Patients Wearing Contact Lenses Research Articles

Failed Treatment of Multidrug-resistant Acinetobacter Baumannii Keratitis Mistaken for a Mixed Infection

Purpose: To report treatment failure of multidrug-resistant <i>Acinetobacter baumannii</i> keratitis in a patient wearing contact lenses for a long time.Case summary: A 48-year-old man using daytime soft lenses for 20 years was transferred due to decreased visual acuity and eye pain. Slit-lamp biomicroscopy showed a large corneal epithelial defect and stromal infiltration, but no hypopyon. Treatment was initiated with moxifloxacin, polyhexamethylene biguanide eye drops, and oral antibiotics. Corneal infiltration worsened, corneal scrapings and culture were performed. Gram staining showed Gram-positive bacteria, potassium hydroxide (KOH) hyphae-positive, and culture yielded Bacillus. He was hospitalized and vancomycin, voriconazole, and amphotericin B eye drops were administered. Oral antifungal agents were also prescribed. The corneal epithelial defect was restored from temporal side for a while, and then deteriorated with an endothelial plaque. Therefore, voriconazole and amphotericin B were injected intracamerally. All four repeated culture tests were negative. Despite total conjunctival flap, the patient complained of severe pain and eventually underwent evisceration. In the culture of intraocular contents, <i>Acinetobacter baumannii</i>, which is resistant to all drugs except minocycline, was detected.Conclusions: In patients wearing contact lens for a long time, not only mixed infection with acanthamoeba and fungi, but also gram-negative bacteria should be considered first, and multidrug-resistant <i>Acinetobacter baumannii</i> should also be considered.

Relationship Between Contact Lens Wear and the Risk of Acquired Blepharoptosis

Abstract
 Introduction & Objectives : Contact lens wear has been reported to be associated with acquired blepharoptosis. This literature review aims to summarize and evaluate the risk of acquired blepharoptosis in contact lens wearers.
 Methods : Literature searching was conducted using three online databases including PubMed, Cochrane Library, and Embase. Search terms such as “contact lens”, “ptosis”, and “blepharoptosis” were included. Reference lists of each study were also assessed for potentially relevant sources. Prospective and retrospective studies as well as meta-analyses and systematic reviews were included.
 Results : Using relevant search terms in various databases, a total of five articles were included in this review. Four studies suggested that wearing hard or soft contact lenses was significantly associated with blepharoptosis. One study indicated hard contact lens wearers presented blepharoptosis 17.38 times more frequently than non-wearers (OR, 17.38, 95% CI=3.71–81.29), while soft contact lens wearers had 8.12 times more risk of presenting blepharoptosis than non-wearers (OR, 8.12, 95% CI=2.68–24.87). Furthermore, long-term contact lens wear, which was 20 years or more, seemed to have a significant effect on the incidence of blepharoptosis. There was only one study which stated that hard contact lens wear did not lead to acquired blepharoptosis in this review.
 Conclusion : There is evidence of a clear association between hard or soft contact lens wear and an increased risk of blepharoptosis. Patients wearing contact lenses should be informed of the risk of blepharoptosis, and a history of contact lens use should be sought in all patients who have acquired blepharoptosis.

HUBUNGAN ANTARA PEMAKAIAN LENSA KONTAK DAN RISIKO BLEFAROPTOSIS DIDAPAT

Objectives: Contact lenses (CL) wear has been reported to be associated with acquired blepharoptosis. This literature review aims to summarize and evaluate the risk of acquired blepharoptosis in contact lens wearers.
 Methods: Literature searching was conducted using three online databases including PubMed, Cochrane Library, and Embase. Search terms such as “contact lens”, “ptosis”, and “blepharoptosis” were included. Reference lists of each study were also assessed for potentially relevant sources.
 Results: Using relevant search terms in various databases, a total of three articles were included in this review. All studies reviewed were single-center retrospective studies. The three studies suggested that wearing contact lens was significantly associated with blepharoptosis. Long-term contact lens wear, ranging from 15 to 34 years, seemed to have a significant effect on the incidence of blepharoptosis. Hard contact lens (HCL) wear has a greater risk for ptosis to occur than soft contact lens (SCL) wear.
 Conclusion: There is evidence of a clear association between hard or soft contact lens wear and an increased risk of blepharoptosis. Patients wearing contact lenses should be informed of the risk of blepharoptosis, and a history of contact lens wear should be sought in all patients who have acquired blepharoptosis.

