Lens Wear Research Articles

Contact lens wear and follow‐up and its association with signs and symptoms of meibomian gland dysfunction

AbstractIntroductionThis study investigated the equivocal association between contact lens (CL) wear and meibomian gland dysfunction (MGD) by comparing the morphological, functional and subjective outcomes of CL wearers versus control, non‐CL wearers. CL wearers were examined as two cohorts based on the annual attendance of follow‐up visits (FLU—attended these visits, whereas non‐FLU did not).MethodsHabitual logMAR visual acuity, invasive and non‐invasive tear break‐up time, Schirmer test, Efron grading scales, meibum quality score (MQS), meibum expressibility score (MES), meibomian gland (MG) loss, lid margin abnormalities and subjective dry eye (DE) symptoms were assessed.ResultsOf the 128 participants, 31 were in the FLU cohort, 43 were in the non‐FLU cohort and 54 were controls (mean ages: 22.2 ± 3.1, 23.0 ± 4.6 and 22.3 ± 3.5, respectively). Non‐FLU CL wearers had more symptoms than controls (3.7 ± 2.4 vs. 2.3 ± 2.1, p < 0.01). Morphologically, FLU (16.9 ± 8.8%, p = 0.02) and non‐FLU (18.6 ± 11.3%, p = 0.001) had more MG loss than controls (11.2 ± 6.8%). Functionally, FLU (0.6 ± 0.7, p = 0.01) and non‐FLU (0.8 ± 0.9, p = 0.001) had worse MES than controls (0.2 ± 0.5). FLU and non‐FLU were both associated with corneal staining (odds ratio [OR] = 3.42, 95% CI: 1.16–10.11, p = 0.03 and OR = 5.23, 95% CI: 1.89–14.48, p = 0.001, respectively) and MG loss (OR = 10.47, 95% CI: 1.14–96.29, p = 0.04 and OR = 16.63, 95% CI: 1.96–140.86, p = 0.01, respectively). Non‐FLU CL wear was also associated with abnormal MQS (OR = 12.87, 95% CI: 1.12–148.41, p = 0.04), conjunctival staining (OR = 12.18, 95% CI: 3.66–40.51, p < 0.001) and lid margin telangiectasia (OR = 3.78, 95% CI: 1.55–9.21, p = 0.003). MGD was three times more prevalent in CL wearers (12%) than in controls (4%).ConclusionsBoth CL‐wearing cohorts demonstrated significantly more MG abnormalities than controls though the difference was not clinically significant. Non‐FLU CL wearers had more DE symptoms. Non‐FLU CL wear is an independent predictor for more abnormalities than FLU CL wear, emphasising the importance of follow‐ups.

Association of ocular surface and meibomian gland alterations with silicone hydrogel contact lens wear

PurposeTo evaluate silicone hydrogel contact lens (SH-CL) effects on the meibomian glands, corneal structure, and ocular surface parameters. MethodsFifty SH-CL wearers for at least 6 months, and 50 sex and age-matched control subjects were recruited for this cross-sectional study. Visual display terminal (VDT) work and CL wear duration were questioned, ocular surface and tear functions were evaluated using OSDI questionnaire, tear break-up time (TBUT), corneal fluorescein staining, and Schirmer test. Corneal sensitivity was measured with Cochet-Bonnet aesthesiometry. Meibography and in vivo confocal microscopy (IVCM) were performed to evaluate meibomian glands and corneal structure. Intergroup comparisons were made using the Chi-square test, Wilcoxon test, or Kruskal–Wallis test. ResultsIn the CL group, TBUT was shorter (P = 0.01), corneal fluorescein staining (P = 0.04), OSDI scores (P < 0.001), and meiboscores (P < 0.001) were higher than the control group. The biomicroscopic evaluation revealed meibomian gland dysfunction (MGD) in 34 % of the CL group and 20 % of the control group, which was not statistically significant (P > 0.05). IVCM showed that endothelial cell density was lower (P = 0.01) and polymegethism was higher (P < 0.001) in the CL group. Subbasal nerve density and corneal sensitivity measurements were similar in the two groups (P > 0.05). The longer VDT work duration was associated with increased CFS in the CL group (P = 0.05). ConclusionThe results showed that SH-CL wear increased dry eye symptoms and ocular discomfort, especially in longer VDT work duration. Meibography revealed significantly worse results in SH-CL wearers. SH-CL-related ocular discomfort seems to be more associated with MGD rather than neurosensorial alterations.

