Chalmers,R. L., Begley,C. G., Edrington,T., Caffery,B., Nelson,D., Snyder,C., Simpson,T. The agreement between self-assessment and clinician assessment of dry eye severity Cornea 2005;24(7):804-810 [ Show Abstract ]

Purpose: The purpose of this analysis was to measure the degree of agreement between clinicians' assessment and subjects' self-assessment of dry eye severity in a cross-sectional, observational dry eye study. A secondary purpose was to identify the role of gender and age in that concordance. Methods: In a cross-sectional observational study, 162 dry eye subjects and 48 controls were recruited from clinical databases of ICD-9 codes in 6 clinical sites. Before examination, subjects gave a global self-assessment of the severity of their dry eye from "none" to "extremely severe." After a clinical examination that included dry eye tests, the clinician discussed the subjects' symptoms and then gave global clinician assessment of dry eye from "none" to "severe." We measured the degree of agreement in these global measures. Results: Although the correlation and agreement between clinician and self-assessment was significant (r = 0.720, P = 0.000; weighted K = 0.471; 95% CI = 0.395, 0.548; P = 0.000), the clinician assessment underestimated the severity in 40.9% of the subjects by at least 1 grade compared with the subjects' self-assessment. Over 54% of subjects over age 65 and 43% of the female subjects had their condition underestimated by the clinician (P < 0.05). Conclusions: Clinicians often relatively underestimated the severity of the subjects' self-assessment of dry eye in this clinical study, especially among the elderly and women. Eye care practitioners need better, more quantitative tools for the assessment of ocular surface symptoms to improve the concordance in severity assessment and to meet the needs of this symptomatic patient population by offering them appropriate treatments. Copyright © 2005 by Lippincott Williams & Wilkins.

Chamberlain,P., Bradley,A., Arumugam,B., Hammond,D., McNally,J., Logan N., Jones,D., Ngo,C., Peixoto-de-Matos S., Hunt,C., Young G. Long-term Effect of Dual-focus Contact Lenses on Myopia Progression in Children: A 6-year Multicenter Clinical Trial Optom Vis Sci 2022;99(3):204-212 [ Show Abstract ]

Significance: Treatment of myopic children with a dual-focus soft contact lens (DFCL; MiSight 1 day) produced sustained slowing of myopia progression over a six-year period. Significant slowing was also observed in children switched from control to treatment lenses (3 years in each lens).

Purpose: Evaluate the effectiveness of DFCLs in sustaining slowed progression of juvenile-onset myopia over a 6-year treatment period. Assess myopia progression in children who were switched to DFCL at the end of year 3.

Methods: Part 1 was a 3-year clinical trial comparing DFCLs with control CLs (Proclear 1 day) at four investigational sites. In Part 2, subjects completing Part 1 were invited to continue for 3 additional years during which all children were treated with MiSight 1 day DFCLs (52 and 56 from the initially treated (T6) and control (T3) groups, respectively). 85 subjects (45 (T3) and 40 (T6)) completed Part 2. Cyclopleged spherical equivalent refractive errors (SERE) and axial lengths (AL) were monitored and linear mixed model was used to compare their adjusted change annually.

Results: Average age at Part 2 baseline was 13.2 ± 1.3 and 13.0 ± 1.5 for the T6 & T3 groups respectively. Slowed myopia progression in the T6 group observed during Part 1 was sustained throughout Part 2 (Mean ± SEM: Change from baseline SERE(D) = -0.52 ± 0.076 vs -0.51 ± 0.076; change in AL(mm) = 0.28 ± 0.033 vs 0.23 ± 0.033, both P > .05). Comparing progression rates in Part 2 for the T6 and T3 groups respectively indicate that prior treatment does not influence efficacy (SERE -0.51 ± 0.076 vs -0.34 ± 0.077; AL 0.23 ± 0.03 vs 0.18 ± 0.03, both P > .05). Within-eye comparisons of AL growth revealed a 71% slowing for the T3 group (3-years older than Part 1), and further revealed a small subset of eyes (10%) that did not respond to treatment.

Conclusions: DFCLs continue to slow the progression of myopia in children over a six-year period revealing an accumulation of treatment effect. Eye growth of the initial control cohort with DFCL was slowed by 71% over the subsequent 3-year treatment period.

