OPTI-FREE RepleniSH Research Articles

Physical properties of soft contact lens multipurpose solutions commercially available in Ghana

PurposeTo investigate the physical properties of commercially available multipurpose soft contact lens solutions in Ghana. MethodspH (Kelilong ICL-099 pH meter, China), osmolality (OSMOMAT 3000, GONOTEC, Germany), surface tension (Sigma 700 Tensiometer, Sweden), and viscosity (CFOC-200 Viscometer, Cannon Company, USA) of various soft contact lens multipurpose solutions (MPS) were measured in triplicates at room temperature. Viscosity measurements were also taken at 34 °C ocular surface temperature. The solutions examined were Opti-Free Replenish (OFR), Trufresh (TF), Avizor (AV), Freshlook (FL), and Refresh (RF). ResultsSeveral solutions were largely hypo-osmotic in the range of 108–231 mOsm/kg, the exception being Avizor, which had osmolality values that were closer to human tears (301 ± 0.58 mOsm/kg). The range of pH values of the solutions (6.33–8.24, mean (SD) = 7.53 ± 0.18) fell within the reported tolerable range for the ocular surface (6.20–9.00). Surface tension values ranged from 35.86 to 42.27 mNm with a mean of 38.49 ± 2.32 mNm. The average viscosity of most solutions at room temperature (25 °C) was 1.44 ± 0.49 cP with a range of 1.04–2.15 cP. Significantly lower values ranging from 0.79 to 1.58 cP were obtained at ocular surface temperature (34 °C), p = 0.0001). ConclusionsThe physical properties of many of the solutions used as MPS in Ghana are markedly variable. Nevertheless, pH, surface tension, and viscosity fall within the acceptable limits of ocular physiological tolerance; except for osmolality, which majority were outside the reported tolerable range for the ocular surface. This information may partly explain the reason some patients exhibit strong preferences for certain care systems and should aid clinical decision-making when prescribing eye care systems to patients.

Acanthamoeba castellanii trophozoites that survive multipurpose solutions are able to adhere to cosmetic contact lenses, increasing the risk of infection

Amoebae of the genus Acanthamoeba are etiological agents of amoebic keratitis, for which up to now there is no treatment of choice and one of its main risk factors is the use of contact lenses, including cosmetic contact lenses. Recently there has been an increase in amoebic keratitis cases due to the use of cosmetic contact lenses. Therefore, having a solution for the care of lenses with an efficient disinfectant effect that prevents the adhesion of trophozoites to lenses becomes essential. This study was carried out to determine the effect of 8 multipurpose contact lenses care solutions on Acanthamoeba castellanii trophozoites viability, and the efficiency of two of them to prevent the trophozoites adherence onto two cosmetic contact lenses (Acuvue 2, approved by the US Food and Drug Administration, and Magic Eye CCL, not approved). After 3 h of interaction, only AO Sept Plus, OPTI FREE Replenish, Renu Plus, Bio True and Multiplus significantly reduced the number of viable trophozoites with respect to the control; at 6 h Renu Plus, and at 12 h Conta Soft Plus and Multiplus, maintained the inhibitory effect. Only Opti Free Pure Moist did not significantly reduce the number of viable trophozoites. Multiplus and Opti Free Pure Moist (selected for their greater and lesser antiamibic effect) significantly reduced trophozoite adherence to both lenses; however, Opti Free Pure Moist was more efficient, despite the fact that A. castellanii adhered similarly to both lenses. Our results show that in all the multipurpose solutions evaluated, hundreds of viable A. castellanii trophozoites remain after several hours of incubation. Therefore, storage of the lenses in their case with MPS maintains the potential risk of amoebic keratitis in, cosmetic contact lenses wearers. Moreover, the use of CCL, not approved by the FDA, can increase the risk factor for AK since its poor manufacture can favor the permanence of amoebae, in addition to being a risk for corneal integrity.

Activity of Deposited Lysozyme on Contemporary Soft Contact Lenses Exposed to Differing Lens Care Systems.

