Lens Replacement Research Articles

Intracameral phenylephrine and ketorolac injection (OMS302) for maintenance of intraoperative pupil diameter and reduction of postoperative pain in intraocular lens replacement with phacoemulsification.

BackgroundThe purpose of this study was to evaluate the effect of OMS302 on intraoperative pupil diameter and early postoperative ocular pain when administered during intraocular lens replacement surgery.MethodsFour hundred and six patients (406 study eyes; 202 in the OMS302 group and 204 in the placebo group) were entered into this randomized, double-masked, placebo-controlled, multicenter Phase III study, which was conducted at 15 centers in the USA and the Netherlands. The patients received OMS302 (60.75 mM phenylephrine HCl and 11.25 mM ketorolac tromethamine) or placebo in irrigation solution during intraocular lens replacement. No other changes in procedure were required. Coprimary endpoints were change in pupil diameter over time from surgical baseline to end of procedure and patient-reported ocular pain during the first 12 hours postoperatively. Secondary endpoints included additional measures of pupil diameter and postoperative pain.ResultsOMS302 was superior to placebo in maintaining intraoperative mydriasis, preventing miosis, and reducing postoperative pain. The weighted mean (standard error) difference (OMS302 – placebo) in change in the area under the curve from baseline for pupil diameter was 0.590 ([0.049]; 95% confidence interval 0.494 to 0.686; P<0.0001). For ocular pain scores, the weighted mean (standard error) difference was −4.580 ([1.192]; 95% confidence interval −6.917 to 2.244; P=0.0002). All secondary efficacy results favored OMS302. Specifically, analyses supporting prevention of miosis (patients with ≥6 mm pupil diameter at completion of cortical clean-up and those with <6 mm diameter at any time during surgery) were significant for OMS302 (95.9% versus 77.0% and 9.2% versus 38.0%, respectively; P<0.0001 for each endpoint). OMS302 was well tolerated and not associated with any unexpected adverse events.ConclusionOMS302 maintained mydriasis, prevented miosis, and reduced early postoperative pain when administered in irrigation solution during intraocular lens replacement, with a safety profile similar to that of placebo. OMS302 is preservative-free and bisulfite-free, and its administration does not require any modification to the surgical procedure.

What’s new about contact lens complications?

AbstractThe results of a study about 2260 contact lens related complications reported in Germany between 2006 to 2013 shall be presented. The analysis was done with a questionnaire including the following topics: ‐ For how many years were the lenses worn before the damage appeared? ‐ Which kind of contact lenses is related to the highest incidence of complications? ‐ Where had the contact lenses been fitted and bought? ‐ Which was the wearing modality? ‐ What kind of cleaning solutions were used? ‐ How was the hygienic behavior of the wearer? ‐ Which were the ophthalmological findings? ‐ Which therapy was given? ‐ Was the contact lens wearer unable to work? The results are the following: contact lens complications occur rather in the first year of contact lens wearing and with monthly replacement lenses. Most of them are cheap lenses bought without prescription or any control through a contact lens specialist. Poor hygiene is another important risk factor as well as the kind of wearing modality. The most frequent ophthalmological finding was a contact lens associated red eye. Antibiotic drops are the most frequently prescribed therapy. The results will be discussed and recommendations will be given.

Management of mydriasis and pain in cataract and intraocular lens surgery: review of current medications and future directions.

The maintenance of mydriasis and the control of postoperative pain and inflammation are critical to the safety and success of cataract and intraocular lens replacement surgery. Appropriate mydriasis is usually achieved by topical and/or intracameral administration of anticholinergic agents, sympathomimetic agents, or both, with the most commonly used being cyclopentolate, tropicamide, and phenylephrine. Ocular inflammation is common after cataract surgery. Topical steroids and nonsteroidal anti-inflammatory drugs are widely used because they have been proved effective to control postsurgical inflammation and decrease pain. Topical nonsteroidal anti-inflammatory drugs have also been shown to help maintain dilation. However, use of multiple preoperative drops for pupil dilation, inflammation, and pain control have been shown to be time consuming, resulting in delays to the operating room, and they cause dissatisfaction among perioperative personnel; their use can also be associated with systemic side effects. Therefore, ophthalmologists have been in search of new options to streamline this process. This article will review the current medications commonly used for intraoperative mydriasis, as well as pain and inflammation control. In addition, a new combination of ketorolac, an anti-inflammatory agent, and phenylephrine, a mydriatic agent has recently been designed to maintain intraoperative mydriasis and to reduce postoperative pain and irritation from intraocular lens replacement surgery. Two Phase III clinical trials evaluating this combination have demonstrated statistically significant differences when compared to placebo in maintaining intraoperative mydriasis (P<0.00001) and in reducing pain in the early postoperative period (P=0.0002). This medication may be of benefit for use in cataract and lens replacement surgery in the near future.