Chamberlain,P., Gonzalez-Meijome,J., Ngo,C., Jones,D., Young,G. A three-year randomised clinical trial of MiSight lenses for myopia control Optometry & Vision Science 2019;96(8):556-567 [ Show Abstract ]

SIGNIFICANCE: Results of this randomized, double-masked clinical trial demonstrate the effectiveness of the MiSight soft contact lens in slowing myopia progression over multiple years.

PURPOSE: The purpose of this study was to quantify the effectiveness of MiSight daily disposable soft contact lens in slowing the progression of juvenile-onset myopia.

METHODS: Myopic children (spherical equivalent refraction, -0.75 to -4.00 D; astigmatism, <1.00 D) aged 8 to 12 years with no prior contact lens experience were enrolled in a 3-year, double-masked, randomized clinical trial at four investigational sites in four countries. Subjects in each group were matched for age, sex, and ethnicity and were randomized to either a MiSight 1-day contact lens (test) or Proclear 1-day (control; omafilcon A) and worn on a daily disposable basis. Primary outcome measures were the change in cycloplegic spherical equivalent refraction and axial length.

RESULTS: Of the subjects enrolled, 75.5% (109/144) completed the clinical trial (53 test, 56 control). Unadjusted change in spherical equivalent refraction was -0.73 D (59%) less in the test group than in the control group (-0.51 ± 0.64 vs. -1.24 ± 0.61 D, P < .001). Mean change in axial length was 0.32 mm (52%) less in the test group than in the control group (0.30 ± 0.27 vs. 0.62 ± 0.30 mm, P < .001). Changes in spherical equivalent refraction and axial length were highly correlated (r = -0.90, P < .001). Over the course of the study, there were no cases of serious ocular adverse events reported. Four asymptomatic corneal infiltrative (one test, three control) events were observed at scheduled study visits.

CONCLUSIONS: Results of this clinical trial demonstrate the effectiveness of the MiSight daily disposable soft contact lens in slowing change in spherical equivalent refraction and axial length.

TRIAL REGISTRATION: ClinicalTrials.gov NCT01729208.

Chan,V. W. Y., Phan,C-M., Ngo,W., Jones,L. Lysozyme Deposition on Contact Lenses in an In Vitro Blink-Simulation Eye Model Versus a Static Vial Deposition Model Eye & Contact Lens 2021;47(7):388-393 [ Show Abstract ]

Purpose:
To evaluate active lysozyme deposition on daily disposable (DD) contact lenses (CL) using a novel in vitro blink model.

Methods:
Three conventional hydrogel DD CL materials (etafilcon A, omafilcon A, nelfilcon A) and three silicone hydrogel DD CL materials (delefilcon A, senofilcon A, somofilcon A) were tested. The device blink rate was set to 6 blinks/min with a tear flow rate of 1 μL/min using an artificial tear solution (ATS) containing lysozyme and other typical tear film components. After incubation at 2, 4, or 8 hr, lenses were removed, and lysozyme activity was measured. A separate experiment was conducted with lenses incubated in a static vial containing 480 μL of ATS.

Results:
Etafilcon A deposited significantly higher amounts of active lysozyme (402±102 μg/lens) than other lens materials after 8 hr (P<0.0001). Etafilcon A had a higher amount of active lysozyme using the blink model compared with the static vial (P=0.0435), whereas somofilcon A (P=0.0076) and senofilcon A (P=0.0019) had a higher amount of lysozyme activity in the vial compared with the blink model.

Conclusion:
The blink model can be tuned to provide quantitative data that closely mimics ex vivo studies and can be used to model deposition of lysozyme on CL materials.

Chan,V. W. Y., Phan,C-M., Walther,H., Ngo,W., Jones,L. Effects of Temperature and Blinking on Contact Lens Dehydration of Contemporary Soft Lens Materials Using an In Vitro Blink Model Translational Vision Science & Technology 2021;10(8):11 [ Show Abstract ]

Purpose: The purpose of this studywas to evaluate the effects of temperature and blinking on contact lens (CL) dehydration using an in vitro blink model.

Methods: Three silicone hydrogel (delefilcon A, senofilcon A, and comfilcon A) and two conventional hydrogel (etafilcon A and omafilcon A) CL materials were evaluated at 1
and 16 hours. The water content (WC) of the CLs was measured using a gravimetric method. Lenses were incubated on a blink model, internally heated to achieve a clinically relevant surface temperature of 35°C. An artificial tear solution (ATS) was delivered to the blink model at 4.5 μL/min with a blink rate of 6 blinks/min. A comparison set of lenses were incubated in a vial containing either 2 mL of ATS or phosphate-buffered saline (PBS) at 35°C.

