Contact Lens Surface Research Articles

Photoacoustic imaging methodology for the optical characterization of contact lenses

We demonstrate photoacoustic microscopy as a metrology method for the optical characterization and quality control of contact lenses (CLs). Dual-wavelength excitation is applied to CLs tinted on both sides with two thin ink layers, each of them possessing distinctly different optical absorption properties. Thus, the method is capable of measuring the elevation maps of both CL surfaces during two subsequent imaging sessions and extracting the CL thickness, curvatures, and dioptric power. We show that such an easily implementable technique provides robust, high-precision, cost-effective three-dimensional imaging and characterization of both rigid and soft CLs, which renders it highly favorable for a broad range of applications.

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

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

Effect of contact lens surface properties on comfort, tear stability and ocular physiology.

Retrospective analysis of different contact lens wearing groups suggests lens surface lubricity is the main factor influencing contact lens comfort. However, the examined commercially available contact lenses differ in material and design as well as surface properties. Hence this study isolates the contribution of lens surface properties using an ultra-thin coating technology. Nineteen habitual contact lens wearers (21.6±1.7years) wore formofilcon B soft monthly disposable contact lenses with and without coating technology modified surface properties for a month each in a randomised double-masked cross-over study. OBJECTIVE NON-INVASIVE: breakup time (NIKBUT), NIKBUT average and ocular redness (Jenvis grading scale) were evaluated (Keratograph 5M) after 1 week and 1 month of wear. Symptoms were assessed using the Contact Lens Dry Eye Questionnaire (CLDEQ-8); perceived vision quality and subjective lens comfort at insertion, mid-day and end of the day were rated with four Visual Analog Scales. Perceived visual quality (F=5.049,p=0.037), contact lens dry eye symptoms (F=14.408,p=0.001) and subjective lens comfort (F=28.447,p<0.001) were better for coated compared to uncoated lenses. The surface coating postponed the lens dewetting (F=8.518,p=0.009) and increased the pre-lens tear film stability (F=5.626,p=0.029), but bulbar (F=0.340,p=0.567) and limbal (F=0.110,p=0.744) redness were similar for both contact lenses. No parameter changed significantly between a weeks' and months' wear (p>0.05). Lens surface wettability and ocular redness were not correlated to changes in symptoms (p>0.05). As previously hypothesised, enhancing the physical surface properties of a soft contact lens improves subjectively rated wearer comfort, which, in turn, should result in reduced contact lens discontinuation.

Contact lens and ocular surface ‐ After all, its still a foreign body

SummaryContact lenses, as indicated by the name, are in direct contact with the ocular surface. CL are swimming within the tear film, between eye ball &amp; palpebral conjunctiva ‐ in the middle of the Ocular Surface Unit. Interactions thus have direct impact on tear film &amp; tissues with the risk of potential side effects (for details please see: WWW.OSCB‐BERLIN.ORG).One main impact is increased mechanical friction by the ′additional structure′. Friction increases during eye movements and blinks when the lid border moves over the contact lens rim and along its anterior lens surface. Limited diffusion of nutritients can occur through the lens, particularly the supply with oxygen is critical for the cornea that depends on gas diffusion – Modern materials have meanwhile decreased this risk. Chemical impacts occur by the lens material or by solutions for lens cleaning &amp; storing.

A novel in-vitro method for assessing contact lens surface dewetting: Non-invasive keratograph dry-up time (NIK-DUT)

