Spafford,M. M., Chow,A. H. Y., Labreche,T., Jones,D. A., Christian,L. W. T., Furtado,N. M., MacIver,S., Irving,E. L. Trust and Access: Eye Information-seeking Practices and Preferences among Canadians Optometry and Vision Science 2023;100(7):467-474 [ Show Abstract ]

SIGNIFICANCE
This study highlights the value that the public places on obtaining trusted and accessible health-related information and their preference for obtaining it from their health care practitioners. Previous research has not been specific to Canadians or vision. Findings can be used to increase eye health literacy and eye care utilization.

PURPOSE
Canadians underuse eye care and underestimate the occurrence of asymptomatic eye disease. This study explored eye information-seeking practices and preferences among a group of Canadians.

METHODS
Using snowball sampling, a 28-item online survey collected respondent perceptions about their eye and health information-seeking practices and preferences. Questions examined electronic device access, information source use, and demographics. Two open-ended questions examined information-seeking practices and preferences. Respondents were at least 18 years old and living in Canada. Individuals working in eye care were excluded. Response frequencies and z scores were computed. Written comments were assessed using content analysis.

RESULTS
Respondents searched for less eye than health information (z scores ≥ 2.25, P < .05). For eye and health information, primary care providers were the used and preferred source, and reliance on Internet searches was greater than desired. Trust and access drove information-seeking practices. Respondent comments suggested that a hierarchy of trust operates across My Health Team, My Network, and My External Sources, with a persistent threat posed by Discredited Sources. Access to information sources seemed mediated by enablers (Convenience and Accessible Features) and barriers (Unreachable Health Team and Absent Systems). Eye information was seen as more specialized and harder to find. There was a high regard for health care practitioners who provide their patients with curated trusted information.

CONCLUSIONS
These Canadians value trusted and accessible health-related information. They prefer eye and health information from their health care practitioners and value when their health team provides online curated information, particularly regarding eyes.

Spafford,M. M., Jones,D. A., Christian,L. W., Labreche,T., Furtado,N. M., MacIver,S., Irving,E. L. What the Canadian public (mis)understands about eyes and eye care Clinical and Experimental Optometry 2021;Online ahead of print [ Show Abstract ]

Clinical relevance
Inadequate public knowledge about eyes and eye care poses avoidable risks to vision-related quality of life.

Background
This study of eye care knowledge among Canadians extends earlier findings from focus groups.

Methods
Perceptions about eyes and eye care were sought using a 21-item online survey and snowball sampling. Inclusion criteria were living in Canada and being at least 18-years old; eye care professionals and staff were excluded. Response frequencies were converted to percentages, with eye condition items analysed according to ‘expected’ or ‘unexpected’ eye impacts. Proportions selecting these impacts or ‘unsure’ were determined.

Results
There were 424 respondents: 83.0% aged 20-65 years and 69.6% female. Mismatches existed between perceived recommendations and behaviours for booking eye exams: within two years (86.7% vs. 68.4%) and symptom-driven (3.3% vs. 13.0%). First eye exams after age one year were deemed appropriate by 43.6%. Few respondents associated glaucoma with no symptoms (6.0%) or amblyopia with blurred vision (13.5%). A notable proportion incorrectly related tunnel vision with age-related macular degeneration (AMD, 36.8%) and cataract (21.9%). Identifying all ‘expected’ responses was unlikely for glaucoma (1.9%), amblyopia (6.7%), and cataract (12.0%). Most respondents identified no ‘expected’ effects for glaucoma (63.8%) and AMD (46.2%) and some ‘expected’ effects for cataract (59.5%) and amblyopia (72.6%). Selecting ‘unsure’ was 9-10 times more common among respondents choosing no ‘expected’ impacts than those choosing some. Awareness of thyroid-associated eye disease was lowest (32.4%) of seven conditions. Respondents were most likely to consult optometrists for routine eye exams, eye disease, diabetes eye checks and blurred vision but family physicians for red eyes and sore eyes. Respondents typically paid for their eye exams and eyewear but wanted government to pay.

Conclusion
Vision-threatening knowledge gaps and misinformation about eyes and eye care among Canadian respondents highlight the need for accessible, targeted public education.

