Contact Lens Practitioners Research Articles

Contact lens king

Emma White speaks to contact lens practitioner of the year winner Mark Drake, owner of Mark Drake Opticians in Penarth, about building a successful contact lens business and exceeding patient expectations

A proposed methodology for conducting a remote rigid gas permeable contact lens consultation

PurposeCOVID-19 spread to numerous countries, overwhelming healthcare systems and economies worldwide. COVID-19 restrictions have prevented patients from attending consultations in person and led to the further development of telemedicine to provide health care. The situation also applies to contact lens (CL) practitioners and their patients; telemedicine enables practitioners to provide patients with regular and continuing care. This study aimed to investigate available tools to enable continuing care for rigid gas permeable (RGP) CL wearers who are unable to attend face-to-face consultations. MethodsThe study consists of three components. Firstly, an approach to enable the assessment of a patient’s CL fitting and cornea remotely. Secondly, to find an affordable and reliable method to obtain a patient’s visual acuity (VA), and thirdly, to develop a questionnaire to provide practitioners with information to deliver optimal patient care. ResultsThe use of a macro lens, smartphone, and auxiliary materials enables high-quality images of the anterior eye and RGP CL to be obtained. Two free and validated smartphone applications (apps) for VA measurements were identified which are available on Android and iOS systems. Two questionnaires were also developed to enable practitioners to obtain additional patient information to facilitate optimal patient care. ConclusionThis study has developed the components of a remote CL consultation to enable patients who cannot attend scheduled appointments to receive care and advice to ensure the safety of their RGP CL wear. The tools involved in this study are low-cost, affordable, and an adjunct, not a substitute, for face-to-face consultations.

Reliability and Agreement of Keratometry Measurements Obtained With Eye Surface Profilometry and Partial Coherence Interferometry.

The aim of this study was to assess the repeatability of keratometry parameters obtained using the Eye Surface Profiler (ESP) system and their agreement with the IOL Master 500 device. Seventy-one eyes of 71 healthy participants were evaluated. Three repeated measurements were performed using the ESP system. Simulated keratometry in the flat (SimKf) and steep (SimKs) meridians, astigmatism, and axis were obtained. The same parameters were measured using the IOL Master 500 device. The J0 and J45 vector components of the astigmatism were calculated. The intrasession repeatability was analyzed using within-subject SD (Sw) and intraclass correlation coefficient (ICC). Agreement was assessed using paired statistical tests and the Bland-Altman method. The Sw was 0.07 mm, 0.04 mm, 0.51 D, 0.33 D, and 0.22 D, and the ICC was 0.96, 0.98, 0.74, 0.61, and 0.55 for SimKf, SimKs, astigmatism, J0, and J45, respectively. The mean difference and limits of agreement when comparing the ESP system with the IOL Master 500 device were 0.37 mm (0.08/0.66) for SimKf ( P < 0.001), 0.18 mm (0.00/0.35) for SimKs ( P < 0.001), -0.93 D (-2.42/0.56) for astigmatism ( P < 0.001), 0.51 D (-0.22/1.24) for J0 ( P < 0.001), and 0.06 D (-0.48/0.60) for J45 ( P = 0.09). The ESP system provides consistent values for simulated keratometry, showing moderate consistency for astigmatism parameters. Contact lens practitioners should be aware that the ESP system and IOL Master 500 device provide different simulated keratometry from a clinically viewpoint.

