Discontinuation Of Contact Lens Wear Research Articles

Validation of the Greek version of the contact lens dry eye questionnaire-8 (CLDEQ-8)

PurposeContact lens discomfort (CLD) has been cited as one of the prime reasons for discontinuing contact lens wear. The CLDEQ-8 was created in 2008 to reflect status of and change in overall opinion of soft contact lenses. The purpose of this study is to examine the validity and reliability of a Greek version of the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8), using Rasch statistical analysis. MethodsThis an observational prospective study of 150 consecutive patients who received soft contact lenses and were followed through with a single follow-up appointment up to a year following their initial one. The patients filled in the Greek versions of the CLDEQ-8, the Ocular Surface Disease Index (OSDI) and a self-report item on their experience of contact lens use. The CLDEQ-8 was analyzed with Rasch analytic methodology. ResultsThe original scoring system of the CLDEQ-8 had to be altered regarding the response categories collapsing in fewer options in items b, 2b, 3b and item 5 of the original scale. The revised scoring system proved more psychometrically valid and the CLDEQ-8 had good measurement precision, category threshold order, targeting and differential item functioning for gender. Two alternative result indexes are proposed, a symptom intensity index and a symptom frequency index to address dimensionality issues that are evident with the items relating to symptom intensity versus the rest. Results from the CLDEQ-8 correlated with the OSDI total score and the self-reported experience of contact lens use. ConclusionsThe Greek version of the CLDEQ-8 is a psychometrically valid and reliable assessment tool for contact lens discomfort in Greek-speaking populations.

The diagnosis and treatment of contact lens-induced limbal stem cell deficiency

Objective: To analyze the clinical features and treatment outcomes of eyes with contact lens-induced limbal stem cell deficiency (CL-iLSCD). Methods: This cross-sectional study involved patients diagnosed with CL-iLSCD at the Eye, Ear, Nose & Throat Hospital of Fudan University between October 2018 and September 2022. A total of 17 patients (25 eyes) with a mean age of (36.4±6.9) years were enrolled. Among them, 14 were females (82.4%). Corneal and limbal abnormalities, especially the range of epitheliopathy, were observed under a slit lamp biomicroscope with fluorescein staining. Anterior segment optical coherence tomography and in vivo laser scanning confocal microscopy were performed to obtain the central corneal epithelial thickness, density of basal epithelial cells and corneal nerve fiber length. The clinical features of CL-iLSCD, along with their treatment outcomes and related risk factors, were analyzed. Results: All patients wore soft contact lenses, with an average daily wearing time of (10.5±2.5) hours and a median wearing duration of 10 (4 to 30) years. Ocular symptoms, including decreased vision, ocular discomfort or pain, redness, and photophobia, were present in 22 eyes (88.0%). The most characteristic clinical sign of CL-iLSCD was comb-or whorl-pattern late fluorescein staining under cobalt blue light, which was most commonly seen at the superior limbus (25/25, 100.0%). Additionally, reductions in central corneal epithelial thickness, basal cell density, and corneal nerve fiber length were observed. A comprehensive score was assigned to each eye based on clinical findings and in vivo imaging biomarkers. LSCD was mild, moderate, and severe in 5, 11, and 8 eyes, respectively. A history of misdiagnosis was found in 20 eyes (80.0%). After discontinuing the use of contact lenses and receiving medical treatment, significant improvement was observed in all eyes, with 13 eyes fully recovered. Conclusions: The symptoms and clinical signs of CL-iLSCD can be subtle at the early stage. Discontinuing contact lens wear and medication are effective to treat CL-iLSCD.

Myopia control with dual-focus soft contact lenses during the first year of measures to contain the COVID-19 pandemic.

This study compared refractive and axial length (AL) changes in children wearing dual-focus soft contact lenses for myopia control (MiSight®) with myopic children wearing spectacles one year from the start of lockdown during the COVID-19 pandemic. This retrospective, descriptive, parallel-group, observational study reviewed the charts of 11 children who began treatment for myopia control with dual-focus soft contact lenses for myopia control (MiSight®) in March 2020 and 11 matched spectacle-wearing controls. The mean increase in spherical equivalent refraction (SER) and AL from the beginning of the lockdown and up to 1 year later were compared. The parents of the children were asked about the average time spent on near work, contact lens wearing time both during and after the strict confinement and whether they had discontinued contact lens wear during lockdown. During this first year of preventive COVID-19 measures (March 2020-March 2021), for the contact lens group the average SER and AL increased -0.14 ± 0.09D and 0.13 ± 0.05 mm, respectively. For the spectacle wearers, the corresponding increases were -0.54 ± 0.16D and 0.25 ± 0.08 mm, respectively. A significant difference was found between the groups for both SER (p < 0.001) and AL (p < 0.05). The average time spent outdoors was restricted for both groups during lockdown and increased after. However, statistically significant changes in the time spent outdoors during and after lockdown were only found for the spectacle group (p < 0.05; t-test), whereas this change was not significant for the contact lens group (p=0.08). Over the observed time period, dual-focus soft contact lenses for myopia control were effective despite the decreased time spent outdoors during the COVID-19 pandemic.