Anonic Silicon Hydrogels Affect the Concentration of Proteins in Tears during Wear

Purpose The objective of this study was to quantitatively assess the concentration of human tear proteins in patients wearing contact lenses of various ionicities and determine whether differences were related to the incidence of corneal infiltrative events (CIE). Methods 24 subjects (samples) were randomly selected for spectral count analysis to obtain protein concentrations using LCMS analysis. The subjects were neophyte and ametropic with ages between 18 and 40; 6 wore control lenses, 8 wore TestLens1, and 10 wore TestLens2. 16 subjects experienced CIEs during the study. Results A pairwise multiple hypothesis test identified 7 proteins that significantly differed in concentration between TestLens1 and control, and 11 proteins that differed between TestLens2 and control. Of the 12 unique proteins, 9 were at increased concentration and 3 were at lower concentration in the tears of test lens wearers compared to the control lens group. Bootstrap clustering confirmed these findings, showing 3 similar clusters to the original sample groups which separated people wearing control lenses from those wearing TestLens1 or TestLens2 with 83% accuracy and between TestLens1 and TestLens2 with 45% accuracy. Permutation testing identified 5 proteins that had significantly changed in concentration between people wearing TestLens2 and Control lenses. There was no difference in protein concentrations between those subjects who experienced a CIE and those who did not. Conclusion Wearing contact lenses of different ionicities can affect the concentration of proteins in the tear film. The current study did not find any associations of the concentration of proteins with CIEs. Future tests with increased sample size are needed to establish any relations between these changes and clinical performance.

Transplantation of autologous cultivated oral mucosal epithelial sheets for limbal stem cell deficiency at Siriraj Hospital: a case series

BackgroundThe loss of limbal stem cells owing to either corneal burn or inflammation leads to the repopulation of opaque skin over the raw surface of the cornea. It has been proposed that reconstitution of oral mucosal stem cells over this raw surface will mimic the limbal stem cells and restore vision. The efficacy and safety of applying a sheet of cultivated oral mucosal cells as an autologous graft for corneal replacement were evaluated.Case presentationThe study was conducted during 2014–2015 and involved a total of six patients, of whom three had suffered a chemical burn and three had Stevens-Johnson Syndrome (SJS). Oral mucosal tissue was dissected from each patient, seeded onto irradiated J2 fibroblast feeder cells for 14 days, and analyzed for quality and safety 1 day before being transplanted onto the cornea of the affected eyes. After transplantation, topical antibiotic and anti-inflammatory eye drops were instilled four times daily, and the patients wore contact lenses. Subjects were clinically followed for visual acuities and adverse effects at 2, 4, and 6 weeks, 3 and 6 months, and 1 year post-transplantation. Data were presented descriptively. Visual acuities in patients improved at 2 weeks post-surgery. However, two patients with SJS had corneal ulcer at 2 weeks postoperatively. At the 1-year postoperative examination, the eyes of two patients were in good condition with decreased vascularization and epithelial defect.ConclusionsCultivated oral mucosal epithelial sheet transplantation in limbal stem cell deficiency had a favorable efficacy. In this study, patients with chemical burn had more clinical benefit than those with SJS.Trial registration ClinicalTrials.gov: NCT02415218. Registered retrospectively 4 Apr 2015 (https://clinicaltrials.gov/ct2/show/NCT02415218).

