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.

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.

Willcox,M., Keir,N., Maseedupallu,V., Masoudi,S., McDermott,A., Mobeen,R., Purslow,C., Santodomingo-Rubio,J., Tavazzi,S., Zeri,F., Jones,L. W. CLEAR - Contact lens wettability, cleaning, disinfection and interactions with tears Contact Lens Anterior Eye 2021;44(2):157-191 [ Show Abstract ]

Contact lens materials have undergone significant changes over the past 20 years, particularly with respect to the introduction of silicone hydrogel materials. Whilst this development addressed hypoxic issues, other important areas relating to contact lens success, notably comfort, require further research.

Contact lens wettability remains a crucially important part of biocompatibility. Contact lenses can be made more wettable by incorporation of surfactants into blister packs, internal wetting agents, surface treatments or care solutions. However, there remains no clear association between contact lens wettability and comfort, making it challenging to determine the potential for these approaches to be of significant clinical benefit. Most contact lenses are used on a daily wear, reusable basis, which requires them to be disinfected when not worn. The ideal disinfecting solution would also improve comfort during wear. However, balancing these requirements with other factors, including biocompatibility, remains a challenge. Soft lens materials invariably take up and subsequently release certain components of disinfecting solutions onto the ocular surface. This may affect tear film stability and the normal ocular microbiome, and further research is needed in this area to determine whether this has any affect on comfort. Finally, contact lens materials sorb components of the tear film, and these interactions are complex and may change the biochemistry of the tear film, which in turn may affect their comfort.

In conclusion, the interaction between lens materials, tear film and disinfection solution plays an important role in the biocompatibility of lenses. However, the exact role and whether this can be altered to improve biocompatibility and comfort during wear remains debatable. This report summarises the best available evidence to examine this complex relationship and the opportunities for practitioners to enhance in-eye comfort of contemporary lenses, along with providing suggestions for areas of study that may provide further information on this topic.

Wolffsohn, J. S., Benítez-Del-Castillo, J., Loya-Garcia, D., Inomata, T., Iyar, G., Liang, L., Pult, H., Sabater, A., Starr, C., Vehof, J., Wang, M. T. M., Chen, W., Craig, J. P., Dogru, M., Perez Quinones, V. L., Stapleton, F., Sullivan, D. A., Jones, L., Arita, R., Belmonte, C., Chalmers, R. L., Galor, A, Ghosh, A., Labetoulle, M., Nichols, K. K., Pucker, A. D., Rocha, E, M., Sullivan, B., Versura, P., Willcox, M. D. P. TFOS DEWS III Diagnostic Methodology American Journal of Ophthalmology 2025;Online ahead of print [ Show Abstract ]

A standard approach to the diagnosis of dry eye disease across eye care practitioners is critical to reassuring the patient, providing consistency between practitioners and informing governments as to the true prevalence and resulting healthcare needs. The Tear Film & Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) III has reviewed the evidence-base since their previous reports published in 2017 and revised the definition to “Dry eye is a multifactorial, symptomatic disease characterized by a loss of homeostasis of the tear film and/or ocular surface, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities are etiological factors.” Key features from the definition include that dry eye disease is multifactorial, is a disease and not a syndrome and is always symptomatic. Differential diagnosis and ocular examination guidance is given along with the risk factors that should be discussed with the patient. The recommended screening questionnaire is the OSDI-6 with a cut-off score ≥4. A positive result together with a non-invasive breakup time 8mOsm/L) gives a diagnosis of dry eye. In addition, the ocular surface should be stained and positive symptomology together with >5 corneal fluorescein and/or >9 conjunctival lissamine green punctate spots and/or lid margin lissamine green staining of ≥2mm length & ≥25 %width also gives a diagnosis of dry eye. Subclassification was separated into tear film (lipid, aqueous and mucin/glycocalyx) and ocular surface and adnexa (anatomical misalignment, blink/lid closure, lid margin, neural dysfunction, ocular surface cell damage/disruption and primary inflammation/oxidative stress) components, with appropriate clinical tests and cut-offs provided to identify these etiological drivers in an individual, to inform appropriate management and therapy.

