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Peer-reviewed articles

2020

Jones,L., Walsh,K., Willcox,M., Morgan,P., Nichols,J. The COVID-19 pandemic: Important considerations for contact lens practitioners Cont Lens Anterior Eye 2020;43196-203 [ Show Abstract ]

A novel coronavirus (CoV), the Severe Acute Respiratory Syndrome Coronavirus - 2 (SARS-CoV-2), results in the coronavirus disease 2019 (COVID-19). As information concerning the COVID-19 disease continues to evolve, patients look to their eye care practitioners for accurate eye health guidance. There is currently no evidence to suggest an increased risk of contracting COVID-19 through contact lens (CL) wear compared to spectacle lens wear and no scientific evidence that wearing standard prescription spectacles provides protection against COVID-19 or other viral transmissions.

During the pandemic there will potentially be significant changes in access to local eyecare. Thus, it is imperative CL wearers are reminded of the steps they should follow to minimise their risk of complications, to reduce their need to leave isolation and seek care. Management of adverse events should be retained within optometric systems if possible, to minimise the impact on the wider healthcare service, which will be stretched. Optimal CL care behaviours should be the same as those under normal circumstances, which include appropriate hand washing (thoroughly with soap and water) and drying (with paper towels) before both CL application and removal. Daily CL cleaning and correct case care for reusable CL should be followed according to appropriate guidelines, and CL exposure to water must be avoided. Where the availability of local clinical care is restricted, practitioners could consider advising patients to reduce or eliminate sleeping in their CL (where patients have the appropriate knowledge about correct daily care and access to suitable lens-care products) or consider the option of moving patients to daily disposable lenses (where patients have appropriate lens supplies available). Patients should also avoid touching their face, including their eyes, nose and mouth, with unwashed hands and avoid CL wear altogether if unwell (particularly with any cold or flu-like symptoms).

Willcox,M. D. P., Walsh,K. Nichols,J. J., Morgan,P. B., Jones,L. W. The ocular surface, coronaviruses and COVID‐19 Clinical and Experimental Optometry 2020;103(4):418-424 [ Show Abstract ]

The ocular surface has been suggested as a site of infection with Coronavirus‐2 (SARS‐CoV‐2) responsible for the coronavirus disease‐19 (COVID‐19). This review examines the evidence for this hypothesis, and its implications for clinical practice. Severe Acute Respiratory Syndrome Coronavirus‐2 (SARS‐CoV‐2), responsible for the COVID‐19 pandemic, is transmitted by person‐to‐person contact, via airborne droplets, or through contact with contaminated surfaces. SARS‐CoV‐2 binds to angiotensin converting enzyme‐2 (ACE2) to facilitate infection in humans. This review sets out to evaluate evidence for the ocular surface as a route of infection. A literature search in this area was conducted on 15 April 2020 using the Scopus database. In total, 287 results were returned and reviewed. There is preliminary evidence for ACE2 expression on corneal and conjunctival cells, but most of the other receptors to which coronaviruses bind appear to be found under epithelia of the ocular surface. Evidence from animal studies is limited, with a single study suggesting viral particles on the eye can travel to the lung, resulting in very mild infection. Coronavirus infection is rarely associated with conjunctivitis, with occasional cases reported in patients with confirmed COVID‐19, along with isolated cases of conjunctivitis as a presenting sign. Coronaviruses have been rarely isolated from tears or conjunctival swabs. The evidence suggests coronaviruses are unlikely to bind to ocular surface cells to initiate infection. Additionally, hypotheses that the virus could travel from the nasopharynx or through the conjunctival capillaries to the ocular surface during infection are probably incorrect. Conjunctivitis and isolation of the virus from the ocular surface occur only rarely, and overwhelmingly in patients with confirmed COVID‐19. Necessary precautions to prevent person‐to‐person transmission should be employed in clinical practice throughout the pandemic, and patients should be reminded to maintain good hygiene practices.