Identification of coagulase-negative staphylococci in daily disposable contact lens wearers.

This study aimed to identify and quantify the number of contaminating organisms on daily disposable (DD) soft contact lenses, which may be responsible for mild cases of keratitis that occur with this lens wear modality. Ten participants wore DD lenses, and 10 participants wore planned replacement (PR) lenses. Lenses were collected aseptically and analysed for microbial contamination. Colony-forming units (CFU) were recorded, and representative colonies were used for identification using the API identification system. The DD lenses evaluated in this study were contaminated with coagulase-negative staphylococcus (CNS), ranging from 1 to 653 CFU. PR lenses showed more diversity in the types of contaminating micro-organisms and consisted of CNS, Gram-negative bacteria (Pseudomonas), a yeast (Candida) and a mould (Aspergillus), ranging from 1 to 230 CFU. CNS was the only type of micro-organism found on DD contact lenses and therefore may be the cause of any form of keratitis observed in DD lens wearers. This is the first study to determine the frequency and identify the contaminating organisms found on daily disposable (DD) soft contact lenses. The contaminating organisms identified on DD contact lenses were solely coagulase-negative staphylococcus (CNS), suggesting that CNS may be the causative organism associated with infectious keratitis that occurs with DD contact lens wear.

Contact Lens Fitting and Long-Term Management for the Boston Keratoprosthesis

To examine the types of contact lenses used as bandage lenses in the postoperative management of patients with Boston type 1 keratoprosthesis (K-Pro). We examined the lens parameters, the number of trial lenses used to achieve successful fit, and lens replacement schedule. The strategies to achieving a successful fit in these complex patients are reviewed. This was a single-center, retrospective chart review of patients who had undergone implantation of the Boston keratoprosthesis in 1 or more eyes from January 2006 to December 2011. Patients included male and female subjects aged 18 years or older who had been fit with bandage contact lenses as part of their postoperative management. Twenty-two eyes of 15 patients met the criteria for this review. The age range was 30 to 90 years. There were eight men and seven women. The average number of lenses to achieve a successful fit varied from 1 to 8, with an average of 2.22 trial lenses used per patient. By 6 months after the surgery, 12 K-Pro eyes showed visual acuity of 20/200 or better, with 7 of those eyes attaining better than 20/80 best-corrected Snellen distance acuity. Our results show that it is often necessary to use custom contact lenses for K-Pro patients. Management of poor tear film quality, protein deposition, inflammation, lens replacement schedule, and antibiotic resistance are related considerations.

Hydrothermal Alteration and Mineralization of the Galore Creek Alkalic Cu-Au Porphyry Deposit, Northwestern British Columbia, Canada