Results: Increasing temperature to 35°C resulted in a decrease in WC for all tested CLs over time (P ≤ 0.0052). For most CLs, there was no significant difference in WC over time between ATS or PBS in the vial (P > 0.05). With the vial system, WC decreased and plateaued over time. However, on the blink model, for most CLs, the WC significantly decreased after 1 hour but returned toward initial WC levels after 16 hours (P > 0.05).

Conclusions: The reduction in WC of CLs on the eye is likely due to both an increase in temperature and dehydration from air exposure and blinking.

Translational Relevance: This study showed that the novel, heated, in vitro blink model could be used to provide clinical insights into CL dehydration on the eye.

Chang,J. M. L., Seo,J., Kwan,M. M. Y., Oh,S., McCanna,D. J., Subbaraman,L., Jones,L. Determining the Toxicity of UV Radiation and Chemicals on Primary and Immortalized Human Corneal Epithelial Cells Journal of Visualized Experiments 2021;173(July):e62675 [ Show Abstract ]

This article describes the methods of measuring the toxicity of ultraviolet (UV) radiation and ocular toxins on primary (pHCEC) and immortalized (iHCEC) human corneal epithelial cell cultures. Cells were exposed to UV radiation and toxic doses of benzalkonium chloride (BAK), hydrogen peroxide (H2O2), and sodium dodecyl sulfate (SDS). Metabolic activity was measured using a metabolic assay. The release of inflammatory cytokines was measured using a multi-plex interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor-alpha (TNF-α) assay, and cells were evaluated for viability using fluorescent dyes.

The damaging effects of UV on cell metabolic activity and cytokine release occurred at 5 min of UV exposure for iHCEC and 20 min for pHCEC. Similar percent drops in metabolic activity of the iHCEC and pHCEC occurred after exposure to BAK, H2O2, or SDS, and the most significant changes in cytokine release occurred for IL-6 and IL-8. Microscopy of fluorescently stained iHCEC and pHCEC BAK-exposed cells showed cell death at 0.005% BAK exposure, although the degree of ethidium staining was greater in the iHCECs than pHCECs. Utilizing multiple methods of assessing toxic effects using microscopy, assessments of metabolic activity, and cytokine production, the toxicity of UV radiation and chemical toxins could be determined for both primary and immortalized cell lines.

Chang,J. M. L., McCanna,D. J., Subbaraman,L. N., Jones,L. W. Efficacy of antimicrobials against biofilms of achromobacter and pseudomonas Optometry and Vision Science 2015;92(4):506-513 [ Show Abstract ]

Purpose. Achromobacter xylosoxidans and Pseudomonas aeruginosa biofilms can develop in ophthalmic products and accessories such as contact lens cases, leading to the development of ocular infections. This study evaluated the efficacy of the antimicrobials polyaminopropyl biguanide (PAPB) and benzalkonium chloride (BAK) against A. xylosoxidans and P. aeruginosa biofilms. Methods. Biofilms of A. xylosoxidans and P. aeruginosa used as a comparative control were formed by incubating the bacteria on contact lens cases and on coverslips in phosphate-buffered saline. The biofilms were then exposed to PAPB and BAK for 5 minutes and 4 hours. After exposure, alginate swabs were used to remove the biofilms from the lens cases and the bacteria were plated on tryptic soy agar for determination of survivors. Also, after exposure to these disinfectants, the A. xylosoxidans and P. aeruginosa biofilms were stained with SYTO 9 and propidium iodide. Using a confocal microscope with a 488-nm laser, the number of cells with damaged cell membranes was determined. Results. After 5 minutes of exposure to BAK or PAPB, A. xylosoxidans biofilms were more resistant to the antimicrobial effects of these disinfectants than P. aeruginosa biofilms. After 4 hours, both organisms were reduced by more than 3 logs after exposure to either BAK or PAPB. Confocal microscopy studies revealed that BAK was more effective at damaging A. xylosoxidans and P. aeruginosa cell membranes than PAPB at the concentrations used in ophthalmic products. Conclusions. Biofilms of the emerging pathogen A. xylosoxidans were more resistant to the disinfectants PAPB and BAK than biofilms of P. aeruginosa. Because of the emergence of A. xylosoxidans and the demonstrated greater resistance to the common ophthalmic preservatives BAK and PAPB than the standard Gram-negative organism P. aeruginosa, A. xylosoxidans biofilms should be assessed in antimicrobial challenge tests to assure the safety of multiuse ophthalmic products. Copyright © 2015 American Academy of Optometry.