PurposeThe amount of protein deposition on soft contact lenses and to what extent the proteins are denatured may have an impact on comfortable wearing times of contact lenses. The purpose of this study was to evaluate the effects of two lens care systems on total protein and the quantity and activity of lysozyme deposited on worn senofilcon A, silicone hydrogel contact lenses.Participants and MethodsThirty symptomatic soft contact lens wearers were enrolled into a 4-week prospective, randomized, bilateral eye, daily-wear, crossover, double-masked study. Participants were fitted with biweekly senofilcon A lenses and were assigned either a polyquaternium-1 and myristamidopropyl dimethylamine-containing system (OPTI-FREE RepleniSH) or a peroxide-based system (CLEAR CARE). After each wear period, proteins were extracted from the lenses and analyzed for total protein, total lysozyme quantity and activity.ResultsThe use of either the peroxide-based system or the polyquaternium-1 and myristamidopropyl dimethylamine-containing system resulted in no difference (P>0.05) to the amount of total protein deposited on the lenses (6.7 ± 2.8 micrograms/lens versus 7.3 ± 2.8 micrograms/lens, respectively) or to the amount of denatured lysozyme deposits (0.8 ± 0.7 versus 0.9 ± 0.7 micrograms/lens), respectively. The total amount of lysozyme deposited on the lenses was significantly lower when using the peroxide-based system (1.3 ± 0.9 micrograms/lens) compared to the polyquaternium-1 and myristamidopropyl dimethylamine-containing system (1.7 ± 1.0 micrograms/lens) (P=0.02).ConclusionThe inactivation of lysozyme deposited on senofilcon A lenses when disinfected with the peroxide-based or the polyquaternium-1 and myristamidopropyl dimethylamine-containing systems were neither statistically nor clinically significant and the overall amounts of denatured lysozyme recovered from the lenses were low (<1 microgram/lens).

Lipid deposition on contact lenses in symptomatic and asymptomatic contact lens wearers

PurposeLipid deposition on contact lenses (CL) has traditionally been believed to reduce comfort during CL wear. The purpose of this study was to quantify lipid deposition on CL in a group of symptomatic and asymptomatic adapted CL wearers. MethodsThis was a single-masked, randomized clinical trial. Only confirmed symptomatic (comfortable lens wear time (CWT) < 8 h and a noticeable reduction in comfort over the course of the day) and asymptomatic (CWT > 10 h and minimal reduction in comfort over the course of the day) participants were recruited to participate in the study. Participants wore senofilcon A lenses in combination with a polyquaternium-based care solution (OPTI-FREE Replenish). Worn CL samples were collected on Day 14. Deposited lipid amounts from the lenses (including cholesteryl ester, cholesterol and triolein) were quantified using a liquid chromatography-mass spectrometry technique. ResultsLipid deposition was significantly higher in CL extracts of asymptomatic wearers compared to the symptomatic wearers for all lipid types quantified, including cholesteryl ester (2.1 ± 0.6 vs 1.6 ± 0.5 log μg/lens), cholesterol (1.5 ± 0.3 vs 1.1 ± 0.3 log μg/lens) and triolein (0.3 ± 0.2 vs 0.1 ± 0.1 log μg/lens) (all p < 0.002). The amount of cholesteryl ester deposited was greatest (p = 0.0001), followed by cholesterol, then triolein, for both the asymptomatic and symptomatic groups (both p = 0.0001). ConclusionThis study demonstrated that the asymptomatic group deposited a significantly greater amount of lipid on their CL. Although lipid levels measured are considered low to trigger any observable clinical deposition, they may influence other clinical outcomes, particularly comfort.

Analysis of P. aeruginosa disinfectant sensitivity and microbial adhesions to worn cosmetic contact lenses

PurposeTo compare the sensitivity of two genotypes of P. aeruginosa to various disinfectant solutions and analyze the attached bacteria on worn cosmetic contact lenses (cosCLs). MethodsIn this prospective study, healthy volunteers wore etafilcon (brown), nelfilcon (gray), or hilafilcon (black) cosCLs and microbial adhesion analysis was performed. A rub-off test determined pigment dislodgement. Disinfectant sensitivity to Optifree Replenish (Alcon), Optifree Pure Moist (Alcon), Renu Fresh (Bausch & Lomb), and AoSept Plus (Ciba Vision) was tested at various disinfection times and compared between various genotypes and Type III secretion (T3S) system mutants. ResultsOf the 1152 cosCLs collected, 364 were culture positive (32%). The highest rate of culture-positive lens was hilafilcon (chi square, P = 0.0001). Hilafilcon also had a significantly greater number of isolates than etafilcon (P < 0.0001). Hilafilcon was the only lens to fail the rub-off test. Cytotoxic strains were significant more resistant to Renu Fresh than were invasive strains, even at 100% of recommended disinfection time (P = 0.0005). Of the tested disinfectants, Renu Fresh was significantly less effective in killing both genotypes of P. aeruginosa compared to AoSept Plus at all time points (25%, 50%, 75%, and 100% recommended disinfection time, P = 0.0001, 0.0001, 0.0005, and 0.0005, respectively). When the T3S system was dysfunctional, mutant strains were all susceptible to disinfectants (P = 0.0001 for both invasive and cytotoxic strains). ConclusionPseudomonas species is commonly found on cosCLs of asymptomatic individuals. Wearers of cosCLs that dislodge pigments may be predisposed to microbial contamination. Cytotoxic strains are more resistant to disinfectant solutions, especially to Renu Fresh. P. aeruginosa disinfectant resistance requires a functional T3S system.

