Publications

Showing 25 results out of 25 in total.

Craig,J.P., Muntz,A., Wang,M.T.M., Luensmann,D., Tan,J., Travé-Huarte,S., Xue,A.L., Jones,L.W., Willcox,M.D.P., Wolffsohn,J.S. Developing evidence-based guidance for the treatment of dry eye disease with artificial tear supplements: A six-month multicentre, double-masked randomised controlled trial Ocular Surface 2021;2062-69 [ Show Abstract ]

Purpose
To assess the six-month therapeutic profiles of lipid and non-lipid-based artificial tear supplements in managing dry eye disease (DED).

Methods
Ninety-nine participants fulfilling the TFOS DEWS II diagnostic criteria for DED (64% females; mean ± SD age, 44 ± 16 years) were enrolled in a prospective, multicentre, double-masked, parallel group, randomised controlled trial. Participants instilled lipid-based nanoemulsion drops or non-lipid-based aqueous drops for six months, at least four times daily. Symptomology, tear film and ocular surface characteristics were assessed at Days 0, 30, 60, 90, 120, 150 and 180.

Results
Sustained reductions in OSDI, DEQ-5, and SANDE symptom scores from baseline were observed from Day 30 onwards in both groups (all p < 0.05) and decreased superior lid wiper epitheliopathy grades from Day 60 onwards (all p ≤ 0.01). Improvements in non-invasive tear film breakup time, and sodium fluorescein and lissamine green staining scores followed from Day 120 onwards in both groups (all p < 0.05). Tear lipid layer grades increased from Day 90 onwards only with the lipid-based drops, and with significantly greater improvement in those with suboptimal lipid layer thickness at baseline (grade ≤3; p = 0.02). By Day 180, 19% of participants no longer fulfilled the diagnostic criteria for DED.

Conclusions
Over a six-month treatment period, improvements in dry eye symptomology preceded tear film and ocular surface changes with regular use of both lipid and non-lipid-based artificial tear supplements. Both formulations addressed most mild-to-moderate forms of aqueous deficient and evaporative DED, while evaporative cases benefitted preferentially from lipid-based supplementation. This represents a first step towards mapping DED therapeutic strategies according to disease subtype and severity.

Efron,N., Morgan,P. B., Jones,L. W., Morgan,G. A., Nichols,J. A Global optometrist top 200 research ranking Clinical and Experimental Optometry 2021;Online ahead of print [ Show Abstract ]

Clinical relevance: Clinical optometric practice is underpinned by a rigorous research base, the
primary evidence for which is publications in refereed scientific journals. Leading optometrists who
publish this work should be identified and celebrated.
Background: This work aims to derive publication metrics of the leading optometric researchers
worldwide.
Methods: An extensive global search was conducted to discover leading optometric researchers; 480
names were identified. A custom-designed bibliographic search tool was developed to interrogate
the Scopus database (Elsevier) and extract publication metrics using the unique Scopus Author
Identifier number for each optometrist. On 13 January 2021, the full list was reduced to 200
optometrists (the ‘Top 200’) ranked by h-index – the ‘Global Optometrist Top 200 Research
Ranking’. The output from the custom tool automatically updates every 24 hours and is available at
www.optomrankings.com.
Results: The Top 200 have h-indices ranging from 20 to 67 and have published between 28 and 440
papers. Sixty one (30.5%) are women. Konrad Pesudovs has the highest h-index (67) and citations
(51,193). The most prolific author is Robert Hess (442 papers). David Piñero is publishing at the
fastest rate (17.6 papers per year). The Top 200 work in 13 nations, of whom 172 (86.0%) work in
four nations: USA – 76 (38.0%), Australia – 43 (21.5%), UK – 41 (20.5%) and Canada – 16 (8.0%). Of
the 72 institutions represented, the University of California, Berkeley, USA is home to the most Top
200 optometrists (17) and has the highest combined h-index of Top 200 optometrists (132).
Conclusions: The optometric profession is supported by a robust research base, prosecuted by
a large international cohort of optometric researchers who publish extensively on a broad range of
ophthalmic issues and whose work is highly cited. The 200 most impactful optometrists in the world
are identified

Efron,N., Morgan,P. B., Jones,L. W., Nichols,J. A 21st century citation analysis of the field of contact lenses Clinical and Experimental Optometry 2021;Online ahead of print [ Show Abstract ]

Clinical relevance: The scientific foundations for clinical contact lens practice are rooted in the ophthalmic literature. This analysis of contact lens papers celebrates contemporary research achievements in the contact lens field.