The influence of large-diameter multifocal contact lens on ocular surface, visual quality, and visual function for presbyopic adults with dry eye syndromes

This study investigated the influence of large-diameter multifocal contact lenses on the ocular surface, visual quality, and visual function for presbyopic adults with dry eye syndromes. The study enrolled 40–55-year-old adults with presbyopia and dry eye syndromes (DES). The subjects were randomly assigned to three groups wearing different designs of contact lenses (Proclear, SMR, and Optimum) for 6–8 h a day for two weeks. Ocular surface health, tear quality, visual quality, and visual function were measured before and after lens wear. No significant difference was observed across all three groups for the amount of conjunctival redness, blink frequency (lens on), and stereopsis vision before and after wearing. Although there seemed to be a significant declining trend for corneal staining and limbal redness, non-invasive tear break-up time (TBUT), and lipid layer thickness while lens wear, the measured values were all within the normal range. Vice-versa after lens removal, results also showed significant improvement on lipid layer thickness, blink frequency (lens off), and contact TBUT. A significant improvement was observed in the modulation transfer function (MTF) of the total area ratio after wearing contact lenses. In contrast, the MTF of the high-order aberration area ratio resulting from lens wear was lower than that of the baseline measurement. There are also significant improvements observed for SMR and Optimum regarding near visual acuity, near point of accommodation, and the subjective questionnaire (OSDI and VBP) scores. Although it is difficult to avoid a specific negative impact on the ocular surface and tear film, visual function and visual quality can still be positively improved, especially shown on larger diameter and distance-center designed multifocal contact lenses.

Anterior, Posterior, and Thickness Cornea Differences after Scleral Lens Wear in Post-LASIK Subjects for One Year.

The aim of this study is to analyze the anterior and posterior corneal surface shape and the corneal thickness difference outcomes between before and after scleral lens (ScCL) wear in post-LASIK ectasia subjects for one year. Twenty eyes with post-LASIK ectasia wearing scleral lenses were evaluated in a visit before contact lens and after 1, 6, and 12 months. The study variables analyzed included the apex, nasal, temporal, inferior, and superior corneal thickness; the anterior and posterior surface corneal at corneal diameters of 8, 6, 4, and 2 mm, and high-contrast visual acuity. A statistically significant increment of corneal thickness (p < 0.05) was observed in the inferior area after 6 months and in the superior area in the 12-month follow-up after wearing ScCLs. The anterior corneal curvature presented a flattening and a statistically significant steepening (p < 0.05) in the central and peripheral radii, respectively, after one year. The posterior corneal curvature showed a significant (p < 0.05) steepening, which mainly affected the central region after one year. Despite these changes, high-contrast visual acuity with ScCL correction remained at the same values. The prolonged use of scleral lenses in post-LASIK subjects showed significant changes in the corneal curvature and thickness. These outcomes recommend more detailed and periodic topographic and vision quality checks to monitor the wear in ScCL patients.

Bowman Layer Onlay Grafting as a Minimally Invasive Treatment for the Most Challenging Cases in Keratoconus

PurposeTo analyze the clinical outcomes after Bowman layer (BL) onlay grafting for the treatment of progressive, advanced keratoconus. DesignProspective, interventional case series. MethodsTwenty-one eyes underwent BL onlay grafting. After removing the epithelium, a single or double BL-graft was “stretched” onto the corneal surface, allowed to dry-in, and a soft bandage lens was placed until the graft was re-epithelialized. Best spectacle- and/or best contact lens-corrected visual acuity (BSCVA/BCLVA), corneal tomography, and postoperative complication rates were analyzed for the total group and two subgroups [Group 1: preoperative maximum keratometry (Kmax) <69D (n=7), Group 2: preoperative Kmax ≥69D (n=14)]. Follow-up ranged from 6-36 months (mean 21±11 months). ResultsAll 21 surgeries were uneventful. Overall, Kmax changed from 76±12D preoperatively to 72±9D at 6-36 months postoperatively (P=0.015). Kmax decreased by 6D in Group 2 (P=0.002) but did not change in Group 1. Average BSCVA remained stable for Group 1 and improved from preoperatively 0.8±0.4 to 0.4±0.2 LogMAR postoperatively in Group 2 (P=0.032); BCLVA remained stable (P>0.05). Within the first postoperative weeks, two eyes required BL-graft re-positioning after inadvertent bandage lens removal and four eyes underwent BL re-transplantation for incomplete re-epithelialization. One eye underwent BL-regrafting 12-month postoperative after traumatic corneal erosion. All eyes showed a completely re-epithelialized graft at the last available follow-up. ConclusionsBL onlay grafting is a completely extraocular, minimally invasive surgical technique, providing up to -6D of corneal flattening in eyes with advanced progressive keratoconus, allowing for continued (scleral) contact lens wear and therefore preserving the BCLVA.