This study was designed to develop a novel technique called non-invasive keratograph dry-up time (NIK-DUT), which used an adapted corneal topographer, to analyse in-vitro contact lens surface dewetting and the effects of combinations of lenses and lens care solutions on dewetting. Variables were assessed to optimise sensitivity and reproducibility. To validate the method, in-vitro dewetting of silicone hydrogel contact lenses (balafilcon A, comfilcon A, lotrafilcon A, lotrafilcon B and senofilcon A) was tested. All lens types were soaked in OPTI-FREE® PureMoist® Multipurpose Disinfecting Solution (OFPM) and Sensitive Eyes® Saline Solution. The mean NIK-DUT, defined as drying of 25% of the placido ring measurement segments (NIK-DUT_S25), was calculated for each lens/lens solution combination and a visual map constructed representing the time and location of the dry-up event. Optimal conditions for NIK-DUT measurement included mounting onto a glass stage with a surface geometry of r=8.5mm, e=0, and measuring with high intensity red or white illumination. This method detected significant differences in contact lens dewetting with different lens soaking solutions. NIK-DUT_S25 for all lenses was longer when pre-soaked in OFPM versus saline. Visual analysis showed that dewetting of contact lenses was not uniform across surfaces and differed between test solutions. NIK-DUT is suitable for detecting differences in dewetting among various contact lenses and lens-care combinations. NIK-DUT can quantify the dewetting of large areas of lens surfaces with little subjective influence. Lens care solutions containing surface-active wetting agents were found to delay surface dewetting of silicone hydrogel lenses.

Electrically atomised formulations of timolol maleate for direct and on-demand ocular lens coatings

Advances in nanotechnology have enabled solutions for challenging drug delivery targets. While the eye presents numerous emerging opportunities for delivery, analysis and sensing; issues persist for conventional applications. This includes liquid phase formulation localisation on the ocular surface once administered as formulated eye-drops; with the vast majority of dosage (>90%) escaping from the administered site due to tear production and various drainage mechanisms. The work presented here demonstrates a single needle electrohydrodynamic (EHD) engineering process to nano-coat (as an on demand and controllable fiber depositing method) the surface of multiple contact lenses rendering formulations to be stationary on the lens and at the bio-interface. The coating process was operational based on ejected droplet charge and glaucoma drug timolol maleate (TM) was used to demonstrate surface coating optimisation, bio-surface permeation properties (flux, using a bovine model) and various kinetic models thereafter. Polymers PVP, PNIPAM and PVP:PNIPAM (50:50%w/w) were used to encapsulate the active. Nano-fibrous and particulate samples were characterised using SEM, FTIR, DSC and TGA to confirm structural and thermal stability of surface coated formulations. More than 52% of nano-structured coatings (for all formulations) were <200nm in diameter. In vitro studies show coatings to exhibit biphasic release profiles; an initial burst release followed by sustained release; with TM-loaded PNIPAM coating releasing most drug after 24h (89.8%). Kinetic modelling (Higuchi, Korsmeyer-Peppas) was indicative of quasi-Fickian diffusion whilst biological evaluation demonstrates adequate ocular tolerability. Results from permeation studies indicate coated lenses are ideal to reduce dosing regimen, which in turn will reduce systemic drug absorption. Florescent microscopy demonstrated probe and probe embedded coating behaviour from lens surface in vitro. The multiple lens surface coating method demonstrates sustained drug release yielding promising results; suggesting both novel device and method to enhance drug activity at the eyes surface which will reduce formulation drainage.

Care System Versus Transmitted Light Wavefront Pattern of Contact Lenses.

This article compares the optical performance of soft contact lenses (CLs) treated with multipurpose or hydrogen peroxide care systems. The investigated care systems were (1) 3% hydrogen peroxide solution Oxysept (Abbot Medical Optics, Abbott Park, IL) and (2) multipurpose solution Regard (Vita Research, Ariccia, Italy). Three types of silicone hydrogel CLs were studied (comfilcon A, lotrafilcon B, and balafilcon A), unworn and exposed for 30 times to the solutions, which were replaced every 8 hr. The optical performance of the CLs was evaluated through the on-eye transmitted light wavefront patterns by considering new CLs as references. The surface morphology of the CLs was investigated by scanning electron microscopy. Statistically significant modifications in the range 0.1 to 0.3 μm of Zernicke coefficients and modifications of the root mean square of the wavefront aberration function were found for CLs treated with multipurpose solution, in agreement with the observed modifications of the surface morphology. Statistically significant changes were also found after exposure to the hydrogen peroxide solution, but the variation of the Zernicke coefficients was found lower than 0.1 μm, thus being negligible in CL optical performances. In addition to disinfection ability and ocular surface reactions, CL care systems are different in solution-related CL optical performance. Multipurpose solutions may affect the CL surface morphology with significant modifications of the transmitted light wavefront pattern.