Kontaktlinsenhygiene ein Literatur-Review

Purpose. Contact lens hygiene is a crucial factor for a success- ful contact lens fitting and, above all, for long-term healthy contact lens wear. A review of the literature is intended to summarize the most important points especially in relation to recent publications. Material and Methods. A narrative literature review was performed to identify relevant publications. PubMed (www. pubmed.gov) was used as the platform for the search. The search term used was “contact lens hygiene”. Results. Successful contact lens hygiene depends on the effectiveness of the care solution, the instruction of the pa- tient by the contact lens practitioner and the correct imple- mentation of the recommended care steps. Basically, either multipurpose solutions (combination solutions) or peroxide systems are available for care. The advantage of peroxide systems is the higher disinfection performance compared to multipurpose solutions. For rigid gas permeable contact lenses, manual surface cleaning in combination with a surface cleaner is essential. The likelihood of occurrence of microbial keratitis is lower in wearers of rigid gas permeable contact lenses than in wearers of soft contact lenses. Conclusion. In addition, to hand hygiene, the selection of the care product and regular instruction of the user by the eye care practitioner play a vital role. From a hygienic perspective, daily disposable contact lenses are the safest option. Keywords Contact lens hygiene, contact lens compliance, contact lens storage case, microbial keratitis, RGP contact lenses, soft contact lenses

Managing visual symptoms in cone-rod dystrophy with prosthetic soft contact lens

This case demonstrates the utilization of a prosthetic type C contact lens to manage visual symptoms such as photophobia and glare in patients with cone-rod dystrophy. A 20-year-old female patient reported to our clinic with complaints of photophobia, glare, and impaired vision and was evaluated with different contact lens trials to improve her ability to use her remaining vision effectively. The patient was fitted with ACUVUE OASYS transitions, X-chrome red-tinted contact lenses, and tinted type C contact lenses. All the trials manifest optimal fitting and better comfort but only the tinted type C contact lens resulted in pronounced improvement in photophobia, glare, and vision both indoors and outdoors. Finally, a tinted type C contact lens is effective in relieving photophobia and glare and making a remarkable changeover in the quality of life. Thus, all contact lens practitioners should use these lenses to treat victims with glare and photophobia caused by cone-rod dystrophy.

Knowledge and Compliance among Contact Lens Wearers Living in Kuala Lumpur, Malaysia: A Cross-Sectional Study.

Many factors determine the success of wearing contact lens, including knowledge and compliance towards lens care. This study aimed to evaluate the level of knowledge and compliance between two groups of adult contact lens wearers in Kuala Lumpur, Malaysia. A total of 60 participants aged 18-30 years old volunteered to participate in this study (30 participants prescribed contact lenses at the Universiti Kebangsaan Malaysia [UKM] optometry clinic and 30 participants fitted at private practices). Participants were interviewed using a structured questionnaire consisting of nine questions on basic knowledge related to lens wear and 13 questions on compliance, categorised into questions on the cleaning process, disinfection, accessories care and replacement schedule. All participants wore disposable contact lens 53.3% (n = 32) participants preferred using monthly disposable lenses. Both groups had the same level of knowledge, except knowledge of the effects of makeup (P < 0.000) and duration of the solution used for cleaning (P < 0.010), showing lack of knowledge on contact lenses among participants in private practices group. There were no significant differences between the groups in terms of the level of compliance with the cleaning process (P = 0.830), disinfection (P = 0.725), accessories care (P = 0.865) and replacement schedule (P = 0.699). Participants from UKM optometry clinic had better knowledge on wearing contact lens; moreover, both groups had good compliance towards lens care. Contact lens practitioners should provide all the necessary information to contact lens wearers so that they are equipped to handle contact lenses correctly, which would minimise the risk of eye complications.

Mikrobakterielle Keratitis: Wie sicher ist Orthokerato- logie heute?

Purpose. The purpose of this review is to summarize and clinically evaluate microbial keratitis (MK) in accelerated orthokeratology (OK). Material and Methods. Based on a PubMed and EMBASE search, a systematic literature review of previous and current studies and theories on the pathogenesis of contact lens associated MK was performed. In chronological order, the results were described and analyzed. Results. Risk factors of MK are inadequate contact lens care, use of tap water, non-adherence to hygiene procedures and wearing contact lenses despite pre-existing ocular irritation. The statistical absolute incidence MK is 7.7 MK cases per 100,000 patient-years for all contact lens (CL) wearers and 13.9 per 100,000 patient-years for young CL wearers. The most significant germ is Pseudomonas aeruginosa followed by Acanthamoeba. The predominant age group is 15.4 years old on average, and the predominant ethnic group is persons of Asian descent. Most MK cases are diagnosed in the first 19 months – most users are not contact lens novices. The cor- neal epithelium is the most significant tissue for OK success and most significant for infection protection. Conclusion. Contact lens practitioners have a high respon- sibility for safety in OK. MK in OK is highly preventable if risk factors and general hygiene are observed. Regular check-ups at short intervals, adherence to agreed procedures, discipline, education/training and communication are important tools to minimize the risk of MK in OK. Keywords Orthokeratology, contact lenses, microbacterial keratitis, risk factors