Ocular and Nonocular Adverse Events during 3 Years of Soft Contact Lens Wear in Children.

Children are being fitted at younger ages with soft contact lenses for myopia control. This 3-year investigation of adverse events related to contact lens wear in 7- to 11-year-old participants helps optometrists understand what to expect when fitting children with soft contact lenses. The purpose of this article is to report the frequency and type of ocular and nonocular adverse events related to soft contact lens wear in children. Seven- to 11-year-old children wore soft contact lenses for 3 years. Adverse events were defined by a slit-lamp examination finding of grade 3 or worse; parental report of a clinically meaningful change (determined by the examiner) in eyes, vision, or health; or a clinically meaningful response (determined by examiner) to a symptom checklist. Adverse events were categorized and reported by examiners and finalized by the Executive Committee. The presence or absence of an infiltrate and a list of diagnoses was determined at the conclusion of the study. The 294 participants wore their contact lenses 73.0 ± 26.5 hours per week, and 220 (74.8%) encountered at least 1 adverse event. Of the 432 adverse events, 75.2% were ocular, and 24.8% were nonocular. Contact lens wear was probably or definitely related to 60.6% of the ocular and 2.8% of the nonocular adverse events. None of the ocular adverse events were serious or severe or caused permanent contact lens discontinuation. The corneal infiltrate incidence was 185 cases per 10,000 patient-years of wear (95% confidence interval, 110 to 294). The incidence of moderate ocular adverse events that were definitely or probably related to contact lens wear was 405 cases per 10,000 patient-years of wear (95% confidence interval, 286 to 557). The adverse events experienced by 7- to 11-year-old myopic children rarely required meaningful treatment and never led to permanent discontinuation of contact lens wear or loss of best-corrected vision.

Investigating the Synergistic Interactions of Surface Immobilized and Free Natural Ocular Lubricants for Contact Lens Applications: A Comparative Study between Hyaluronic Acid and Proteoglycan 4 (Lubricin).

The main reasons for the discontinuation of contact lens wear are ocular dryness and discomfort. Proteoglycan 4 (PRG4), a mucinous glycoprotein, and hyaluronic acid (HA), a nonsulfated linear glycosaminoglycan, are naturally present in the eye and contribute to ocular hydration and lubrication. This study aimed to investigate the impact of the structure of the recombinant human PRG4 (rhPRG4)/HA complex on contact lens properties, when one agent is grafted and the counterpart is physisorbed on the surface of model conventional or silicone contact lens materials. Investigation of the wettability, water retention, antifouling, and boundary lubricant properties of the prepared hydrogels showed that the rhPRG4/HA interactions varied with the rhPRG/HA configuration on the hydrogel surface as well as the composition of the underlying substrate used. The rhPRG4-physisorbed/HA-grafted sample was characterized by better antifouling and boundary lubricant properties on the model conventional hydrogels, while the HA-physisorbed/rhPRG4-grafted sample exhibited improved surface wettability, antifouling, and water-retentive properties on the model silicone hydrogels. The results of this study contribute to the design of biomimetic contact lens surfaces that work synergistically with ocular fluid-phase biological agents to enhance compatibility between the contact lens and the ocular environment, alleviating dry eye symptoms and improving comfort.

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.

Development of a mass cytometry protocol to assess the inflammatory status of the ocular surface

Purpose Discomfort is leading factor resulting in discontinued contact lens wear, however the inflammatory mechanisms potentially underpinning discomfort are not well defined. Characterisation of the inflammatory status of epithelial cells and immune cells removed from the ocular surface represents a powerful tool to investigate the coordination of these processes by different cell types. We have developed a mass cytometry method, which enables simultaneous assessment of up to 40 surface or intracellular proteins, to identify the immune cell infiltrate and inflammatory status of epithelial cells in contact lens wearers and validated this using primary corneal epithelial cells.

