Dynamic Changes of Ocular Surface in First-Time Contact Lens Wearers and the Effective Factors of Contact Lens Discomfort.

Yangyang Xu,Yuzhou Wang,Zhiqiang Xu,Liang Hu,Xupeng Shu,Qiaoli Liu,Jia Qu,Jiahui Xia,Yong Li

doi:10.3389/fmed.2022.833962

Abstract

PurposeThe purpose of the study is to investigate the dynamic changes in ocular surface indicators in first-time contact lens (CL) wearers and identify the most influential factors in CL discomfort (CLD).MethodsA total of 26 healthy non-CL wearers (26 eyes) were recruited and fitted monthly with disposable hydrogel CLs. Each participant underwent a full ocular surface evaluation, which include Efron grading, tear film breakup time, Schirmer's I test, corneal dendritic cell (DCs) imaging by in vivo confocal microscopy (IVCM), and conjunctival microvasculature evaluation by functional slit-lamp biomicroscopy. CLD was assessed using the Ocular Surface Disease Index questionnaire at baseline, 1 week, 1, 3, and 6 months after wearing it and another 6 months after discontinuing it.ResultsClinical signs and CLD were significantly increased in the first week (p < 0.05). The microvascular response and DC activation peaked at the 1-month interval (p < 0.05). During CL wear, CLD is positively correlated with corneal staining (B = 0.238, p = 0.002), papillary conjunctivitis (B = 0.245, p < 0.001), and microvascular blood flow velocity (B = 0.353, p < 0.001). After discontinuation, only DC activation remained elevated at 6 months, whereas the other signs recovered.ConclusionsThe first week of CL wear was the main period for the appearance of ocular surface clinical signs, and the first month was the main period for the activation of subclinical inflammation. Corneal staining and conjunctival microvascular response are the main factors affecting CLD. Even if the clinical signs recover after discontinuing wear, subclinical inflammation may persist.

Highlights

In 2016, Efron [1] emphasized that “contact lens wear is intrinsically inflammatory” and reported that inflammation exists on the ocular surface of normal, asymptomatic contact lens (CL) wearers, which is caused by the inherent factor of the lens
This study aimed to evaluate ocular surface inflammatory indicators and CL discomfort (CLD) in first-time CL wearers to reveal the dynamic changes in the ocular surface and the most influential factors of ocular surface clinical and subclinical inflammation in CLD
We reported that increased vessel blood flow and corneal staining were the main factors that affect the increase in CLD

Summary

Introduction

In 2016, Efron [1] emphasized that “contact lens wear is intrinsically inflammatory” and reported that inflammation exists on the ocular surface of normal, asymptomatic contact lens (CL) wearers, which is caused by the inherent factor of the lens. Some studies have reported dynamic changes in ocular surface inflammation in CL wearers. Maldonado-Codina et al [6] observed that corneal limbal hyperemia increased significantly after 2 weeks of lens wear, but decreased after the fourth week. These studies have described dynamic inflammatory changes with time at only one level, but the overall longitudinal observation of ocular surface clinical signs and subclinical mediators simultaneously has not yet been reported. The dynamic changes of discomfort, and the relationship between discomfort and ocular surface inflammation, need further study for investigation, which was suggested by Efron [2]

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