Background: This work aims to assemble contact lens-related publication metrics so as to identify the most impactful papers published so far this century, as well the top countries, authors, institutions and journals.

Methods: A search was undertaken of the titles of papers on the Scopus database to identify contact lens-related articles published this century. The ten most highly cited papers were determined from the total list of 4,164 papers found. Rank-order lists by count were assembled for the ‘top 25ʹ in each of four categories: authors, institutions, countries and journals. A 20-year subject-specific contact lens h-index (hCL-20-index) was derived for each author, institution, country and journal to serve as a measure of impact in the field. The top 10 constituents (of the top 25) of each category were ranked by hCL-20-index and tabulated for consideration.

Results: The most highly cited paper this century is entitled ‘Soft contact lens polymers: An evolution’, by Nicholson and Vogt. Lyndon Jones is the most impactful author, with a hCL-20-index of 32. The University of New South Wales (Australia) produces the most impactful contact lens-related papers, and the United States is the most highly-ranked country. Optometry and Vision Science is the most impactful journal in the contact lens field.

Conclusions: Contact lens materials and lens-associated keratitis are topics of high interest in the contemporary contact lens literature, with an emerging interest in orthokeratology for myopia control and glucose monitoring. Impactful 21st century authors, institutions, countries and journals are identified. Optometry is revealed as the leading profession in relation to the publication of impactful contact lens-related papers.

Efron,N., Morgan,P. B., Jones,L. W., Nichols,J. A Bibliometric analysis of the refractive error field Clinical and Experimental Optometry 2021;Online ahead of print [ Show Abstract ]

Research into the epidemiology, aetiology, and optics of ametropia is a fundamental cornerstone of the correction and management of refractive errors by eye care practitioners. At present, much of this work is driven by the clinical concern that myopia is a common cause of vision loss, with uncorrected myopia the leading cause of vision impairment globally. Holden et al. predict that by 2050, about 50% of the population of the world will be myopic.
The aetiology of myopia continues to be hotly debated, centring around the relative impact of nature (genetics) versus nurture (environment). Research aimed at optimising optical (spectacles and contact lenses) and surgical (laser refractive techniques) modes of correcting refractive error continues unabated, and novel approaches for arresting the progression of myopia, using ophthalmic lenses, contact lenses (including orthokeratology), pharmacological approaches, or lifestyle modification, are also under active investigation. As is the case in all fields of investigation, the foundation of these various lines of refractive error research is rooted in the ophthalmic literature. Modern bibliographic search tools enable targeted interrogation of this vast literature to facilitate identification of the research foundations that underpin our understanding of refractive error. This Viewpoint uses
these bibliographic search tools and employs a subjectspecific measure of impact to identify key papers, authors, institutions, countries, and journals in the field of refractive error research.

Jones L. Material and solution impacts on contact lens discomfort and dropout OVN (Netherlands Association of Optometrists) webinar, March 15, 2021

Jones L. Dry eye & contact lenses: COVID-19 did not help! Online Optom Learning Series, Webinar (India), March 6, 2021

Jones L. Contact lens comfort: Materials and methodologies to reduce drop outs Optician Contact Lens Week webinar, February 10, 2021

Jones L, Stahl U, Guthrie S, Yang M, Moezzi A, Thom M. Contact Lens Compendium: Contact Lenses & Solutions Available in America. Vol 2 2021.

Jones L, Stahl U, Guthrie S, Yang M, Moezzi A, Thom M. Contact Lens Compendium: Contact Lenses and Solutions Available in Canada. Vol 47 2021.