Comparison of the Antimicrobial Efficacy of Various Contact Lens Solutions to Inhibit the Growth of Pseudomonas aeruginosa and Staphylococcus aureus.

Soft contact lenses provide perfect conditions for the breeding of pathogens. The study is a prospective, experimental study, conducted to know the antimicrobial ability of multipurpose contact lens solution against standard strains of Staphylococcus aureus and Pseudomonas aeruginosa by the stand-alone test. The test method is based on the procedures in the ISO 14729 standard primary stand-alone test. Three multipurpose contact lens care solutions commercially available in Mangalore markets, namely, Biotrue (Bausch & Lomb), Opti-Free Replenish (Alcon), and Aquasoft (Stericon Pharma), were tested for its antimicrobial effect in the microbiology lab at Kasturba Medical College, Mangalore. According to this study, the solutions named “Biotrue” and “Aquasoft” met the primary stand-alone and reached the 3log reduction and 5log reduction criteria in the manufacturer recommended time, respectively. No conclusion could be drawn for Opti-Free Replenish since the minimum recommended disinfection time was overnight, whereas it was noted for 6 hr only, and it should have been experimented further. The effectiveness of multipurpose solutions varies against different bacterial species. We have observed that the antimicrobial activity of different solutions varies with respect to time of incubation, and also there was a marked difference in the activity of some solutions against S. aureus and P. aeruginosa. So, it is necessary for the contact lens users to store their lenses in solutions for longer duration of hours. It is also recommended to use solutions that clear the ISO 14729 standards for better health conditions of the eye.

Susceptibility of Stenotrophomonas maltophilia clinical isolates to antibiotics and contact lens multipurpose disinfecting solutions.

To determine the susceptibility of Stenotrophomonas maltophilia to various antibiotics and contact lens multipurpose disinfecting solutions. Forty S. maltophilia strains from contact lens cases, contact lenses, or eye swabs of contact lens wearers including 27 asymptomatic wearers and 13 keratitis patients were examined for their susceptibility to different antibiotics, using a disc diffusion assay, and to multipurpose disinfecting solutions using a broth microdilution method. Certain strains were resistant to aztreonum (15%), imipenem (93%), chroramphenicol (13%), and cefepime (8%). Two of those strains were multidrug resistant. All strains were sensitive to trimethoprim-sulfamethoxazole, tigecycline, ceftazidime, and fluoroquinolones. Overall, the minimum inhibitory concentration (MIC) for all strains was significantly higher (P < 0.05) for AQuify (50% dilution) and OPTI-FREE RepleniSH (25%) than all other multipurpose contact lens disinfecting solutions (MPDS) (3%-14%, except RepleniSH versus MeniCare Soft [14%]). AQuify, OPTI-FREE RepleniSH, and MeniCare Soft had significantly higher minimum bactericidal concentrations (undiluted MPDS) than other disinfecting solutions (P < 0.05). The Australian ocular isolates of S. maltophilia remain susceptible to trimethoprim-sulfamethozole, tigecycline, and most fluoroquinolones. However, the isolates showed resistance to certain multipurpose disinfecting solutions.