The Late Triassic Galore Creek porphyry district is the largest accumulation of Cu-Au prospects in British Columbia, Canada, in terms of contained metal. The principal economic resource is the Central zone deposit. It comprises three high-grade centers: the Au-rich North and South gold lenses and the Cu-dominated Central replacement zone. Alteration footprints, ore shells, and porphyry intrusions in these centers dip 45° to 60° to the west in the North gold lens and southwest in the South gold lens and Central replacement zone, indicative of significant postmineral tilting. This inclination created an oblique vertical expression of the Central zone at surface and at depth, providing a +700-m depth profile through the deposit. Galore Creek is considered to be the end-member of the silica-undersaturated class of alkalic porphyry Cu-Au deposits. It displays a unique hydrothermal alteration footprint, generally devoid of quartz veining. Despite the lack of crosscutting veins, a paragenetic sequence of several discrete potassic and calcic alteration events has been established. During main-stage alteration, two mineralization events occurred that formed the economic resource in the Central zone. Highly oxidizing fluids derived from porphyritic syenite to monzonite intrusions produced initial potassic alteration and sulfide mineralization in the North gold lens and South gold lens. Cu-Au ore shells are characterized by a gold-rich core dominated by bornite associated with hematite-dusted orthoclase, specular hematite, and anhydrite. The second period of hydrothermal activity caused brecciation and calcic alteration in the Central replacement zone. The calcic fluids formed hydrothermal cement grading from Ti-rich andraditic to grossularitic garnet in the core of the breccia to a diopside and magnetite-dominated assemblage at the margins. Calcic alteration also formed in the surrounding host rock. This alteration event was followed by potassic alteration and mineralization, characterized by biotite, anhydrite, and chalcopyrite in the Cu-rich ore shell of the Central replacement zone. Most of the Au is hosted in bornite that is spatially associated with oxidized (reddened) rock units dominated by an alteration assemblage of orthoclase ± hematite ± specular hematite ± garnet ± anhydrite. High-grade Cu in the Central zone is related to abundant chalcopyrite that has commonly replaced an assemblage of biotite ± magnetite ± diopside. This distinct spatial separation strongly suggests that the local redox environment within the wall rocks governed sulfide and gold distributions. The switch from early Au-rich mineralization to late-stage Cu-dominated mineralization appears to have been controlled by varying redox conditions within the magma. The change from more oxidized alteration assemblages (Fe3+ > Fe2+) to more reduced assemblages (Fe3+ ≤ Fe2+) is indicative of a change in oxidation potential that may have propelled sulfide saturation in the magma and, thus, the subsequent depletion of most of the Au.

Consequences of Wear Interruption for Discomfort With Contact Lenses

To establish whether increased end-of-day discomfort during soft contact lens wear is associated with short-term changes occurring to the lens itself. Twenty-seven subjects wore hydrogel lenses (Focus Dailies; Alcon) bilaterally for 10 hours on two separate days. Comfort was reported using 1-100 numerical rating scales (1 = intolerable discomfort, 100 = lens cannot be felt). Day 1 ratings were taken before lens insertion and at 0.05, 5, and 10 hours post-insertion. Day 2 ratings occurred at similar times, but lenses were removed after the 5-hour assessment and either reinserted (n = 14) or newly replaced (n = 12). An additional rating was taken 5 minutes after re-insertion. Wear then continued to the 10-hour point. In a separate study, 24 different subjects repeated these procedures using a silicone hydrogel lens (AirOptix Aqua; Alcon) with wear taking place on 3 days to permit lens replacement to be with existing as well as new lenses in all subjects. For hydrogel lenses, comfort scores (mean ± 95% CI) reported after 10 hours were 79.4 ± 8.3 when lenses were worn un-replaced, compared with 73.2 ± 9.2 for replacement with the existing lens. When replacement was with a brand new lens, the corresponding values were 72.9 ± 10.9 (un-replaced) versus 69.2 ± 12.8 (new lens replacement). For silicone hydrogel lenses, 10-hour comfort was 90.3 ± 3.2 (un-replaced) versus 92.2 ± 2.9 (replacement with existing lens) versus 90.0 ± 3.3 (replacement with new lens). Differences between replacement conditions were not significant in any case (analysis of variance, p > 0.05). Final comfort was not influenced by replacing lenses midway through the wearing period. Comfort decrements experienced by users of these daily contact lenses towards the later part of the wearing period are not caused by changes occurring to the lenses on this time scale. Possible alternative etiological factors include a fatigue-like response in one or more ocular tissues or stimulation of ocular surface nociceptors induced by the presence of the contact lens.