Wolffsohn,J. S., Arita,R., Chalmers,R., Djalilian,A., Dogru,M., Dumbleton,K., Gupta,P. K., Karpecki,P., Lazreg,S., Pult,H., Sullivan,B. D., Tomlinson,A., Tong,L., Villani,E., Yoon,K. C., Jones,L., Craig,J. P. TFOS DEWS II Diagnostic Methodology report Ocular Surface 2017;15(3):539-574 [ Show Abstract ]

The role of the Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II Diagnostic Methodology Subcommittee was 1) to identify tests used to diagnose and monitor dry eye disease (DED), 2) to identify those most appropriate to fulfil the definition of DED and its sub-classifications, 3) to propose the most appropriate order and technique to conduct these tests in a clinical setting, and 4) to provide a differential diagnosis for DED and distinguish conditions where DED is a comorbidity. Prior to diagnosis, it is important to exclude conditions that can mimic DED with the aid of triaging questions. Symptom screening with the DEQ-5 or OSDI confirms that a patient might have DED and triggers the conduct of diagnostic tests of (ideally non-invasive) breakup time, osmolarity and ocular surface staining with fluorescein and lissamine green (observing the cornea, conjunctiva and eyelid margin). Meibomian gland dysfunction, lipid thickness/dynamics and tear volume assessment and their severity allow sub-classification of DED (as predominantly evaporative or aqueous deficient) which informs the management of DED. Videos of these diagnostic and sub-classification techniques are available on the TFOS website. It is envisaged that the identification of the key tests to diagnose and monitor DED and its sub-classifications will inform future epidemiological studies and management clinical trials, improving comparability, and enabling identification of the sub-classification of DED in which different management strategies are most efficacious.

Wolffsohn,J. S., Berkow,D., Chan,K. Y., Chaurasiya,S. K., Fadel,D., Haddad,M., Imane, T., Jones,L., Sheppard,A. L., Vianya-Estopa,M., Walsh,K., Woods,J., Zeri,F., Morgan,P. B. BCLA CLEAR Presbyopia: Evaluation and diagnosis Contact Lens Anterior Eye 2024;47(4):102156 [ Show Abstract ]

It is important to be able to measure the range of clear focus in clinical practice to advise on presbyopia correction techniques and to optimise the correction power. Both subjective and objective techniques are necessary: subjective techniques (such as patient reported outcome questionnaires and defocus curves) assess the impact of presbyopia on a patient and how the combination of residual objective accommodation and their natural DoF work for them; objective techniques (such as autorefraction, corneal topography and lens imaging) allow the clinician to understand how well a technique is working optically and whether it is the right choice or how adjustments can be made to optimise performance. Techniques to assess visual performance and adverse effects must be carefully conducted to gain a reliable end-point, considering the target size, contrast and illumination. Objective techniques are generally more reliable, can help to explain unexpected subjective results and imaging can be a powerful communication tool with patients. A clear diagnosis, excluding factors such as binocular vision issues or digital eye strain that can also cause similar symptoms, is critical for the patient to understand and adapt to presbyopia. Some corrective options are more permanent, such as implanted inlays / intraocular lenses or laser refractive surgery, so the optics can be trialled with contact lenses in advance (including differences between the eyes) to better communicate with the patient how the optics will work for them so they can make an informed choice.

Wolffsohn,J. S., Calossi,A., Cho,P., Gifford,K., Jones,L., Jones,D., Guthrie,S., Li,M., Lipener,C., Logan,N. S., Malet,F., Peixoto-de-Matos,S. C., González-Méijome,J. M., Nichols,J. J., Orr,J. B., Santodomingo-Rubido,J., Schaefer,T., Thite,N., van der Worp,E., Tarutta,E., Iomdina,E., Ali,B. M., Villa-Collar,C., Abesamis-Dichoso,C., Chen,C., Pult,H., Blaser,P., Parra Sandra Johanna,G., Iqbal,F., Ramos,R., Carrillo Orihuela,G., Boychev,N. Global trends in myopia management attitudes and strategies in clinical practice – 2019 Update Cont Lens Anterior Eye 2020;43(1):9-17 [ Show Abstract ]

Purpose: A survey in 2015 identified a high level of eye care practitioner concern about myopia with a reported moderately high level of activity, but the vast majority still prescribed single vision interventions to young myopes. This research aimed to update these findings 4 years later. Methods: A self-administrated, internet-based questionnaire was distributed in eight languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy of available strategies and adoption levels of such strategies, and reasons for not adopting specific strategies. Results: Of the 1336 respondents, concern was highest (9.0 ± 1.6; p < 0.001) in Asia and lowest (7.6 ± 2.2; p < 0.001) in Australasia. Practitioners from Asia also considered their clinical practice of myopia control to be the most active (7.7 ± 2.3; p < 0.001), the North American practitioners being the least active (6.3 ± 2.9; p < 0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by pharmaceutical approaches and approved myopia control soft contact lenses (p < 0.001). Although significant intra-regional differences existed, overall, most practitioners did not consider single-vision distance under-correction to be an effective strategy for attenuating myopia progression (79.6 %), but prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients (63.6 ± 21.8 %). The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (20.6 %) and inadequate information (17.6 %). Conclusions: While practitioner concern about myopia and the reported level of activity have increased over the last 4 years, the vast majority of eye care clinicians still prescribe single vision interventions to young myopes. With recent global consensus evidence-based guidelines having been published, it is hoped that this will inform the practice of myopia management in future.

