Short-term Effects of Artificial Tears on Visual Performance in Normal Subjects

Abstract

Temporal changes in tear film structure can distort the optical wavefront as it passes through the tear layer and reduce contrast sensitivity. Theoretically, any substance applied to the tear layer that alters its structure could affect contrast sensitivity. The purpose of this study is to investigate how different formulations of carboxymethylcellulose sodium (CMC) applied to the tear layer affect contrast sensitivity over time. Additionally, the visual effect of these drops applied over soft and rigid, gas-permeable contact lenses was also investigated. Twenty normal subjects took part in this project. Refresh Celluvisc (Allergan, Irvine, CA, 1.0% high-viscosity CMC) was compared with Refresh Liquigel (Allergan, 1.0% total CMC made by blending 0.35% high-viscosity with 0.65% medium viscosity CMC). Ten of the subjects were habitual soft contact lens wearers and 10 were habitual gas-permeable lens wearers. The stimulus, viewed monocularly, was a stationary, vertically oriented, sine wave grating (14 CPD). A temporal, two-alternative, forced-choice paradigm combined with a self-paced method of limits was used to monitor threshold over time. After baseline data collection, a drop of the artificial tear was applied to the tear layer and the procedure continued for 30 min. This allowed continual tracking of the threshold. Data were collected while viewing the stimulus with the subject's contact lens or with their spectacle prescription. One drop of Liquigel or Celluvisc decreased contrast sensitivity for a 14 CPD sine wave grating (all p values < 0.005). This decrease in contrast sensitivity was observed during spectacle, soft contact lens, and gas-permeable contact lens wear. Soft contact lens wear resulted in a greater decrease in contrast sensitivity than spectacles when Liquigel was applied to the tear layer. None of the other conditions were different between contact lens and spectacle wear. The return to baseline contrast sensitivity was not significantly different between soft or gas-permeable contact lens wear and spectacles for either Liquigel or Celluvisc. In general, Celluvisc had a greater effect on visual performance than Liquigel. These results suggest that Liquigel and Celluvisc alter the tear layer and affect contrast sensitivity. The results agree with patient observations that Celluvisc causes a moderate amount of blur that gradually subsides. In such patients, the shorter duration of blur with Liquigel (about half that of Celluvisc) may be more acceptable. The technique of blending various viscosity CMC materials while maintaining the total CMC concentration of 1.0% may be beneficial in dry eye therapy without causing excessive blur to patients.