Srinivasan,S., Chan,C., Jones,L. Apparent time-dependent differences in inferior tear meniscus height in human subjects with mild dry eye symptoms Clinical and Experimental Optometry 2007;90(5):345-350 [ Show Abstract ]

PURPOSE: The aim of the study was to track the volume of tears contained in the inferior tear meniscus over the course of the day in subjects with symptoms of mild dry eye and a control asymptomatic group. METHODS: Forty non-contact lens-wearing subjects (aged 27 +/- 6 years) were enrolled in this investigator-masked study. They were divided into 'dry eye' (DE) and 'non-dry eye' (NDE) individuals based on their responses to the Allergan Subjective Evaluation of Symptoms of Dryness (SESOD) questionnaire. Measurement of the tear meniscus height (TMH) was undertaken on the centre of the right eye at 9:00 am, noon, 3:00 pm, 6:00 pm and 9:00 pm on the lower lid using a non-contact, non-invasive optical coherence tomographer (OCT). The TMH was determined from scanned images using customised software. RESULTS: A monotonous and significant reduction in the central TMH occurred over the course of the day in both groups (p < 0.05), with the values constantly decreasing (NDE = 0.162 to 0.125 mm; DE = 0.154 to 0.121 mm). While the TMH values in the DE group were always lower than the NDE group, these were not significantly different at any time (p > 0.05). CONCLUSIONS: A diurnal reduction in tear volume, as assessed by evaluation of the inferior TMH, may be one of the reasons responsible for the common increase in end-of-day ocular dryness symptoms reported by many patients in clinical practice.

Srinivasan,S., Heynen,M. L., Martell,E., Ritter III,R., Jones,L., Senchyna,M. Quantification of MUCIN 1, cell surface associated and MUCIN16, cell surface associated proteins in tears and conjunctival epithelial cells collected from postmenopausal women Molecular Vision 2013;19970-979 [ Show Abstract ]

Purpose: To quantify the expression of mucin 1, cell surface associated (MUC1) and mucin 16, cell surface associated (MUC16) proteins and messenger ribonucleic acid (mRNA) in a cohort of postmenopausal women (PMW), to explore the relationship between mucin expression, dry eye symptomology, and tear stability. Methods: Thirty-nine healthy PMW (>50 years of age) were enrolled in this study. No specific inclusion criteria were used to define dry eye; instead, a range of subjects were recruited based on responses to the Allergan Ocular Surface Disease Index (OSDI) questionnaire and tear stability measurements as assessed by non-invasive tear breakup time (NITBUT). Tears were collected from the inferior tear meniscus using a disposable glass capillary tube, and total RNA and total protein were isolated from conjunctival epithelial cells collected via impression cytology. Expression of membrane-bound and soluble MUC1 and MUC16 were quantified with western blotting, and expression of MUC1 and MUC16 mRNA was assessed with real-time PCR. Results: OSDI responses ranged from 0 to 60, and NITBUT ranged from 18.5 to 2.9 s. Only two statistically significant correlations were found: soluble MUC16 protein concentration and MUC16 mRNA expression with OSDI vision related (-0.47; p=0.01) and ocular symptom (0.39; p=0.02) subscores, respectively. Post hoc exploratory analysis on absolute expression values was performed on two subsets of subjects defined as asymptomatic (OSDI =6, n=12) and moderate to severe symptomatic (OSDI =20, n=12). The only significant difference between the two subgroups was a significant reduction in MUC16 mRNA expression found in the symptomatic dry eye group (1.52±1.19 versus 0.57±0.44; p=0.03). Conclusions: A broad exploration of mucin expression compared to either a sign (NITBUT) or symptoms of dry eye failed to reveal compelling evidence supporting a significant relationship, other than a potential association between MUC16 with specific symptoms. Furthermore, comparison of mucin protein and expression levels between the asymptomatic and moderate to severe symptomatic subgroups revealed only one significant difference, a reduction in MUC16 mRNA expression in the symptomatic subgroup. © 2013 Molecular Vision.

Srinivasan,S., Joyce,E., Boone,A., Simpson,T., Jones,L., Senchyna,M. Tear lipocalin and lysozyme concentrations in postmenopausal women Ophthalmic and Physiological Optics 2010;30(3):257-266

Srinivasan,S., Joyce,E., Jones,L. W. Tear osmolality and ferning patterns in postmenopausal women Optometry and Vision Science 2007;84(7):588-592 [ Show Abstract ]