Surface-Functionalized Model Contact Lenses with a Bioinspired Proteoglycan 4 (PRG4)-Grafted Layer.

Ocular dryness and discomfort are the primary reasons for the discontinuation of contact lens wear. This is mainly due to poorly hydrated contact lens surfaces and increased friction, particularly at the end of the day and can potentially cause reduced vision or even inflammation. Proteoglycan 4 (PRG4) is a mucinous glycoprotein with boundary lubricating properties, naturally found in the eye, able to prevent tear film evaporation and protect the ocular surface during blinking. Aiming to improve the interfacial interactions between the ocular surface and the contact lens, the synthesis and characterization of surface-modified model contact lenses with PRG4 is described. Full-length recombinant human PRG4 (rhPRG4) was successfully grafted onto the surface of model conventional and silicone hydrogel (SiHy) contact lenses via its somatomedin B-like end-domain using N, N'-carbonyldiimidazole linking chemistry. Grafting was assessed by Fourier transform infrared spectroscopy-attenuated total reflectance, X-ray photoelectron spectroscopy, and radioactive (I131) labeling. Surface immobilization of rhPRG4 led to model conventional and SiHy materials with improved antifouling properties, without impacting optical transparency or causing any toxic effects to human corneal epithelial cells in vitro. The surface wettability and the boundary friction against human corneal tissue were found to be substrate-dependent, with only the rhPRG4-grafted model SiHy exhibiting a reduced contact angle and kinetic friction coefficient compared to the unmodified surfaces. Hence, clinical grade rhPRG4 can be an attractive candidate for the development of novel bioinspired SiHy contact lenses, providing improved comfort and overall lens performance.

Surface modification of model hydrogel contact lenses with hyaluronic acid via thiol-ene "click" chemistry for enhancing surface characteristics.

Discontinuation of contact lens wear as a result of ocular dryness and discomfort is extremely common; as many as 26% of contact lens wearers discontinue use within the first year. While patients are generally satisfied with conventional hydrogel lenses, improving on-eye comfort continues to remain a goal. Surface modification with a biomimetic, ocular friendly hydrophilic layer of a wetting agent is hypothesized to improve the interfacial interactions of the contact lens with the ocular surface. In this work, the synthesis and characterization of poly(2-hydroxyethyl methacrylate) surfaces grafted with a hydrophilic layer of hyaluronic acid are described. The immobilization reaction involved the covalent attachment of thiolated hyaluronic acid (20 kDa) on acrylated poly(2-hydroxyethyl methacrylate) via nucleophile-initiated Michael addition thiol-ene "click" chemistry. The surface chemistry of the modified surfaces was analyzed by Fourier transform infrared spectroscopy-attenuated total reflectance and X-ray photoelectron spectroscopy. The appearance of N (1s) and S (2p) peaks on the low resolution X-ray photoelectron spectroscopy spectra confirmed successful immobilization of hyaluronic acid. Grafting hyaluronic acid to the poly(2-hydroxyethyl methacrylate) surfaces decreased the contact angle, the dehydration rate, and the amount of nonspecific sorption of lysozyme and albumin in comparison to pristine hydrogel materials, suggesting the development of more wettable surfaces with improved water-retentive and antifouling properties, while maintaining optical transparency (>92%). In vitro testing also showed excellent viability of human corneal epithelial cells with the hyaluronic acid-grafted poly(2-hydroxyethyl methacrylate) surfaces. Hence, surface modification with hyaluronic acid via thiol-ene "click" chemistry could be useful in improving contact lens surface properties, potentially alleviating symptoms of contact lens related dryness and discomfort during wear.

A Survey of Presbyopic Contact Lens Wearers in a University Setting.