Effect of Voriconazole on Biofilm of Filamentous Species Isolated from Keratitis

Background: Biofilm formation is a vital feature of the pathogenesis in filamentous fungi. Objectives: Herein, we investigated in vitro antifungal pattern of biofilm of filamentous species keratitis isolates, and the effect of different concentrations of voriconazole on biofilm morphology changes using scanning electron microscopy. Methods: Here 25 ocular fungal isolates were included (Fusarium solani; (n = 15) and Aspergillus flavus; (n = 10). We determined the biofilm formation of isolates in terms of their susceptibilities to different antifungals on sessile cells. This procedure was performed according to CLSI-M38-3rd. Biofilm morphology changes revealed with scanning electron microscopy (SEM). Results: Twelve F. solani strains displayed the capacity to form biofilms from patients wearing contact lenses, while 8 A. flavus strains were recovered from cornea scrapings of trauma. Itraconazole, posaconazole and natamycin had the maximum activity against biofilms of all tested filamentous strains (MIC ranging from 0.031 - 0.25 µg/mL, 0.031 - 0.25 µg/mL and 2 - 4 µg/mL), respectively. Three F. solani and one A. flavus strains showed the high MIC values against voriconazole (MIC ≥ 1 µg/mL). Posaconazole revealed the lowest MIC values against biofilms of two strains (MIC ranging from 0.031 - 0.25 µg/mL); however, no significant difference was observed for itraconazole (P > 0.05). The efficacy of 16 µg/mL and 4 µg/mL of voriconazole was confirmed for biofilm of F. solani and A. flavus, respectively. The considerable changes in the morphologies of improved biofilms were seen by SEM. Conclusions: For the successful treatment of fungal biofilm infections, it was necessary to have knowledge of the mechanism of action, penetration rates, and therapeutic concentrations of drugs.

SUBSTANTIATION OF SUBSTITUTION THERAPY MEDICATION FOR DRY EYE SYNDROME TREATMENT IN PATIENTS USING CONTACT LENS VISION CORRECTION

The aim: To substantiate the selection of a substitution therapy medication for dry eye syndrome treatment in patients wearing different kinds of contact lenses. Materials and methods: A structural analysis of the assortment of substitution therapy medications for dry eye syndrome treatment as well as a content analysis of the information given in the labelling claims of various substitution therapy medication was conducted. Than they were segmented using the criteria of whether the substitution therapy medications may be used in patients with dry eye syndrome who wear contact lenses. Results: The labelling claims of 82.36% substitution therapy medications registered in Ukraine assortment contain information on either full or partial compatibility with contact lenses. The use of 11.76% of the assortment is impossible for patients wearing soft contact lenses, while patients wearing hard contact lenses need to wait for some period of time (15-20 min) before putting contact lenses back on. Conclusions: The pharmaceutical market of Ukraine is characterized by a wide assortment of substitution therapy medications for dry eye syndrome treatment, which can be used in patients wearing contact lenses. Based on the data received, it has been determined that 70.59% of substitution therapy medications are compatible with contact lenses of all types and only the use of 8.82% of the substitution therapy medications assortment is contraindicated for dry eye syndrome treatment in patients wearing contact lenses.

Are professionals and patients wearing contact lenses during the COVID-19 pandemic?

Objective: To know the frequency and characteristics of contact lens use in professionals and patients during the COVID-19 pandemic. Method: A digital questionnaire was used to obtain demographic information, use and frequency of contact lenses in professionals and fitting or refitting in patients before and during the COVID-19 pandemic. Results: 172 professionals participated in the survey, of which 70.3% were women. There were refractive errors in 74.4%, and only 32.0% have used contact lenses during the COVID-19 pandemic. The lenses most used by professionals are silicone hydrogel, 99.9%. The replacement modality has been 69.0% biweekly or monthly. Optometrists (63.4%) reported that the frequency of fitting and/ or refitting contact lenses decreased during the pandemic. Before and during the pandemic, the lens material used more frequently was silicone hydrogel with 79.7% and 76.7%, respectively.The replacement modality was biweekly or monthly, with 76.2% before and 73.3% during the pandemic. Of all the participants, 58.1% consider that the sale of contact lenses has decreased. Conclusions: During the pandemic, the fitting, refitting, and sale of contact lenses have decreased. The lenses most used by professionals and patients are silicone hydrogels replaced every two weeks or monthly.