2019

Walsh,K., Jones,L. The use of preservatives in dry eye drops Clinical Ophthalmology 2019;13:1409-1425 [ Show Abstract ]

Topical ocular preparations are widely recommended by health care professionals, or chosen by patients, to help manage dry eye disease (DED). The chronic and progressive nature of DED may result in the administration of topical products several times a day, over a period of many years. Given DED is a condition that by definition affects the ocular surface, it is important to understand how the repeated use of eye drops may impact the ocular surface, influence clinical signs, affect symptoms, and impact the overall disease process of dry eye. The component in topical preparations with the greatest potential to adversely affect the ocular surface is the preservative. This paper reviews the literature in relation to the use of preservatives in formulations for dry eye. The ocular effects of benzalkonium chloride (BAK) are summarised and compared to the performance of alternative preservatives and preservative-free formulations. Use of preserved and preservative-free drops in relation to the management of varying stages of DED is discussed.

2018

Luensmann,D., Schaeffer,J. L., Rumney,N. J., Stanberry,A., Walsh,K., Jones,L. Spectacle prescriptions review to determine prevalence of ametropia and coverage of frequent replacement soft toric contact lenses Contact Lens and Anterior Eye 2018;41(5):412-420 [ Show Abstract ]

Purpose: To determine the prevalence of ametropia and astigmatism in a clinic population and to estimate the coverage of frequent replacement soft toric lenses. Methods: A review of patient files was conducted at three clinical sites. Prescription data collected between January 2014 and March 2017 in a patient cohort 14 to 70 years of age inclusive were analyzed to determine prevalence of ametropia and astigmatism. The percent coverage of frequent replacement soft toric contact lenses has further been estimated using different ranges for sphere, cylinder and axis availability. Results: In total 101,973 patients were included in the analysis of which 69.5% were considered myopic, 26.9% hyperopic and 3.5% emmetropic as determined by the eye with the larger absolute value of the spherical equivalent refraction. Astigmatism in at least one eye was found in 87.2% of the population, with 37.0% of the patients exhibiting astigmatism of at least −1.00DC in at least one eye. With-the-rule astigmatism was most prevalent in the 14 to 20 year-olds (53.0%), while against-the-rule astigmatism was most prevalent in the 41 to 70 year-olds (50.7%). For astigmatic eyes with a cylinder of at least −0.75DC (n = 83,540; 41% of all eyes), the coverage with toric soft lenses varied greatly depending on parameter availability and ranged between 30.7% (sphere: Plano to −3.00D, cylinder: up to −1.75DC, axes: 90 ± 10° and 180 ± 10°) and 96.4% (sphere: + 6.00D to −10.00D, cylinders: up to −2.75DC, 18 axes). Conclusion: Currently available frequent replacement soft toric contact lenses provide coverage for up to 96.4% of potential patients.

Scientific Presentations

2019

Tichenor A, Cofield S, Gann D, Elder M, Ng A, Walsh K, Jones L, Nichols J. Frequency of contact lens complications between contact lens wearers using multipurpose solutions versus hydrogen peroxide in the United States and Canada American Academy of Optometry, Orlando, 2019 [ Show Abstract ]

Purpose: To retrospectively compare frequency and likelihood of contact lens complications in long-term soft contact lens (CL) users of hydrogen peroxide (PXD) and multipurpose solutions (MPS).

Methods: This was a multicenter, retrospective chart review study of soft CL patient records. The study was conducted at two academic clinic sites, the University of Alabama at Birmingham School of Optometry and CORE, School of Optometry & Vision Science, University of Waterloo, and across five private practice clinical sites (three in the US and two in Canada). Records of established, adult soft CL wearers were reviewed from the three most recent full examination visits. Patients must have used the same CL solution technology (either MPS or PXD) documented at the first and last visit for at least three years. Data collected included demographics, CL solution, and any complications for either eye. Univariate analyses were conducted using Chi-Square or Fisher’s Exact test for categorical measures, as applicable. Covariate adjusted logistic regression models were used for categorical outcomes using Likelihood Ratio Chi-Square Test.

Results: In total, there were 1137 subjects included across the seven clinical locations, with 670 (59%) MPS users and 467 (41%) PXD users. The MPS users were 57% female with a mean (±SD) age of 42.9 (±14.7) years. The PXD users were 43% female with a mean age of 43.2
(±14.2) years. At the academic clinic sites, 428 records (38%) were reviewed of which 244 (57%) were MPS users. At the private practice sites, 709 records (62%) were reviewed and 426 (60%) were MPS users. Of all subjects, 706 (62%) experienced at least one complication over three visits; 409 were MPS users and 297 were PXD users. The most common complication was papillae (n=311, 27%) followed by hyperemia (n=242, 21%) and discomfort (n=240, 21%).There was no difference in the proportion of subjects experiencing at least one complication over the three visits between MPS (61%) and PXD (64%) users (p=0.38). Nonetheless, MPS users were more likely to report discomfort at least one time over the three visits compared to PXD users (p=0.04). Infectious keratitis was experienced by 25 subjects (2%); 19 were MPS users and 9 were PXD users (p=0.60).