PURPOSE: To compare tear osmolality and ferning patterns in postmenopausal women (PMW) with and without dry eye symptoms. METHODS: Thirty-seven healthy PMW (>50 years of age), not on hormone replacement therapy, were categorized as being symptomatic or asymptomatic of dry eye based on their responses to an Allergan "Single-Item Score Dry Eye Questionnaire" (SIDEQ). They subsequently completed the Allergan "Ocular Surface Disease Index" (OSDI) questionnaire. Tear samples were collected from participants to evaluate osmolality and ferning patterns. A novel freezing point depression osmometer (Advanced Instruments Inc., Model 3100 Tear Osmometer), was used to measure the osmolality of the tear film. The tear ferning test was performed and evaluated for the quality of ferning based on the Rolando grading system. RESULTS: SIDEQ responses revealed 21 symptomatic and 16 asymptomatic participants. The OSDI total score was 6.5 +/- 5.9 for the non-dry-eyed (NDE) group and 25.7 +/- 12.4 for the dry-eyed (DE) group. The subscores for the DE group were significantly greater than the NDE group (p < 0.001). Osmolality values in DE individuals were significantly different from NDE (328.1 +/- 20.8 vs. 315.1 +/- 11.3 mOsm/kg; p = 0.02). Fifty percent of the DE participants showed type II ferning patterns and 29% of the DE participants showed type III ferning patterns, whereas the NDE participants showed either type I (44%) or II (66%) ferning patterns. There was a significant difference between the DE and NDE participants for the ferning patterns (p = 0.019). There was no significant correlation between tear osmolality and tear ferning (DE: r = 0.12; p > 0.05, NDE: r = -0.17; p > 0.05). CONCLUSIONS: Osmolality in mild and moderately DE PMW is higher than in NDE PMW and tear ferning is a rapid, simple, noninvasive laboratory procedure that indicates altered tear quality in PMW with symptoms of dry eye.

Srinivasan,S., Joyce,E., Jones,L. W., Senchyna,M. Subconjunctival cyst-like formations following impression cytology Contact Lens and Anterior Eye 2005;28(4):181-184 [ Show Abstract ]

Purpose: To report a case of an unusual adverse event subsequent to undertaking Conjunctival Impression Cytology (CIC). Methods: CIC was un dertaken on a 54-year-old healthy Caucasian female, using a 10 mm Millipore™ membrane on the bulbar conjunctiva. Prior to the CIC procedure, two drops of topical proparacaine (Alcaine®) were instilled and following the procedure two drops of artificial tears (GenTeal®) were administered. Results: The subject reported excessive bulbar conjunctival hyperaemia in the left eye 5 min postprocedure, with no marked pain or discomfort. Slitlamp biomicroscopic evaluation revealed several "bubbles" or cystic formations trapped underneath the conjunctival tissue, in association with moderate to severe bulbar conjunctival redness. These cysts began to regress fairly rapidly and completely disappeared within 1 h. Conclusion: CIC is a useful tool for studying the ocular surface; however, care should be taken while performing this mildly invasive procedure. This is the first report of bubble formation in the conjunctiva following CIC. Subjects should be advised about the short term redness and discomfort that could occur following CIC. © 2005 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Srinivasan,S., Menzies,K. L., Sorbara,L., Jones,L. W. Imaging meibomian glands on a patient with chalazia in the upper and lower lids: A case report Contact Lens and Anterior Eye 2013;36(4):199-203 [ Show Abstract ]

Aim: To describe the meibomian gland (MG) appearance in a case of eyelid chalazia, using a novel meibography method. Methods: A 29-year-old female of South Asian origin presented with mild swelling in the lower lid of the left eye. The patient also presented with a history of a recurrent chalazion in the upper lid of the same eye, which later progressed to an active chalazion. A chalazion also developed in the upper lid of the right eye. Meibography was performed using a novel Keratograph (Keratograph 4, OCULUS, Wetzlar, Germany) to evaluate the structure of the MG in the area affected by the chalazia. Results: The area of the recurrent chalazion in the upper left lid showed partial and/or complete MG loss. The active chalazia in the lower left lid and the upper right lid showed inflammation and MG drop out at the affected site. The inflammation was found to be reduced during the follow-up visits, however disappearance of MG very specific to the region of the chalazion was observed. Conclusion: The Keratograph 4 was able to image the MG structures clearly, allowing the clinician to monitor the progression of chalazia and the MG loss in the affected areas. © 2013 British Contact Lens Association.

Srinivasan,S., Menzies,K., Sorbara,L., Jones,L. Infrared imaging of meibomian gland structure using a novel keratograph Optometry and Vision Science 2012;89(5):788-794 [ Show Abstract ]