Acanthamoeba keratitis in a mouse model using a novel approach

ContextAcanthamoeba is increasingly implicated in causing keratitis in patients wearing contact lens or ocular trauma and has a poor prognosis. Establishment of an animal model is critical to study the disease pathology, pathogenesis and to evaluate anti-amoebic drugs. Some studies have used contact lenses to establish Acanthamoeba keratitis (AK) in a mouse model, which is expensive and not very successful as lenses get dislodged. ObjectiveTo assess the feasibility of using parafilm (Bemis Company Inc., USA) as an alternative to contact lens for the establishment of AK in the mouse model. MethodsThirty-six Balb/c mice in three groups of six mice each for two strains of Acanthamoeba were used to induce AK. Three experimental approaches used were; i) Acanthamoeba impregnated contact lens, ii) Acanthamoeba impregnated parafilm and iii) scratching followed by inoculation of Acanthamoeba suspension. In all three models, tarsorrhaphy was performed. Infection was evaluated by clinical examination and also through microscopic examination of corneal scrapings and corneal sections. ResultsAK model was successfully established with parafilm whereas only one mouse developed AK with the use of contact lens and none with scratching and Acanthamoeba inoculation. ConclusionThe use of parafilm is convenient, reliable and cheaper and can be considered an alternative to contact lenses to induce AK in a mouse model.

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.

Effect of Soft Contact Lens Wear on Tear Film Break up Time

Purpose: To see the effect of soft contact lens wears on tear breakup time.
 Study Design: Descriptive Observational study.
 Place and Duration of Study: College of Ophthalmology and Allied Vision Sciences, King Edward Medical University, Mayo Hospital, Lahore. From January to March 2016.
 Material and Methods: Students of King Edward Medical University Lahore wearing soft contact lens for more than 3 months with no known ocular pathology were selected by non-probability convenient sampling technique. Subjects with history of using any eye drops, history of oral drugs, which could cause dry eye and individuals any ocular disease, were excluded from the study. Tear film BUT was tested by using Fluorescein sodium dye and examinig under cobalt blue filter of slit lamp.SPSS version 20 is used to analyze the data.
 Results: There were 30 participants with mean age of 24.5 ± 5 years. All were females. Sixty percent were wearing corrective lenses, and 40% were wearing cosmetic lenses. Out of 30 patients wearing contact lenses, only 6.67% had marginal tear film BUT and none of the patients has shown dry eyes. Individuals using contact lenses for 9 – 12 years had decreased BUT as compared to subjects using lenses for 3 – 6 months. 33.33% of extended lens wearers had reduced BUT as compared to disposable and daily wearers of contact lenses. Discomfort with contact lenses was observed in only 4 patients.
 Conclusion: As the duration of contact lens wear increases, the tear film break up time decreases. Individuals using extended wear contact lenses are more prone to develop decreased TFBUT.

Detection of Fusarium Species in Clinical Specimens by Probe-Based Real-Time PCR.

The mold Fusarium is a ubiquitous fungus causing plant, animal and human infections. In humans, Fusarium spp. are the major cause of eye infections in patients wearing contact lenses or after local trauma. Systemic infections by Fusarium spp. mainly occur in immunosuppressed patients and can disseminate throughout the human body. Due to high levels of resistance to antifungals a fast identification of the causative agent is an urgent need. By using a probe-based real-time PCR assay specific for the genus Fusarium we analysed several different clinical specimens detecting Fusarium spp. commonly found in clinical samples in Germany. Also, a large collection of lung fluid samples of haematological patients was analysed (n = 243). In these, two samples (0.8%) were reproducibly positive, but only one could be confirmed by sequencing. For this case of probable invasive fungal disease (IFD) culture was positive for Fusarium species. Here we describe a rapid, probe-based real-time PCR assay to specifically detect DNA from a broad range of Fusarium species and its application to clinically relevant specimens.

Healthy Contact Lens Behaviors Communicated by Eye Care Providers and Recalled by Patients - United States, 2018.