Wolffsohn,J. S., Calossi,A., Cho,P., Gifford,K., Jones,L., Li,M., Lipener,C., Logan,N. S, Malet,F., Matos,S., Meijome,J. M. G., Nichols,J .J., Orr, J.B., Santodomingo-Rubido,J., Schaefer,T., Thite,N., van der Worp,E., Zvirgzdina, M. Global trends in myopia management attitudes and strategies in clinical practice. Contact Lens and Anterior Eye 2016;39(2):106-116

Wolffsohn,J. S., Dhallu,S., Aujla,M., Laughton,D., Tempany,K., Powell,D., Gifford,K., Gifford,P., Wan,K., Cho,P, Stahl,U., Woods,J. International multi-centre study of potential benefits of ultraviolet radiation protection using contact lenses Contact Lens Anterior Eye 2022;45(6):101593 [ Show Abstract ]

Purpose
To examine the effects of long-term ultraviolet radiation (UVR) blocking wearing contact lenses on ocular surface health, eye focus and macular pigment.

Method
210 pre-presbyopic patients were recruited from Birmingham UK, Brisbane Australia, Hong Kong China, Houston USA and Waterloo Canada (n = 42 at each site). All patients had worn contact lenses for ≥ 5 years, half (test group) of a material incorporating a UVR-blocking filter. Ocular health was assessed using slit-lamp biomicroscopy and UV autofluorescence. Accommodation was measured subjectively with a push-up test and overcoming lens-induced defocus. Objective stimulus response and dynamic measures of the accommodative response were quantified with an open-field aberrometer. Macular pigment optical density (MPOD) was assessed using heterochromatic flicker photometry (MPS II).

Results
The two groups of participants were matched for age, sex, race, body-mass-index, diet, lifestyle, UVR exposure, refractive error and visual acuity. Limbal (p = 0.035), but not bulbar conjunctival redness (p = 0.903) was lower in eyes that had worn UVR-blocking contact lenses compared to controls. The subjective (8.0 ± 3.7D vs 7.3 ± 3.3D; p = 0.125) and objective (F = 1.255, p = 0.285) accommodative response was higher in the test group, but the differences did not reach significance. However, the accommodative latency was shorter in eyes that had worn UVR-blocking contact lenses (p = 0.003). There was no significant different in MPOD with UVR filtration (p = 0.869).

Conclusions
Blocking the transmission of UVR is beneficial in maintaining the eye’s ability to focus, suggesting that presbyopia maybe delayed in long-term UVR-blocking contact lenses wearers. These lenses also provide protection to the critical limbal region.

Wolffsohn,J. S., Dumbleton,K., Huntjens,B., Kandel,H., Koh,S., Kunnen,C. M. E., Nagra,M., Pult,H., Sulley,A. L., Vianya-Estopa,M., Walsh,K., Wong,S., Stapleton,F. CLEAR - Evidence-based contact lens practice Contact Lens Anterior Eye 2021;44(2):368-397 [ Show Abstract ]

Evidence-based contact lens -->practice involves finding, appraising and applying research findings as the basis for patient management decisions. These decisions should be informed by the strength of the research study designs that address the question, as well as by the experience of the practitioner and the preferences and environment of the patient. This reports reviews and summarises the published research evidence that is available to inform soft and rigid contact lens history and symptoms taking, anterior eye health examination (including the optimised use of ophthalmic dyes, grading scales, imaging techniques and lid eversion), considerations for contact lens selection (including the ocular surface measurements required to select the most appropriate lens parameter, lens modality and material selection), evaluation of lens fit, prescribing (teaching self-application and removal, adaptation, care regimen and cleaning instructions, as well as -->minimising risks of lens wear through encouraging compliance) and an aftercare routine.