To determine why presbyopic patients discontinue contact lens wear and describe their opinions of comfort and visual quality with contact lenses. A survey assessing current age, gender, contact lens material/design, and opinions of contact lens comfort and visual quality was mailed to 2400 presbyopic patients (age 40 years and older) that have had eye exams in the Ohio State University College of Optometry's Contact Lens Services over the last 4 years. A total of 496 surveys were analyzed. The mean age of survey respondents was 57 ± 9 years, and 68% of the sample was female. Permanent discontinuation of contact lens wear was reported by 15%. No association was found between contact lens discontinuation and age (p = 0.7), gender (p = 0.2), age of beginning contact lens wear (p = 0.1), or contact lens material (p = 0.1). Poor vision (38%), discomfort (34%), convenience (20%), and cost (6%) were the primary reported reasons for discontinuation. There was no difference between the proportion of subjects reporting "poor vision" as their primary discontinuation reason and those reporting "discomfort" (p = 0.7). Discontinued wearers had a worse overall opinion of their distance (p = 0.03), intermediate (p = 0.01), and near vision (p = 0.002) compared to subjects who were still wearing their contact lenses. Discomfort has been reported as the primary reason for contact lens discontinuation. In this presbyopic population, dissatisfaction with vision and discomfort were reported equally as often as primary reasons for discontinuation. As well, subjects who ceased contact lens wear had worse overall opinions of their vision at all distances than current contact lens wearers. The results of this survey suggest that presbyopes have unique demands and opinions related to contact lens wear.

Supernumerary punctum: an unusual case of seeing double

Supernumerary punctum is an under‐reported congenital anomaly, in which there is more than one lacrimal punctum. Although usually asymptomatic, supernumerary puncta have been reported to cause dry eye or epiphora (excessive tearing) and should be included in their differential diagnosis. Tearing is often associated with dry eyes and can lead to discontinuation of contact lens wear. A comprehensive evaluation of the causes of tearing may uncover other contributory factors of epiphora.This case report highlights unilateral inferior double puncta in an otherwise asymptomatic patient. Due to increased evacuation of tears in the affected eye, manual occlusion of the puncta was advocated to allow topical medication to be more efficacious.

Medically Reversible Limbal Stem Cell Disease: Clinical Features and Management Strategies

To describe the clinical features and management strategies in patients whose limbal stem cell (LSC) disease reversed with medical therapy. Retrospective case series. Twenty-two eyes of 15 patients seen at 3 tertiary referral centers between 2007 and 2011 with 3 months or more of follow-up. Medical records of patients with medically reversible LSC disease were reviewed. Demographic data, causes, location and duration of disease, and medical inventions were analyzed. Primary outcomes assessed included resolution of signs of LSC disease and improvement in visual acuity. Causes of the LSC disease included contact lens wear only (13 eyes), contact lens wear in the setting of ocular rosacea (3 eyes), benzalkonium chloride toxicity (2 eyes), and idiopathic (4 eyes). Ophthalmologic findings included loss of limbal architecture, a whorl-like epitheliopathy, or an opaque epithelium arising from the limbus with late fluorescein staining. The superior limbus was the most common site of involvement (95%). The corneal epithelial phenotype returned to normal with only conservative measures, including lubrication and discontinuing contact lens wear in 4 patients (4 eyes), whereas in 11 patients (18 eyes), additional interventions were required after at least 3 months of conservative therapy. Medical interventions included topical corticosteroids, topical cyclosporine, topical vitamin A, oral doxycycline, punctal occlusion, or a combination thereof. All eyes achieved a stable ocular surface over a mean follow-up of 15 months (range, 4-60 months). Visual acuity improved from a mean of 20/42 to 20/26 (P < 0.0184). Disturbances to the LSC function, niche, or both may be reversible with medical therapy. These cases, which represent a subset of patients with LSC deficiency, may be considered to have LSC niche dysfunction.

Cytotoxic Effect on Corneal Surface of Multipurpose Soft Contact Lens Solution Which Contains Aloe Vera

Multipurpose solutions (MPSs) used for soft contact lens care contain agents, which can produce alterations in the tear film and ocular surface, such as keratitis, dry eye or conjunctivitis [1,2] Currently, the objective in the contact lens industry is to create novel formulations of MPSs with new agents in order to improve the ocular heath, comfort and to avoid discontinuing contact lens wear [3-5].

Corneal and Conjunctival Sensory Function: The Impact on Ocular Surface Sensitivity of Change from Low to High Oxygen Transmissibility Contact Lenses