Antimicrobial Efficacy of Contact Lens Care Solutions Against Neutrophil-Enhanced Bacterial Biofilms.

PurposeNeutrophil-derived extracellular debris has been shown to accelerate bacterial biofilm formation on hydrogel and silicone hydrogel contact lens surfaces compared to lenses inoculated with bacteria alone. The purpose of this study was to evaluate the disinfection efficacy of four standard commercial contact lens cleaning regimens against neutrophil-enhanced bacterial biofilms formed on silicone hydrogel contact lenses.MethodsFour reference strains were used: Pseudomonas aeruginosa, Serratia marcescens, Stenotrophomonas maltophilia, and Staphylococcus aureus. Human neutrophils were isolated from peripheral blood by venipuncture. Unworn Lotrafilcon B lenses were incubated overnight in each respective strain with stimulated neutrophils. Contact lenses were then cleaned using one of four contact lens care solutions according to manufacturer instructions. Bacterial viability was assessed by colony counts and confocal microscopy. Volume of residual debris on lens surfaces after cleaning was quantified using IMARIS software.ResultsAll four solutions tested showed effective antimicrobial activity against each bacterial strain; however, substantial amounts of nonviable bacteria and cellular debris remained on the lens surface despite concomitant digital cleaning.ConclusionsNecrotic cellular debris that accumulates under the posterior lens surface during wear of an inoculated contact lens is not fully removed during routine cleaning and disinfection.Translational RelevanceThe accumulation of residual cellular debris on the contact lens surface may contribute to new colonization of the lens and represents a significant risk factor for a contact lens–related adverse event. Additional studies are needed to correlate these findings with risk for corneal infiltrative and/or infectious events in a standard animal model.

Fractal Features and Surface Micromorphology of Unworn Surfaces of Rigid Gas Permeable Contact Lenses

ABSTRACTPurpose: The aim of this exploratory study was to investigate the micromorphology of surfaces of rigid gas permeable (RGP) contact lenses (CLs) using atomic force microscopy (AFM) followed by fractal analysis.Materials and methods: In order to characterize in a quantitative manner the micromorphology of surfaces of new and unworn RGP CLs made of twelve different materials, AFM was taken and then analyzed using fractal methods. Surface topography was sampled in an intermittent-contact mode in air, on square areas of 5 × 5 µm2 (MultiMode with Nanoscope V (Bruker). Spatial characteristics of 3-D surface texture were obtained using parameters defined in ISO 25178-2: 2012 norm.Results: The surface texture turned out to have complex 3-D nanoscale geometry. For quantitative characterization of the properties of surface geometry at nanometer level of CL on the global scale, a series of fractal parameters was used.Conclusions: Statistical and fractal parameters of 3-D surfaces can be used by manufacturers to assess the micromorphology of CLs in order to improve their 3-D surface texture characteristics. These parameters can also be used in an elastic–plastic finite element model with contact elements to simulate the friction, wear and micro-elastohydrodynamic lubrication at a nanometer scale between the CL with the corneal surface.