Wolffsohn,J. S., Flitcroft,D. I., Gifford,K. L., Jong,M., Jones,L., Klaver,C. C. W., Logan,N. S., Naidoo,K., Resnikoff,S., Sankaridurg,P., Smith,E. L. 3rd, Troilo,D., Wildsoet,C. F. IMI - Myopia Control Reports Overview and Introduction Invest Ophthalmol Vis Sci 2019;60(3):M1-M19 [ Show Abstract ]

With the growing prevalence of myopia, already at epidemic levels in some countries, there is an urgent need for new management approaches. However, with the increasing number of research publications on the topic of myopia control, there is also a clear necessity for agreement and guidance on key issues, including on how myopia should be defined and how interventions, validated by well-conducted clinical trials, should be appropriately and ethically applied. The International Myopia Institute (IMI) reports the critical review and synthesis of the research evidence to date, from animal models, genetics, clinical studies, and randomized controlled trials, by more than 85 multidisciplinary experts in the field, as the basis for the recommendations contained therein. As background to the need for myopia control, the risk factors for myopia onset and progression are reviewed. The seven generated reports are summarized: (1) Defining and Classifying Myopia, (2) Experimental Models of Emmetropization and Myopia, (3) Myopia Genetics, (4) Interventions for Myopia Onset and Progression, (5) Clinical Myopia Control Trials and Instrumentation, (6) Industry Guidelines and Ethical Considerations for Myopia Control, and (7) Clinical Myopia Management Guidelines.

Wolffsohn,J. S., Kollbaum,P. S., Berntsen,D. A., Atchison,D. A., Benavente,A., Bradley,A., Buckhurst,H., Collins,M., Fujikado,T., Hiraoka,T., Hirota,M., Jones,D., Logan,N. S., Lundström,L., Torii,H., Read,S. A., Naidoo,K. IMI - Clinical Myopia Control Trials and Instrumentation Report Invest Ophthalmol Vis Sci 2019;60(3):M132-M160 [ Show Abstract ]

The evidence-basis based on existing myopia control trials along with the supporting academic literature were reviewed; this informed recommendations on the outcomes suggested from clinical trials aimed at slowing myopia progression to show the effectiveness of treatments and the impact on patients. These outcomes were classified as primary (refractive error and/or axial length), secondary (patient reported outcomes and treatment compliance), and exploratory (peripheral refraction, accommodative changes, ocular alignment, pupil size, outdoor activity/lighting levels, anterior and posterior segment imaging, and tissue biomechanics). The currently available instrumentation, which the literature has shown to best achieve the primary and secondary outcomes, was reviewed and critiqued. Issues relating to study design and patient selection were also identified. These findings and consensus from the International Myopia Institute members led to final recommendations to inform future instrumentation development and to guide clinical trial protocols.

Wolffsohn,J. S., Morgan,P. B., Barnett,M., Downie,L. E., Jacobs,D. S. Jones,L. W., Richdale, K., Stapleton,F., Vincent,S. J., Willcox,M. Contact Lens Evidence-Based Academic Reports (CLEAR) Contact Lens Anterior Eye 2021;44(2):129-131 [ Show Abstract ]

Since contact lenses were invented in 1887, innovations have included advances in optical design, material, care systems, wear modality, lens size, lens shape and applications. Over 19,000 peer reviewed academic papers on the contact lenses have been published. The Contact Lens Evidence-based Academic Reports (CLEAR) follow the exemplary work of organisations such as the Tear Film and Ocular Surface Society dry eye, meibomian gland disease, contact lens discomfort and dry eye II workshops and the International Myopia Institute white papers on myopia control, in collating and appraising the academic literature in an ocular field of interest. CLEAR represent the work of nearly 100 multidisciplinary experts in the field, who set out to critically review, synthesise and summarise the research evidence on contact lenses to date; this serves to inform both clinical practice, manufacturing innovation and future research directions.

Wolffsohn,J. S., Semp,D. A., Dutta,D., Jones,L., Craig,J. P., the TFOS ambassadors Clinical practice patterns in the management of dry eye disease: A TFOS international survey 2023-24 Ocular Surface 2024;Online ahead of print [ Show Abstract ]

Aims: To understand current clinical management of dry eye disease (DED), based on its perceived severity and subtype by practitioners across the world.

Methods: The content of the anonymous survey was chosen to reflect the DED management strategies reported by the Tear Film and Ocular Surface Society (TFOS) 2nd Dry Eye Workshop (DEWS II). Questions were designed to ascertain practitioner treatment choice, depending on the subtype and severity of DED. It was first created in English and then translated/back-translated into 14 languages for online completion.