Deprivation of oxygen to the ocular surface during contact lens wear has been implicated in the alteration of sensory function. This study investigates whether increasing oxygen availability through discontinuation of contact lens wear or transfer into highly oxygen transmissible (high Dk/t) lenses leads to a change in corneal or conjunctival sensitivity. Twenty-seven long-term extended wearers of low Dk/t soft contact lenses ceased lens wear for 1 week and were refitted with high Dk/t silicone hydrogel lenses. A control group of 25 nonwearers matched for age and sex was also recruited. Central corneal and inferior conjunctival sensitivity were measured using an air-jet aesthesiometer. Threshold was determined using a staircase technique. Measurements were taken during low Dk/t lens wear; after 1 week of no wear; and after 1, 3, 6, and 12 months of high Dk/t lens wear. Measurements were carried out on one occasion on the nonwearers. Corneal sensitivity decreased 1 week after discontinuation of low Dk/t lenses and no further change in sensitivity occurred with high Dk/t lens wear. Conjunctival sensitivity did not change over the same time frame. Ocular surface sensitivity in long-term low Dk/t soft lens wearers was similar to that of nonwearers. Sensitivity was higher in females than males in the nonwearers, but not in the lens-wearing group. An interaction of sex on change in conjunctival threshold was found in the lens wearers. These findings indicate that factors other than oxygen availability alone determine sensitivity of the ocular surface. Silicone hydrogel contact lenses appear to have only a minor impact on ocular surface sensitivity in previous lens wearers.

Contact Lens-Induced Keratitis Resembling Central Toxic Keratopathy Syndrome

To document a case of contact lens-induced keratitis resembling central toxic keratopathy syndrome. A 23-year-old female developed an acute, central, stromal haze subsequent to soft contact lens overwear. Slit lamp examination revealed corrugated stromal "mud cracks," as seen in stage IV diffuse lamellar keratitis (DLK). This was accompanied by relative corneal thinning and flattening with a hyperopic shift of approximately 6 diopters. Eight weeks after discontinuing contact lens wear and after a 2-week tapering regimen of topical steroids, she had partial resolution of the central haze, partial increase in corneal thickness, steepness, and decrease in hyperopic shift. The authors present a case with a history of soft contact lens overwear and a clinical presentation notably similar to the central toxic keratopathy syndrome, which has recently been reported after laser refractive surgery.

Purchase of contact lenses and contact-lenses-related symptoms following the Contact Lenses in Pediatrics (CLIP) Study

The rate and reasons for discontinuation of contact lens wear by young patients are not well known. The Contact Lenses in Pediatrics (CLIP) Study surveyed participants 3 months after the final study visit to determine the percentage of participants who continued to wear contact lenses after study conclusion. The factors associated with continued contact lens wear and differences in behaviors between the children and teens were also determined to provide insights to practitioners who provide refractive correction for patients in those age groups. Three months after the CLIP Study completion, participants and parents returned mailed surveys that assessed post-study lens purchase and symptoms related to contact lens wear if contact lenses wear had been continued. Responses were compared between the children and teens using chi(2) or Fisher's exact test. Almost 92% of the surveys were returned. Eighty percent of teens' parents reported purchasing lenses after the study, vs. 63% of the children's parents (p=0.02). Symptoms reported at the last study visit were not significantly associated with future purchase, though there was a trend towards more light sensitivity in those who did not purchase more contact lenses (23.1% vs. 11.8%). Satisfaction with contact lenses was high among both those purchasing additional contact lenses and those who did not. Both children and teens reported similar frequencies of symptoms such as burning, itching or tearing eyes 3 months following study completion. Teens reported having contact-lens-related dry eyes more frequently than children. A large proportion of children and an even higher proportion of teens continued wearing their lenses 3 months after completing the CLIP Study. Children and teens reported similar contact lens comfort and low frequencies of most symptoms, though teens experienced more dry-eye symptoms. Overall, reports of symptoms in this sample were lower than had been reported in adult populations by other investigators.

Corneal stability after discontinued soft contact lens wear

Purpose To determine the time needed to reach corneal stability after discontinued daily wear of soft contact lenses and to identify corneal topographic and pachymetric changes during this period. Methods We prospectively studied the eyes of 21 consecutive soft contact lens wearers evaluated for keratorefractive surgery. Each eye was examined once immediately after lens removal, 3 and 7 days later, and weekly thereafter. At each visit, manifest refraction, keratometry, corneal topography (EyeSys Corneal Analysis system, EyeSys Laboratories, Houston, TX) and pachymetry were performed. Incidence of associated corneal warpage and changes in corneal curvature and thickness during corneal stability time were determined. Results Of the 42 eyes examined, 26 corneas showed no significant change after the initial evaluation (stable group). The minimum stability time was 3 days in the remaining 16 eyes (unstable group), 7 of which had significant evidence of abnormal topography. Statistical analysis showed no significant differences between two groups regarding age, sex, duration of contact lens wear, and refractive and topographic measures. The mean central corneal thickness on the final visit was significantly different between two groups ( P < 0.05). Conclusion Contact lens induced corneal warpage may occur in a considerable proportion of soft contact lens wearers. A 2-week contact lens free period seems to be adequate for the cornea to stabilize; however, one cannot predict the minimum time needed for each individual patient. Repeating examinations to document corneal stability before refractive surgery may be a safer alternative.