Cultivation of Human Oral Mucosal Explants on Contact Lenses

ABSTRACTPurpose/Aim: Autologous cultivated oral mucosal (OM) epithelial transplantation has been successfully used as corneal epithelial replacement in bilateral limbal stem cell deficiency. Recently, lotrafilcon A contact lens (CL) surface was described as a suitable carrier for cultured stem cells in corneal epithelial transplantation. Our aim was to establish explant cultures from human OM on CL carriers that are free of animal-derived materials and feeder cells.Materials and methods: Human cadaveric 2 mm OM explants were sutured onto CL surfaces and cultivated with fetal calf serum (FCS) or human serum (HS) supplemented culture medium without feeder cells. Confluent cultures were harvested and evaluated morphologically with hematoxylin and eosin stain and with immunofluorescence microscopy for the presence of p63, vimentin and cytokeratins (CK) 3, 4, 13 and 14.Results: Confluent cell sheets covering the whole CL surface were produced from OM explants after 2 weeks of culture with HS and after 3 weeks with FCS. A basal layer consisted of small, vimentin, p63 and CK14 positive putative stem/progenitor cells, which were present in the whole cell sheet. Large, CK3, CK4 and CK13 positive, differentiated cells appeared to spread above this confluent layer.Conclusions: We have established an animal-free culture system from human OM explants on CL surface. The cultured OM sheets contain large numbers of putative stem cells including limbal-like CK3 and CK14 positive cells. This method can be adapted to good manufacturing practice (GMP) conditions and has, therefore, great potential for clinical use.

Effect of Lens Care Systems on Silicone Hydrogel Contact Lens Hydrophobicity.

To analyze changes in wettability of hydrogel and silicone hydrogel contact lenses (CLs) when preserved in different lens care systems. In this research, four silicone hydrogel CLs (senofilcon A, balafilcon A, comfilcon A, and lotrafilcon B) and one conventional CL (etafilcon A) and appropriate lens care solutions (ReNu MultiPlus, Biotrue, OPTI-FREE PureMoist, and AOSept Plus) were used. Lenses were immersed in each lens care system for 12 hr and then CL hydrophobicity was determined through water contact angle (CA) measurements using the OCA 20 instrument (DataPhysics). Mean CA values obtained when CLs were removed from blisters (baseline value) were lower for etafilcon A (49.6°±3.0°) and comfilcon A (48.0°±2.8°) and higher for senofilcon A (78.9°±2.5°), lotrafilcon B (82.6°±1.7°), and balafilcon A (91.5°±0.7°). Depending on CL and lens care combination, it was detected a statistically significant reduction by 70% of the 20 combinations studied and any significant increase in the CA. When compared to baseline values, CA varied between etafilcon A: 2° and 11°, comfilcon A: 1° and 7°, senofilcon A: 2° and 28°, lotrafilcon B: 14° and 31°, and balafilcon A: 18° and 29°. Comfilcon A was the most stable lens material presenting only one significant decrease in CA. This study reveals the existence of interactions between CL material and lens solutions that can play an important role in CL surface wettability. The major changes were obtained in lenses with higher baseline CA, which showed significant changes with each of the solutions. These differences can be positive, because in almost all of the combinations, the lenses became more wettable.

The nature and consequence of vitronectin interaction in the non-compromised contact lens wearing eye.

The aim of this work was to investigate the locus and extent of vitronectin (Vn) deposition on ex vivo contact lenses and to determine the influence of wear modality together with surface and bulk characteristics of the lens material. The quantity and location of Vn deposition on the surfaces of contact lens materials was investigated using a novel on-lens cell attachment assay technique. Vn mapping showed that deposition resulted from lens-corneal interaction rather than solely from the tear film. Higher cell counts on the posterior surface of the lenses were determined in comparison to the anterior surface. Overall gross Vn deposition was greater for high water content-low modulus materials (117±4 average cell count per field) than low water content-high modulus materials (88±6 average cell count per field). The role of Vn in plasmin regulation and upregulation is widely recognised. The findings in this paper suggest that the locus of Vn on the contact lens surface, which is affected by material properties such as modulus, is potentially an important factor in the generation of plasmin in the posterior tear film. Consequently, the potential for materials to affect Vn deposition will influence lens-induced inflammatory processes.

Marine Sponge-Derived Streptomyces sp. SBT343 Extract Inhibits Staphylococcal Biofilm Formation.