Neuanpassung von formstabilen Kontaktlinsen bei Keratokonus und eingeschränkter Kontaktlinsentoleranz

Purpose. The aim of the case report is to describe the visual rehabilitation of a keratoconus patient with RGP contact lenses and here specifically the change from classical RGP lenses to contact lenses with a larger diameter to improve wearing comfort and daily wearing time. Material and Methods. RGP contact lenses were fitted to the eyes with the aid of corneal topography and the assess- ment of diagnostic lenses. The pros and cons of different contact lens designs are discussed in the context of visual rehabilitation of eyes with keratoconus. Results. Re-fitting of new contact lenses to a geometry with a larger (limbal) overall diameter increased comfortable wearing time from 8h to 12h. Conclusion. Contact lens practitioners should use all options for fitting RGP lenses – from corneal, to limbal, to corneo- scleral, to (mini-)scleral lenses – to find the solution with good wearing comfort and best long-term physiologically accept- ance. The aim is the possibility of lifelong contact lens wearing. Keywords keratoconus, corneal lens, limbal lens, corneoscleral lens

How Can We Best Measure the Performance of Scleral Lenses? Current Insights

Scleral lenses (SLs) present several unique advantageous characteristics for patients. As these lenses are mainly fitted in severely diseased eyes, a thorough evaluation of the ocular surface before and after SL fitting and the on-eye SL fitting evaluation are essential and help minimize potential physiological complications. This review will explore the current and emerging techniques and instrumentation to best measure SL performance ensuring optimal lens fitting, visual quality, comfort and physiological responses, highlighting some potential complications and follow-up recommendations. A single physician could perform the great majority of evaluations. Still, the authors consider that the assessment of SL fitting should be a collaborative and multidisciplinary job, involving contact lens practitioners, ophthalmologists and the industry. This publication has reviewed the most up-to-date work and listed the most used techniques; however, the authors encourage the development of more evidence-based recommendations for SL clinical practice.

Global contact lens prescribing 2000-2020

ABSTRACT Clinical relevance Contact lens prescribing data serve as a benchmark for eye care clinicians in assessing their own prescribing patterns and provide useful contextual information for researchers and the contact lens industry. Purpose To document global trends in contact lens prescribing during the first two decades of this century. Methods A longitudinal survey of contact lens prescribing was conducted by asking contact lens practitioners to provide 11 items of information from 10 consecutive contact lens fits between January and March each year from 1996 to 2020, inclusive. Results Data relating to 406,859 contact lens fits were collected from 71 countries between 1996 and 2020, generating 4.5 million data points. Demographic analysis for 61 nations returning ≥100 fits demonstrated that a majority of lenses (65–70%) were fitted to females. The average age of lens wearers was 30.8 ± 13.9 years for males and 32.5 ± 14.3 years for females. Trend analysis of 20 countries returning prescribing data for ≥13 years between 2000 and 2020 revealed the following: increase in the age of lens wearers; dramatic rise in the extent of fitting silicone hydrogel and daily disposable lenses; increased fitting of soft toric and multifocal lenses; increasing proportion of rigid lens fits in specialist (non-spherical) designs; incomplete provision of near contact lens corrections for contact lens wearing presbyopes; ongoing low levels of extended wear fits; and almost exclusive use of multi-purpose care systems. Daily disposable lenses were used for both full-time and part-time wear, whereas rigid and soft reusable lenses were primarily worn full time. Conclusions The evolution of international contact lens fitting over the first two decades of this century is documented. The data presented here may assist all stakeholders in advancing contact lens clinical practice, informing contact lens research, and guiding contact lens manufacturers.