Conclusion: While no differences were found in the frequency of contact lens complications between MPS and PXD users, the ocular surface health benefits of PXD should be considered when determining the best lens care option for patients. In addition, MPS users were more likely to report low levels of discomfort at least once over the time period reviewed. Therefore, PXD may be a beneficial solution alternative in CL users who report discomfort.

2018

Nakhla N, Killeen RM, de Waal D, Haines L, Srinivasan S, Sivak A, Walsh K, Pantazi F. Enhancing Eye Care Through Interprofessional Collaboration – A joint pharmacist-optometrist initiative Lifelong Learning in Pharmacy conference. Brisbane, Australia, 2018

Nakhla N, Killeen RM, de Waal D, Haines L, Srinivasan S, Sivak A, Walsh K, Pantazi F. Enhancing Eye Care Through Interprofessional Collaboration – A joint pharmacist-optometrist initiative Association of Faculties of Pharmacy of Canada conference. Ottawa, ON, Canada, 2018

Sivak A, Srinivasan S, Walsh K, Haines L, MacIver S, Killeen R, Nakhla N, Jones L. Professional Collaboration for Patient-Centred Eye Care – A Continuing Education Program for Optometrists and Pharmacists American Academy of Optometry, San Antonio, USA, 2018 [ Show Abstract ][ PDF ]

SIGNIFICANCE: Collaboration between North American pharmacists and optometrists is inconsistent, despite overlapping goals and concerns relating to eye care.
PURPOSE: The Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science and School of Pharmacy at the University of Waterloo (UW) collaborated to address this gap in information sharing by developing a series of web-based multimedia continuing education modules directed at pharmacists, optometrists and optometric assistants. These modules were designed to highlight unique and overlapping spheres of knowledge in addition to providing guidance with respect to developing a plan for interprofessional collaboration.
METHODS: Content was developed through interprofessional discussion and by consulting emerging research, evidence-based guidelines and needs assessments, and was informed by the Canadian Interprofessional Health Collaborative competency framework. The UW Centre for Extended Learning provided guidance with respect to instructional design and usability. Content was reviewed by community-based optometrists and pharmacists as well as external content matter experts representing both professions. The modules were reviewed and accredited by the Council on Optometric Practitioner Education (COPE) and the Canadian Council on Continuing Education in Pharmacy (CCCEP).
RESULTS: The completed program includes four hours of content comprising four modules: (1) an overview of interprofessional collaboration, (2) contact lens care systems, (3) management of dry eye disease, and (4) contact lens red eye. Each module includes profession-specific perspectives, guidelines related to ocular needs and treatment options, and profession-specific roles in addressing patient needs. Modules also outline topic-specific opportunities for communication, collaboration and referral.
CONCLUSIONS: Opportunities for collaboration between optometrists and pharmacists are rich but largely unexplored within the confines of profession-specific “tunnel vision.” These CE modules aim to start a conversation about the ways in which optometrists and pharmacists can work together to enhance patient-focused care.

Continuing Education Presentations

2020

Jones L, Walsh K, Willcox M, Morgan P, Nichols J. Key considerations for contact lens practitioners during the coronavirus pandemic. Optician 2020;April, 19-25: [ Show Abstract ][ PDF ]

A novel coronavirus (CoV), the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), results in the coronavirus disease 2019 (COVID-19). The World Health Organisation (WHO) declared the rapid spread of cases of COVID-19 a pandemic on March 11, 2020. The global response to COVID-19 has resulted in substantial changes to business and social practices around the world. With concerns existing around the pandemic, many reports relating to how best limit the chance of infection have been shared via various news outlets and on social media, with significant amounts of misinformation and speculation being reported. Among these, recent rumours have circulated stating that contact lens wear is unsafe, that wearers of contact lenses are more at risk of developing COVID-19, that certain contact lens materials are ‘riskier’ than others and that contact lens wearers should immediately revert to spectacle wear to protect themselves. How true are these statements, and are they supported by evidence? Importantly, are contact lens wearers increasing their risk of contracting COVID-19 by wearing contact lenses? Furthermore, what are the ramifications of a potential reduction in the availability of local ophthalmic care for contact lens wearers during this pandemic?