Staphylococcus epidermidis and Staphylococcus aureus are opportunistic pathogens that cause nosocomial and chronic biofilm-associated infections. Indwelling medical devices and contact lenses are ideal ecological niches for formation of staphylococcal biofilms. Bacteria within biofilms are known to display reduced susceptibilities to antimicrobials and are protected from the host immune system. High rates of acquired antibiotic resistances in staphylococci and other biofilm-forming bacteria further hamper treatment options and highlight the need for new anti-biofilm strategies. Here, we aimed to evaluate the potential of marine sponge-derived actinomycetes in inhibiting biofilm formation of several strains of S. epidermidis, S. aureus, and Pseudomonas aeruginosa. Results from in vitro biofilm-formation assays, as well as scanning electron and confocal microscopy, revealed that an organic extract derived from the marine sponge-associated bacterium Streptomyces sp. SBT343 significantly inhibited staphylococcal biofilm formation on polystyrene, glass and contact lens surfaces, without affecting bacterial growth. The extract also displayed similar antagonistic effects towards the biofilm formation of other S. epidermidis and S. aureus strains tested but had no inhibitory effects towards Pseudomonas biofilms. Interestingly the extract, at lower effective concentrations, did not exhibit cytotoxic effects on mouse fibroblast, macrophage and human corneal epithelial cell lines. Chemical analysis by High Resolution Fourier Transform Mass Spectrometry (HRMS) of the Streptomyces sp. SBT343 extract proportion revealed its chemical richness and complexity. Preliminary physico-chemical characterization of the extract highlighted the heat-stable and non-proteinaceous nature of the active component(s). The combined data suggest that the Streptomyces sp. SBT343 extract selectively inhibits staphylococcal biofilm formation without interfering with bacterial cell viability. Due to absence of cell toxicity, the extract might represent a good starting material to develop a future remedy to block staphylococcal biofilm formation on contact lenses and thereby to prevent intractable contact lens-mediated ocular infections.

Biofilm formation of Achromobacter xylosoxidans on contact lens

Achromobacter spp. may contaminate lenses, lens cases, and contact lens solutions and cause ocular infections. The aim of this study was to investigate the possibility of isolated strain of Achromobacter xylosoxidans to form biofilm on the surface of soft contact lenses (CL), to quantify the production of the formed biofilm, and compare it with the reference strains (Pseudomonas aeruginosa, Staphylococcus aureus, and Haemophilus influenzae). Bacterial strain isolated from one contact lens case was identified as A. xylosoxidans using Vitek2 Automated System. Biofilm forming capacity of isolated strain of A. xylosoxidans and reference strains of P. aeruginosa, S. aureus, and H. influenzae on soft CL were analyzed by commonly used microtitre plate method. Our results showed that isolated strain of A. xylosoxidans was capable to form biofilm on the surface of soft contact lens. A. xylosoxidans was strong biofilm producer while all examined reference strains were moderate biofilm producers. A. xylosoxidans appears to be superior biofilm producer on soft CL compared to reference strains.

Compatibility of phospholipid liposomal spray with silicone hydrogel contact lens wear.

To assess the effects of two weeks of regular phospholipid liposomal spray application on lipid layer grade, tear film stability, subjective comfort, visual acuity, and lipid deposition in silicone hydrogel contact lens wearers. Thirty-one existing contact lens wearers were enrolled and fitted with two week planned replacement silicone hydrogel contact lenses (Acuvue® Oasys®) in a prospective, randomized, paired-eye, investigator-masked trial. A phospholipid liposomal spray (Tears Again®) was applied to one eye (randomized) four times daily for two weeks. LogMAR high contrast visual acuity (VA), low contrast glare acuity (LCGA), non-invasive tear film break-up time (NIBUT), and lipid layer grade (LLG) were measured at baseline and day 14, in both treated and control eyes. Subjective comfort relative to baseline, and spectrofluorophotometric assessment of contact lens surface lipid deposition were also assessed on day 14. All measurements did not differ at baseline between treated and control eyes. Lipid layer thickness and tear film stability were increased on day 14 in treated eyes (all p<0.05), but not in control eyes (all p>0.05). A greater proportion of participants reported improved comfort in the treated eye relative to the control eye (p=0.002). There were no significant differences in visual acuity or in contact lens surface lipid deposition, between treated and control eyes, on day 14 (all p>0.05). The phospholipid liposomal spray increased tear film stability, lipid layer thickness and subjective comfort in silicone hydrogel contact lens wearers, without adversely affecting visual acuity or contact lens surface lipid deposition.