Results: Completed surveys were received from 905 eye care practitioners (52% optometrists and 42% ophthalmologists) from across the globe. Many treatment strategies for DED were observed to be utilised by respondents, independent of severity and subtype, the most common being advice (82%), low (82%) and high (81%) viscosity unpreserved lubricants and lid wipes/scrubs (79%). Several treatments were prescribed across all severity levels (scaled from 1 mild to 10 severe), such as advice (median 4.5, range 4.8), artificial tears (median 5.1, range 4.6) and nutritional supplements (median 5.3, range 4.2). Others were prescribed more frequently with increasing disease severity, for instance, biologics (median 8.2, range 2.8) and surgical approaches (median 8.1, range 2.2). While a similar number of practitioners reported prescribing advice, artificial tears and anti-inflammatories regardless of DED subtype, the majority reported approaches for aqueous deficient DED were punctal occlusion, therapeutic contact lenses and secretagogues, while the use of oral essential fatty acids, topical lipid-containing products, lid hygiene and lid warming were the preferred management choices for evaporative DED.

Conclusions: There remains great variability in clinical approaches to DED management and until research-evidence definitively informs improved guidance, data from this survey can be used by clinicians to benchmark their practice.

Wolffsohn,J. S., Travé-Huarte,S., Jones,L., Craig,J. P., Wang,M. T. M., the TFOS ambassadors. Clinical practice patterns in the management of dry eye disease: A TFOS international survey Ocular Surface 2021;21(July):78-86 [ Show Abstract ]

Purpose
To examine clinical management and prescribing patterns for dry eye disease (DED), in relation to severity and subtype, by eye care practitioners across the globe.

Methods
An online, anonymous cross-sectional survey (on Qualtrics) translated into 14 languages was distributed to eye care practitioners across the globe. The survey included six questions around the management of DED, in relation to severity and subtype.

Result
The survey was completed by 1139 eyecare professionals (37% ophthalmologists and 58% optometrists) from 51 countries. Management varied significantly by continent and country (p < 0.01). The most commonly recommended management approaches, internationally, included general advice (87%), low (85%) and high (80%) viscosity-enhancing unpreserved lubricants and lid wipes/scrubs (81%). Some treatments were prescribed largely independently of severity (e.g. artificial tears and nutritional supplements) while oral antibiotics, punctal occlusion, topical anti-inflammatory/immunosuppressants, secretagogues, biologics, therapeutic contact lenses and surgical approaches were prescribed by more practitioners as severity increased. Essential fatty acids, lipid sprays/drops, lid hygiene, warm compresses, intense pulsed light therapy and antibiotics (topical or oral) were more commonly recommended for evaporative DED, while punctal occlusion, therapeutic contact lenses, secretagogues and biologics were more commonly recommended for aqueous deficient DED.

Conclusions
DED management differs across continents and countries. A wide range of management strategies are utilised at each severity level and between subtypes. The survey results enable clinicians to benchmark their practice to that of their peers, indicate where further research is required to optimise patient management and inform industry on how best to target product development.

Wolffsohn,J., Travé-Huarte,S., Stapleton,F,, Downie,L.E., Schulze,M., Guthrie,S., Stahl,U., Wang,M., Craig,J. Relative importance of tear homeostatic signs for the diagnosis of dry eye disease The Ocular Surface 2025;36(April):151-155 [ Show Abstract ]

Aim: Disease misdiagnosis is more likely if standardised diagnostic criteria are not used. This study systematically examined the effect on diagnosing dry eye disease (DED), when tests for evaluating tear film homeostasis were included or excluded from a multi-test protocol.

Method: For 1,427 participants across five sites, data for the full suite of diagnostic tests defined in the Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) Diagnostic Methodology report algorithm were evaluated; diagnostic sensitivity was calculated when individual signs were removed, and when different combinations of signs were required.

Results: Evaluating just one of the three TFOS DEWS II homeostatic signs resulted in between 12.3 % and 36.2 % of patients who met the DED diagnostic criteria not being assigned this diagnosis. While comprehensive ocular surface staining evaluation, comprising of corneal, conjunctival and lid margin staining, in combination with symptoms had the highest sensitivity (87.7 %) of the three markers, the sensitivity dropped to 44.6 % if only corneal staining was evaluated. Omitting either non-invasive tear breakup time or tear osmolarity each dropped the sensitivity by <5 %. The prevalence of DED was substantially reduced if a diagnosis required symptoms and two of the three signs to be present (by 43.7 %–61.2 %) and by 65.9 % if all three signs indicating a loss of tear film homeostasis were required. The outcomes of the analysis did not change significantly across differing severities of DED symptoms.