Preoperative Assessment of Corneal and Refractive Stability in Soft Contact Lens Wearing Photorefractive Candidates

This pilot study compared traditional methodologies; manifest refraction and keratometry, with that of newer technologies; corneal topography, and optical pachymetry, in assessing corneal and refractive stabilization after soft contact lens wear in photorefractive candidates. The timeline differences among these various technologies in determining refractive and corneal stability were investigated. This was a masked prospective observational clinical study of full-time soft contact lens subjects on various wear schedules, all eligible candidates for photorefractive surgery. Subjects discontinued contact lens wear within 30 min of the initial study visit. During each study visit, the same sequence of tests were performed (manifest refraction, keratometry, corneal topography, and optical pachymetry). The timing of the last visit was determined when the four procedures resulted in stable findings when compared with the previous visit. Fifteen soft contact lens wearers and five noncontact lens wearing controls completed the study. The mean number of days until stability of the 15 test subjects were: 10.7 +/- 10.4 days with manifest refraction, 16.2 +/- 17.5 days with keratometry, 28.1 +/- 17.7 days with topography, and 35.1 +/- 20.8 days with pachymetry. Within the control group, intraclass correlation coefficients for all four methods were > or =0.89, indicating very little variability. Analysis with the randomized block design found statistical differences between traditional and newer technologies in their assessment of stability (p < 0.001). One-way Analysis of variance of the various soft contact lenses modalities suggested extended hydrogel wearers taking the longest time to reach stability after discontinuing full-time contact lens use. Corneal curvature and thickness measurements took the longest to achieve consistency. Thus, topography and pachymetry may be better methods to determine ocular stability before photorefractive surgery. In light of this finding, the current protocol in practice of determining the readiness of contact lens candidates for photorefractive surgery may be inadequate.

Tinted contact lenses in Bothnia dystrophy

To determine whether tinted contact lenses can improve visual function in patients with Bothnia dystrophy (BD), a genetically defined retinal dystrophy with prolonged dark adaptation. Twelve patients with BD were fitted with the same type of soft contact lenses tinted dark brown. Visual acuity (VA), contrast vision, near vision and visual fields were tested before and 1 month after contact lens fitting. The patients completed a visual function questionnaire. The physical properties of the contact lenses were tested using spectrophotometry. The patients with the lowest VA described the most obvious improvement in visual function. This group of patients preferred darker contact lenses and continued wearing their contact lenses after the study ended. The patients with the best VA preferred lighter contact lenses and a few patients in this group discontinued contact lens wear upon completion of the study. Visual function in BD patients was improved by dark tinted contact lenses. The optimal colour for lenses varies, depending on the season and the individual. Other patient groups with retinal dystrophies associated with prolonged dark adaptation or dysfunction of the cone system, such as cone dystrophies or achromatopsia, may also benefit from this type of contact lens.

Frequency of and Factors Associated With Contact Lens Dissatisfaction and Discontinuation

To determine the frequency of and factors associated with contact lens dissatisfaction and discontinuation. A cross-sectional survey of 730 subjects was conducted using a self-administered survey instrument. The survey collected information about present age and sex, history of contact lens wear, types of lenses worn, age at starting wear, current wearing schedule (hours per day, days per week), self-perceived contact lens satisfaction, and contact lens-related problems. A variety of statistical analyses including analysis of variance, logistic regression, and repeated-measures logistic regression were used to model the data. Current or previous experience with contact lenses was reported by 453 (62%) of the subjects. Of these subjects, 119 (26.3%) reported that contact lenses were not the ideal form of visual correction for them (contact lens dissatisfaction) and another 109 (24.1%) had permanently discontinued contact lens wear. Dissatisfied contact lens wearers had reduced self-reported wearing times compared with satisfied contact lens wearers. Previous lens wearers were more likely than current lens wearers to be men, older (by approximately 9.5 years), have started contact lens wear at a later age (approximately 4-5 years later), and have tried either rigid or both soft and rigid lenses. The primary self-reported reason for both contact lens dissatisfaction and discontinuation was ocular symptoms (dryness and discomfort), followed by preference for another corrective modality. A significant number of contact lens wearers are not satisfied with contact lenses and are at risk for discontinuation.