Compliance Factors Associated With Contact Lens-Related Dry Eye

To determine if compliance factors are associated with contact lens-related dry eye (CLDE). The data were derived from subject responses to a compliance survey administered in a cross-sectional study including 100 healthy, daily (nonovernight), experienced soft contact lens wearers (50 normal and 50 with CLDE). Classification into normal or CLDE groups was based on Contact Lens Dry Eye Questionnaire scores, tear breakup time, and 2 hours difference between total and comfortable daily lens wear hours. The compliance survey queried aspects of lens care, rub and rinse practices, lens and lens case replacement frequency, solution replacement, and sleeping with lenses. Statistical analysis of the data was performed using unpaired T tests, χ, and Fisher exact tests as applicable. The average age of all subjects was 24.8±4.4 years, and 60% were women. Overall compliance rates were low for several variables including recommended replacement of contact lenses (53%), rub and rinse practices (69% and 45%, respectively), care solution topping-off (80%), and washing hands before handling lenses (48%). However, almost no compliance factors were associated with CLDE status, with the exception of perceived ease or difficulty with lens care, which was rated as more difficult by the CLDE group (P=0.004). Overall compliance rates with contact lens care practices are very low, highlighting the need for more effective methods of patient education regarding contact lens care and compliance. However, almost no compliance factors were found to be associated with CLDE. Factors other than compliance likely play a bigger role in CLDE.

Compliance and hygiene behaviour among soft contact lens wearers in the Maldives

BackgroundSignificant levels of non‐compliance and poor hygiene among contact lens wearers have been reported previously from different parts of the world. This survey aimed at identifying the scope of hygiene and non‐compliant behaviour of soft contact lens wearers in the Maldives.MethodsEstablished soft lens wearers attending two eye clinics in Male' city, were interviewed in office or via telephone. A set of interviewer‐administered questions was used to access the subjective response on compliance and hygiene behaviour (hand and lens case hygiene, water exposure, adherence to lens replacement schedule, dozing and overnight wear, awareness of aftercare visits and reuse of disinfecting solution). Participants were also asked to rate themselves as a contact lens user based on their perceived compliance and hygiene practices.ResultsOut of 107 participants, 79 (74.8 per cent) were interviewed in the office and the rest via telephone. The majority of lens wearers were female, office workers and students, with a mean age of 20.64 ± 4.4 years. Mean duration of lens wear was 28.04 ± 8.36 months. Most of them were using spherical lenses (86.9 per cent) on a daily wear basis (96.3 per cent). Major reported forms of non‐compliance were poor hand hygiene (60.7 per cent), lack of aftercare awareness (39.3 per cent), water exposure (35.5 per cent) and over‐use of lenses (24.3 per cent). While females were more likely to overuse their lenses than males (p < 0.005), other socio‐demographic factors were not associated with reported non‐compliance. Although around 90 per cent of the participants considered themselves average or good contact lens wearers, most exhibited some form of non‐compliant and poor hygienic behaviour.ConclusionA significant number of Maldivian contact lens wearers exhibited poor levels of hygiene and compliance with contact lenses and lens care systems. An effective educational reinforcement strategy needs to be developed to modify lens wearers' non‐compliance.

Compliance with correct replacement of daily disposable contact lenses in Italy

Purpose: To assess the compliance of daily disposable contact lens (DDCL) wearers in terms of frequency of replacement. Evaluate the possibility of predicting compliance by two different Health Behavioral Theories (HBT): The Health Belief Model (HBM) and The Theory of Planned Behavior (TPB).

Functional and Visual Improvement With Prosthetic Replacement of the Ocular Surface Ecosystem Scleral Lenses for Irregular Corneas

To evaluate the Doheny Eye Institute Experience with Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) scleral lenses for the management of irregular corneas with outcomes based on visual acuity (VA) and visual function. A retrospective chart review of 58 subjects (90 eyes) with irregular corneal surfaces referred to the Doheny Eye Institute for PROSE treatment between July 2009 and December 2011 was performed. The best-corrected VA before and after PROSE fitting was recorded. A functional assessment before and after PROSE fitting was also performed using the Ocular Surface Disease Index, a 12-item questionnaire that grades the severity of ocular discomfort and vision-related function. Keratoconus (43%) represented the largest group, and post-PK astigmatism (31%) represented the second largest group of patients with irregular corneas who had completed the PROSE treatment. Patients with keratoconus had the greatest improvement in VA after PROSE fitting with an 88% improvement in the logarithm of the minimal angle of resolution vision. Patients with post-PK astigmatism had the greatest improvement in Ocular Surface Disease Index scores with a 79% improvement observed after PROSE fitting. PROSE scleral lenses offer improvements in the VA and function, and they could be an option for patients with irregular corneas who have failed conventional treatments before considering additional surgery.