Plasma graft of poly(ethylene glycol) methyl ether methacrylate (PEGMA) on RGP lens surface for reducing protein adsorption**The study was supported by National Natural Science Foundation of China (No. 51273072).

Poly(ethylene glycol) methyl ether methacrylate (PEGMA) was grafted on fluorosilicone acrylate rigid gas permissible contact lens surface by means of argon plasma induced polymerization to improve surface hydrophilicity and reduce protein adsorption. The surface properties were characterized by contact angle measurement, x-ray photoelectron spectroscopy (XPS) and atomic force microscopy respectively. The surface protein adsorption was evaluated by lysozyme solution immersion and XPS analysis. The results indicated that a thin layer of PEGMA was successfully grafted. The surface hydrophilicity was bettered and surface free energy increased. The lysozyme adsorption on the lens surface was reduced greatly.

Biofilm Formation on Bandage Contact Lenses Worn by Patients with the Boston Type 1 Keratoprosthesis: A Pilot Comparison Study of Prophylactic Topical Vancomycin 15 mg/mL and Linezolid 0.2.

To determine the rate of biofilm formation on bandage contact lenses worn by patients with the Boston type 1 keratoprosthesis (K-Pro) while on prophylactic topical vancomycin versus linezolid. Patients wearing a bandage contact lens (BCL) with a K-Pro were eligible for enrollment. After irrigation of the ocular surface with 5% povidone-iodine solution, each patient was placed on either topical vancomycin 15 mg/mL or linezolid 0.2% BID for one month. At the one-month visit, the BCL was collected and stored in fixative solution. Standard photographs were taken of each lens at high magnification using scanning electron microscopy (SEM), which were subsequently analyzed for evidence of biofilm. Nineteen contact lenses were obtained from 12 K-Pro patients at the Illinois Eye and Ear Infirmary. Zero of eight (0%; 95% CI=0 to 37%) contact lenses from patients treated with topical vancomycin, and 1 of 11 (9%; 95% CI=0 to 41%; P-value=1.00) contact lenses from patients treated with topical linezolid were found to have biofilm formation at one month as detected by SEM. None of the patients developed a clinically significant infection while on either prophylactic vancomycin or linezolid during the study period. Overall, the rate of biofilm formation as detected by SEM on the surface of bandage contact lenses was low. These results suggest that vancomycin and linezolid are both relatively effective in reducing biofilm-forming bacterial growth at one month. Accordingly, linezolid may be an effective alternative to vancomycin in patients with allergy or intolerance. However, further investigation is required to develop evidence-based antibiotic prophylaxis regimens.

Morphological Properties of Siloxane-Hydrogel Contact Lens Surfaces

ABSTRACTPurpose: The aim of this study was to quantitatively characterize the micromorphology of contact lens (CL) surfaces using atomic force microscopy (AFM) and multifractal analysis.Materials and Methods: AFM and multifractal analysis were used to characterize the topography of new and worn siloxane-hydrogel CLs made of Filcon V (I FDA group). CL surface roughness was studied by AFM in intermittent-contact mode, in air, on square areas of 25 and 100 μm2, by using a Nanoscope V MultiMode (Bruker). Detailed surface characterization of the surface topography was obtained using statistical parameters of 3-D (three-dimensional) surface roughness, in accordance with ISO 25178-2: 2012.Results: Before wear, the surface was found to be characterized by out-of-plane and sharp structures, whilst after a wear of 8 h, two typical morphologies were observed. One morphology (sharp type) has a similar aspect as the unworn CLs and the other morphology (smooth type) is characterized by troughs and bumpy structures. The analysis of the AFM images revealed a multifractal geometry. The generalized dimension Dq and the singularity spectrum f(α) provided quantitative values that characterize the local scale properties of CL surface geometry at nanometer scale.Conclusions: Surface statistical parameters deduced by multifractal analysis can be used to assess the CL micromorphology and can be used by manufacturers in developing CLs with improved surface characteristics. These parameters can also be used in understanding the tribological interactions of the back surface of the CL with the corneal surface and the front surface of the CL with the under-surface of the eyelid (friction, wear, and micro-elastohydrodynamic lubrication at a nanometer scale).