Morgan P, Woods CA, Tranoudis IG, Efron N, Jones L, Grupcheva CN, Jones D, Beeler-Kaupke M, Qi P, Tan KO, Rodriguez Cely LM, Belova S, Ravn O, Santodomingo-Rubido J, Bloise L, Plakitsi A, Végh M, Erdinest N, Montani G, Itoi M, Bendoriene RL, Mulder J, van der Worp E, Ystenaes AE, Romualdez-Oo J, Abesamis-Dichoso C, Gonzalez-Meijome JM, Belousov V, Johansson O, Hsiao J, Nicholes JJ.. International contact lens prescribing in 2020 Contact Lens Spectrum 2021;36, January: [ Show Abstract ]

This article is our 20th consecutive annual report of international contact lens prescribing for Contact Lens Spectrum. The premise of the work is simple. As an alternative to asking a cross section of contact lens wearers about the lenses that they use and the basis on which the lenses are worn, we move upstream in the process and directly survey those who are fitting contact lenses in numerous markets around the world. This presents a more “leading edge” indicator of contact lens fitting habits; the lenses fitted today are those sold tomorrow. The aim here is to provide summary information for colleagues in clinical practice, industry, and academia about contact lens prescribing behaviors to inform their patient management, research and development, and educational curricula, respectively.

Ng AY, Yang M. Why you shouldn’t neglect eye care during the pandemic The Conversation 2021;March 7 [ Show Abstract ]

Since COVID-19 emerged, access to eye care has continued to change. Lockdowns and concerns about virus exposure have caused people of all ages to cancel and delay routine appointments, raising red flags among eye-care professionals. As the pandemic continues into its second year, can ocular health be neglected any longer?

Our team of optometrists and clinical scientists at the Centre for Ocular Research & Education (CORE) hear the confusion and concerns about people’s eyes during COVID-19. Addressing the most common questions — many of which we keep up to date at COVIDeyefacts.org — can help you and your family maintain the best vision while staying safe.

Nichols,J. J., Morgan,P. M., Jones,L. W., Efron,N 21st century bibliometric analysis of the field of dry eye disease Clinical and Experimental Optometry 2021;Online ahead of print [ Show Abstract ]

In 2012, the lead author of this paper (JJN) conducted a citation analysis of dry eye research to identify the leading papers, authors, institutions, countries and journals in the field. That analysis was essentially an historical overview of publications on this topic extending back over the past century. Because a strong and growing foundation of scientific literature is a fundamental component of evidenced-based clinical care of patients, the current work was conducted to update the research community on trends in the 21st century dry eye literature, and to compare this new literature with the prior analysis in the context of events or trends in the dry eye field.

Omali,N. B., Subbaraman,L. N., Heynen,M., Lada,M., Canavan,K., Fadli,Z., Ngo,W., Jones,L. Lipid deposition on contact lenses in symptomatic and asymptomatic contact lens wearers Cont Lens Anterior Eye 2021;44(1):56-61 [ Show Abstract ]

Purpose
Lipid deposition on contact lenses (CL) has traditionally been believed to reduce comfort during CL wear. The purpose of this study was to quantify lipid deposition on CL in a group of symptomatic and asymptomatic adapted CL wearers.

Methods
This was a single-masked, randomized clinical trial. Only confirmed symptomatic (comfortable lens wear time (CWT) < 8 h and a noticeable reduction in comfort over the course of the day) and asymptomatic (CWT > 10 h and minimal reduction in comfort over the course of the day) participants were recruited to participate in the study. Participants wore senofilcon A lenses in combination with a polyquaternium-based care solution (OPTI-FREE Replenish). Worn CL samples were collected on Day 14. Deposited lipid amounts from the lenses (including cholesteryl ester, cholesterol and triolein) were quantified using a liquid chromatography-mass spectrometry technique.

Results
Lipid deposition was significantly higher in CL extracts of asymptomatic wearers compared to the symptomatic wearers for all lipid types quantified, including cholesteryl ester (2.1 ± 0.6 vs 1.6 ± 0.5 log μg/lens), cholesterol (1.5 ± 0.3 vs 1.1 ± 0.3 log μg/lens) and triolein (0.3 ± 0.2 vs 0.1 ± 0.1 log μg/lens) (all p < 0.002). The amount of cholesteryl ester deposited was greatest (p = 0.0001), followed by cholesterol, then triolein, for both the asymptomatic and symptomatic groups (both p = 0.0001).

Conclusion
This study demonstrated that the asymptomatic group deposited a significantly greater amount of lipid on their CL. Although lipid levels measured are considered low to trigger any observable clinical deposition, they may influence other clinical outcomes, particularly comfort.