A multi-country assessment of compliance with daily disposable contact lens wear

To investigate compliance with daily disposable contact lens (DDCL) wear and investigate re-use of lenses according to country and DDCL material worn. Optometrists invited eligible DDCL patients from their practices to participate in a survey on DDCL wear in Australia, Norway, the United Kingdom (UK) and the United States (US). Eligible participants completed an online or paper version of the survey. 805 participants completed the survey (96% online): Australia 13%, Norway 32%, UK 17%, US 38%. The median age was 38 years; 66% were female. Silicone hydrogel (SiHy) DDCLs were worn by 14%. Overall, 9% were non-compliant with DDCL replacement; Australia 18%, US 12%, UK 7% and Norway 4%. There were no differences with respect to sex, years of contact lens wear experience or DDCL material (SiHy versus hydrogels). The primary reason for re-use was "to save money" (60%). Re-use of DDCLs resulted in inferior comfort at insertion and prior to lens removal (p=0.001). 75% reported occasional napping and 28% reported sleeping overnight for at least one night in the preceding month, while wearing their DDCLs. Non-compliance with replacement of DDCLs occurred in all countries investigated; the rate was highest in Australia and lowest in Norway. Re-use of DDCLs was associated with reduced comfort. DDCL wearers often reported wearing lenses overnight. It is important for optometrists to counsel their patients on the importance of appropriate lens wear and replacement for DDCLs.

아이라이너 침착에 의한 소프트 콘택트렌즈 파라미터의 변화 및 세척효과의 비교

목적: 본 연구에서는 눈 화장품인 아이라이너에 노출시킨 소프트 콘택트렌즈의 파라미터가 어떻게 변하는가를 알아보고, 세척방법을 달리하여 세척하였을 때의 세척효과와 렌즈 파라미터의 회복정도를 비교하고자 하였다. 방법: 서로 다른 재질로 제조된 3종류의 소프트 콘택트렌즈에 각각 1시간, 4시간 및 6시간 동안 아이라이너를 침착시킨 후 안경용 초음파 세척 및 손 세척을 시행하였으며, 세척 전후 렌즈의 가시광선 투과도, 직경 및 표면의 변화를 비교하였다. 결과: 소프트 콘택트렌즈의 가시광선 투과도는 아이라이너의 침착시간이 길어질수록 감소하였다. 렌즈의 표면을 관찰한 결과 아이라이너의 침착 양상은 렌즈재질의 물성에 따라 다르게 나타나 narafilcon A 재질 렌즈에서 가장 침착이 큼을 알 수 있었다. 렌즈 직경은 hilafilcon B 및 etafilcon A 재질 렌즈는 감소하였으나, narafilcon A재질 렌즈는 증가하는 것으로 나타났다. 이러한 아이라이너의 침착은 안경용 초음파 세척기를 이용한 세척보다는 다목적 용액을 이용한 손 세척 시 세척효율이 우수한 것으로 나타났으나 렌즈의 직경이나 가시광선 투과도, 렌즈표면 등 렌즈 파라미터가 원래 상태로 회복되는 데에는 한계가 있었다. 결론: 이상의 결과로 소프트렌즈를 착용한 상태에서 눈 화장 하는 것을 최소화하는 것이 옳으며, 반복적으로 눈 화장을 할 때에는 렌즈 파라미터의 변화를 고려한 착용시간의 단축이나 빠른 렌즈의 교체주기가 필요하다고 사료된다. Purpose: This study was conducted to investigate the change of soft contact lens parameters after eyeliner deposition and compare the cleaning efficiency and the recovery rate of lens parameters by different cleaning methods. Methods: The eyeliner was deposited on three types of soft contact lenses made of different materials for 1 hour, 4 hours and 6 hours and those lenses were washed by the eyeglasses ultrasonic cleaning and by hands. The changes in visible light transmittance, diameter and surface of those lenses were compared before and after cleaning of the lens. Results: The visible light transmittance of soft contact lenses decreased along with the deposition time of eyeliner. The patterns of the eyeliner deposition on soft contact lens appeared differently depending on the physical properties of the lens material. Thus, the largest eyeliner deposition was found on narafilcon A lens. The diameters of hilafilcon B and etafilcon A lenses were decreased, however, the diameter of narafilcon A lens was increased. The cleaning efficiency of the eyeliner deposition was greater with the multipurpose solution by hands than with the eyeglasses ultrasonic cleaner. However, the recovery of lens parameters such as the lens diameter, visible light transmittance and lens surface due to the eyeliner deposition to its original state was limited. Conclusions: From these results, it is suggested to minimize eye makeup when wearing soft contact lens. Furthermore, the reduced wearing time and shorter cycle of lens replacement may be needed by considering a change of lens parameter when the repeat eye makeup is applied.