Patient Experiences With Therapeutic Contact Lenses and Dry Eye Disease.

To report patient-reported experiences with dry eye disease and therapeutic contact lenses. A survey was distributed to patients with dry eye disease. Demographics, Ocular Surface Disease Index (OSDI), systemic disease, contact lens history, and burden of care information were collected. Descriptive statistics are presented and categorized by nonlens, soft lens, and scleral lens (SL) wearers. Of 639 respondents, 15% (94/639) were currently using therapeutic soft or SLs (47 soft and 69 SL). Mid-day fogging or clouding of vision was reported by SL (75%, 50/67) and soft lens (62%, 29/47) wearers. Seventy-two percent of SL wearers spent more than 20 min daily on dry eye treatment while 43% of soft lens wearers spent more than 20 min. Median annual expenditure was higher for SL ($1,500, n=63) than nonlens ($500, n=371) or soft lens wearers ($700, n=43). Mean OSDI scores in all groups were in the severe category (51±22 years, n=401 nonlens wearers; mean age; 45±22 years, n=47 soft lens wearers; 60±24 years, n=69 SL wearers). Mid-day fogging and blurring of vision was reported by most of the individuals using therapeutic lenses for dry eye disease. SL wearers allocate the most resources for dry eye care.

The Perception of Spectacles Use Among the General Population in Ha'il Region, Saudi Arabia: A Cross-Sectional Study.

The study aims to assess the perception of optical spectacles use among the Ha'il region population in Saudi Arabia. A cross-sectional survey was distributed via various social media applications to the residents of the Ha'il region. An online questionnaire was designed and included informed consent and questions assessing the participants' perceptions about wearing eyeglasses, contact lenses, and general eye health. 32.4% of the participants think that long-term eyeglasses wearing worsens vision, and 43% think eyeglasses wearing improves vision. 75.2% believe that long-term use of glasses could cause lifetime dependency on eyeglasses. Regarding contact lenses, 45.9% believe that long-term wearing worsens vision, and 24.1% think long-term wearing of contact lenses improves vision. 60% think long-term use of lenses causes lifetime dependency on those contact lenses. Our results highlighted the misconceptions among the study population regarding wearing prescribed eyeglasses and contact lenses. Thus, education programs and media are warranted to correct the misconceptions about spectacles and raise the awareness about refractive errors and treatment options.

Comment on: Comfort After Refitting Symptomatic Habitual Reusable Toric Lens Wearers with a New Daily Disposable Contact Lens for Astigmatism [Letter

Comment on: Comfort After Refitting Symptomatic Habitual Reusable Toric Lens Wearers with a New Daily Disposable Contact Lens for Astigmatism [Letter

Comfort after Refitting Symptomatic Habitual Reusable Toric Lens Wearers with a New Daily Disposable Contact Lens for Astigmatism [Response to Letter

Comfort after Refitting Symptomatic Habitual Reusable Toric Lens Wearers with a New Daily Disposable Contact Lens for Astigmatism [Response to Letter