PURPOSE.: To examine the ability of a novel non-contact device (Keratograph 4) to image the meibomian gland (MG) structures and their morphological changes in the upper and lower eyelids. METHODS.: Thirty-seven participants (mean age 57.8 ± 8.5 years; 3 males and 34 females) completed the Ocular Surface Disease Index questionnaire to assess dryness symptoms. Meibum secretion quality score, number of blocked gland orifices, and meibum expressibility scores were assessed. The lower lid (LL) and upper lid (UL) of all subjects were everted and images of the MGs were taken using the Keratograph 4 (OCULUS). A MG dropout score (MGDS) due to complete or partial gland loss of both lids was obtained using a subjective 4-grade scoring system, and digital analysis of the images using ImageJ was performed. Presence of tortuosity and visible acinar changes of the MGs were also noted. RESULTS.: MGDS for both lids was significantly positively correlated with the Ocular Surface Disease Index score (r = 0.51; p < 0.05). The MGDS determined using the digital grading was also significantly positively correlated (UL: r = 0.68, p < 0.05; LL: r = 0.42, p < 0.05). The sum of the MGDS for both lids using the subjective grading scale was significantly different between the non-MGD and MGD group (1.3 ± 1.0 vs. 3.1 ± 1.1; p = 0.0004). MGDS assessment using the digital grading was significantly different between non-MGD (UL = 6%, LL = 8%) and MGD group (UL = 32%, LL = 42%; p = 0.001). Tortuous MG was observed only on the UL in 6% of the participants. Visible acinar changes were noted in 40% of the study participants. CONCLUSIONS.: Infrared meibography is now possible in a clinical setting using commercially available devices, and meibography can help determine differences in MG structure in subjects symptomatic of dry eye. Copyright © 2012 American Academy of Optometry.

Srinivasan,S., Otchere,H., Yu,M., Yang,J., Luensmann,D., Jones,L. Impact of cosmetics on the surface properties of silicone hydrogel contact lenses Eye and Contact Lens 2015;41(4):228-235 [ Show Abstract ]

Purpose: This study evaluated the impact of various cosmetics on the surface properties of silicone hydrogel (SiHy) contact lens materials. Methods: In this in vitro experiment, 7 SiHy contact lens materials were coated with 1 of 9 cosmetics, including common hand creams (3), eye makeup removers (3), and mascaras (3). Dark-field microscopy images were taken to determine pixel brightness (PB) after cosmetic exposure, which describes the visible surface deposition (n=6 for each lens type), with a higher PB indicating increased deposition. The sessile drop technique was used to determine the advancing contact angle (CA). Measurements were repeated for both methods after a single peroxide-based cleaning cycle. Results: Pixel brightness was significantly higher for mascara-coated lenses compared with the other cosmetic products (P,0.01). The peroxide-based lens care solution removed most deposits from the nonwaterproof mascara for 4 lens types, whereas deposits remained relatively unchanged for 1 waterproof mascara (P.0.05). Hand creams and makeup remover had minimal impact on PB. Changes in CA measurements after cosmetic application were highly lens dependent. Hand creams caused primarily a decrease in CA for 5 of the 7 lens types, whereas 1 of the waterproof mascaras caused a significant increase of 30 to 50° for 3 lens types. Conclusion: Some mascara-lens combinations resulted in increased CA and PB, which could have an impact on in vivo lens performance. Nonwaterproof mascara was mostly removed after a cleaning cycle. Further research is needed to understand the clinical implications for SiHy lens wearers using cosmetics. © 2015 Contact Lens Association of Opthalmologists, Inc.

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

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.

Stapleton,F., Abad,J. C., Barabino,S., Burnett,A., Iyer,G., Lekhanont,K., Li,T., Liu,Y., Navas,A., Obinwanne,C. J., Qureshi,R., Roshandel,D., Sahin,A., Shih,K., Tichenor,A., Jones,L. TFOS Lifestyle: Impact of societal challenges on the ocular surface Ocular Surface 2023;28(April):165-199 [ Show Abstract ]

Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.

Stapleton,F., Alves,M., Bunya,V. Y., Jalbert,I., Lekhanont,K., Malet,F., Na,K. -S, Schaumberg,D., Uchino,M., Vehof,J., Viso,E., Vitale,S., Jones,L. TFOS DEWS II Epidemiology Report Ocular Surface 2017;15(3):334-365 [ Show Abstract ]

The subcommittee reviewed the prevalence, incidence, risk factors, natural history, morbidity and questionnaires reported in epidemiological studies of dry eye disease (DED). A meta-analysis of published prevalence data estimated the impact of age and sex. Global mapping of prevalence was undertaken. The prevalence of DED ranged from 5 to 50%. The prevalence of signs was higher and more variable than symptoms. There were limited prevalence studies in youth and in populations south of the equator. The meta-analysis confirmed that prevalence increases with age, however signs showed a greater increase per decade than symptoms. Women have a higher prevalence of DED than men, although differences become significant only with age. Risk factors were categorized as modifiable/non-modifiable, and as consistent, probable or inconclusive. Asian ethnicity was a mostly consistent risk factor. The economic burden and impact of DED on vision, quality of life, work productivity, psychological and physical impact of pain, are considerable, particularly costs due to reduced work productivity. Questionnaires used to evaluate DED vary in their utility. Future research should establish the prevalence of disease of varying severity, the incidence in different populations and potential risk factors such as youth and digital device usage. Geospatial mapping might elucidate the impact of climate, environment and socioeconomic factors. Given the limited study of the natural history of treated and untreated DED, this remains an important area for future research.