Compliance with Lens Replacement and the Interval between Eye Examinations

Eye care practitioners (ECPs) acknowledge that their patients do not always follow recommendations for lens replacement, but many may not realize the possible implications for their offices. The study was conducted to investigate whether there is a relationship between contact lens compliance and the interval between full eye examinations (IEE). The study was conducted in ECP offices in the United States. Eye care practitioners and patients independently completed linked questionnaires, evaluating their contact lens wear and care. Patients were required to be current wearers of daily disposable (DD) lenses or reusable silicone hydrogel lenses with a manufacturer-recommended replacement frequency (MRRF) of 2 weeks (2WR) or 1 month (1MR). A total of 2147 questionnaires from 141 offices were eligible. Fifty-four percent of patients were wearing 2WR, 37% 1MR, and 9% DD lenses. Wearers of 2WR lenses were significantly less compliant with replacement than wearers of both DD and 1MR lenses (34% vs. 74% and 67%, both p < 0.001); patients purchasing an annual supply were more compliant (55% vs. 45%, p < 0.001). The mean IEE was 16 months and was longer for wearers who were noncompliant with the MRRF (17.4 months vs. 14.5 months, p < 0.001). Other factors affecting IEE were household income (p = 0.030), insurance (p < 0.001), purchase source (p < 0.001), and sex (p = 0.007). Patients who were not compliant with the MRRF had longer IEEs and were less likely to purchase an annual supply of lenses. Patients who purchased lenses from their ECP, had a higher household income, had eye examination insurance, and were female had shorter IEEs. Patients failing to replace their lenses when scheduled were also found to be less compliant with lens care procedures. Eye care practitioners should reinforce the importance of all aspects of lens wear and care with their patients, with the overall aim of reducing possible complications and retaining successful contact lens wearers in their offices.

Geographic and temporal risk factors for interruptions to soft contact lens wear in young wearers

This was a secondary analysis of an existing dataset of soft contact lens wearers age 8-33 years, who received eye care outside of a clinical trial. The aim was to identify geographical and temporal factors associated with interruptions to contact lens wear. Data from six academic centers in North America captured 522 events in 3549 patients. Cases were analyzed overall and in subcategories of allergic, and serious and significant adverse events. General estimating equations were used to model the effect of geographic (Northwest, West, Central, Northeast, Southeast) and temporal (season, month, day of the week) factors, along with previously identified risk factors associated with interruptions in lens wear (patient age, contact lens material, overnight wear, lens care system, replacement schedule, and years of contact lens wear). After controlling for established risk factors, both region and temporal factors disrupted the patients' ability to maintain contact lens wear. About 4% of all visits had complications that led to an interruption in wear. Allergic events were highest in the Central region. Serious and significant adverse events peaked in the Southeast during the Autumn and Winter months (September, October, December). Day of the week was not significant in any model. This study provides evidence of seasonal and regional challenges to contact lens wear. As the use of soft contact lenses expands for both cosmetic and medical reasons, practitioners must examine ways to maintain continuous, safe, and healthy use of contact lenses across all patients.