Conclusions: The TFOS DEWS II diagnostic algorithm of symptoms plus assessing for a tear film (non-invasive tear breakup time or tear osmolarity) and ocular surface sign can be considered a robust and appropriate approach for DED diagnosis.

Wong,K-Y., Liu,Y., Phan,C-M., Jones,L., Wong,M-S., Liu,J. Selection of DNA aptamers for sensing drugs treating eye disease: atropine and timolol maleate Sensors & Diagnostics 2024;3(10):1679-1688 [ Show Abstract ]

Effective monitoring of ocular drugs is crucial for personalized medicine and improving drug delivery efficacy. However, traditional methods face difficulties in detecting low drug concentrations in small volumes of ocular fluid, such as that found on the ocular surface. In this study, we used capture-SELEX to select aptamers for two commonly used ocular drugs, timolol maleate and atropine. We identified TMJ-1 and AT-1 aptamers with binding affinities of 3.4 μM timolol maleate and 10 μM atropine, respectively. Our label-free TMJ-1 biosensor using thioflavin T staining achieved a limit of detection (LOD) of 0.3 μM for timolol maleate. The AT-1 biosensor showed an LOD of 1 μM for atropine, and exhibited a 10-fold higher sensitivity compared to UV-visible spectroscopy. Future research in this area holds promise in enhancing drug delivery monitoring and improving the treatment of ocular diseases.

Wong,K. Y., Phan,C.M., Chan,Y.T., Chuy-Ying Yuen,A., Zhao,D., Chan,K. Y., Do,C. W., Chuen Lam,T., Han Qiao,J., Wulff,D., Hui,A., Jones,L., Wong,M. S. A review of using Traditional Chinese Medicine in the management of glaucoma and cataract Clinical and Experimental Optometry 2024;107(2):156-170 [ Show Abstract ]

Traditional Chinese Medicine has a long history in ophthalmology in China. Over 250 kinds of Traditional Chinese Medicine have been recorded in ancient books for the management of eye diseases, which may provide an alternative or supplement to current ocular therapies. However, the core holistic philosophy of Traditional Chinese Medicine that makes it attractive can also hinder its understanding from a scientific perspective – in particular, determining true cause and effect. This review focused on how Traditional Chinese Medicine could be applied to two prevalent ocular diseases, glaucoma, and cataract. The literature on preclinical and clinical studies in both English and Chinese on the use of Traditional Chinese Medicine to treat these two diseases was reviewed. The pharmacological effects, safety profile, and drug-herb interaction of selected herbal formulas were also investigated. Finally, key considerations for conducting future Traditional Chinese Medicine studies are discussed.

Wong,S., Murphy,P.J., Jones,L. Tear evaporation rates: What does the literature tell us? Contact Lens and Anterior Eye 2018;41(3):297-306 [ Show Abstract ]

Purpose: A previous literature review reported tear evaporation rates (TERs) from studies conducted on rabbits and humans between 1941 and 2003. Closer examination of the presented data revealed inaccuracies in the reporting of some values. This paper presents updated tables of TERs using values from the original papers cited in the review, in addition to incorporating new studies published between 2003 and 2016. Methods: A copy of each paper cited in the literature review was obtained and checked against the evaporation rate reported in the review. If the expected value could not be found in the cited paper, other papers by the same author were consulted to see if the value had been reported elsewhere. A PubMed and Scopus database search was conducted to find papers published on tear evaporimetry since 2003. Results: Two new tables of TERs were created, based on the values reported by the original author. To aid in interpretation, the majority of results are expressed in units of x 10−7 g/cm2/sec. Where it was not possible to convert these values, some values are expressed as x 10−7 g/sec, x 10−7 g/sec/eye or W/min. Conclusions: Two new tables of TERs have been compiled to provide an accurate representation of the values reported in the original papers. These tables can be used as a point of reference for other researchers to compare their results.

Wong,S., Srinivasan,S., Murphy,P. J., Jones,L. Comparison of meibomian gland dropout using two infrared imaging devices Cont Lens Anterior Eye 2019;42(3):311-317 [ Show Abstract ]

Purpose: To measure the degree of meibomian gland (MG) dropout in the lower eyelid determined by analysis of images obtained from the LipiView II (LVII) and the Keratograph 5M (K5M).

Methods: The inferior eyelid of each participant was imaged in a random order using both devices. All images were subjectively assessed by a single-masked investigator to determine the extent of MG loss using the Arita 4-point meiboscore grading scale. The images were also semi-objectively analyzed with ImageJ to calculate the percentage of MG dropout, by tracing around the non-glandular area and the total exposed area of the lower lid.