Inefficacy of marketed contact lens disinfection solutions against keratitis-causing Acanthamoeba castellanii belonging to the T4 genotype

The aim of this study was to assess the anti-amoebic effects of marketed contact lens disinfecting solutions. Using amoebistatic, amoebicidal, and cysticidal assays, nine different contact lens solutions were tested including: ReNu MultiPlus, DuraPlus, Ultimate Plus, OptiFree Replenish, OptiFree Express, Kontex Clean, Kontex Normal, Kontex Multisol extra+, Kontex Soak. In vitro growth inhibition (amoebistatic) assays were performed by incubating Acanthamoeba castellanii with aforementioned contact lens disinfection solutions as per manufacturer’s instructions in the growth medium for up to 48h at 30°C. To determine amoebicidal and cysticidal effects, amoebae were incubated with contact lens solutions in phosphate buffered saline for 24h and viability was determined by haemocytometer counting as well as re-inoculating them in the growth medium. For controls, solutions were tested against bacterial corneal pathogen, Pseudomonas aeruginosa, as well as amoebae were incubated with the solvent alone. Of the nine contact lens solutions tested, none of them showed potent amoebicidal effects. Only DuraPlus and OptiFree Replenish exhibited trophozoite lysis of 85.3% and 73.7% respectively. In contrast, all contact lens disinfection solutions except Kontex Clean, Kontex Normal, Kontex Multisol extra+, tested showed amoebistatic effects. Importantly, none of the contact lens disinfection solutions exhibited cysticidal effects using qualitative assays, i.e., cysts treated with aforementioned solutions re-emerged as viable amoebae upon inoculation in the growth medium. However, more than 3-log reduction was observed when ReNu MultiPlus, DuraPlus and OptiFree Express were tested against P. aeruginosa which is in accordance with the ISO Stand-Alone Primary acceptance criteria. These findings are of great concern for contact lens users.

Pilot study on the clinical performance of three different multipurpose solutions with a silicone hydrogel contact Lens

Method: The volume required for each step of a daily contact lens cleaning and storage regime were calculated for: COMPLETE EasyRub (CER),OPTI-FREERepleniSH (OFR) andAll InOneLite (AIL). The volumes of solution used in each regime step were then combined for a range of daily regime types, and the number of days of possible lens care for each notional monthly allowance (NMA) were then calculated. Results: For a simple daily regime of placing lenses in a case filled to the designated line with solution, manymore than 30 days of solution use was possible for each solution. With an additional step of lens rubbing with a one sided 1s rinse and case rinsing, 23.1, 20,8 and 22.7 days per NMA were possible for CER, OFR and AIL respectively. If the rinse was increased to a 5s per side rinse (according to the instructions of OFR and CER) then only 8.8, 7.1 and 8.9 days per NMA were possible. Conclusions: Solutionmulti-packs positioned for threemonths’ use provide sufficient solution if no rub and rinse step is advocated, or if a short lens rinse is prescribed. However, such packs do not provide enough solution if a longer (5s) rinse is prescribed. Given the importance of compliance to contact lens wearers, these findings should be considered by clinicians when supplying contact lens solutions.

Tear cytokine response to multipurpose solutions for contact lenses.

PurposeAn increased risk of corneal infiltrative events has been noted with the use of certain contact lenses and multipurpose solutions (MPS). This study was designed to evaluate tear cytokine assay as a sensitive, objective, and quantitative measure of the ocular surface response to contact lens/MPS and to consider the assay’s clinical relevance in the context of other measures of ocular surface response.MethodsTwo MPS, ReNu® Fresh™ (RNF) and Opti-Free® RepleniSH (OFR), were used with daily wear silicone hydrogel contact lenses in a randomized, prospective crossover study involving 26 subjects. Clinical data collection (conjunctival hyperemia, ocular surface sensitivity, solution induced corneal staining (SICS) test score, and subjective responses) and tear cytokine assays were conducted masked. Responses were tracked as change from baseline throughout the experimental schedule.ResultsSimilar response patterns for several inflammatory cytokines were seen throughout both phases: subjects who received OFR in Phase I had mean tear concentrations that were generally higher than those of the RNF Phase I group. OFR Phase I subjects had significant (P < 0.01) increases over baseline at day 1 and/or following washout for 13 cytokines (cc chemokine ligands [CCL] 3, CCL5, CCL11, granulocyte-macrophage colony-stimulating factor [GM-CSF], interferon [INF]-γ, interleukin [IL]-2, IL-4, IL-5, IL-6, IL-13, IL-15, IL-17, tumor necrosis factor [TNF]-α). These changes were not observed in RNF Phase I subjects, even though SICS test scores increased. Phase I OFR subjects also had increased dryness, while RNF Phase I subjects had decreased bulbar hyperemia. No changes were detected with respect to limbal hyperemia or surface sensitivity thresholds.ConclusionThe tear cytokine assay can detect and differentiate contact lens/MPS induced increases in inflammatory cytokines. Changes in cytokine levels were consistent with measurement of hyperemia and dryness but not with SICS scores, thereby suggesting a proinflammatory response to OFR compared to RNF that is not related to SICS test score. Tear cytokine profiles may be useful for reconciling clinical relevance of test results and in revealing signaling involved in the development of corneal infiltrative events.