The Impact of Antibiotic Usage Guidelines, Developed and Disseminated through Internet, on the Knowledge, Attitude and Prescribing Habits of Orthokeratology Contact Lens Practitioners in China.

It has been previously reported that the improper prescribing of antibiotic eye drops is common among orthokeratology (ortho-k) practitioners. Guidelines have since been developed and disseminated to improve their understanding and implementation of antibiotic prescriptions. This study aimed to investigate the influence of these guidelines on the knowledge, attitude, and prescribing habits of ortho-k practitioners by means of a questionnaire, which was administered nationwide via an official online account to eye care practitioners (ECPs) involved in ortho-k lens fitting, 548 of whom completed the survey. Differences in characteristics before and after the dissemination of the guidelines and between the groups were explored using χ2 tests. The relationship between prescribing habits and demographics was analyzed using stepwise logistic regression models. The implementation of the guidelines significantly improved the overall prescribing habits of ECPs (p < 0.001), especially for prophylactic antibiotic use before and after ortho-k lens wear (p < 0.001). Most ECPs who prescribed antibiotics properly displayed significantly better knowledge of correct antibiotic use, which in turn affected the compliance in their ortho-k patients (p < 0.001). The ECPs’ occupations (professionals other than ophthalmologists and optometrists, including nurses and opticians), clinical setting (distributor fitting centers), and age (younger than 25 years) were risk factors for the misuse of antibiotics. Although the implementation of the antibiotic guidelines significantly improved overall prescribing habits, some practitioners’ prescribing behavior still needs improvement. A limitation of this study was that all questions were mandatory, requiring ECPs to recall information, and therefore was subjected to selection and recall bias.

Knowledge and Awareness of the Coronavirus Disease and Perceptions Towards Ophthalmic Practice Among Ophthalmologists

Objective:To investigate the level of awareness of ophthalmologists towards COVID-19 and their perceptions towards infection control in ophthalmic practice.Methods:A web-based survey was conducted using Google Forms during the month of December 2020. All ophthalmologists practicing in Sudan were invited to participate in the study. Participants who did not agree to the terms of the electronic consent form presented at the beginning of the questionnaire as well as those who did not complete the survey, were excluded from the analysis. Knowledge of causes, symptoms, and methods of transmission of COVID-19; ophthalmologists’ attitudes and perceptions towards COVID-19 and clinical practice, including contact lens practice, were assessed using a set of 26 multiple-choice close-ended questions.Results:Of the 307 participants, 77.4% were in the age range 30-40 years and 73% were contact lens practitioners. While 96.1% acknowledged the scientific name of COVID-19, 46.9% were aware of its cause. Ophthalmologists aged 40-50 years were more likely to agree that air-puffing tonometer risks infection spread (OR 1.62, 95% CI: 0.27-9.70, p&lt;0.01). Ophthalmologists aged 30-40 years were more likely to agree that a slit lamp shield would reduce infection risk (OR 1.52, 95% CI: 0.33-6.96, p&lt;0.01). Contact lens practitioners were more likely to perceive that frequent replacement contact lens use can increase the infection spread (OR 2.64, 95% CI: 1.17-5.94, p&lt;0.01).Conclusion:Ophthalmologists in Sudan demonstrated a mixed level of knowledge of the causes, symptoms, and modes of transmission of COVID-19. While the majority were able to identify the protective measures generally required by medical practitioners and patients, there was a limited level of knowledge regarding protective measures specific to ophthalmic practices, especially when dealing with contact lenses. Official national guidelines about safe ophthalmic service provision during the COVID-19 pandemic are recommended.