An estimated 45 million U.S. residents enjoy the benefits of contact lens wear, but many of them might be at increased risk for complications stemming from improper wear and care behaviors (1). One of the most serious complications of contact lens wear is a corneal infection known as microbial keratitis, which can sometimes result in reduced vision or blindness (2). In 2014, 50% of contact lens wearers reported ever sleeping in contact lenses, and 55% reported topping off* their contact lens solutions (3), which put them at greater risk for a contact lens-related eye infection (2,4). Data on communication between eye care providers and contact lens wearers on contact lens wear and care recommendations are limited. Two surveys were conducted to better understand and assess contact lens education about nine recommendations: the first assessed contact lens wearer experiences regarding recommendations received from eye care providers during their most recent appointment; the second evaluated provider-reported practices for communicating contact lens wear and care recommendations to their patients. One third (32.9%) of contact lens wearers aged ≥18 years recalled never hearing any lens wear and care recommendations. Fewer than half (47.9%) recalled hearing their provider recommend not sleeping in lenses at their last visit, and 19.8% recalled being told to avoid topping off their contact lens solution. A majority of providers reported sharing recommendations always or most of the time at initial visits, regular checkups, and complication-related visits. Providers reported sharing nearly all recommendations more frequently at initial and complication-related visits than at regular checkups. Of the nine recommendations for safe contact lens wear and care, eye care providers at regular checkups most often recommend complying with the recommended lens replacement schedules (85% of regular visits), not sleeping in lenses (79.0% of regular visits), and not topping off solutions (64.4% of regular visits). Eye care providers play an important role in the health of their contact lens-wearing patients and can share health communication messages with their patients to help educate them about healthy wear and care habits. These findings can assist in the creation of health communication messages to help encourage eye care providers to communicate more effectively with their patients.

The Case for Using Hydrogen Peroxide Contact Lens Care Solutions: A Review.

Despite their established disinfection and safety benefits, the use of hydrogen peroxide (H2O2) lens care systems among today's wearers of reusable contact lenses remains low in comparison with multipurpose solution (MPS) use. Multipurpose solution systems, however, present several potential drawbacks that may impact patient outcomes, including the use of chemical preservatives for disinfection, biocompatibility issues, and challenges with respect to lens care compliance. Given their unique composition and mechanism of action, one-step H2O2 systems offer the opportunity to avoid many of the challenges associated with MPS use. This article reviews the evolution of H2O2 lens care systems and examines the current scientific and clinical evidence regarding the relative ease of use, lens and tissue compatibility, disinfection efficacy, and ocular surface safety of H2O2 systems. Evaluation of the available data indicates that in comparison with MPS, one-step H2O2 systems tend to promote more favorable compliance, efficacy, comfort, and ocular surface outcomes for a wide range of contact lens-wearing patients. Based on the current published evidence, the authors recommend that eye care practitioners consider making one-step H2O2 systems their first-line contact lens care recommendation for most wearers of reusable lenses.

Endothelial parameters in central and peripheral cornea in patients wearing contact lenses.

To measure the parameters of endothelium in the central and peripheral parts of the cornea and evaluate the influence of wearing the hard and soft contact lenses on the mentioned parameters. A specular microscope was used to measure the corneal endothelium parameters in both eyes of 139 Caucasians (a total of 278). All participants were divided into three groups: soft lens wearers, hard lens wearers and a control group. Factors, such as age, smoking, types of lens material, duration of lens wear and lens air permeability were assessed to determine their impact on the morphometric parameters of the endothelium. A lower percentage of hexagon-like cells and higher cell variation than in other groups were determined in hard contact lens wearers. The difference in density of endotheliocytes between the groups was not observed. The measurements of the morphometric parameters in soft contact lens wearers did not depend neither on the duration of lens wear, nor on air permeability. The relation between the patients' age and the variation of endothelium parameters was determined in the group of hard contact lens wearers. Wearing hard contact lenses provokes pleomorphism and polymegethism of the corneal endothelium, while soft contact lenses do not impact any parameters of the endothelium, most likely due to higher air permeability.