Visualization of a hyaluronan network on the surface of silicone-hydrogel materials.

Biotrue multipurpose solution (MPS) is a bioinspired disinfecting and conditioning solution that includes hyaluronic acid (HA) as a natural wetting agent. Previous studies demonstrated that HA sorbed from Biotrue MPS on both conventional and silicone hydrogel (SiHy) contact lens materials; an in vitro simulated-wear test validated the presence of HA on the lens surfaces for as long as 20 hours. In this study, the morphology and distribution of HA sorbed from both Biotrue and pure HA solution on SiHy contact lens surfaces was examined. Atomic force microscopy imaging was used to illustrate the topography of fresh SiHy contact lens materials before and after incubation with 0.1% (w/v) HA solution. The distribution, as well as fine details of the HA network, were resolved by first staining HA with Gram’s safranin, then imaging with confocal laser-scanning microscopy and differential interference-contrast microscopy. In this approach, SiHy materials take up the dye (safranin) nonspecifically, such that the resultant safranin–HA complex appears dim against the fluorescent lens background. Balafilcon A was chosen as the representative of glassy SiHy lenses that require postpolymerization plasma treatment to increase wettability. Senofilcon A and samfilcon A were chosen as representatives of SiHy materials fabricated with an internal wetting agent. A confluent and dim HA–safranin network was observed adhered to balafilcon A, senofilcon A, and samfilcon A lens surfaces incubated with either 0.1% (w/v) HA solution or Biotrue MPS. Therefore, the conditioning function provided by Biotrue MPS may be in part explained by the presence of the HA humectant layer that readily sorbs on the various types of SiHy contact lens materials.

Lid wiper epitheliopathy.

Some recent research has resulted in a hypothesis that there is a common 'lid wiper' region that is apposite to the ocular surface or anterior lens surface (where contact lenses are worn), responsible for spreading tears during blinking. In the upper eyelid, it extends about 0.6mm from the crest of the sharp posterior (inner) lid border (i.e. the mucocutaneous junction, or line of Marx) to the subtarsal fold superiorly and from the medial upper punctum to the lateral canthus horizontally. Histologically, it is seen as an epithelial elevation comprising of stratified epithelium with a transitional conjunctival structure of (moving posteriorly) squamous cells then cuboidal cells, with some parakeratinised cells and goblet cells. Lid wiper epitheliopathy (LWE) denotes staining of the lid wiper observed after instillation of dyes such as fluorescein, rose bengal or lissamine green. There have been some reports of higher rates of LWE in dry eye patients and contact lens wearers, but others have failed to find such associations. The primary cause of LWE is thought to be increased friction between the lid wiper and ocular or anterior contact lens surface due to inadequate lubrication, which could be caused by dry eye and may be exacerbated by factors such as abnormal blinking patterns, poor contact lens surface lubricity and adverse environmental influences. Recent evidence suggests that LWE is associated with sub-clinical inflammation. LWE has the potential to provide the missing mechanistic link between clinical observation and symptoms associated with dry eye and contact lens wear. Clinical and fundamental research into LWE is still in its infancy and in many instances equivocal; however, it is an idea that provides a potentially important new avenue for further investigation of anterior eye discomfort associated with ocular dryness and contact lens wear.