The clinical performance of three contact lens solutions in symptomatic and asymptomatic contact lens wearers

Purpose: To investigate the performance of a new multipurpose solution based on alexidine and polyquaternium-1 (AMO RevitaLens Ocutec) and two current solutions, based on polyquaternium-1 and Aldox (Alcon Optifree RepleniSH) and hydrogen peroxide (CIBA Vision ClearCare).

In-vitroanalysis of the microbicidal activity of 6 contact lens care solutions

BackgroundContact lens-related infections are often associated with inadequate contact lens hygiene, and therefore, contact lens care products should be able to sufficiently minimise the amount of pathogens that are responsible for these infections. In 2001, the EN ISO 14729 was introduced to ensure adequate disinfection efficacy of contact lens care solutions, but this norm has recently been criticised.MethodsIn this study, six frequently used contact lens care solutions were retested according to the Stand Alone Test of the EN ISO 14729 (2001). The Stand Alone Test is a quantitative suspension test. In addition, the products were tested in a modified setting adding an organic load. The load was a mixture of human blood serum, lysozyme, and mucine, which resembles tear fluid.ResultsThe criteria of the Stand Alone Test recommended in EN ISO 14729 were only met by Aosept Plus. This 3% hydrogen-peroxide-based contact lens care solution attained a reduction factor of > 5 log units for bacteria and > 4 for fungi in all cases. Two further contact lens care solutions, Blue Vision and Optifree Replenish, met the criteria of a reduction factor of > 3 log units for bacteria and > 1 log unit for fungi, but only in the presence of artificial tear fluid. The three remaining products did not exhibit adequate disinfecting efficacy, at least against one of the tested microorganisms.ConclusionsThrough the observation that the artificial tear fluid used in this study influences the disinfecting efficacy of contact lens care solutions, especially that of multi-purpose solutions, in a different way than does albumin, mucine, or even the organic load suggested in EN ISO 14729, it becomes obvious that the test conditions in the EN ISO 14729 should be revised in order to create more realistic conditions, e.g., by using a more realistic artificial tear fluid. Furthermore, we suggest adapting the EN ISO 14729 to the European test hierarchy for chemical disinfectants and antiseptics, which consists of three test phases and also requests meeting stricter criteria in order to pass the test. Unless the test conditions guarantee a sufficient reduction of potential pathogens, the risk of contact lens-related microbial keratitis and other infections will remain for the users.

Effect of Multipurpose Solutions on Cell Morphology and Cytokine Production by Corneal Epithelial Cells

We sought to determine whether human corneal limbal epithelial cells (HCLE) differ in their physiological response and production of inflammatory mediators during exposure to two multipurpose disinfecting solutions that differ in only four excipients. HCLE were exposed to dilutions (1%-20%) of OPTI-FREE Express and OPTI-FREE RepleniSH for 2, 6, or 18 h. Cell numbers were measured using CyQuant and metabolic activity assays. Morphology, viability, and apoptotic changes were examined by confocal microscopy after staining with Calcein AM/propidium iodide or Hoechst 33,342/propidiun iodide/YO-PRO-1. Cytokine responses and arachidonic acid metabolites were examined by enzyme-linked immunosorbent assay. OPTI-FREE Express showed greater reductions in corneal cell metabolic activity (up to 3-fold) than OPTI-FREE RepleniSH over 18 h. Cells exposed to OPTI-FREE Express were highly vacuolated, whereas those exposed to OPTI-FREE RepleniSH had morphology consistent with a presumed apoptotic response. OPTI-FREE Express elicited higher levels of interleukin (IL)-6 (maximum 4225 ± 300 pg/mL) and IL-8 (maximum 1094 ± 250 pg/mL) from cells than OPTI-FREE RepleniSH (maximum of 1717 ± 225 pg/mL and 930 ± 300 pg/mL, respectively) at all concentrations tested after 18 h. HCLE did not produce leukotriene B4 or prostaglandin E2 on stimulation, and IL-1β was produced in low levels, but its production was not different between multipurpose disinfecting solution types. The findings reported here are the first to describe the pattern of cytokine production produced in corneal epithelial cells in response to contact lens solutions. Alteration of only four excipients in the formulations had such effects on corneal epithelia; however, these differences do not explain differences in the incidences of corneal infiltrative events between these solutions. This might indicate that changes in the rates of infiltrative events result from interactions of the solutions with the contact lens surface, or directly with the corneal immune system, or as the result of gram-negative contamination of lens cases.