The Impact of Contemporary Contact Lenses on Contact Lens Discontinuation

Discontinuation or "dropout" from contact lens (CL) wear continues to afflict the CL industry. This study was conducted to determine whether the advent of new CL materials and designs has impacted the dropout rate and the reasons for discontinuation. Current and lapsed CL wearers residing in Canada were recruited using Facebook to take part in an on line survey investigating CL wearing experiences during 2008 to 2010 and to establish the percentage of participants who temporarily and permanently discontinued CL wear during the period surveyed. Four thousand two hundred seven eligible surveys were received (64% female; median age 27 years). Forty percent had lapsed from lens wear for at least 4 months; however, 62% of the lapsed wearers (LWs) resumed wear. There were no differences between LWs and nonlapsed wearers (NLWs) with respect to gender; however, LWs were older, started lens wear when older, and had not worn lenses for as long as NLWs (all P<0.001). More NLWs than LWs wore silicone hydrogel CLs (49% vs. 38%, P<0.001) and more LWs than NLWs wore daily disposable lenses and hydrogel CLs (24% vs. 19% and 22% vs. 18%, respectively, P≤0.001). Primary reasons for discontinuation were discomfort (24%), dryness (20%), red eyes (7%), and expense (7%). Compliance with lens replacement was no different between LWs and NLWs (48% vs. 45%). About 23% of those surveyed had discontinued CL wear permanently. The primary reasons for dropping out continue to be discomfort and dryness. Dropout rates were lower in silicone hydrogel wearers.

The Effect of Daily Lens Replacement During Overnight Wear on Ocular Adverse Events

Compared with daily disposable wear schedule, continuous wear (CW) or extended wear of contact lenses has been associated with an increased risk of developing an ocular infection. Proof-of-principle studies were conducted to investigate the impact of daily replacement of lenses on the rate of contact lens-related ocular adverse events (AEs) during 30-night CW. A total of 215 subjects were dispensed with silicone hydrogel lenses on a 30-night CW schedule but replaced lenses daily either each night before sleeping (n = 178 eyes) or each morning after waking (n = 252 eyes). Scheduled clinic visits were conducted at 1 week and 1 month. Neophytes were required to complete 1 week of daily wear before commencing CW. A historical control (n = 191 eyes) using the same site, subject demographics, and visit schedule but monthly lens replacement was used for AE rates. Logistic regression analysis showed a significant reduction in mechanical AEs (0.8 vs 5.2%, p = 0.01) and overall AEs (inflammatory and mechanical events) (4.0 vs 8.9%, p = 0.04) when lenses were replaced each morning compared with being replaced monthly. Estimation of handling-related lens contamination of unworn lenses in a subgroup of subjects showed isolation of Staphylococcus aureus from the lenses of 35% of subjects, and 65% of subjects had more than 1000 colony-forming units per lens of gram-positive bacterial contamination. Morning lens replacement during CW reduced mechanical and overall ocular AEs. Replacing lenses at night had no beneficial effects perhaps because the benefit of a fresh lens at night might be partially negated by contamination of the contact lens caused by lens handling before overnight eye closure. Contact lens wearers on an extended wear or CW schedule should be advised to minimize lens handling before sleep to reduce the risk of complications.

The influence of masked lens replacement on subjective comfort and vision with aging soft contact lenses

Purpose: To evaluate changes in subjective comfort (SC) and vision (SV) with masked replacement (MR) for symptomatic soft contact lens (SCL) wearers (SYM) reporting decreased comfort with lens age, and asymptomatic wearers (ASYM).

A Study of the Hereditary Hyperferritinemia Cataract Syndrome in Patients of Greek Origin