Patel K, Draper M, Bull Z, Walsh K. Contact lenses: So much more than simple correction of refractive error Optician 2021, February: 25-29

Patel K, Walsh K. Soft toric contact lenses: Aligning patient expectations and eye care professional attitudes Optician 2021, March: 32-36 [ Show Abstract ]

In this article Krupa Patel and Karen Walsh examine the expectations around soft toric lenses from both the practitioner and patient’s point of view. It serves as a timely review of current toric fitting practices and how they relate to the prevalence of astigmatism, highlighting a number of opportunities for enhancing patient satisfaction and increasing practice revenue (C77594, one distance learning CET point suitable for optometrists, contact lens opticians and dispensing opticians).
Some simple facts help set the scene for this global review. It has been established that modern soft toric contact lenses are as quick and simple to fit as spherical lenses, with good visual outcomes and rotational stability across many visual tasks. However, when 400 eye care professionals (ECPs) in the US were asked, only around half agreed soft torics are as easy to fit as the equivalent spherical lens (49%), and that they have excellent rotational recovery (55%). How does this disparity between reported product performance and practitioner attitude influence fitting practices? Ultimately, what is the impact on patients, and how close does current practice come to meeting their
expectations?

Phan,C. M., Qiao,H., Yee,A., Jones,L. Deposition of Fluorescently Tagged Lysozyme on Contact Lenses in a Physiological Blink Model Eye & Contact Lens 2021;47(2):127-133 [ Show Abstract ]

PURPOSE: To visualize the deposition of fluorescein isothiocyanate (FITC) lysozyme on daily disposable contact lenses (CLs) using a novel blink model.

METHODS: Three daily disposable conventional hydrogel CLs (etafilcon A, omafilcon A, and nelfilcon A) and three silicone hydrogel CLs (delefilcon A, senofilcon A, and somofilcon A) were evaluated in the study. The CLs were mounted onto a novel blink model and exposed to an artificial tear solution containing FITC lysozyme for 2 and 10 hr. The flow rate and blink speed were set to 1 μL/min and 6 blinks/min, respectively. After the incubation period, a 5-mm-diameter disc was punched out from the center of the lens and mounted on a microscope slide. The slides were imaged using the Zeiss 510 Meta confocal laser scanning microscope, which scanned the lens from the front to the back surface at 5-μm increments.

RESULTS: There was an increase in deposition of FITC lysozyme for all lens types with increasing incubation time (P<0.05), with the exception of somofilcon A, which did not show statistical significance between 2 and 10 hr (P>0.05). The conventional hydrogel CLs deposited higher amounts of FITC lysozyme than the silicone hydrogel CLs (P<0.001), with etafilcon A depositing the highest at all time points (P<0.05). Interestingly, at the 2-hr incubation time, most CLs showed a higher amount of deposition at the front surface than the back surface of the lens. In particular, etafilcon A showed preferred deposition at the front surface at all time points.

CONCLUSION: The results suggest that there is differential deposition at the front surface of the CL, which is exposed to the prelens tear film, compared with the back surface of the CL, which is exposed to the postlens tear film. Therefore, it may be beneficial to design CL materials with differing surface properties for the front and back surfaces of the CL to enhance interactions with the tear film and ocular surface.

Phan,C. M., Shukla,M., Walther,H. Heynen,M., Suh,D., Jones,L Development of an In Vitro Blink Model for Ophthalmic Drug Delivery Pharmaceutics 2021;13(3 (Special Issue Ocular Drug Delivery)): [ Show Abstract ]

Purpose: The purpose of this study was to develop an advanced in vitro blink model that
can be used to examine the release of a wide variety of components (for example, topical ophthalmic
drugs, comfort-inducing agents) from soft contact lenses. Methods: The model was designed using
computer-aided design software and printed using a stereolithography 3D printer. The eyelid and
eyeball were synthesized from polyvinyl alcohol and silicone material, respectively. Simulated
tear fluid was infused through tubing attached to the eyelid using a syringe pump. With each
blink cycle, the eyelid slides and flexes across the eyeball to create an artificial tear film layer. The
flow-through fluid was collected using a specialized trough. Two contact lenses, etafilcon A and
senofilcon A, were incubated in 2 mL of a water-soluble red dye for 24 h and then placed on the eye
model (n = 3). The release of the dye was measured over 24 h using a tear flow rate of 5 µL/min.
Results: Approximately 25% of the fluid that flowed over the eye model was lost due to evaporation,
nonspecific absorption, and residual dead volume. Senofilcon A absorbed more dye (47.6 ± 2.7 µL)
than etafilcon A (22.3 ± 2.0 µL). For etafilcon A, the release of the dye followed a burst-plateau
profile in the vial but was sustained in the eye model. For senofilcon A, the release of the dye was
sustained in both the vial and the eye model, though more dye was released in the vial (p < 0.05).
Overall, the release of the dye from the contact lenses was higher in the vial compared with the eye
model (p < 0.05). Conclusion: The blink model developed in this study could be used to measure
the release of topical ophthalmic drugs or comfort agents from contact lenses. Simulation of a blink
mechanism, an artificial tear film, and nonspecific absorption in an eye model may provide better
results than a simple, static vial incubation model.

