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Peer-reviewed articles

2018

Delaveris,A., Stahl,U., Madigan,M., Jalbert,I. Comparative performance of lissamine green stains Contact Lens and Anterior Eye 2018;41(1):23-27 [ Show Abstract ]

Purpose To investigate the performance of lissamine green strips from different manufacturers. Additionally, the repeatability, need for sequential dye instillation and impact of repeated lid evertion on lid wiper staining were assessed. Methods Study 1 was a prospective, randomised cross-over study where controlled volumes of lissamine green solution prepared from strips (Biotech, Lissaver, GreenGlo, OPGreen) were instilled (right eye: single; left eye: double instillation) on five different days, with OPGreen being tested twice. Lids were everted and digital photographs taken, which were later assessed by a masked observer. Study 2 was an investigator-masked, randomised, controlled study testing the impact of single versus repeated lid evertion. Lid wiper staining was graded (0 to 3 in 0.5 steps). Results Lid wiper staining differed significantly between lissamine green solutions, with GreenGlo showing the highest amount of staining, and Lissaver the least (all p > 0.009). There were no differences in lid wiper staining over two days, using the OPGreen solution (all p > 0.05). The number of drops instilled (single versus double) did not significantly affect lid wiper staining (all p > 0.05). Repeated lid evertion increased lid wiper staining (p = 0.007 when combined with double drop instillation). Light absorbance patterns and measured concentrations aligned with clinical findings. Conclusion There were significant differences in performance between lissamine green solutions. Lid wiper staining was impacted by repeated lid evertion but sequential instillation and use of the Korb grading scale provided little advantage over simpler methods Clinicians must consider this when investigating lid wipers, especially when interpreting a negative finding. © 2017 British Contact Lens Association

Stahl,U., Jalbert,I. Exploring the links between contact lens comfort, osmolarity and lid wiper staining Contact Lens and Anterior Eye 2018;41(1):110-116 [ Show Abstract ]

Purpose Contact lens discomfort remains poorly understood, not least due to lack of associations between clinical signs and symptoms. This study aimed to explore the relationships between osmolarity, comfort and lid wiper epitheliopathy in contact lens wear. Methods Twenty subjects participated in a randomized, cross-over study where comfilcon A and lotrafilcon A lenses were each worn for 10 days separated by a 7 days washout period. Tear and contact lens osmolarity, ocular symptoms including comfort, tear stability and production, and lid wiper epitheliopathy were measured. Results Comfort and tear stability decreased and upper lid wiper staining and foreign body sensation increased with lens wear. These were not affected by lens type. A reduction in tear production was seen after 10 days of comfilcon A lens wear. High proportions of lid wiper epitheliopathy were observed at the upper (range 65%–85%) and lower (range 90%–100%) lid margins. Tear and contact lens osmolarity were unaffected by lens wear or type. Contact lens osmolarity was associated with comfort (r = 0.45, p = 0.009). Tear osmolarity moderately correlated with tear stability (r = -0.53, p = 0.014) and tear production (r = -0.44, p = 0.012) but not with lid wiper staining. Conclusions A relationship between comfort and contact lens osmolarity and between tear osmolarity and tear stability and production were found, however, this study was unable to demonstrate an association between comfort and tear osmolarity or lid wiper epitheliopathy. Further studies using contact lenses with a wider range of comfort responses are warranted to investigate these associations further. © 2017 British Contact Lens Association

2017

Willcox,M. D. P., Argüeso,P., Georgiev,G. A., Holopainen,J. M., Laurie,G. W., Millar,T. J., Papas,E. B., Rolland,J. P., Schmidt,T. A., Stahl,U., Suarez,T., Subbaraman,L. N., Uçakhan,O. Ö., Jones,L. TFOS DEWS II Tear Film Report Ocular Surface 2017;15(3):366-403 [ Show Abstract ]

The members of the Tear Film Subcommittee reviewed the role of the tear film in dry eye disease (DED). The Subcommittee reviewed biophysical and biochemical aspects of tears and how these change in DED. Clinically, DED is characterized by loss of tear volume, more rapid breakup of the tear film and increased evaporation of tears from the ocular surface. The tear film is composed of many substances including lipids, proteins, mucins and electrolytes. All of these contribute to the integrity of the tear film but exactly how they interact is still an area of active research. Tear film osmolarity increases in DED. Changes to other components such as proteins and mucins can be used as biomarkers for DED. The Subcommittee recommended areas for future research to advance our understanding of the tear film and how this changes with DED. The final report was written after review by all Subcommittee members and the entire TFOS DEWS II membership.

2016

Stahl,U., Keir,N. J., Landers,A., Jones,L. W. Effect of short recovery periods on ocular comfort during daily lens wear Optometry and Vision Science 2016;93(8):861-871 [ Show Abstract ]