Chen,H., Ge,J., Liu,X., Lu,F. The clinical analysis of 260 combined surgery of glaucoma and cataract Yan ke xue bao = Eye science / "Yan ke xue bao" bian ji bu 2000;16(2):102-105 [ Show Abstract ]

PURPOSE: To evaluate the efficacy of the combined surgery of glaucoma and cataract. METHODS: We reviewed 260 consecutive cases (279 eyes) who underwent the combined procedure of glaucoma and cataract. The patients were divided into three groups: group 1: extracapsular cataract extraction combined with trabeculectomy; group 2: extracapsular cataract extraction and intraocular lens implantation combined with trabeculectomy; group 3: cataract phacoemulsification and intraocular lens implantation combined with trabeculectomy; We analyzed and compared the postoperative visual acuity (VA), intraocular pressure(IOP) and complications among three groups. RESULTS: 16.2%, 32.4% and 43.5% of patients in three groups achieved 0.3 or better VA. The VA improved rate were 46.6%, 70.4% and 78.3% respectively. The mean postoperative IOP of three groups were 12.72 +/- 6.66 mmHg(1 mmHg = 0.133 kPa), 13.01 +/- 5.26 mmHg, 12.63 +/- 4.66 mmHg(compared with preoperative IOP, P < 0.01). The complications of group 3 were much less than those of the other two groups. CONCLUSION: The combined surgery can control the IOP effectively; The triple procedure can improve the VA rapidly and the phacoemulsification technique can decrease the complications.

Chen,P. Z., Pollit,L., Jones,L., Gu,F. X. Functional Two- and Three-Dimensional Architectures of Immobilized Metal Nanoparticles Chem 2018;4(10):2301-2328 [ Show Abstract ]

Recent methodological advances have led to unprecedented precision in the immobilization of metal nanoparticles. These methodologies come from a broad range of disciplines and organize nanoparticle building blocks into a diverse selection of distinct architectures—from small arrays to ordered superstructures. Because properties can be dictated by assembly, architectures can present enhanced properties of the constituent nanoparticles or generate emergent properties of the collective architecture that are unavailable to their constituent nanoparticles. Functional architectures use these properties to further tailor and optimize performance in myriad applications. This review discusses the methodological advances that enable the immobilization of metal nanoparticles in distinct two- and three-dimensional architectures. Discussion will include their distinctions, properties associated with the assemblies and their applications, and the key challenges and future directions in this growing field. The integration of nanomaterials has transformed key applications in a multitude of scientific fields, such as in energy, environmental technologies, water, medicine, and chemical processing. Metal nanoparticles, the predominant type of nanomaterial, are at the center of many of these applications. Conventionally, the physical properties of metal nanoparticles, such as size and shape, are engineered to alter properties and enhance performance. Recent work has developed a new approach: immobilizing metal nanoparticles in architectures. These structures generate enhanced or emergent properties, which can be used to further improve performance in applications, and promise the next generation of applications of metal nanoparticles in science and society. This review discusses the methods (from a wide range of disciplines) that immobilize nanoparticles in precise two- and three-dimensional architectures. Also discussed are the properties that arise from and the utility of the architectures. Metal nanoparticles present enhanced, or emergent, properties when immobilized in precisely configured two- and three-dimensional architectures. Recent methodological advances in a broad range of fields enable the construction of a diverse selection of such architectures. This review discusses these methodologies, their constructed products, and the properties exhibited by the architectures. It also discusses the distinctions, sometimes subtle, between methodologies that often dictate the types of architectures that they can construct and thus the resultant properties that can be presented.