Schulze,M., Ng,A. Y., Yang,M., Panjwani,F., Srinivasan,S., Jones,L., Senchyna,M. Bulbar redness and dry eye disease: comparison of a validated subjective grading scale and an objective automated method Optometry & Vision Science 2021;98(2):113-120 [ Show Abstract ]

SIGNIFICANCE
In this study, assessments of conjunctival redness were performed to evaluate whether patients with or without dry eye disease (DED) could be discriminated based on this measure. Our findings suggest that subjectively grading redness by quadrant, as opposed to automated en face measurements, may be more suitable for this purpose.

PURPOSE
This study aimed to quantify bulbar redness using the validated bulbar redness (VBR) grading scale and an automated objective method (Oculus Keratograph 5M; K5M) in participants with DED and non-DED controls.

METHODS
Participants with DED (Ocular Surface Disease Index score ≥20 and Oxford scale corneal staining ≥2) and controls (Ocular Surface Disease Index score ≤10 and corneal staining ≤1) attended two study visits. In part 1A of visit 1, baseline bulbar redness was graded with the VBR scale in each conjunctival quadrant of both eyes, followed by automated measurements of temporal and nasal redness with the K5M. This was immediately followed by part 1B, during which a topical vasoconstrictor was instilled into both eyes. Redness assessments were repeated 5 and 30 minutes after instillation with both instruments. Participants returned 14 days later for visit 2, where the same assessments as for visit 1A were repeated.

RESULTS
Seventy-four participants (50 DED and 24 controls) completed the study. There were statistically significant differences in redness between the DED and control groups when assessed with the VBR scale (14/16 comparisons; all, P < .05), whereas no significant differences in K5M-derived redness between the DED and non-DED groups were found at any location or time point. Both subjective and objective instruments detected statistically significant reductions in redness 5 and 30 minutes after instillation of the vasoconstrictor (all, P < .01).

CONCLUSIONS
Although both subjective and objective instruments were sensitive to detecting changes in redness induced by vasoconstriction, statistically significant differences in redness between DED and control groups were only found using the VBR scale.

Walsh K, Jones L. COVID-19: A year in review and the impact on CL practice Contact Lens Spectrum 2021;36, February: E1-E6 [ Show Abstract ]

For everyone involved in eye care, 2020 was going to be a special year. The numerous “20/20” puns and articles circulating in January were full of hope and future-gazing. No one could have predicted the direction that the year would take and its resulting impact on the world at large and, for this audience specifically, on the delivery of routine contact lens care. As the end of this unprecedented year has finally come to pass, it feels right to pause and reflect on the last 12 months, to examine the journey that the profession has taken, and to summarize the situation. This article reviews what the profession has learned and asks whether enough is known to successfully navigate the months and years ahead. With no small amount of irony and a large nod to those aforementioned puns, does being approximately one year into the pandemic result in having a useful amount of “20/20 hindsight”?

Walsh K, Jones L. Covid-19 and contact lenses: Keeping it simple in the ‘new normal’ Optician 2021, March: 25-30 [ Show Abstract ]

Karen Walsh and Professor Lyndon Jones examine how Covid-19 has affected routine contact lens practice and what that means for both eye care practitioners and their patients (C77595, one distance learning CET point suitable for optometrists, contact lens opticians and dispensing opticians).