A retrospective cohort study on orthokeratology for high myopia progression

Objective To study the therapeutic effect and safety of orthokeratology in the teenagers with high myopia. Methods A retrospective cohort study was carried out.The clinical data of 120 eyes from 60 high myopia patients wearing orthokeratology contact lens for 1 year in Henan Eye Hospital from June 2013 to June 2014 was analyzed, and the data of contemporaneous 118 eyes from 59 matched high myopia patients wearing conventional glasses were used as controls.The initial spherical equivalent (SE) of all the patients was -6.00 to -9.00 D. The maximum correction amplitude of the orthokeratology contact lens was set as 6.00 D based on the Regulation of China Food & Drug Administration.The contact lenses were worn for 1 month firstly and then the conventional glasses were used at daytime and contact lenses were consecutively worn at night for 1 year in the contact lenses group, and only glasses were worn in the conventional glasses group.The uncorrective visual acuity (UCVA), SE, corneal fluorescein staining were examined 1 week, 1 month, 3 months, 6 months and 12 months after wearing lenses.The changes of corneal endothelial cells were examined 6 and 12 months after wearing lenses. Results The UCVA was improved and SE was reduced 1 month and 3, 6 and 12 months after wearing lenses in comparison with 1 week after wearing lenses in the contact lenses group (all at P 0.05). Compared with wearing contact lenses, the SE was increased in various time points after wearing glasses in the conventional glasses group (all at P<0.01). The axial length and SE extended by (0.08±0.12)mm and (0.19±0.21)D in the contact lenses group and those in the conventional glasses group were (0.29±0.14)mm and (0.69±0.27)D, showing significant differences between the two groups (t=10.024, 5.691, both at P<0.01). No significant differences were found in corneal endothelial cell density, percentage of hexagonal cells and coefficient of variation of corneal endothelial cells in various time points after wearing contact lenses (corneal endothelial cell density: Fgroup=0.090, P=0.769; Ftime=0.133, P=0.563.percentage of hexagonal cells: Fgroup=0.071, P=0.836; Ftime=1.091, P=0.203.coefficient of variation: Fgroup=0.107, P=0.734; Ftime=1.948, P=0.156). The incidence of corneal fluorescein staining was 31.67% in the contact lens group, which was much higher than 3.51% in the conventional glasses group (χ2=97.910, P=0.001). Conclusions Compared with wearing only conventional glasses, orthokeratology can improve UCVA and control axial length extension in juvenile with high myopia, but orthokeratology is more likely to damage the corneal superficial layer. Key words: Orthokeratology; Contact lens; High myopia; Corneal endothelial cells; Axial length; Retrospective study

Modeling Corneal Oxygen with Scleral Gas Permeable Lens Wear.

The main goal of this current work is to use an updated calculation paradigm, and updated boundary conditions, to provide theoretical guidelines to assist the clinician whose goal is to improve his or her scleral gas permeable (GP) contact lens wearing patients' anterior corneal oxygen supply. Our model uses a variable value of corneal oxygen consumption developed through Monod equations that disallows negative oxygen tensions within the stroma to predict oxygen tension at the anterior corneal surface of scleral GP contact lens wearing eyes, and to describe oxygen tension and flux profiles, for various boundary conditions, through the lens, tears, and cornea. We use several updated tissue and boundary parameters in our model. Tear exchange with GP scleral lenses is considered nonexistent in this model. The majority of current scleral GP contact lenses should produce some levels of corneal hypoxia under open eye conditions. Only lenses producing the thinnest of tear vaults should result in anterior corneal surface oxygen tensions greater than a presumed critical oxygen tension of 100 mmHg. We also find that corneal oxygen tension and flux are each more sensitive to modification in tear vault than to changes in lens oxygen permeability, within the ranges of current clinical manipulation. Our study suggests that clinicians would be prudent to prescribe scleral GP lenses manufactured from higher oxygen permeability materials and especially to fit without excessive corneal clearance.

Mullers Muscle Conjunctival Resection for Treatment of Contact Lens-Associated Ptosis.