Results: Twenty participants (mean age 37 years, range 23–60, 60% female) completed the study. A significant difference in meiboscore (mean ± SD) was obtained between the LVII and the K5M (1.43 ± 0.78 vs. 1.90 ± 0.81, Z = 3.25, p = 0.001). The meiboscore 95% limit of agreement (LOA) ranged from −1.88 to +0.93. A significant difference was found with mean ImageJ percentage dropout between the LVII and the K5M (31.5% vs 43.4%, t = −4.8, p = 0.00003). The percentage dropout 95% LOA ranged from −42.79% to +19.06%.

Conclusions: LVII images had significantly lower meiboscores and less percentage MG dropout. Varying amounts of dropout were observed between the devices due the amount of eyelid that was typically everted and because of differences in image quality. These results indicate that these devices should not be used interchangeably to evaluate MG dropout.

Wong,S., Woods,J., Schulze,M., Fadel,D., Stahl,U., Jones,L. Performance of Delefilcon A Daily Disposable Contact Lenses in a Group of Digital Device Users Clinical Ophthalmology 2025;19(July):2439-2452 [ Show Abstract ]

Purpose: To assess the performance of delefilcon A daily disposable contact lenses (CL) in lens wearers who reported heavy digital device use.

Patients and Methods: This prospective study involved lens wearers who used digital devices ≥ 8 hours per day. Delefilcon A CL were dispensed for 2-weeks, to be worn ≥ 5 days/week, ≥ 13 hours/day, using digital devices as normal. At-home questionnaires rating comfort, dryness, and clarity of vision (0– 100 scale, 100=best) were completed on Days 1, 7, and 14± 1 upon insertion, after 8 hours of device use, and before removal. At the Day 14 visit, participants rated overall comfort, dryness, and vision (0– 100 scale) and completed a 5-point Likert-type scale questionnaire.

Results: Thirty-five participants were eligible, 32 completed (27 females; age: 25.3± 6.3 years). Median at-home ratings for comfort, dryness, and vision were ≥ 85, with no difference between days (all p≥ 0.09). Ratings decreased throughout the day (p≤ 0.005), except comfort (Day 7) and vision (Days 1 and 7), where ratings before removal were similar to 8 hours of device use (p≥ 0.014). After 2-weeks, median (range) overall ratings for comfort, dryness, and vision were 96 (70– 100), 93 (50– 100), and 95 (75– 100), respectively. Most agreed the CL performed well, providing good comfort (91%) and vision all-day-long (94%), and did not have dryness with device use (69%). When devices were used ≥ 8 hours, most felt the CL performed well (84%), were satisfied with comfort (88%) and vision (88%), did not experience eye strain (81%), eye fatigue (66%), or episodes of blurred vision (75%).

Conclusion: Delefilcon A lenses provided high satisfaction levels among lens wearers who spent a significant portion of their day using digital devices. Participants rated the CL highly for comfort and vision throughout the day, with most reporting no issues with dryness, eye strain, or blurred vision while wearing lenses and using digital devices.

Woods,C. A. Working better with GPs: Lessons to be learned from a study of health care networks in the management of diabetes Clinical and Experimental Optometry 2005;891-2

Woods,C. A., Cumming,B. The impact of test medium on use of visual analogue scales Eye and Contact Lens 2009;35(1):6-10 [ Show Abstract ]

OBJECTIVES: Visual analog scales are frequently used as a means of allowing participants to rate symptoms during clinical trials. The accuracy and reproducibility of these scales play an important role in determining the experimental value of the data they provide. This study was initiated to compare the data collected using paper- and computer-based (Tablet PC) analog scales to better understand the variability in data provided by a visual analog scale. METHODS: Thirty participants rated ocular comfort, redness, and clarity of vision (right and left eyes) on a nondemarcated horizontal line on both paper and a Tablet PC. Measurements were taken in the morning between the hours of 8:30 and 10:30 am and again the same day between 2:30 and 4:30 pm. RESULTS: The mean difference between the measures recorded in the morning for the 2 media was 2.6 ± 0.9 (confidence intervals, 2 standard errors of the differences) units on a 100 unit scale, with the Tablet PC having the higher mean measure. The limits of agreement (2 standard deviations of the differences) was 9.4 units. Comparing the difference of the differences (1.0 ± 1.3) between the 2 methods of measure (morning vs. afternoon) the visual analog scales on the Tablet PC seemed to have good reproducibility of agreement in comparison with the paper version. CONCLUSIONS: Discrepancy analysis yielded no significant difference and slight bias between paper- and computer-based analog scales. Repeatability of measures using the Tablet PC was also demonstrated. These results suggest that the choice of medium does not significantly influence the outcome for subjective analog scales. © 2009 Lippincott Williams & Wilkins, Inc.