Abstract 3205 Background:Hereditary hyperferritinemia cataract syndrome (HHCS) is an autosomal dominant disorder characterized by elevated serum L-ferritin and early onset bilateral cataracts. The syndrome, first described in Italy and France in 1995, is caused by mutations in the iron responsive element (IRE) of the L-ferritin gene (FTL-ferritin light chain) on chromosome 19q13.3. The conformational changes in the mutated IRE disrupt the binding of the iron regulatory proteins (IRPs) to the IRE, resulting in loss of the posttranscriptional control in L-ferritin synthesis. L-ferritin is constitutively expressed in tissues, irrespective of cellular iron status and without otherwise disrupting cellular iron metabolism. Despite the five to twenty-fold increase in serum L-ferritin, there is no clinical or laboratory evidence of iron overload. Serum iron and transferrin saturation remain within normal limits. Visual impairment and early cataract formation is the only clinical symptom of HHCS, with lens replacement being the only treatment needed. Extensive and invasive investigations in the undiagnosed hyperfferitinemic patient, as well as unnecessary treatment with phlebotomies, can be avoided with awareness of the syndrome, leading to the correct clinical and molecular diagnosis. Aim:HHCS has been previously reported in a limited number of patients of Greek origin, with the study of three unrelated families in Greece. Papanikolaou et al. (Blood Cells Mol Dis. 2006) detected the C39>G mutation in the IRE of the FTL in all affected individuals. Our aim was to further investigate the syndrome within the Greek population, both phenotypically and genetically. Methods:We investigated 81 patients with undiagnosed hyperferritinemia referred to the Hepatology Outpatients Clinic of the 1st Department of Internal Medicine at “Laikon” General Hospital in Athens. For all patients full medical history and clinical examination (including ophthalmological evaluation) was performed, and laboratory investigations were tailored accordingly. Where indicated from the medical history and laboratory findings, molecular analysis for mutations in the IRE of the FTL was performed using direct DNA sequencing. Results:From the total of 81 patients referred for undiagnosed hyperferritinemia, 18 unrelated subjects had a positive history of cataract and elevated ferritin. In those subjects ferritin levels ranged from 600 to 2070μg/L (normal values: 12–160μg/L). Serum iron was within normal limits and transferrin saturation ranged from 9 to 40%. Cataract diagnosis was reported as early as 5 years of age and 8 out of the 18 subjects had undergone surgery for lens replacement at the time of referral. From the 18 subjects that were screened for mutations in the IRE of the FTL, mutations were detected in 12 unrelated subjects. Ten out of the 12 individuals were positive for the previously described C39>G point mutation. The other two subjects were found to carry the A40>G mutation. The A40>G mutation has been described in the literature as part of the spectrum of mutations causing HHCS (Beaumont et al, Nat. Genet. 1995), however it has not up to now been reported in subjects of Greek origin. From the 12 subjects positive for either mutation, 8 reported positive family history for either early onset cataracts, hyperferritinemia or both. Where possible, clinical, laboratory and molecular investigations were extended to other members of these families. A total of 40 subjects from the members of the studied families fulfilled the clinical criteria of HHCS. Genetic testing was performed in 12 of them, revealing 11 subjects heterozygous for the C39>G mutation and 1 heterozygous for the A40>G mutation. Conclusion:HHCS is a non-iron loading, rare disorder that should be considered in all patients with unexplained hyperferritinemia, in order to avoid unnecessary investigations, potentially hazardous treatment and confer reassurance to the patient. Our findings contribute to the clinical and molecular characterization of the syndrome and extend the study of the disorder in the Greek population. Disclosures:No relevant conflicts of interest to declare.

Trends in Contact Lens–Related Corneal Ulcers at a Tertiary Referral Center

To evaluate the changes and trends in the number and characteristics of contact lens-related ulcers (CLRUs) and to compare the results with those of previously published series at our institution. Medical records of all patients diagnosed with presumed bacterial corneal ulcers seen at the Cornea Service, Wills Eye Institute, between January 1, 2004, and December 31, 2007, were retrospectively reviewed. Five hundred seven corneal ulcers were identified. Of these, 223 (43.9%) were contact lens (CL) related and 284 (56.1%) were not CL related. The proportion of CLRU showed a significant increase over time (P = 0.003), with significantly greater percentage of CLRU in 2006 and 2007 compared with 2004 (P = 0.004 and P = 0.005, respectively). One hundred thirty-one (58.7%) of the 223 CLRU patients were men. Many CLRUs were vision threatening, with 45.7% (92 of 201) more than 4 mm in size, 36.3% (81 of 223) associated with hypopyon, and 46.4% (103 of 222) central or paracentral in location. Pseudomonas aeruginosa was the most frequent agent isolated in CLRUs, found in 75 (63.0%) of 119 positive cultures. Soft daily-wear frequent replacement lenses were the most common lenses associated with corneal ulcers and were used in 68 (33.5%) of 203 cases. There was a history of overnight wear of CLs in more than half of the cases (121 of 223, 54.3%). Of these, 21 (9.4%) were not approved for overnight wear. There was a significant increase in the number of cases of presumed bacterial keratitis associated with soft CL wear over the study period from 2004 to 2007 at our institution. The significant increase in CLRU noted from 1996 to 1999 to 1999 to 2002 reported previously seems to have continued between 2004 and 2007.