Purpose. To assess the impact of lens-free intervals of varying lengths on end-of-day comfort with soft contact lenses. Methods. Twenty-five symptomatic lens wearers participated in this randomized, cross-over study involving nine individual 12-hour days: one spectacle (no lens) and eight lens wear days. On each lens wear day, lenses were worn bilaterally in 2-hour intervals, separated by lens-free (recovery) periods of 0, 30, 60, or 80 minutes (repeated throughout the day). For each 2-hour lens wear interval, new lenses were worn. Ocular comfort was rated on a 0 to 100 visual analogue scale (0 = extremely uncomfortable); tear film and ocular parameters were assessed at the beginning and end of each study day. This study involved two different types of silicone hydrogel lenses, and the order of lens type and length of recovery period was randomized. Participants were unaware of the true study purpose and that a new lens pair was used for each lens wear interval. Results. End-of-day comfort on lens wear days was significantly worse than on the spectacle day (p 0.05). Although lens wear affected noninvasive tear film break-up time and conjunctival staining, there were no effects of recovery period length on noninvasive tear film break-up time (p > 0.05), tear meniscus height (p > 0.05), corneal staining (p > 0.05), conjunctival staining (p > 0.05), bulbar conjunctival redness (p > 0.05), or limbal redness (p > 0.05). There was no consistent effect of recovery period length on lid margin staining. Conclusions. Lens-free recovery periods during a 12-hour lens wear day did not positively impact end-of-day comfort in this study. Cumulative lens wear times ranged from 8 to 12 hours, and the results suggest that once the length of lens wear exceeds the usual comfortable wear time, there is no benefit of short recovery periods. © Copyright 2016 American Academy of Optometry.

2015

Liu,S., Chang,C. N., Verma,M. S., Hileeto,D., Muntz,A., Stahl,U., Woods,J., Jones,L. W., Gu,F. X. Phenylboronic acid modified mucoadhesive nanoparticle drug carriers facilitate weekly treatment of experimentallyinduced dry eye syndrome Nano Research 2015;8(2):621-635

2013

Craig,J. P., Willcox,M. D. P., Argüeso,P., Maissa,C., Stahl,U., Tomlinson,A., Wang,J., Yokoi,N., Stapleton,F. The TFOS International Workshop on Contact Lens Discomfort: Report of the contact lens interactions with the tear film subcommittee Investigative Ophthalmology and Visual Science 2013;54(11):TFOS123-TFOS156

Scientific Presentations

2016

Stahl U, Keir N, Guthrie S, Jones L. Effect of monocular lens wear on ocular comfort TFOS conference, Montpelier, France, 2016

2014

Liu S, Chang C, Verma M, Hileeto D, Muntz A, Stahl U, Woods J, Jones L, Gu F. Phenylboronic acid modified mucoadhesive nanoparticles facilitate weekly treatment of dry eye syndrome Invest Ophthalmol Vis Sci 2014;55: E-abstract 2160

Schulze M, Subbaraman L, Babaei Omali N, Stahl U, Canavan K, Jones L. Is there a difference between clinical signs and symptoms in asymptomatic adapted contact lens and spectacle wearers? BCLA Clinical Conference and Exhibition, 2014 [ PDF ]

Stahl U, Luensmann D, Lemp J, Moezzi A, Schulze M, Varikooty, Dumbleton K, Jones L. Determination of higher order aberrations with two silicone hydrogel toric lenses Optom Vis Sci 2014;91: E-abstract 145188 [ PDF ]

Subbaraman L, Stahl U, Heynen M, Babaei Omali N, Canavan K, Jones L. Is there a difference in tear film and meibum composition in asymptomatic adapted contact lens and spectacle wearers? BCLA Clinical Conference and Exhibition, 2014 [ PDF ]

2013

Stahl U, Keir N, Varikooty J, Nandakumar K, Keech A, Landers A, Jones L. The effect of recovery periods on end of day comfort Invest Ophthalmol Vis Sci 2013;54: E-Abstract 5462

2009

Stahl U, Jones L, Willcox M, Stapleton F. Tear osmolality measurements - effect of instrumentation and of freezing Invest Ophthalmol Vis Sci 2009;50: E-abstract 2611

Continuing Education Presentations

2018

Stahl U. Highlights of TFOS DEWS II report and its clinical implications Novartis Symposium, Moncton, New Brunswick, 2018

Stahl U. Highlights of TFOS DEWS II report and its clinical implications Novartis Symposium, Halifax, Nova Scotia, 2018

Stahl U. Highlights of TFOS DEWS II report and its clinical implications Novartis Symposium, Cambridge, Ontario, 2018

Professional Publications

2017

Stahl U. Summary: Clinical trial design report ContactLensUpdate.com 2017

2014

Stahl U. Summary: Report of the Contact Lens Interactions with the Tear film Subcommittee ContactLensUpdate.com 2014

2012

Varikooty J, Stahl U. Visualization of limbal/conjunctival folliculitis associated with soft contact lens wear ContactLensUpdate.com 2012

Books

2019

Jones L, Stahl U, Guthrie S, Luensmann D, Yang M, Thom M. Contact Lens Compendium: Contact Lenses and Solutions Available in Canada. Vol 45 2019.

2018

Jones L, Sorbara L, Stahl U, Yang M, Thom M, Guthrie S. Contact Lens Compendium: Contact Lenses and Solutions Available in Canada. Vol 44 2018.

2017

Jones L, Sorbara L, Stahl U, Thom M, Guthrie S. Contact Lens Compendium: Contact Lenses and Solutions Available in Canada. Vol 43 2017.

2016

Jones L, Sorbara L, Stahl U, Thom M, Guthrie S. Contact Lens Compendium: Contact Lenses and Solutions Available in Canada. Vol 42 2016.

2015

Jones L, Sorbara L, Stahl U, Thom M, Guthrie S. Contact Lens Compendium: Contact Lenses and Solutions Available in Canada. Vol 41 2015.

2014

Jones L, Sorbara L, Stahl U, Thom M, Guthrie S. Contact Lens Compendium: Contact Lenses and Solutions Available in Canada. Vol 40 2014.

2013

Jones L, Sorbara L, Stahl U, Guthrie S, Menzies K, Rossy J, Thom M. Contact Lens Compendium: Contact Lenses and Solutions Available in Canada. Vol 39 2013.