Visualizing Hydrophobic Domains in Silicone Hydrogel Lenses with Sudan IV

A lipophilic dye is used to investigate the degree to which the surface and bulk hydrophobic domains of the lenses can be imaged and to identify specific changes in the availability of those domains after in vitro wear and cleaning conditions. The effect of a multipurpose solution (MPS), OPTI-FREE RepleniSH, on lens hydrophobic domains was also investigated. Hydrophobic domains were determined using a saturated solution of Sudan IV. Staining periods of 30 minutes and 16 hours were used to determine surface versus bulk hydrophobic domains. Four types of silicone hydrogel lens materials were tested. The degree of staining was visually documented by photography and quantitatively determined by extraction and analysis of the total amount of dye adsorbed. Specific differences in staining were found for all control lenses. Exposure to in vitro wear conditions significantly decreased the staining response for all lens types as compared with unworn lenses (P = 0.001). However, the trend of staining remained the same: balafilcon A > galyfilcon A > senofilcon A > lotrafilcon B. MPS decreased the extent of staining; the degree of its effect varied with lens type. Hydrophobic staining with Sudan IV visualized domains on and within silicone hydrogel lenses. Differences in staining response after exposure to wear and cleaning conditions indicate the potential for protein and lipid deposition on the different lens types and the ability of MPS to affect that deposition. Hydrophobic staining may be useful for determining differences in surface modification and lipophilicity of silicone hydrogel lenses.

Corneal Staining and Cell Shedding during the Development of Solution-Induced Corneal Staining

This non-dispensing cross-over study was conducted to determine if lenses presoaked in Opti-Free RepleniSH (OFR) or ReNu MultiPlus (RMP) cause solution-induced corneal staining (SICS) and subsequent cell sloughing before the typical 2 h in vivo examination point. METHODS.: Study lenses (PureVision) were worn bilaterally by 13 participants for periods of 15, 30, 60, and 120 min using two different contralateral care regimen pairings. The lens worn on the test eye was soaked overnight in either OFR or RMP and the control eye in Clear Care (CC). After lens removal, corneal staining was rated on a scale of 0 (negligible) to 100 (severe) for four peripheral quadrants and the central region, and the differential global staining score was calculated by subtracting baseline staining scores. Following the staining assessment, corneal cells were collected from the ocular surface using a non-contact irrigation system to determine ocular cell shedding rates. Differential global staining score with OFR was greater than CC with the differences being statistically significant at 30 and 60 min (p < 0.01). Maximum staining with RMP was significantly greater than OFR and peaked after 60 and 120 min of lens wear (p < 0.01). On average, 710 ± 470 ocular cells were collected after lens wear, with similar shedding seen independent of solution or lens wear duration (p > 0.05). SICS occurred earlier but to a significantly lower degree when PureVision lenses were presoaked in OFR compared with RMP, while lenses presoaked in CC did not cause SICS. Ocular surface cell shedding after lens removal was not impacted by lens wear durations of ≤2 h.

Dendritic immune cell densities in the central cornea associated with soft contact lens types and lens care solution types: a pilot study