Vision related quality of life among Nepalese patients with keratoconus

Introduction: Keratoconus (KC) is a bilateral progressive noninflammatory disorder characterized by irregular astigmatism and corneal thinning. KC results in a disproportionate impact on major aspects of quality of life (QoL) of a person due to its early onset and chronic nature. This study aims to evaluate vision-related QoL in Nepalese patients with KC. Method: A cross-sectional hospital-based study was carried out for 1 year. A sample of 35 KC subjects and 38 control subjects who met the eligibility criteria were enrolled. All subjects underwent corneal topography and abberometry along with a comprehensive eye examination. Both cases and controls completed the NEI VFQ 25 questionnaire. Visual acuity (high contrast visual acuity and LCVA), CS, color vision, refraction, and scores of all subscales of QoL were measured. The QoL scores were correlated with each of the visual function parameters in KC subjects. Result: The mean scores of all of the subscales of QoL were found significantly less in the KC group than in age and sex matched control group with P&lt;0.001 The mean composite score was found to reduce significantly as the grade of KC increased. The mean composite score for grade 1 KC was 70.79±7.96, grade 2 KC was 60.56±6.49 and for grade 3 KC was 55.99±0.67 with P=0.001 about better eye. There was a highly significant difference in the mean composite score of QoL between these contact lens wearers and spectacle wearers. The mean composite score for spectacle wearer was 67.86±07.99 and that of contact lens wearer was 58.63±04.26 with P=0.004. Conclusion: This study concluded that the QoL of keratoconic individuals was found to reduce gradually as the severity of the disease increased. QoL score in contact lens-wearing Nepalese KC patients is worse than spectacle wearers. By stopping the progression of disease we can maintain functional vision as well as a vision-related QoL. Our study findings suggested that vision and visual function parameters in the better eye is the most important parameter affecting VR-QOL of patients with KC. KC patients should maintain the best vision that they can have.

Current approaches to soft contact lens handling training – Global perspectives

PurposeAll neophyte contact lens wearers require training on how to handle contact lenses. Currently, almost no published information exists describing the most common approaches used by those involved in such training in soft contact lens wearers. This study aimed to gather information on the approaches taken by those conducting this training worldwide. MethodsAn online survey was created in English and translated to Spanish and distributed internationally via social media, conference attendees, and professional contacts. The anonymous survey included information on workplace setting of respondents, information about the typical approaches used for application and removal of soft contact lenses, length of the appointment, and success rate with their approach. Survey responses were received between May 2021 and April 2022. ResultsA total of 511 individuals completed the survey and responses were received from 31 countries with 48.7% from the UK. The most common approach taught for application was to have the patient hold the upper eyelashes (84.7%) and to hold the lower eyelid with the same hand as the lens (89.4%). Lenses were applied directly to the cornea by 57.7% of the respondents. The most common approach taught for lens removal was to drag the lens inferiorly from the cornea prior to removal (49.3%). Most respondents did not use videos to aid the teaching appointment (62.0%); however, they felt that their approach was successful in most cases (90). Application and removal training sessions lasted a median of 30 min and contact lenses were typically dispensed after the instructor witnessing successful application and removal three times. ConclusionVarious methods are adopted globally for training of application and removal of soft contact lenses, with many advising a patient-specific approach is required for success. The results of this survey provide novel insights into soft contact lens handling training in clinical practice.

Orthokeratology in road traffic – a random sample

Purpose. The German regulation on granting persons permission to drive on the road specifies minimum visual requirements for obtaining a driving licence. The aim of this pilot study was to determine orthokeratology-related diurnal variations in visual acuity, contrast sensitivity and mesopic vision, as well as sensitivity to glare, and to verify compliance with the requirements for obtaining a driving licence. Material and Methods. Ten orthokeratology lens wearers (26.0 ± 7.1 years) with myopia of −2.43 ± 0.97 D and astig- matism of −0.31 ± 0.41 D were tested twice daily (08:30 and 20:30 h) with the Binoptometer 4P (Oculus, Wetzlar, Ger- many). Monocular and binocular visual acuity were tested according to the ISO 8596 and compared with the visual acu- ity requirements for obtaining a driving licence. In addition, binocular contrast and mesopic vision as well as sensitivity to glare were tested in both exams. Differences between the morning and evening examinations were determined using the paired t-test or the Wilcoxon signed-rank test (for non-normally distributed data). Results. There was no statistically significant difference between monocular visual acuity (logMAR) in the morning (right −0.07 ± 0.16; left −0.03 ± 0.15) and evening (right −0.09 ± 0.14; left −0.06 ± 0.17) (p = 0.875; p = 0.353) or binocular visual acuity in the morning (−0.11 ± 0.15) and evening (−0.13 ± 0.13) (p = 0.500). Decimal visual acuity ranged monocularly from 0.63 to 2.00 and binocularly from 0.70 to 2.00. This corre- sponds to the threshold value of an ophthalmological as- sessment for visual acuity of the better eye or for a binocular visual acuity of 0.5. There was no statistically significant difference between the quality of contrast vision in the morning (mean We- ber contrast 11.5 ± 3.4 %) and in the evening (15.5 ± 9.3 %) (p = 0.070), and mesopic vision and glare sensitivity in the morning (both 0.27 ± 0.09 logCS) and in the evening (both 0.27 ± 0.09 logCS) (p = 1.000). Conclusion. Visual acuity, contrast sensitivity, mesopic vision and sensitivity to glare were stable throughout the day in this sample for orthokeratology lens wearers. The requirements of the eye test needed to drive were fulfilled by all but one of the participants in the standard eye test, both in the morning and evening examinations. A more comprehensive eye test was also carried out. This was passed by all test subjects, both in the morning and evening examinations. Keywords Orthokeratology, driving licence regulation, ISO 8596, ophthalmological assessment, mesopic vision, sensitivity to glare