Stapleton,F., Bakkar,M., Carnt,N., Chalmers,R., Kumar Vijay,A., Marasini,S., Ng,A. Y., Tan,J., Wagner,H., Woods,C., Wolffsohn,J. S. CLEAR - Contact lens complications Contact Lens Anterior Eye 2021;44(2):330-367 [ Show Abstract ]

Contact lens-related complications are common, affecting around one third of wearers, although most are mild and easily managed. Contact lenses have well-defined anatomical and physiological effects on the ocular surface and can result in other consequences due to the presence of a biologically active material. A contact lens interacts with the tear film, ocular surface, skin, endogenous and environmental microorganisms, components of care solutions and other antigens which may result in disease specific to contact lens wear, such as metabolic or hypersensitivity disorders. Contact lens wear may also modify the epidemiology or pathophysiology of recognised conditions, such as papillary conjunctivitis or microbial keratitis. Wearers may also present with intercurrent disease, meaning concomitant or pre-existing conditions unrelated to contact lens wear, such as allergic eye disease or blepharitis, which may complicate the diagnosis and management of contact lens-related disease.

Complications can be grouped into corneal infection (microbial keratitis), corneal inflammation (sterile keratitis), metabolic conditions (epithelial: microcysts, vacuoles, bullae, tight lens syndrome, epithelial oedema; stromal: superficial and deep neovascularisation, stromal oedema [striae/folds], endothelial: blebs, polymegethism/ pleomorphism), mechanical (corneal abrasion, corneal erosion, lens binding, warpage/refractive error changes; superior epithelial arcuate lesion, mucin balls, conjunctival epithelial flaps, ptosis, discomfort), toxic and allergic disorders (papillary conjunctivitis, solution-induced corneal staining, incomplete neutralisation of peroxide, Limbal Stem Cell Deficiency), tear resurfacing disorders/dry eye (contact lens-induced dry eye, Meibomian gland dysfunction, lid wiper epitheliopathy, lid parallel conjunctival folds, inferior closure stain, 3 and 9 o'clock stain, dellen, dimple veil) or contact lens discomfort. This report summarises the best available evidence for the classification, epidemiology, pathophysiology, management and prevention of contact lens-related complications in addition to presenting strategies for optimising contact lens wear.

Subbaraman,L. N., Bayer,S., Glasier,M. -A, Lorentz,H., Senchyna,M., Jones,L. Rewetting drops containing surface active agents improve the clinical performance of silicone hydrogel contact lenses Optometry and Vision Science 2006;83(3):143-151 [ Show Abstract ]

PURPOSE: The purpose of this study was to investigate the impact of using a rewetting drop (RWD) containing surface active agents (OPTI-FREE RepleniSH; Alcon, Fort Worth, TX) on the clinical performance and protein deposition when using a continuous-wear (CW) silicone hydrogel (SH) contact lens. METHODS: Subjects wore lotrafilcon A SH lenses on a 30-day CW basis for two consecutive 1-month periods while inserting either 0.9% unpreserved unit-dose saline (control) or multidose OPTI-FREE RepleniSH (test RWD). Subjective comfort and symptoms were assessed after 2 and 4 weeks with each product. After 1 month of wear with each product, lenses were collected and analyzed in the laboratory for total protein, total lysozyme, and percentage of denatured lysozyme. RESULTS: Symptoms of dryness and comfort varied across the day regardless of drop type (p < 0.001) with dryness being maximal on waking, least in the middle of the day, and increased towards the evening. The test RWD provided greater comfort on insertion (p = 0.02), better visual quality (p < 0.01), and less mucous discharge on waking (p = 0.02) than the control product. Lysozyme deposition was significantly reduced after the use of the test RWD as compared to saline (0.73 +/- 0.5 microg/lens vs. 1.14 +/- 0.7 microg/lens; p < 0.001) as was total protein deposition (1.17 +/- 0.7 microg/lens vs. 1.86 +/- 0.8 microg/lens; p < 0.001). Lysozyme denaturation was also reduced with the use of the test RWD compared with the control (76 +/- 10% vs. 85 +/- 7%; p < 0.01). CONCLUSIONS: The use of a RWD containing surface active agents provided greater subjective satisfaction, reduced lysozyme and total protein deposition, and reduced denatured lysozyme than a RWD containing saline alone.