Jones L, Walsh K, Willcox M, Morgan P, Nichols J. Key considerations for contact lens practitioners during the coronavirus pandemic. Contact Lens Spectrum 2020;June, 19-26: [ Show Abstract ][ PDF ]

A novel coronavirus (CoV), the Severe Acute Respiratory Syndrome Coronavirus-2 (SARSCoV-2), results in the coronavirus disease 2019 (COVID-19). The World Health Organization (WHO) declared the rapid spread of cases of COVID-19 a pandemic on March 11, 2020.
The global response to COVID-19 has resulted in substantial changes to business and social practices around the world. With concerns existing around the pandemic, many reports relating to how to best limit the chance of infection have been shared via various news outlets and on social media, with significant amounts of misinformation and speculation being reported. Among these, recent rumors have circulated stating that contact lens wear is unsafe, that wearers of contact lenses are more at risk of developing COVID-19, that certain contact lens materials are more “risky” compared with others, and that contact lens wearers should immediately revert to spectacle wear to protect themselves. How true are these statements, and are they supported by evidence? Importantly, are contact lens wearers increasing their risk of contracting COVID-19 by wearing contact lenses? Furthermore, what are the ramifications of a potential reduction in the availability of local ophthalmic care for contact lens wearers during this pandemic?

Jones L, Walsh K, Wolffsohn J. Contemporary dry eye disease practice Global Specialty Lens Symposium, Las Vegas, USA, 2020

Jones,L., Walsh,K.. COVID-19 and contact lenses - Practice re-entry considerations Optician 2020;August22-28 [ Show Abstract ]

A return to contact lens practice after the COVID-19 lock down requires an enhanced awareness of the risks and possibilities of contamination in the practice, and how to manage these. Patients can be triaged via a survey and telehealth before the appointment, and then precautions taken to assure distancing and protection as far as possible during their time in the practice. Staff need to be trained in new procedures and protected from exposure via screens and masks. Regular, rigorous cleaning of surfaces and equipment needs to be carried out between appointments and re-useable diagnostic lenses will need to be disinfected according to rigorous guidelines. However, with adequate guidance and care, contact lens wear continues to be a good option for patients.

Walsh K. Lids and Dry Eye Interactive Webinar. April 8th, 2020

Walsh K. Lids and Dry Eye Interactive Webinar. April 14th, 2020

Walsh K, Jones L. Dry eye and contacts: Harmony or havoc? Global Specialty Lens Symposium, Las Vegas, USA, 2020

2019

Jones L, Walsh K. Sensitive to silicone? Understanding and managing the patient who presents with an adverse reaction to their silicone hydrogel contact lenses Global Specialty Lens Symposium, Las Vegas, Nevada, 2019

Jones L, Walsh K. TFOS DEWS II report: Applying the clinical recommendations through case-based learning Alcon CE meeting, Edmonton, Canada, 2019

Jones L, Walsh K, Ng A, Ngo W. TFOS DEWS II report: Applying the clinical recommendations through case-based learning Alcon CE meeting, Cambridge, Canada, 2019

Walsh K, Jones L. Does research guide contact lens clinical practice? Assotticca Conference, Rome, Italy, 2019

Walsh K, Jones L. Developing an enhanced contact lens clinical routine Assotticca Conference, Rome, Italy, 2019

2018

Jones L, Walsh K. Silicone hydrogel daily disposables Philadelphia, 2018

Jones L, Walsh K. Silicone hydrogel daily disposables Budapest, 2018

Jones L, Walsh K. 1 day silicone hydrogels: the best of both worlds? CooperVision Symposium, Budapest, Hungary, 2018

Jones L, Woods J, Walsh K. Contact lens selection on trial Part 1: neophytes NCC, Veldhoven, Netherlands, 2018

Jones L, Woods J, Walsh K. Contact lens selection on trial Part 2: existing wearers NCC, Veldhoven, Netherlands, 2018

Walsh K, Jones L, Luensmann D, Woods J. Rapid Fire: Celebrating 20 Years of Silicone Hydrogels: The Past, Present and Future American Academy of Optometry, San Antonio, USA, 2018 [ Show Abstract ]

Using the analogy of a child growing up, four presenters cover the twenty-year timeline of silicone hydrogels (SiHys). How does the historical performance of this material inform both currently available lenses and future applications? Each part of the talk covers a specific period in the timeline since 1998: from infancy, through to elementary and high school years, balancing properties for comfortable daily wear and gaining increased understanding of interactions with the ocular surface and tear film. At age 20, SiHys have yet to graduate from college, leaving the last talk to share what the future may hold.