Relationship between myopia control and amount of corneal refractive change after orthokeratology lens treatment

BackgroundTo evaluate the relationship between amount of corneal refractive change (CRC) after wearing orthokeratology (Ortho-K) lenses and axial length (AL) growth.MethodsWe retrospectively enrolled 77 patients (77 eyes) aged 8–14 years who wore Ortho-K lenses more than 12 months. We divided the patients into 2 subgroups: spherical equivalent (SE) ≤ -3.0 D and SE > -3.0 D subgroup. The sagittal and tangential curvature maps and corneal topographic data within the 8-mm diameter ring at the baseline and during follow-up visits after wearing Ortho-K lens were recorded in addition to the area, height, and volume of the CRC region. The AL data were recorded at the baseline and during follow-up visits. Multivariate linear regression was conducted to analyze associations between the area, height, and volume of the CRC region, AL elongation, and SE.ResultsThe average change in the CRC region was 9.77 ± 0.60 D in height, 16.66 ± 3.61 mm2 in area, and 87.47 ± 8.96 D*mm2 in volume on the tangential diagram after wearing Ortho-K lenses for 3 months. The AL showed a change of 0.19 ± 0.14 mm after 1 year of Ortho-K lens wear (P < 0.05). At 1 year, AL elongation was negatively correlated with the area (P = 0.019) and volume (P < 0.001) of the CRC region. At 1 year, for every 1-mm2 increase in the area and every 1-D*mm2 increase in the volume of the CRC region, the average AL elongation decreased by 0.01 mm and 0.002 mm, respectively, in the multivariate analysis. In patients with SE ≤ -3.0 D, AL elongation was negatively correlated with the CRC-region volume (β = -0.002, P = 0.018), and in patients with SE > -3.0 D, AL elongation was negatively correlated with the CRC-region area (β = -0.017, P = 0.016).ConclusionsThe AL elongation-control efficacy of Ortho-K lenses may be related to the area and volume of the CRC region.

Prospective assessment of corneal biomechanical properties and intraocular pressure after scleral lens wear: A 12-month follow-up study

PurposeTo investigate the long-term influence of scleral lens (SL) wear on corneal biomechanical properties and intraocular pressure (IOP) in irregular and regular corneas. Secondary goal comprised evaluate the fluid reservoir (FR) thickness overtime and correlate it with the changes in corneal biomechanical parameters and IOP. MethodsSeventy (70) eyes with irregular corneas (IC Group) and 21 eyes with regular corneas (RC Group) were fitted with 16.4 mm SL and wore the lenses for 12 months. Corrected IOP (IOPcc), Goldmann equivalent IOP (IOPg) and corneal biomechanical parameters (Corneal Hysteresis (CH) and Corneal Resistance Factor (CRF)) were measured with Ocular Response Analyzer. Slit lamp images were analyzed with ImageJ software to assess FR thickness overtime. Measurements were taken at lens dispensing visit prior lens wear (LDV1) and after 60 min of lens wear (LDV2) and at 1, 6 and 12-month follow-up visits. Measurements were done immediately after lens removal. ResultsThere were no statistically significant differences on IOPcc, IOPg, CRF and CH over the follow-up visits in both groups. Mean IOPcc and IOPg fluctuations overtime were clinically insignificant and below 1 mmHg in both groups. IOPg, CH and CRF were significantly lower on IC Group (p < 0.001), although no statistically significant differences were found between groups for IOPcc. Regarding FR thickness, statistically significant differences were found over the follow-up on both groups, with a mean decrease of 186.29 µm on IC Group and 175.32 µm on RC Group (p < 0.001). Statistically significant moderate to high negative correlations between FR and IOPg, CRF and CH were found only in the RC Group. ConclusionsLong-term SL wear was not associated to changes in corneal biomechanical parameters neither on IOP as measured after lens removal. Besides IOP measurement without SL removal, more studies are needed to investigate the potential relationship with SL fitting characteristics (namely FR thickness).