In the first quarter of 2020, routine clinical eye care underwent a temporary cessation in most regions around the world due to the coronavirus pandemic. Optometric practice is now predominantly back up and running, albeit with the occasional return to a higher alert level as the infection rates in countries ebb and flow over time. The demands
of working in a world with Covid-19 have necessitated changes to how routine practice is conducted. As a result, the attitudes and needs of eye care practitioners (ECPs) and patients related to eye care in general, and contact lenses (CLs) in particular, may have altered. Within this new shape of optometric practice, the question of where CL practice fits naturally arises. While aftercare for the routine assessment and resupply of existing wearers may seem acceptable, how does the profession approach the option of new fits and upgrades? Given the wider challenges faced by practitioners, is this really the time to focus on such areas? Is it even ‘safe’ to fit CL now, given the close contact required? However, looking at it from a different point of view, are there in fact opportunities arising from the changes dictated by Covid-19 that could be beneficial for CL practice? This article reviews the recommendations
for safe CL practice, looks at their relevance for both practitioners and patients, and addresses how CL can be accommodated into the daily clinic routine as easily as possible.

Walsh K, Sulley A. Soft toric lens fitting practices not meeting patient needs Optometry Times Journal 2021;13, 2: 34-37 [ Show Abstract ]

The inclusion of astigmatic correction in spectacles is common practice. Outside of the need to reduce a high or previously uncorrected astigmatism to ease adaption, eyecare professionals (ECPs) routinely prescribe the full toric correction in spectacles. Historically, the lack of availability of consistently performing, comfortable soft toric contact lens designs resulted in different prescribing practices for astigmats compared to those wearing spectacles, with spherical lenses often recommended over toric lenses for low to moderate levels of astigmatism.

Modern soft toric designs are significantly different from early non-planned replacement versions of 20 or more years ago. Their overall performance—which includes ease of fitting, comfort, rotational stability, vision performance, and consistent manufacturing in a range of designs and materials—enables them to be fit successfully to a wide range of astigmatic patients.

This review provides an overview of current soft toric prescribing, comparing and contrasting different fitting practices around the globe, and explores patient expectations and the opportunities that exist to meet their needs.

Williams R, Srinivasan S, Jones L. Career Transitions ARVO Advance Research Career Development Conference, Virtual Conference, February 26, 2021

Woods,J., Jones,D., Jones,L., Jones,S., Hunt,C., Chamberlain,P., McNally,J Ocular health of children wearing daily disposable contact lenses over a 6-year period Contact Lens Anterior Eye 2021;Online ahead of print [ Show Abstract ]

Purpose
To report on the ocular health and safety of children fit with soft hydrogel daily-disposable contact lenses, and followed for 6-years in a double-masked clinical trial investigating the performance of a dual-focus contact lens designed to control myopia progression.

Methods
Children aged 8−12 years, naïve to contact lens wear, were enrolled across four international sites. During years 1–3, children were randomised to either MiSight® 1 day or Proclear® 1 day (both omafilcon A, CooperVision, Inc.). The lenses were identical in material and geometry except for the front optical zone design. At the end of year-3, all those wearing Proclear 1 day were switched to MiSight 1 day, therefore all wore MiSight 1 day in years 4−6. Subjects agreed to wear the lenses at least 10-hours/day, 6-days/week. After dispensing, study visits were at 1-week, 1-month, 6-months and every 6-months until 6-years. At each visit, ocular measurements and subjective responses were recorded. Biomicroscopy used 0–4 grading scales; grade 0 represented no findings.

Results
144 children were enrolled: 69F:75M; mean age 10.1 years; mean cycloplegic spherical-equivalent refraction -2.11D; ethnicities included 34 East-Asian, 12 West-Asian, and 79 Caucasian. 92 completed the 6-years. Only three subjects discontinued due to an ocular adverse event (AE). No contact lens related AEs were classified as serious. The incidence rate of infiltrative AEs was 0.61% (6.1/1000 wearing-years; 95%CI: 0.24%–1.57%). The most common biomicroscopy findings were limbal, bulbar and tarsal hyperaemia and tarsal roughness. 99% of all biomicroscopy findings were grade-1 or lower. After 6-years of lens wear, ocular health by biomicroscopy was similar to pre-lens wear.

Conclusions
Across the 6-years, there were no contact lens related serious AEs and biomicroscopy showed no significant changes. Results suggest that children this age can successfully wear daily-disposable hydrogel contact lenses with minimal impact on ocular physiology.