Cheung,S., Lorentz,H., Drolle,E., Leonenko,Z., Jones,L. W. Comparative study of lens solutions' ability to remove tear constituents Optometry and Vision Science 2014;91(9):1045-1061 [ Show Abstract ]

PURPOSE: The purpose of this study was to use atomic force microscopy to compare and characterize the cleaning abilities of a hydrogen peroxide-based system (HPS) and a polyhexamethylene biguanide-containing multipurpose solution (MPS) at removing in vitro deposited tear film constituents, as well as to determine deposition patterns on various silicone hydrogel contact lenses. METHODS: Silicone hydrogel materials - balafilcon A (BA), lotrafilcon B (LB), and senofilcon A (SA) - were incubated for 1 week in an artificial tear solution (ATS) containing representative lipids, proteins, and salts from the tear film. Atomic force microscopy was used to resolve each lens before and after being cleaned overnight in HPS or MPS. Atomic force microscopy was used again to resolve HPS/MPS-cleaned lenses, which were reincubated in fresh ATS for 1 week, before and after an overnight clean in their respective cleaning solution. RESULTS: Atomic force microscopy imaging was able to characterize lens deposits with high resolution. Lenses incubated in ATS revealed distinct differences in their deposition pattern across lens materials. The surface of BA contained about 20-nm-high deposits, whereas deposit heights up to 150 nm completely occluded the surface of SA. Lotrafilcon B lenses revealed clusters of deposits up to 90 nm. The use of either lens solution left trace amounts of tear film constituents, although components from the MPS were seen adsorbed onto the surface after cleaning. Surface roughness (Ra) measurements revealed a significant difference between ATS-incubated and HPS/MPS-cleaned SA and LB lenses (p < 0.05). Ra between first incubated and HPS/MPS-cleaned reincubated SA and LB was also significant (p < 0.05). CONCLUSIONS: Unique variations in ATS deposition patterns were seen between lenses with atomic force microscopy. The application of both HPS and MPS removed most visible surface deposits. © American Academy of Optometry.

Cheung,S., Subbaraman,L. N., Ngo,W., Jay,G. D., Schmidt,T. A., Jones,L. Localization of full-length recombinant human proteoglycan-4 in commercial contact lenses using confocal microscopy Journal of Biomaterials Science, Polymer Edition 2020;31(1):110-122 [ Show Abstract ]

The aim of this study was to determine the sorption location of full-length recombinant human proteoglycan 4 (rhPRG4) tagged with fluorescein isothiocyanate (FITC) to four silicone hydrogel contact lenses [balafilcon A (PureVision, Bausch + Lomb), senofilcon A (Acuvue Oasys, Johnson & Johnson), comfilcon A (Biofinity, CooperVision), lotrafilcon B (Air Optix, Alcon)] and one conventional hydrogel lens [etafilcon A (Acuvue 2, Johnson & Johnson)], using confocal laser scanning microscopy (CLSM). Lenses (n = 3 each) were incubated under two conditions: (1) FITC-rhPRG4 solution at 300 μg/mL and (2) phosphate-buffered saline, for 1 h at 37 °C in darkness with gentle shaking. The central 4 mm of each lens was removed and viewed with the Zeiss 510 CLSM using an argon laser at 488 nm (FITC excitation 495 nm, emission 521 nm). Depth scans were taken at 1 μm intervals to a maximum depth of 100 μm. All lens materials demonstrated sorption of rhPRG4. Both senofilcon A and balafilcon A revealed FITC-rhPRG4 penetration into the bulk of the lens, generally favoring the surface. rhPRG4 was observed exclusively on the surface of lotrafilcon B, with no presence within the bulk of the lens. rhPRG4 was evenly distributed throughout the bulk of the lens, as well as on the surface, for comfilcon A and etafilcon A. The sorption profile of FITC-rhPRG4 was successfully visualized using CLSM in various contact lens materials. The polymer composition, surface treatment and pore size of the material can influence the sorption of rhPRG4.

Chong,T., Simpson,T., Fonn,D. The repeatability of discrete and continuous anterior segment grading scales Optometry and Vision Science 2000;77(5):244-251 [ Show Abstract ]

Purpose: To investigate the repeatability of three anterior segment clinical grading scales: 1) verbal descriptors scale (VDS), 2) photographic matching scale (PS), and 3) continuous matching scale (CS). Methods: Five optometrists graded 30 slides each of 3-9-o'clock staining, bulbar redness, and palpebral conjunctival roughness twice, separated by at least a day. VDS and PS were five-point scales (0-4.) with half grades permitted. The CS was a 5-second, 240-frame video movie generated using morphing software. PS and CS grading was done with references presented on a computer screen. Results: Averaged across observers, the test-retest intraclass correlation, correlation coefficient of concordance, and Pearson's r ranged from 0.95 to 0.99 (all p < 0.001). Coefficients of repeatability using CS to grade all three ocular conditions ranged between 0.31 and 0.49. The corresponding PS and VDS coefficients of repeatability ranged between 0.37 and 0.49; PS generally had better repeatability than VDS. Conclusions: Each of the clinical grading scales was reliable. The coefficients of repeatability showed that bulbar redness and palpebral conjunctival roughness were graded with higher precision using CS.