Does dropout happen even with patients fitted with contact lenses for irregular cornea?

Objectives: Different types of contact lenses play a primary role in improving visual acuity in irregular corneas. Although there are multiple evidences for vision improvement with contact lens patients still drop out of lens wear and choose other methods of treatment, surgeries, or discontinue the lenses. Materials and Methods: Three thousand two hundred patients who were evaluated for 5 years at a specialty contact lens clinic in a tertiary eye care center, but did not return to the clinic for over 18 months from the date of dispensing were identified as dropouts. Only 73 patients were identified as falling under this category of dropout. The reasons for dropout were categorized as comfort-related, vision-related, other reasons, and those who underwent surgical procedures. Results: Unlike previous studies, which included soft lenses, this study revealed only 2.28% (73/3200) of dropouts. There were 38 patients with unilateral lens fitting and 35 patients with bilateral lens fitting. The visual acuity was significantly improving with contact lens in these eyes. The clinical presentation of these patients was analyzed to know about their stage of disease while they dropout from the contact lens clinic. Conclusion: Although dropout of contact lens is much lesser in irregular corneal conditions, it is important for the practitioner to be updated with the alternate and latest modality of lens choices to satisfy vision-related and comfort-related issues of patients.

Infectious Complications of Contact Lenses: A Review of the Literature

The use of contact lenses is very common, they are prescribed for the correction of refractive errors that cannot be treated by glasses such as aphakia, keratoconus and strong anisometropia, or as alternatives to glasses. Contact lenses can cause serious complications that are not always easy for patients to manage [1]. Infectious complications in contact lens wearers are a real diagnostic and therapeutic emergency. These infections can be bacterial, amoebic (due to wearing contact lenses in swimming pools, rinsing lenses with tap water or saliva), fungal (due to wearing therapeutic, cosmetic or aphakic lenses, diabetes, alcoholism, immunosuppression, corticosteroids). Infectious complications require emergency treatment. The first line of treatment consists of removing the contact lens and sending it, along with the lens case and lens care product, to the laboratory along with corneal samples and appropriate medical treatment. Infectious keratitis related to contact lens wear is serious and can permanently affect the visual prognosis. The prevention requires a fitting under medical supervision and an awareness of the patients with potential risks of infection.

Two-Dimensional Peripheral Refraction and Higher-Order Wavefront Aberrations Induced by Orthokeratology Lenses Decentration.

The purpose of this study was to explore two-dimensional peripheral refraction and higher-order aberrations (HOAs) induced by orthokeratology lens decentration. Two-dimensional peripheral refraction and HOAs in a rectangular field (horizontally 60 degrees and vertically 36 degrees) were obtained using an open-view Hartmann-Shack wavefront sensor. The peripheral field was divided into 8 regions according to a combination of superior (UZ) or inferior (LZ) and a value, 1 (T25 to T30), 2 (T20 to T25), 3 (N20 to N25), or 4 (N25 to N30). The decentration of the lens was evaluated based on the change of power in the front of the tangential corneal map. All measurements were taken at the baseline and 1 month after lens fitting. In total, 134 myopic children (age = 12.47 ± 1.70 years, SER = -2.44 ± 1.10 diopters [D]) were recruited. In general, horizontally asymmetrical change was observed in relative peripheral refraction (RPR), spherical aberration (SA), and horizontal coma. The root-mean square of higher order aberration (RMSHOA) and vertical coma demonstrated radial symmetrical change and vertically asymmetric change, respectively. Relative peripheral myopia was significantly increased after the treatment, with more myopic refraction in the temporal side. RPR changes in UZ2, UZ3, UZ4, LZ1, and LZ2 were related to the amount of lens decentration (r ≈ 0.4, P<0.05). All HOAs increased after lens fitting (around 0.03 um, 0.02 um, 0.04 um, and 0.41 um for SA, horizontal COMA, vertical COMA, and RMSHOA in the periphery region). RPR and HOAs are related to lens decentration, which might contribute to the efficacy of orthokeratology. The study found a decentration-related optical feature after 1 month of lens wear, which is a suggested protective factor in myopia treatment. The findings might provide new insights for customized contact lens myopia treatment based on optics.