Die Bedeutung des Randprofiles bei der Anpassung weicher Kontaktlinsen: ein Update

Purpose. The edge design of soft contact lenses is often overseen during contact lens fitting or during follow­up visits. Material and Methods. By means of illustrations of different edge profiles and a review of the literature on this topic, the attention of contact lens practitioner should be drawn to edge design of contact lenses. Results. Contact lenses have different edge profiles, which can have an influence on comfort and fitting. If necessary,the edge profile can be observed by the contact lens fitter using various methods. Conclusion. Consideration of the edge design can be par­ ticularly helpful for contact lens fittings that do not lead to the desired success. Keywords soft contact lenses, contact lens edge design, contact lens discomfort, conjunctiva

Effect of Water Exposure on Contact Lens Storage Case Contamination in Soft Lens Wearers.

Water exposure during contact lens wear can transfer pathogenic microorganisms to the eye, causing ocular complications. This study determined that water exposure is prevalent among lens wearers and is independently associated with higher case contamination. Contact lens compliance education to minimize water exposure should be reenforced by contact lens organizations and practitioners. Given the increasing association between water exposure and contact lens disease, this study aimed to explore the effect of water exposure and storage case contamination in soft contact lens users. A total of 165 daily soft lens wearers completed a self-administered questionnaire on contact lens hygiene. Lens cases were collected, and microbial analysis was conducted using an adenosine triphosphate assay (for overall microbial bioburden) and limulus amebocyte lysate assay (for endotoxin levels). The lens hygiene (excellent, >35; moderate, 28 to 35; poor, <28) and water contact (≤1, good; >1, poor) scores measured the compliance and water exposure during lens wear, respectively. Multiple regression determined the association between water behaviors and case contamination. The average (standard deviation) age of participants was 28 (13.5) years (18 to 78 years), and 65% were female. The average overall microbial bioburden of storage cases was 3.10 (0.98) log colony-forming unit/mL (1.09 to 5.94 log colony-forming unit/mL). Forty-five percent of participants reported showering, 49.7% reported swimming while wearing lenses (65.4% of whom swam without goggles), 27.8% used wet hands to handle lenses, and 17.5% used tap water to rinse storage cases. Showering with lenses significantly increased the risk of higher storage case bioburden (P = .001), whereas using wet hands (P = .01) doubled the risk of higher case endotoxin levels (odds ratio, 2.41; confidence interval 1.19 to 4.86). Water contact behavior while wearing lenses is prevalent among soft lens wearers and is associated with higher case contamination. Practitioners may improve contact lens education to reduce water exposure and case contamination to reduce the risk of lens-related adverse events.

Opportunities and threats to contact lens practice: A global survey perspective

AimTo understand the views of contact lens (CL) practitioners across the globe regarding what they perceive as opportunities and threats in CL practice. MethodsA self-administered anonymised questionnaire, constructed in English and translated in six more languages, was distributed through reputed international professional bodies and academic institutions worldwide. The questionnaire included items on demographic characteristics, type of practice, and questions designed to explore practitioners’ perspective on the future of their CL practice over the next five years. ResultsA total of 2408 valid responses were analysed. Multifocal CLs for presbyopia, CLs for myopia control, use of daily disposable (DD) CLs for occasional wear, and biocompatible materials to improve comfort were identified as promising areas of opportunities by practitioners (all 8/10). Respondents from North America, and Europe valued DDCLs for occasional wear moderately more favourable (Median: 9/10 for all) as compared to colleagues in Asia (Median: 8/10, p < 0.001), South America (Median: 8/10, p < 0.01), and Africa (Median: 8/10p < 0.01). Multifocal CLs for presbyopia was perceived as a better opportunity by practitioners in North America and Europe (Median: 9/10 for both), as well as in Australasia (Median: 8/10), in comparison to Asia, Africa, and Middle East (for all Median: 6/10, p < 0.001). Practitioners expressed concerns about the availability of CLs and CL prescriptions online without direct professional involvement (both 9/10). ConclusionsOverall, the most appealing opportunities for CL practice growth were identified in occasional use of DD CLs, biocompatible materials to reduce CL discomfort, multifocal CLs for presbyopia correction and management of myopia control with CLs. Lack of regulation in CL sales, especially online, seemed to be a constant threat. The insights from this study can be used to design targeted strategies to enhance CL practice across the globe and in specific geographical areas.