BackgroundThe purpose of this study was to assess whether differences in central corneal dendritic immune cell densities associated with combinations of soft contact lenses and lens care solutions could be detected by in vivo confocal microscopy.MethodsParticipants were adults naïve to contact lens wear (n = 10) or who wore soft contact lenses habitually on a daily-wear schedule (n = 38) or on a study-assigned schedule for 30 days with daily disposable silicone hydrogel lenses (n = 15). Central corneas were scanned using an in vivo confocal microscope. Cell densities were compared among groups by demographic parameters, lens materials, and lens care solutions (polyhexamethylene biguanide [PHMB], polyquaternium-1 and myristamidopropyl dimethylamine [PQ/MAPD], peroxide, or blister pack solution [for daily disposable lenses]).ResultsAmong lens wearers, no associations were observed between immune cell densities and age, gender, or years of lens-wearing experience. Mean cell density was significantly lower (P < 0.01) in nonwearers (29 ± 23 cells/mm2, n = 10) than in lens wearers (64 ± 71 cells/mm2, n = 53). Mean cell density was lower (P = 0.21) with traditional polymer lenses (47 ± 44 cells/mm2, n = 12) than with silicone hydrogel lenses (69 ± 77 cells/mm2, n = 41). Lowest to highest mean density of immune cells among lens wearers was as follows: PQ/MAPD solution (49 ± 28 cells/mm2), blister pack solution (63 ± 81 cells/mm2), PHMB solution (66 ± 44 cells/mm2), and peroxide solution (85 ± 112 cells/mm2).ConclusionIn this pilot study, in vivo confocal microscopy was useful for detecting an elevated immune response associated with soft contact lenses, and for identifying lens-related and solution-related immune responses that merit further research.

Quantification of Non-Polar Lipid Deposits on Senofilcon A Contact Lenses

To quantify non-polar lipids deposited on senofilcon A silicone hydrogel contact lenses (J&J Acuvue OASYS) when disinfected with a no-rub one-step hydrogen peroxide system (CIBA Vision ClearCare) and a care system preserved with Polyquad & Aldox (Alcon OPTI-FREE RepleniSH). Thirty existing soft lens wearers symptomatic of dryness were enrolled into a 4-week prospective, randomized, bilateral eye (lens type), cross-over (care regimen), daily wear, double masked study. Subjects were refitted with senofilcon A lenses, which were replaced biweekly. During each period of wear, participants used either the peroxide or preserved system. After each period of wear, lenses were collected and lipid was extracted using 1.5 ml of a 2:1 chloroform:methanol solution for 3 h at 37 °C. Lens extracts were analyzed for non-polar lipids [cholesterol oleate (CO), cholesterol, oleic acid (OA), triolein, and OA methyl ester] using normal phase high-performance liquid chromatography. The total lipid (sum of CO and cholesterol) detected was 34 ± 28 μg/lens for the peroxide-based system and 22 ± 21 μg/lens for the system preserved with Polyquad and Aldox (p = 0.029). Although there was no difference between products for cholesterol (1.4 vs. 1.3 μg/lens; p = 0.50), use of a system preserved with Polyquad and Aldox resulted in significantly less deposited CO (33 ± 28 vs. 21 ± 20 μg/lens; p = 0.033). Approximately, 95% of the detectable lipid deposited on the material was CO, followed by cholesterol. OA and triolein contributed <1% of the total lipid and no OA methyl ester was found on any of the lenses. A care system preserved with Polyquad and Aldox removed higher amounts of CO from senofilcon A contact lenses used for 2 weeks than a peroxide-based system, in soft lens wearers who were symptomatic of dry eye.

Detection of virulence factors in Serratia strains isolated from contact lens‐associated corneal ulcers

This paper reports on the microbiological findings pertaining to three Serratia isolates from soft contact lens-related corneal ulcers, which represent a complication of contact lens wear reported with increasing frequency. Bacterial identification and antibiotic susceptibility testing were performed using the Vitek system. Serratia's ability to form biofilm, produce gelatinase, elastase and alkaline protease, and invade human corneal epithelial (HCE) cells was investigated. The isolates' susceptibility to the following disinfectants was tested: (a) ReNu MultiPlus(®) , containing polyaminopropyl biguanide 0.0001%; (b) Opti-Free Express(®) , containing polyquaternium-1 0.001% and myristamidopropyldimethylamine 0.0005%; (c) Opti-Free Replenish(®) , containing polyquaternium-1 0.001% and myristamidopropyldimethylamine 0.0005%, and (d) Oxysept Comfort(®) , a one-step 3% hydrogen peroxide-catalase system. Two Serratia marcescens and one Serratia liquefaciens were identified. All the strains were susceptible to aminoglycosides and fluoroquinolones. No isolate formed biofilm or significantly invaded HCE cells; all produced alkaline protease and gelatinase, but not elastase. Opti-Free Express(®) and Opti-Free Replenish(®) were active against S. liquefaciens, but failed to kill the S. marcescens isolates within the minimum recommended time (6 hours). ReNu MultiPlus(®) needed 6 hours to kill one strain of S. marcescens, which is 2 hours more than recommended. Conversely, Oxysept Comfort(®) was always effective within the minimum recommended time (6 hours). The ability to produce alkaline protease and gelatinase may play a major role in the pathogenesis of contact lens-related Serratia keratitis. Several types of contact lens solutions may be ineffective in eradicating Serratia from contaminated contact lens cases within the minimum recommended time. Only exposure to Oxysept Comfort(®) was always effective against Serratia in this study.