Woods,C. A., Dumbleton,K., Jones,L., Fonn,D. Patient use of smartphones to communicate subjective data in clinical trials Optometry and Vision Science 2011;88(2):290-294 [ Show Abstract ]

Purpose. Various methods have been used in clinical trials to collect time-sensitive subjective responses, including study diaries, telephone interviews, and use of text messaging. However, all of these methods are limited by the uncertainty of when the participants enrolled in the study actually record their responses. This technical note reports on the utility of the BlackBerry smartphone to collect such data and why such a system provides advantages over other methods to report subjective ratings in clinical studies. Methods. The Centre for Contact Lens Research developed an on-line web-enabled system that permits participants to record and immediately transmit subjective rating scores in numerical form directly into a web-enabled database. This, combined with the utility of BlackBerrys, enabled time-specific e-mail requests to be sent to the study participants and then for that data to be simultaneously transmitted to the web-enabled database. This system has been used in several clinical trials conducted at the Centre for Contact Lens Research, in which data were collected at various times and in several specific locations or environments. Results. In the clinical trials conducted using this system, participants provided responses on 97.5% of occasions to the requests for data generated by the automated system. When the request was for data on a set date, this method resulted in responses of 84.1% of the time. Conclusions.The series of clinical trials reported here show the benefits of the utilization of the BlackBerry to collect time- or environment-sensitive data via a web-enabled system. Copyright © 2011 American Academy of Optometry.

Woods,C. A., Jones,D. A., Jones,L. W., Morgan,P. B. A seven year survey of the contact lens prescribing habits of Canadian optometrists Optometry and Vision Science 2007;84(6):505-510 [ Show Abstract ]

PURPOSE: Little is known about the contact lens prescribing habits of optometrists in North America. The purpose of this survey was to obtain data on the types of lenses and solutions prescribed by Canadian optometrists. METHODS: One thousand Canadian optometrists were surveyed annually over seven consecutive years (2000 to 2006; n = 7000) on their contact lens prescribing preferences. Each survey requested a range of information about the contact lenses prescribed to the first 10 patients after its receipt. RESULTS: Over this time period, 1008 (14.4%) of the surveys were returned, providing data on 9383 fits. During the seven-year period, the ratio of male:female fits was 1:2 (3123:6217, 43 not reported), with a mean age of 31.3 +/- 13.6 years (range 2 to 82 years). The ratio of new fits to refits was 2:3 (3780:5518, 85 not reported), with 91.3% of all fits being soft contact lenses (SCL). Of the SCL fits, 59.5% were spherical, 28.5% toric, 9.7% multifocal, and 2.3% cosmetic tints. Gas permeable (GP) fits were 46.6% spherical, 18.6% toric, 19.5% multifocal, and 6.6% were for orthokeratology (OK). Over the seven-year period, SCL prescribed for continuous wear (CW) increased from 3.2% to 14.3% between 2000 and 2004 and reduced to 8.1% in 2006, for all fits. The use of mid-water content (MWC) materials decreased from 34.6% to 2.7% and the use of silicone hydrogel (SH) lenses increased from 61.4% to 96.2%, for all CW fits. GP lens continuous wear increased from 0.7% to 30.6% of all GP lens fits by 2006. Daily wear (DW) of SH lenses decreased from 49.6% (2000) to 33.7% (2004) and then increased to 86.1% in 2006, for SH fits. MWC SCL fit on a monthly planned replacement (PR) basis reduced in popularity over the seven-year period (75.0% to 39.9%) and in 2006 more patients were fit overall with SH lenses (42.9%). The use of non-PR SCL declined from 20.5% to 4.5% of all fits. Fitting of low-water content lenses also declined (15.1% to 7.0%). High-water content (5.4% to10.2%) and SH lenses (5.4% to 42.9%) both increased. By 2006, the majority of GP lenses fit were with high Dk (HDK) materials (50.3%). CONCLUSIONS: The preferred contact lens modality for Canadian optometrists appears to be DW SCL, which are replaced monthly. The proportion of lenses used for CW peaked in 2004, with SH SCL being the preferred material. The market share for GP lenses remains relatively unchanged, with an increasing proportion used for OK and CW. The launch of DW SH lenses in 2004 resulted in a marked increase in their reported fits, with a similar effect following the launch of a HDK GP lens material for CW.