Professional Publications

2020

Fadel D, Walsh K.. COVID-19, quando l'uso delle lenti è sicurio B2Eyes 2020;March. [ Show Abstract ]

Recentemente alcuni articoli di giornali sul possibile contagio da coronavirus tramite lenti a contatto e alcune organizzazioni sanitarie che consigliano il passaggio in questa fase agli occhiali anziché l’uso delle lenti a contatto sollevano facilmente la preoccupazione che l'utilizzo delle lac potrebbe non essere sicuro durante la pandemia da Covid-19. Questa inondazione di informazioni fuorvianti ha portato ricercatori di spicco nel panorama internazionale, da Canada, Regno Unito e Stati Uniti, a rispondere. Lyndon Jones, direttore del Center for Ocular Research & Education (CORE) presso l'Università di Waterloo (Canada), Philip Morgan, direttore di Eurolens Research presso l'Università di Manchester (Regno Unito), e Jason Nichols, vicepresidente associato di ricerca e docente all'Università dell'Alabama presso la Birmingham School of Optometry (Stati Uniti) e direttore editoriale di Contact Lens Spectrum, hanno fornito le seguenti informazioni sulla sicurezza dell'uso delle lenti a contatto.

Walsh K. Artificial tears: preserved or non-preserved, that is the question New Zealand Optics 2020;September, : 26-27

Walsh K, Jones L, Kojima R. Working smart: How to streamline your dry eye practice with new technology 2020

2019

Jones L., Woods J., Walsh K., Luensmann D. Happy 20th, silicone hydrogels! Review of Cornea and Contact Lenses 2019, Jan/Feb: 12-13

Walsh K. Summary: Defining and Classifying Myopia: A Proposed Set of Standards for Clinical and Epidemiological Studies ContactLensUpdate.com 2019

Walsh K. Clinical pearls from GSLS New Zealand Optics 2019, March: 16-19

Walsh K, Dantam J, Luensmann D. Contact Lens Wear and Its Disruption of the Tear Film Review of Cornea & Contact Lens 2019;May/June: 38-42.

Walsh K, Jones L, Woods J, Moody K. Evidence-based contact lens recommendation Contact Lens Spectrum 2019, Nov: 21-26

Walsh K, Lenz Y, Behrens R. Get the support you need: Freely available information can complement basic contact lens practice Contact Lens Spectrum 2019;34, 9: 32-37

Walsh K., Jones L. Aligning clinical practice with professional beliefs Optometry Today 2019, Dec: 71-75

2018

Jones L, Walsh K. The evolution of silicone hydrogel daily disposables Optician 2018, 4 May: 25-32

Walsh K. Myth 3: It is not worth correcting low astigmats with toric contact lenses ContactLensUpdate.com 2018

Walsh K. Myth or reality? ContactLensUpdate.com 2018

Walsh K, Srinivasan S, Jones L. Lid margin health: the forgotten part of contact lens discomfort? Optician 2018, 7 September: 28-32

2017

Walsh K. Three days of the latest in education, innovation and best practice Optik 2017

Walsh K. Building a bigger basket with your contact lens wearers Optik 2017

Walsh K. The astigmat in contact lenses: their experience and your opportunity Optik 2017

Walsh K. Material protection: UV and contacts Optik 2017

Walsh K. Hurry up and fit them while they’re young Optik 2017

Walsh K. A glimpse of a future contact lens practice Optik 2017

Walsh K. Pupil diameter, working distance and illumination during habitual tasks. Implications for simultaneous vision contact lenses for presbyopia - An article review ContactLensUpdate.com 2017

Walsh K. Summary: Definition and classification report ContactLensUpdate.com 2017

2016

Walsh K. Contact lens aftercare: an opportunity to deliver great customer experience Optik 2016

Walsh K. Not all contact lens deposits are bad Optik 2016