The aim of this study was to look at the surgical outcomes of posterior approach Mullers muscle conjunctival resection surgery for contact lens-related ptosis. This was a retrospective, comparative interventional case series. All patients and controls underwent phenylephrine 10% testing and had a positive response prior to surgical intervention. Thirty-one eyelids with ptosis were identified in 20 contact lens wearing patients, which were matched with 27 eyelids in 15 controls. The contact lens wearing patients wore contact lenses for a mean of 20.6 ± 12.1 years. More than half (60%) wore soft contact lenses, as opposed to rigid gas-permeable contact lenses. Preoperative margin-to-reflex distance-1 was lower in patients who wore rigid contact lenses (0.8 ± 0.7 mm) as compared with patients with soft contact lenses (1.7 ± 1.1 mm) (p = 0.01). Surgical success, as defined by margin-to-reflex distance-1 ≥3 mm or symmetry of upper eyelid height (within 1 mm), was achieved in 93.5% in the contact lens group and 92.6% of controls. Postoperative margin-to-reflex distance-1 was significantly higher in the contact lens wearers (3.9 ± 1.3 mm) compared with the controls (3.2 ± 1.1 mm; p = 0.01). There was a significant correlation between the amount of tissue resected intraoperatively and the improvement in margin-to-reflex distance-1 (Pearsons correlation coefficient, r =0.36; p = 0.006). There were no surgical complications of any patients in the study. Mullers muscle conjunctival resection surgery is an effective surgical correction for contact lens-associated ptosis. Patients can achieve excellent results with minimal risk of residual ptosis or asymmetry.

Real-world assessment of diquafosol in dry eye patients with risk factors such as contact lens, meibomian gland dysfunction, and conjunctivochalasis: subgroup analysis from a prospective observational study.

PurposeTo evaluate the efficacy and safety of diquafosol (DQS) ophthalmic solution in dry eye (DE) patients wearing contact lenses (CLs) or with concomitant meibomian gland dysfunction (MGD) or conjunctivochalasis in a real-world setting.Patients and methodsFrom a cohort of patients enrolled in a prospective observational study, DE patients who met the Japanese diagnostic criteria and who received DQS as a monotherapy were extracted and stratified according to the presence or absence of CL use, MGD, and conjunctivochalasis. Corneal and conjunctival fluorescein staining score, tear film break-up time, total symptom score (12 DE-related subjective symptoms), patient-reported outcomes, and adverse reactions were investigated.ResultsDQS treatment resulted in significant improvement in total symptom score, corneal and conjunctival fluorescein staining score, and tear film break-up time without significant differences between patient subgroups with versus without CL use, MGD, or conjunctivochalasis. Comparable proportions of patients perceived symptomatic improvements in all subgroups. There were no adverse reactions specifically associated with the CL use or any comorbidity of MGD or conjunctivochalasis.ConclusionDQS can be used effectively and safely as a monotherapy for the treatment of DE patients wearing CLs or with concomitant MGD or conjunctivochalasis.

Optical quality &amp; visual performance with customised lenses for keratoconus

Purpose: This study investigated how aberration- controlling soft contact lenses (ACCLs) corrected ocular aberrations and visual performance in keratoconic patients compared to other forms of refractive correction. Method: Twenty-two patients (16 RGP contact lens wearers and 6 spectacle wearers) were fitted with standard toric soft lenses (TCLs) and customised ACCLs (designed to correct 3rd-order coma). In the RGP lens- wearing patients, aberrations were measured without lenses, with the patient?s habitual lenses and with the study lenses (using Hartmann-Shack aberrometry). In the spectacle-wearing patients, aberrations were measured both with and without the study lenses. LogMAR visual acuity (high-contrast and low-contrast) was evaluated with the patient wearing their habitual correction (of either spectacles or RGP lenses) and with the study lenses. Results: In the contact lens-wearing patients, the habitual RGP lenses and ACCLs provided significant reductions in uncorrected 3rd-order coma root-mean-square (RMS) error, 3rd-order RMS and higher-order RMS (HORMS) error (p?0.004). In the spectacle-wearing patients, both the TCLs and ACCLs significantly reduced uncorrected 3rd- order RMS and HORMS errors (p?0.005). The spectacle- wearing patients showed no significant differences in visual performances with their habitual spectacles versus the study lenses. In contrast, the habitual RGP lenses and TCLs provided significantly better high- contrast acuities compared to the ACCLs (p?0.006). Conclusions: In this group of keratoconic patients, ACCLs provided substantial reductions in higher-order aberrations; however, the poor visual performances achieved with the study lenses are most likely to be due to small on-eye lens decentrations.