Comparative evaluation of multi-purpose solutions in the stabilization of tear lysozyme

The range and extent of tear proteins removed by various multi-purpose solutions has been investigated, but there is little information in the literature about their ability to prevent denaturation of tear proteins, particularly lysozyme. The purpose of this study was to determine the ability of Bausch + Lomb Biotrue™ multi-purpose solution and other care solutions to affect denaturation of lysozyme using a lysozyme activity assay. The test solutions used were: Biotrue multi-purpose solution, Bausch + Lomb renu ® fresh™, formerly ReNu MultiPlus ®, Alcon OPTI-FREE RepleniSH, Alcon OPTI-FREE EXPRESS, CIBA VISION AQuify, and AMO COMPLETE Multi-Purpose Solution Easy Rub Formula. A phosphate-buffered saline (PBS) solution served as a control. The test and control solutions containing lysozyme were exposed to sodium dodecyl sulfate (SDS), a known denaturant of the enzyme. The assay was based on digestion of the cell wall of Micrococcus luteus in a suspension, a substrate sensitive to active lysozyme. Enzymatic activity against M. luteus was used to assess activity of lysozyme. The decrease in the turbidity of the cell wall suspension, a measure of relative enzyme activity, was determined by following the decrease in absorbance (at 450 nm) over time using a spectrophotometer. Statistically significant greater stabilization of lysozyme was observed with Biotrue multi-purpose solution and renu fresh than with OPTI-FREE RepleniSH, OPTI-FREE EXPRESS, AQuify, COMPLETE Multi-Purpose Solution Easy Rub Formula, and a PBS control. The lysozyme activity assay revealed that Biotrue multi-purpose solution and renu fresh have the ability to stabilize lysozyme under conditions that typically denature the protein.

Effect of a novel multipurpose contact lens solution on human corneal epithelial barrier function

Purpose To explore the effect of a novel multipurpose contact lens solution (MPS) on the junction protein distribution and barrier function of cultured human corneal epithelial cell monolayers. Methods Cultured human corneal epithelial cells (HCEpiC) were exposed to a novel MPS (MPS A; Biotrue™, Bausch & Lomb) at 50%, 75% and 100% for 10 or 30 min. Four commercially available MPS products, MPS B (AQuify, Ciba Vision), MPS C (COMPLETE MPS Easy Rub, AMO), MPS D (OPTI-FREE Express, Alcon) and MPS E (OPTI-FREE RepleniSH, Alcon) were tested in parallel. Tight junction structure and integrity were evaluated by confocal microscopy using ZO-1 antibody and scanning microscopy (SEM). Quantitative evaluation of MPSs on epithelial barrier function was determined by measuring transepithelial electrical resistance (TEER) across HCEpiC grown on Transwell Clear permeable supports and on electric cell-substrate impedance sensing (ECIS) electrode arrays. Results Overall after exposure to the three concentrations (50%, 75%, and 100%) of MPS A, ZO-1 distribution and fluorescent intensity on the cell surface appeared similar to the media control with continuous tight junctions and clear intercellular junctions. At all measured time points after exposure to MPS A (50% or 75%) there was also no effect on the TEER using both resistance methodologies, and SEM showed that MPS A appeared similar to the Hank's balanced salt solution (HBSS) control. In cells exposed to MPS D there was a dose-dependent change in the distribution of ZO-1, some cell detachment, and a decrease in monolayer resistance at all time points measured. Ultrastructurally, MPS D caused gross changes, including damage to cell junctions and plasma membranes. To a lesser extent, the remaining three commercial MPS products demonstrated some effects on tight junction ZO-1 distribution and/or TEER. Conclusions Based on the in vitro measurements of tight junction protein expression, monolayer integrity, and transepithelial electrical resistance, the novel multipurpose contact lens solution (MPS A) did not alter corneal barrier function as compared to media, PBS or HBSS control. Clinical significance of the observed differences in epithelial barrier function among the MPSs tested needs further investigation.