Chow,L. M., Subbaraman,L. N., Sheardown,H., Jones,L. Kinetics of in vitro lactoferrin deposition on silicone hydrogel and FDA group II and group IV hydrogel contact lens materials Journal of Biomaterials Science, Polymer Edition 2009;20(1):71-82 [ Show Abstract ]

The aim of this study was to compare the kinetics of lactoferrin deposition on silicone hydrogel (SH) and conventional FDA group II and group IV hydrogel contact lens materials. Seven lens materials, two conventional (etafilcon A, FDA group IV; omafilcon A, FDA group II) and five SH (lotrafilcon A, lotrafilcon B, balafilcon A, galyfilcon A and senofilcon A), were incubated in 1 ml (125)I-labeled lactoferrin solution for time periods ranging from 1 h to 28 days. At the end of specified incubation periods radioactive counts were determined on the lenses using an Automatic Gamma Counter. There was a gradual increase in lactoferrin deposition on all the lenses across all time points. At the end of 28 days the amount of lactoferrin/lens in microg was 11.3 +/- 1.9 for etafilcon A, 6.8 +/- 2.0 for omafilcon A, 2.1 +/- 0.9 for lotrafilcon A, 3.1 +/- 1.0 for lotrafilcon B, 11.8 +/- 2.9 for balafilcon A, 5.4 +/- 1.1 for galyfilcon A and 5.6 +/- 0.6 for senofilcon A. After 28 days, etafilcon A and balafilcon A deposited lactoferrin to the greatest degree (P < 0.05), but these were not different from each other (P = 0.48), while lotrafilcon A and B deposited the least (P < 0.05 vs. other lenses; P = 0.57 with each other). Galyfilcon A, senofilcon A and omafilcon A (P < 0.05 compared with other lenses; P > 0.05 with each other) deposited intermediate levels of lactoferrin. We concluded that radiochemical analysis is a sensitive and effective technique to determine the small quantities of lactoferrin deposited on SH lenses. The kinetics of lactoferrin deposition on contact lens materials depend on the chemical structure of the lens material.

Cox,S. M., Berntsen,D. A., Chatterjee,N., Hickson-Curran,S. B., Jones,L. W., Moezzi,A. M., Morgan,P. B., Nichols,J. J. Eyelid margin and meibomian gland characteristics and symptoms in lens wearers Optometry and Vision Science 2016;93(8):901-908 [ Show Abstract ]

Purpose. To describe the lid margin characteristics of contact lens wearers and relate them to comfort during lens wear. Methods. Three study sites enrolled habitual contact lens wearers. Subjects completed the Comfort domain of the Contact Lens User Experience (CLUE) questionnaire, and each eye was graded for the presence of mucocutaneous junction (MCJ) displacement, lid margin irregularity, and lid margin vascularity. Examiners counted the number of meibomian gland (MG) orifices in the central centimeter of the lower eyelid and the number of those that showed pouting/plugging and vascular invasion. MG expressibility was graded according to the Shimazaki schema. Subjects were grouped based on presence/ absence of each characteristic, total number of orifices (=5 vs. 0). Descriptive statistics are reported. A linear model was used to assess the fixed effect of each characteristic on combined CLUE score and each CLUE statement, if the effect on combined CLUE score showed p < 0.10. Results. The study included 203 subjects (67.5% female) with mean age (±SD) of 30.3 ± 9.6 years. The most commonly observed characteristics were orifice pouting/plugging, compromised MG expressibility, and lid margin vascularity (35.0, 30.3, and 20.4%, respectively). MCJ displacement and MG expressibility had an effect on the combined CLUE score such that individual CLUE statements were analyzed (p = 0.01 and p = 0.06, respectively). MCJ displacement had an effect on comfort upon insertion (p = 0.01), comfort after 5 minutes (p = 0.03), end-of-day comfort (p = 0.01), and ability to maintain ocular moisture (p = 0.030). MG expressibility had a significant effect on general comfort (p = 0.01), comfort throughout the day (p = 0.02), and the ability to maintain ocular moisture (p = 0.02). Conclusions. MCJ displacement and MG expressibility have an effect on contact lens comfort. © Copyright 2016 American Academy of Optometry.