Subbaraman,L. N., Borazjani,R., Zhu,H., Zhao,Z., Jones,L., Willcox,M. D. P. Influence of protein deposition on bacterial adhesion to contact lenses Optometry and Vision Science 2011;88(8):959-966 [ Show Abstract ]

Purpose. The aim of the study is to determine the adhesion of Gram positive and Gram negative bacteria onto conventional hydrogel (CH) and silicone hydrogel (SH) contact lens materials with and without lysozyme, lactoferrin, and albumin coating. Methods. Four lens types (three SH-balafilcon A, lotrafilcon B, and senofilcon A; one CH-etafilcon A) were coated with lysozyme, lactoferrin, or albumin (uncoated lenses acted as controls) and then incubated in Staphylococcus aureus (Saur 31) or either of two strains of Pseudomonas aeruginosa (Paer 6294 and 6206) for 24 h at 37°C. The total counts of the adhered bacteria were determined using the H-thymidine method and viable counts by counting the number of colony-forming units on agar media. Results. All three strains adhered significantly lower to uncoated etafilcon A lenses compared with uncoated SH lenses (p 0.05). Lactoferrin coating on lenses increased binding (total and viable counts) of Saur 31 (p < 0.05). Lactoferrin-coated lenses showed significantly higher total counts (p < 0.05) but significantly lower viable counts (p < 0.05) of adhered P. aeruginosa strains. There was a significant difference between the total and viable counts (p < 0.05) that were bound to lactoferrin-coated lenses. Albumin coating of lenses increased binding (total and viable counts) of all three strains (p < 0.05). Conclusions. Lysozyme deposited on contact lenses does not possess antibacterial activity against certain bacterial strains, whereas lactoferrin possess an antibacterial effect against strains of P. aeruginosa. © 2011 American Academy of Optometry.

Subbaraman,L. N., Glasier,M. -A, Senchyna,M., Jones,L. Stabilization of lysozyme mass extracted from lotrafilcon silicone hydrogel contact lenses Optometry and Vision Science 2005;82(3):209-214 [ Show Abstract ]

PURPOSE: Lysozyme deposits extracted from lotrafilcon silicone hydrogel (SH) contact lens materials demonstrate a loss in total mass as a function of storage time when assessed by Western blotting. This loss represents a potential source of error when quantifying total lysozyme deposition on SH lenses. The purpose of this study was to devise a method whereby lysozyme mass would be preserved over time to allow for its accurate quantitation after its removal from SH lenses. METHODS: Lysozyme deposits from 12 human worn lotrafilcon lenses were extracted using a 50:50 mixture of 0.2% trifluoroacetic acid and acetonitrile. Extracts were lyophilized to dryness, then resuspended in either reconstitution buffer (10 mM Tris-HCl, 1 mM EDTA) or modified reconstitution buffer (reconstitution buffer + 0.9% saline). BIOSTAB Biomolecule Storage Solution (Sigma-Aldrich) was added to one half of the samples from each buffer group. One microliter of each of the samples was immediately subjected to sodium dodecyl sulfate polyacrylamide gel electrophoresis and Western blotting, whereas the remaining volume was aliquoted and stored at -20 degrees C or -70 degrees C and subjected to the same procedures after 48 h of storage. Comparison of lysozyme band intensity in stored vs. fresh samples enabled calculation of percentage mass loss of lysozyme. RESULTS: Samples stored at -20 degrees C in reconstitution buffer with no BIOSTAB demonstrated a 33% loss in mass over 48 h of storage. Identical samples stored at -70 degrees C in modified reconstitution buffer with BIOSTAB added demonstrated <1% loss in mass. Statistical analysis indicated that buffer composition (p < 0.001), storage temperature (p = 0.04), and addition of BIOSTAB (p < 0.001) were all important in controlling loss of mass over time. CONCLUSION: We have optimized a procedure whereby the extracted mass of lysozyme deposits found on lotrafilcon SH lenses can be preserved, thus enabling accurate quantitation after extraction and resuspension.

Subbaraman,L. N., Glasier,M. -A, Senchyna,M., Sheardown,H., Jones,L. Kinetics of in vitro lysozyme deposition on silicone hydrogel, PMMA, and FDA groups I, II, and IV contact lens materials Current eye research 2006;31(10):787-796 [ Show Abstract ]

We sought to compare the kinetics of in vitro lysozyme deposition on silicone hydrogel (SH), polymethyl methacrylate (PMMA), and FDA groups I, II, and IV contact lenses. Lenses were incubated in 125I-labeled lysozyme for time periods ranging from 1 hr to 28 days, and radioactive counts were determined. SH lenses and PMMA deposited less lysozyme than conventional hydrogel lenses (p < 0.05). Lysozyme accumulation on group IV lenses reached a maximum on the seventh day and then plateaued, whereas on groups I, II, and SH lenses, deposition continued to increase across all time periods, reiterating that kinetics of lysozyme deposition is highly material dependent.