The short journey to contact lens success

Dr Cristina Schnider and David Ruston describe the presbyopic journey and explain why this represents such an important opportunity for the contact lens practitioner to help them.

Tried and Tested: Ortho-K

Optometrist and Optician Award-winning contact lens practitioner Bhavin Shah tells Simon Jones that going the extra mile with Ortho-K is well worth the effort

Contact lens education for the practitioners of the future.

The World Health Organization has identified a shortage of trained human resources as one of the greatest challenges to increasing the availability of eye care services and reducing preventable visual impairment around the world. Increased prevalence of myopia and new strategies for myopia management have raised the prospect of various interventions, including contact lenses for therapeutic use as well as for refractive correction. More personnel skilled in contact lens fitting will be needed to address potential worldwide demand for these interventions. This review investigates the current status and future requirements of global contact lens education in light of these developments. The COVD-19 pandemic led educational institutions worldwide to move towards online delivery. An online survey among 546 educators, conducted in May 2020, investigated changes to contact lens education delivery before and after the onset of the pandemic. A total of 214 responses were received from 32 countries. Prior to COVID-19 restrictions, 23% of educators had conducted more than 50% of their total teaching online; however, 69% expected to conduct more than half of their teaching online by the end of 2020 and 12% anticipated 90% or more of their teaching would be online. Some 76% of educators expected to provide more online lectures after the pandemic and 63% anticipated new methods to deliver practical education. Around half were planning to introduce new teaching online platforms (54%) and more online assessment methods (53%). The global need for increasing numbers of skilled personnel points to a crucial role for educators in teaching the contact lens practitioners of the future. Contact lens education delivery was already evolving prior to COVID-19, and changes that are currently occurring may lead to permanent differences in the way contact lenses are taught in future. The International Association of Contact Lens Educators (IACLE) provides educators with a standardised global curriculum, online resources and teaching technology that could also serve as a model for wider ophthalmic education in future.

Clinical guidelines for the management of keratoconus patients with gas permeable contact lenses based on expert consensus and available evidence.

Fitting rigid gas permeable contact lenses (RGP CLs) in keratoconic patients is the most common visual rehabilitation option to improve patients' quality of life, but require long patient and practitioner chair time. The purpose of this review is to provide evidence-based clinical practice guidelines (CPG) in the management of patients with keratoconus with RGP CLs. An extensive literature review from 1990 to 2017 identified 354 potentially relevant publications. Fifty-two articles were reviewed and included in the CPG. An international expert panel of eight contact lens practitioners, with vast experience in keratoconus management reviewed and appraised the CPG following the Appraisal of Guidelines for Research and Evaluation II consortium requirements. The developed CPG clearly outlines a strategy for the successful fitting of RGP CLs in patients with keratoconus. This includes how to calculate parameters of the first diagnostic lens, criteria for assessing good fit and a standardized schedule of wear time and follow-up appointments. The current evidence and consensus-based CPG helps guide clinicians in a successful strategy for fitting RGP CLs in patients with keratoconus.

Contact Lens Wear and Dry Eye: Beyond the Known.

Contact lens wear is one of the relevant risk factors for dry eye, and the coexistence of dry eye poses a serious challenge in patients wearing contact lenses. The Tear Film and Ocular Surface Society Workshop addressed issues around the topic of discomfort in contact lens wear, which is a major cause for discontinuation of contact lens wear, and termed this condition as contact lens discomfort. With the rapid advances in contact lens technology and pharmacological agents and deeper understanding of this field, updating the "new normal" beyond what is known as standard is essential. This review aims to summarize the latest topics in contact lens and dry eye that would be useful for clinicians and contact lens practitioners.