Craig,J. P., Alves,M., Wolffsohn,J., Downie,L. E., Efron,N., Galor,A., Gomes,J. A. P., Jones,L., Markoulli,M., Stapleton,F., Starr,C. E., Gallant Sullivan,A., Willcox,M. D. P., Sullivan,D. A. TFOS lifestyle report introduction: A lifestyle epidemic – Ocular surface disease Ocular Surface 2023;28(April):304-309 [ Show Abstract ]

Lifestyle defines how a person lives. While the way we live can impact our environment, thed environment can influence the way we live, and both can affect our health. The ocular surface, and in particular the tear film, is susceptible to modifications due to its external (e.g. environmental conditions, lifestyle and societal challenges, and the digital environment), applied (e.g. contact lens wear and cosmetics) or internal (e.g. nutrition, and elective medications and procedures) environments. Consequently, it is critical for clinicians to understand the impact of lifestyle choices on the ocular surface so that they can communicate with their patients to optimise their health and, wherever possible, institute preventative steps to mitigate potential health risk factors.

To increase awareness of the potential impacts of lifestyle choices on ocular surface health, the Tear Film & Ocular Surface Society (TFOS) launched the TFOS Workshop entitled “A Lifestyle Epidemic: Ocular Surface Disease.” Consistent with prior TFOS Workshops [[1], [2], [3], [4]], the aim was to review existing literature, to identify gaps in knowledge and to propose future directions for research, with the long-term goal of improving the lives of individuals affected by ocular surface disease around the world.

Under the leadership of the Workshop Chair Jennifer Craig, Vice Chair Monica Alves, and Organizer David Sullivan, a Steering Committee was formed (Table 1) to plan and execute this TFOS Lifestyle Workshop. The Steering Committee was committed to an evidence-based approach and a process of open communication, dialogue and transparency, to achieve a consensus concerning the relationship(s) between lifestyle factors and their impact on ocular surface disease.

Craig,J. P., Bitton,E., Dantam,J., Jones,L., Ngo,W., Wang,M. T. M Short-term tolerability of commercial eyelid cleansers: A randomised crossover study Contact Lens Anterior Eye 2022;45(6):101733 [ Show Abstract ]

Purpose
To evaluate the short-term tolerability of five commercially available anti-demodectic eyelid cleansers; OCuSOFT Oust Demodex (OD), I-MED I-Lid’n Lash Plus (ILL+), Labtician BlephaDex (BD), Chrissanthe Eye Cleanse (EC), and Théa Blephademodex (BDdx).

Methods
Thirty healthy non-contact lens wearers (18 female; mean ± SD age, 33 ± 12 years) were enrolled in a prospective randomised crossover study. On separate visits, spaced at least 48 h apart, participants were randomised to receive topical application of one of five eyelid cleansers or saline. Participants rated subjective ocular discomfort during the 10-minute post-application period. Visual acuity, non-invasive tear film stability, conjunctival hyperaemia, and ocular surface staining were assessed at baseline and 10 min.

Results
No inter-group differences in ocular parameters were noted at baseline (all p > 0.05). Ocular discomfort scores significantly exceeded baseline scores for 60 s following BD application, 120 s with OD, 135 s with BDdx, 150 s with ILL+, and 195 s with EC (all p < 0.05). Deterioration in non-invasive tear film stability, limbal conjunctival hyperaemia, as well as corneal, conjunctival, and lid margin staining was detected following EC application (all p < 0.05), and increased bulbar conjunctival hyperaemia was observed following both EC and ILL+ treatment (both p < 0.05).

Conclusions
Study outcomes highlight varying tolerability profiles with different anti-demodectic lid cleanser preparations, and the potential to induce tear film instability, conjunctival hyperaemia and ocular surface staining on application. Awareness of possible adverse effects arising from topical application of commercial anti-demodectic lid cleanser formulations may help clinicians set realistic patient expectations and encourage better compliance in their use of lid hygiene therapies.