Subbaraman,L. N., Glasier,M. -A, Varikooty,J., Srinivasan,S., Jones,L. Protein deposition and clinical symptoms in daily wear of etafilcon lenses Optometry and Vision Science 2012;89(10):1450-1459 [ Show Abstract ]

Purpose.: To determine the relationship between clinical signs and symptoms and protein deposition over 8 h of wear of etafilcon A lenses in symptomatic and asymptomatic contact lens wearers. Methods.: Thirty adapted soft contact lens wearers (16 symptomatic and 14 asymptomatic) were fitted with etafilcon A lenses. In vivo wettability, non-invasive tear break-up time, and subjective symptoms (vision, comfort, and dryness) were assessed at baseline and after 2, 4, 6, and 8 h. After 2, 4, 6, and 8 h time points, lenses were collected, and total protein, total lysozyme, and active lysozyme deposition were assessed. Results.: There was a significant reduction (p = 0.032) in the non-invasive tear break-up time at 8 h in both groups. In the symptomatic group, there was a significant reduction in subjective comfort and dryness ratings at 6 and 8 h measurement with respect to baseline (p 94% at 8 h). Pearson's correlations between subjective symptoms and protein deposition showed poor correlations for total protein/lysozyme and any subjective factor (r 0.05), and only weak correlations between dryness and % active lysozyme (r = 0.3 to 0.5 for all time points). However, stronger correlations were found between active lysozyme and subjective comfort (r = 0.6 to 0.7; p < 0.001). Conclusions.: In addition to investigating total protein deposited on contact lenses, it is of significant clinical relevance to determine the conformational state of the deposited protein. Copyright © 2012 American Academy of Optometry.

Subbaraman,L. N., Glasier,M. A., Senchyna,M., Sheardown,H., Jones,L. Extraction efficiency of an extraction buffer used to quantify lysozyme deposition on conventional and silicone hydrogel contact lens materials Eye and Contact Lens 2007;33(4):169-173 [ Show Abstract ]

PURPOSE: Extracting lysozyme from Food and Drug Administration group IV etafilcon lenses by using 0.2% trifluoroacetic acid and acetonitrile (TFA/ACN) is a well-established procedure. TFA/ACN has been the extraction buffer of choice for extracting proteins from silicone hydrogel contact lenses. The purpose of this study was to determine the efficiency of TFA/ACN in extracting lysozyme from silicone hydrogel and etafilcon lenses by using an in vitro model. METHODS: ACUVUE 2, Focus NIGHT & DAY, O2 Optix, PureVision, and ACUVUE Advance lenses were incubated in simple lysozyme solution and a complex artificial tear solution consisting of multiple tear components containing lysozyme labeled with iodine 125. All the silicone hydrogel lenses were incubated for 28 days, whereas the ACUVUE 2 lenses were incubated for 7 days at 37 degrees C with constant rotation. After the incubation period, radioactive counts were determined, and the lenses were placed in an appropriate volume of the buffer for 24 hours in darkness. The lenses were removed from the buffer, and radioactive counts were determined again. RESULTS: Extraction efficiencies for lysozyme from the artificial tear solution were 97.2% +/- 1.2% for ACUVUE 2, 64.3% +/- 6.2% for Focus NIGHT & DAY, 62.5% +/- 5.6% for O2 Optix, 53.5% +/- 5.8% for PureVision, and 89.2% +/- 3.4% for ACUVUE Advance. Results were similar for the lysozyme extracted after incubating in the simple lysozyme solution. CONCLUSIONS: TFA/ACN is extremely efficient at extracting lysozyme deposited on etafilcon lenses. However, it does not extract all the lysozyme deposited on silicone hydrogel lenses, and alternative extraction procedures should be sought.

Subbaraman,L. N., Glasier,M. A., Sheardown,H., Jones,L. Efficacy of an extraction solvent used to quantify albumin deposition on hydrogel contact lens materials Eye and Contact Lens 2009;35(2):76-80 [ Show Abstract ]