Comfort After Refitting Symptomatic Habitual Reusable Toric Lens Wearers with a New Daily Disposable Contact Lens for Astigmatism.

To subjectively evaluate comfort with a daily disposable (delefilcon A for astigmatism) contact lens compared to other common weekly/monthly soft toric contact lenses in symptomatic wearers. This open-label, single arm study enrolled current reusable soft toric lens wearers with minimum score of 12 on the contact lens dry eye (CLDEQ-8) questionnaire. Subjects were also administered the CLDEQ-8 after 1 replacement schedule of their optimized habitual toric lenses (2 to 4 weeks), and after 2 weeks of wear with delefilcon A toric daily disposable lenses (Dailies Total1 for Astigmatism; Alcon Vision LLC, Fort Worth, Texas). A total of 85 subjects completed the study. Mean total CLDEQ-8 score was 16.8 ± 8.1 for subjects refit with their optimized habitual toric lenses and 12.4 ± 7.5 for subjects refit with delefilcon A toric lenses, a difference of 4.3 ± 10.4 (p < 0.001). With delefilcon A toric lenses, 78.9% of subjects reported little to no intensity of eye discomfort, compared to 51.7% for the habitual toric lenses (p = 0.005). In addition, 77.7% of subjects reported little to no intensity of dryness for delefilcon A toric lenses, compared to 50.6% for the habitual toric lenses (p = 0.001). The subjective comfort in symptomatic habitual reusable toric contact lens wearers was improved by refitting with delefilcon A toric lenses.

Impact of Dry Eye Disease on the Uncorrected Distance Visual Acuity after Small Incision Lenticule Extraction.

The aim of this study was to explore the impact of dry eye disease (DED) on the uncorrected distance visual acuity (UDVA) and refractive status after small incision lenticule extraction (SMILE). This prospective cohort study enrolled 29 patients (DED group, 11 eyes; non-DED group, 18 eyes) who underwent SMILE in our center from July to September 2022. The examinations on DED, refractive status and UDVA were performed before surgery, and on day 7 and 20 after surgery. The results showed that on day 20 after SMILE, subjects in the non-DED group reported greater changes of ocular surface disease index value increase and tear-film breakup time reduction compared to baseline than those in the DED group (p < 0.001 and p = 0.048, respectively). Compared to preoperative status, DED patients had greater improvements of UDVA and better optometric outcomes on day 20 after surgery than non-DED subjects (p = 0.008 and 0.026, respectively). Multiple linear regression analysis showed age, contact lens daily wearing time, and tear meniscus height before surgery were of the highest value to predict UDVA on day 20 after SMILE in contact lens wearers (p = 0.006, 0.010 and 0.043, respectively). In conclusion, preoperative tear function could affect UDVA after SMILE. The impact of DED on UDVA and refraction should be taken into consideration before surgery.

Successful treatment of multidrug-resistant Pseudomonas aeruginosa keratitis with meropenem eye drops — a case report

BackgroundThis case report describes the course and therapeutic management of a fast-spreading bacterial keratitis caused by multidrug-resistant (MDR) Pseudomonas aeruginosa (P. aeruginosa).Case presentationA 27-year-old male contact lens wearer presented with a multi-resistant, fast spreading P. aeruginosa keratitis. After initial resistance to various antibiotic therapies, testing revealed a MDR P. aeruginosa. The keratitis was treated successfully with specially prepared 50 mg/ml off-label meropenem eye drops for 18 days as well as systemic meropenem for seven days with rapid improvement of the corneal infiltrate.ConclusionThis case report demonstrates the combination of topical and systemic meropenem as a useful treatment option for corneal ulcers caused by MDR P. aeruginosa.