Yamasaki,K., Mizuno,Y., Kitamura,Y., McCanna,D. J., Ngo,W., Jones,L. W. The efficacy of povidone-iodine, hydrogen peroxide and a chemical multipurpose contact lens care system against Pseudomonas aeruginosa on various lens case surfaces Cont Lens Anterior Eye 2021;44(1):18-23 [ Show Abstract ]

Purpose
To determine the antimicrobial efficacy of a povidone-iodine system (PVP-I; cleadew, OPHTECS Corporation, Kobe, Japan), a peroxide system (AOSEPT Plus with HydraGlyde, Alcon, Fort Worth, TX), and a chemical multipurpose system (renu fresh, Bausch & Lomb, Rochester, NY) on contact lens case surfaces that are both in contact and not in contact with the solutions during lens disinfection.

Methods
The surfaces of the inner walls, underside of the lid, and lens holder (if applicable) of the cases were inoculated with P. aeruginosa ATCC 27853. The cases were disinfected with the solutions as per their manufacturer instructions. After disinfection, the inoculated surfaces were swabbed and the amount of surviving P. aeruginosa was determined. Following this experiment, separate cases were inoculated and disinfected as before. This time the cases were agitated after recommended disinfection time and the amount of P. aeruginosa in the disinfecting solution was quantified immediately, and again after resting for 7 days. Experiments were conducted in triplicate (n = 3).

Results
Units are expressed in log CFU. All three solutions significantly reduced P. aeruginosa on direct-contact surfaces (all p < 0.039). On non-contact surfaces, the reduction of P. aeruginosa in the PVP-I system (pre-disinfection: 6.8 ± 0.5, post-disinfection: 1.0 ± 0.0; p < 0.001) was significant, but not for the hydrogen peroxide system (pre-disinfection: 6.3 ± 0.6, post: 5.5 ± 0.5; p = 0.194) and the chemical multipurpose system (pre-disinfection: 6.6 ± 0.1, post-disinfection: 5.6 ± 0.8; p = 0.336). After 7 days post-disinfection, no P. aeruginosa regrowth was observed in the PVP-I system (Day 1: 1.0 ± 0.0, Day 7: 1.0 ± 0.0; p = 1) and the chemical multipurpose system (Day 1: 4.2 ± 0.2, Day 7: 1.8 ± 0.9; p = 0.012), however regrowth was observed in the hydrogen peroxide system (Day 1: 3.4 ± 0.6, Day 7: 6.1 ± 0.4; p = 0.003).

Conclusion
The PVP-I system was more effective against P. aeruginosa on non-contact surfaces than the hydrogen peroxide system or the chemical multipurpose system and is capable of inhibiting regrowth of P. aeruginosa for at least 7 days post-disinfection.

Yee,A., Walsh,K., Schulze,M., Jones,L The impact of patient behaviour and care system compliance on reusable soft contact lens complications Contact Lens Anterior Eye 2021;Online ahead of print [ Show Abstract ]

Reusable soft daily wear contact lenses (CLs) remain popular and were fit to just over half of all wearers in the most recent international CL prescribing survey. Unlike daily disposable CLs, reusables require cleaning and disinfecting after every use, along with storage in a CL case. These additional requirements add a number of steps to the daily wear and care routine, increasing the opportunities for CL wearers to exhibit non-compliant behaviour. The impact of non-compliance ranges from poor lens comfort through to potentially sight- threatening infective keratitis. The coronavirus pandemic has refocused the profession on the importance of hand hygiene in particular, and the need for promoting safe CL wear in general. This review summarises typical non-compliant behaviour related to reusable CLs, and examines strategies and opportunities to better support wearers. Patient education has a central role in encouraging compliant behaviour, although patient recall of information is low, and personal belief systems may result in continuation of non-compliant behaviour despite awareness of the risks. CL care solutions are required for the daily disinfection of lenses, however misuse of multipurpose solutions (MPS) and hydrogen peroxide (H2O2)-based care systems can challenge their ability to be fully efficacious. Standard efficacy testing is reviewed, with consideration of how well current protocols model real-world use of CL solutions. Although some recommendations are in place for the inclusion of additional variables such as lens cases, CL materials, organic soil and efficacy against Acanthamoeba, opportunity still exists to reevaluate global standards to ensure consistency of testing in all markets. Finally, potential future innovations are discussed which may further support increased safety in reusable lens wear through novel antimicrobial additions to both CL materials and cases