OBJECTIVES: Extracting proteins from conventional hydrogel (CH) and silicone hydrogel (SH) contact lens materials using a mixture of trifluoroacetic acid/acetonitrile (TFA/ACN) is a well-established procedure for quantifying individual and total protein deposited on contact lenses. The purpose of this study was to determine the efficacy of TFA/ACN in extracting albumin from SH and a CH group IV lens material using an in vitro model. METHODS: One CH group IV lens material (etafilcon A) and five different SH lens materials (lotrafilcon A, lotrafilcon B, balafilcon A, galyfilcon A, and senofilcon A) were incubated in both simple albumin solution and a complex artificial tear protein solution containing 125I-labeled albumin. All the lens materials were incubated for 14 days at 37 degrees C with constant rotations. Following the incubation period, radioactive counts were determined and the lenses were placed in an appropriate volume of the extraction solvent. After the specified time, the lenses were removed and radioactive counts were determined again to calculate the amount of albumin remaining on the lenses post-extraction. RESULTS: Extraction efficiencies for albumin from the artificial tear protein solution were 97.2% +/- 2 for etafilcon A, 77.3% +/- 6.2 for lotrafilcon A, 73.5% +/- 5.6 for lotrafilcon B, 81.5% +/- 5.8 for balafilcon, 91.2% +/- 3.4 for galyfilcon A, and 89.2% +/- 3.4 for senofilcon A. Results were similar for the albumin extracted after incubating in the simple albumin solution. CONCLUSIONS: Although TFA/ACN is efficient at extracting albumin deposited on etafilcon lenses, it does not extract all the albumin that is deposited on SH lenses and alternative extraction procedures should be sought.

Subbaraman,L. N., Jones,L. Kinetics of lysozyme activity recovered from conventional and silicone hydrogel contact lens materials Journal of Biomaterials Science, Polymer Edition 2010;21(3):343-358

Subbaraman,L. N., Woods,J., Teichroeb,J. H., Jones,L. Protein deposition on a lathe-cut silicone hydrogel contact lens material Optometry and Vision Science 2009;86(3):244-250 [ Show Abstract ]

PURPOSE: To determine the quantity of total protein, total lysozyme, and the conformational state of lysozyme deposited on a novel, lathe-cut silicone hydrogel (SiHy) contact lens material (sifilcon A) after 3 months of wear. METHODS: Twenty-four subjects completed a prospective, bilateral, daily-wear, 9-month clinical evaluation in which the subjects were fitted with a novel, custom-made, lathe-cut SiHy lens material. The lenses were worn for three consecutive 3-month periods, with lenses being replaced after each period of wear. After 3 months of wear, the lenses from the left eye were collected and assessed for protein analysis. The total protein deposited on the lenses was determined by a modified Bradford assay, total lysozyme using Western blotting and the lysozyme activity was determined using a modified micrococcal assay. RESULTS: The total protein recovered from the custom-made lenses was 5.3 +/- 2.3 microg/lens and the total lysozyme was 2.4 +/- 1.2 microg/lens. The denatured lysozyme found on the lenses was 1.9 +/- 1.0 microg/lens and the percentage of lysozyme denatured was 80 +/- 10%. CONCLUSIONS: Even after 3 months of wear, the quantity of protein and the conformational state of lysozyme deposited on these novel lens materials was very similar to that found on similar surface-coated SiHy lenses after 2 to 4 weeks of wear. These results indicate that extended use of the sifilcon A material is not deleterious in terms of the quantity and quality of protein deposited on the lens.

Sullivan,D. A., Rocha,E. M., Aragona,P., Clayton,J. A., Ding,J., Golebiowski,B., Hampel,U., McDermott,A. M., Schaumberg,D. A., Srinivasan,S., Versura,P., Willcox,M. D. P. TFOS DEWS II Sex, Gender, and Hormones Report Ocular Surface 2017;15(3):284-333 [ Show Abstract ]

One of the most compelling features of dry eye disease (DED) is that it occurs more frequently in women than men. In fact, the female sex is a significant risk factor for the development of DED. This sex-related difference in DED prevalence is attributed in large part to the effects of sex steroids (e.g. androgens, estrogens), hypothalamic-pituitary hormones, glucocorticoids, insulin, insulin-like growth factor 1 and thyroid hormones, as well as to the sex chromosome complement, sex-specific autosomal factors and epigenetics (e.g. microRNAs). In addition to sex, gender also appears to be a risk factor for DED. “Gender” and “sex” are words that are often used interchangeably, but they have distinct meanings. “Gender” refers to a person's self-representation as a man or woman, whereas “sex” distinguishes males and females based on their biological characteristics. Both gender and sex affect DED risk, presentation of the disease, immune responses, pain, care-seeking behaviors, service utilization, and myriad other facets of eye health. Overall, sex, gender and hormones play a major role in the regulation of ocular surface and adnexal tissues, and in the difference in DED prevalence between women and men. The purpose of this Subcommittee report is to review and critique the nature of this role, as well as to recommend areas for future research to advance our understanding of the interrelationships between sex, gender, hormones and DED. © 2017 Elsevier Inc.