monobond Etch & Prime se mostrou estatisticamente equivalente ao ácido fluorídrico e silano em termos de resistência de união. Laminados cerâmicos ultrafinos cimentados sobre esmalte hígido geram menos tensão na superfície do dente e laminado. Laminados cerâmicos cimentados sobre esmalte preparado não provocam concentração de tensão adicional no esmalte(AU)

Laminate veneers are becoming a technique used in the conservative treatments by the ability to restore aesthetics and function. This study aimed to evaluate, in vitro, the effect of two surface treatments on ultrathin lithium disilicate specimens in bond strength between treated ceramics and resin cement. Ceramic ultrathin laminates (12 X 14 X 0.3 mm) were obtained and randomly distributed into two groups (n=20) according to the surface treatment: 5% hydrofluoric acid for 20 s and silane (HF) and Monobond Etch & Prime (Ivoclar, Vivadent) for 60 s (MEP). Two resin cement cylinders were made using cylindrical matrices. After 24 h storage, microshear bond strength tests were performed in a universal testing machine (1 mm/min) and failure mode was analyzed. Bond strength data were submitted to Student's t-test (α=0.05). The contact angle was measured. Micromorphogical analyses of representatives specimens were also performed (atomic force and scanning electron microscopy). Finite element analysis studied the distribution of stress in maxillary central incisors restored with ultrathin laminate veneers of lithium disilicate (0.3 mm). 3D model was elaborated in CAD Rhinoceros® software and exported to analysis software Ansys®. Four groups were modeled and analyzed under two experimental conditions: wear or non-enamel and type of preparation. A load of 100 N was applied at the palatal face. The stress was analyzed by Maximum Principal Stress criteria. Microshear bond strength values showed that HF group was not statistically different from MEP group (p=0.117). Microshear bond strength values showed that HF group was not statistically different from MEP group (p=0.117). Contact angle was influenced by surface treatments (p=0.001); specimens without surface treatment had the highest contact angle (65.37˚) whereas HF group exhibited the lowest contact angle (33.80˚). Surface morphological evaluation showed that hydrofluoric acid etching promoted a more obvious surface pattern regarding pores and irregularities with higher surface roughness in comparison to self-etching glass ceramic primer. Finite element analysis showed that laminates without enamel prepared generated the lowest stress in the enamel and in the laminate. Laminates with enamel prepared showed the stress concentration in the finishing lines of preparation in the tooth/laminate interface. Monobond Etch & Prime obtained statistically equivalent results in terms of bond strength to hydrofluoric acid and silane. Ultrathin laminate veneer cemented over sound enamel generate less stress on the surface of the tooth and laminate. Laminates veneers on prepared enamel do not cause additional tension in the tooth structure(AU)

A sixteen year survey of Canadian contact lens prescribing.

PURPOSE: To understand long-term contact lens prescribing habits of Canadian optometrists. METHODS: One thousand optometrists were surveyed annually from 2000 to 2015. Information was requested on the first ten patients examined after receiving the survey. RESULTS: Over the 16-year survey period, 1987 optometrists provided information on 19,143 patients. Mean age of the patients was 32.7±14.4years. Ratio of females to males was 2:1, the ratio of new fits to refits was 2:3. Soft contact lenses represented 94.5% of all fits. Rigid lenses were more often used as a refit compared to a new fit. Over the 16 years, market share for silicone hydrogel materials grew from 0% to 69.6%, mid-water content materials declined from 75.7% to 14.1%. The multifocal market share grew at the expense of spherical designs, with no change in toric lens fitting. Monthly soft lens replacement remained the preferred option at 48.2%, followed by daily disposable at 40.8%; two-weekly replacement declined to less than10% of patients by 2015. Extended wear was likely used to refit and only to a small proportion of wearers, representing 2.6% of SCL by 2015. The lens care system of choice throughout the period was multipurpose solutions, although the proportion for peroxide systems more than doubled by 2015 from 9.6%, to 21.1%. CONCLUSIONS: Over the 16-year period, SCL material preference changed to silicone hydrogels with monthly replacement being preferred; daily disposables replacing 2-weekly as the alternate. Lens care preference continued to be multipurpose solutions. Rigid lenses appear to be sustained for specialist fitting.

Trends of contact lens prescribing in Jordan.

PURPOSE: To evaluate contact lens prescribing trends among optometrists in Jordan. METHODS: Optometrists from 173 practices in Jordan were surveyed about prescribing contact lenses in their practice. Practitioners were required to record information for the last 10 patients that visited their practice. Demographic data such as age and gender was obtained for each patient. In addition, data relating to lens type, lens design, replacement methods and the care regime advised to each patient were recorded. Practitioners were required to provide information relating to their education and years of experience. The influence of education and experience with respect to lens prescribing trends was explored using linear regression models for the proportions of lens types fitted for patients. RESULTS: A total of 1730 contact lens fits were analyzed. The mean (±SD) age of lens wearers was 26.6 (±7.9) years, of whom 65% were female. Conventional hydrogel lenses were the most prescribed lenses, accounting for 60.3% of the fits, followed by silicone hydrogel lenses (31.3%), and rigid lenses (8.4%). In terms of lens design, spherical lenses appeared to be most commonly prescribed on monthly basis. Daily disposable lenses were second most prescribed lens modality, accounting for 20.4% of the study sample. Multi-purpose solution (MPS) was the preferred care regimen, with a prevalence of 88.1% reported in the study sample, compared to hydrogen peroxide (1-step and 2-step), which represented only 2.8% of the patients in this study. A relationship was established between the two educational groups for rigid lens prescribing (F=17.4, p<0.0001), while the experience of the optometrist was not a significant factor (F=0.4, p=0.54). CONCLUSION: This work has provides an up-to-date analysis of contact lens prescribing trends among optometrists in Jordan. Contact lens prescribing in terms of lens type, lens design, modality of wear and care regimen agree with global market trends with small variations. This report will help practitioners and the industry to detect any deficiencies in the contact lens market in Jordan, which will ease implementing current and future plans in developing contact lens practice and patient eye care in the region.