Craig,J. P., Nelson,J. D., Azar,D. T., Belmonte,C., Bron,A. J., Chauhan,S. K., de Paiva,C. S., Gomes,J. A. P., Hammitt,K. M., Jones,L., Nichols,J. J., Nichols,K. K., Novack,G. D., Stapleton,F. J., Willcox,M. D. P., Wolffsohn,J. S., Sullivan,D. A. TFOS DEWS II Report Executive Summary Ocular Surface 2017;15(4):802-812 [ Show Abstract ]

This article presents an Executive Summary of the conclusions and recommendations of the 10-chapter TFOS DEWS II report. The entire TFOS DEWS II report was published in the July 2017 issue of The Ocular Surface. A downloadable version of the document and additional material, including videos of diagnostic and management techniques, are available on the TFOS website: www.TearFilm.org.

Craig,J. P., Nelson,J. D., Azar,D. T., Belmonte,C., Bron,A. J., Chauhan,S. K., de Paiva,C. S., Gomes,J. A. P., Hammitt,K. M., Jones,L., Nichols,J. J., Nichols,K. K., Novack,G. D., Stapleton,F. J., Willcox,M. D. P., Wolffsohn,J. S., Sullivan,D. A. TFOS DEWS II Report Executive Summary Ocular Surface 2017;15(4):802-812 [ Show Abstract ]

This article presents an Executive Summary of the conclusions and recommendations of the 10-chapter TFOS DEWS II report. The entire TFOS DEWS II report was published in the July 2017 issue of The Ocular Surface. A downloadable version of the document and additional material, including videos of diagnostic and management techniques, are available on the TFOS website: www.TearFilm.org.

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

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;20(April):62-69 [ 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.

Dalton,K., Schneider,S., Sorbara,L., Jones,L. Confocal microscopy and optical coherence tomography imaging of hereditary granular dystrophy Contact Lens and Anterior Eye 2010;33(1):33-40

Dalton,K., Sorbara,L. Fitting an MSD (Mini Scleral Design) rigid contact lens in advanced keratoconus with INTACS Contact Lens and Anterior Eye 2011;34(6):274-281

Dalton,K., Subbaraman,L. N., Rogers,R., Jones,L. Physical properties of soft contact lens solutions Optometry and Vision Science 2008;85(2):122-128 [ Show Abstract ]

Purpose. To investigate the physical properties of commercially available soft contact lens solutions.
Methods. The pH, osmolality, surface tension (ST), and viscosity of various soft contact lens solutions were measured at room temperature. Viscosity measurements were also taken at 34°C. The solutions examined were Opti-Free Express (OFX), Opti-Free RepleniSH (OFR), Complete Moisture Plus (COM), UltraCare (UC), ReNu MultiPlus, Sensitive Eyes, AOSept (AO), Clear Care, SoloCare Aqua, and SoftWear saline. The peroxide solutions were measured before and after neutralization.
Results. The pH of most solutions was close to neutral (range 7.00-7.36), except for OFX and neutralized AO and Clear Care. The osmolality values of most solutions were in the 275 to 310 mOsm/kg range. OFX exhibited a significantly lower osmolality (225 mOsm/kg; p < 0.001), whereas UC was significantly higher (329 mOsm/kg; p < 0.001). Neutralized AO and SoftWear saline had ST values of approximately 67 mN/m. OFX, OFR, and SoloCare Aqua exhibited low ST values in the 30 to 35 mN/m range. The remaining solutions exhibited intermediate ST values of approximately 40 mN/m. These three groupings were significantly different (p < 0.001). The average viscosity of most solutions at room temperature was between 0.95 and 1.26 cP, except for COM (3.02 cP; p < 0.001). At 34°C, the average viscosity of most solutions was between 0.70 and 0.83 cP, except for COM, which had a viscosity of 1.92 cP (p < 0.001). The un-neutralized peroxide solutions had very different pH and osmolality values from all the solutions that would directly contact the eye (p < 0.001). Their viscosity and ST values were similar (p = NS).
Conclusions. This study detailed many physical properties of soft lens solutions that are not readily available and indicated that certain properties vary significantly among these products.

Dantam,J., McCanna,D. J., Subbaraman,L. N., Papinski,D., Lakkis,C., Mirza,A., Berntsen,D. A., Morgan,P., Nichols,J. J., Jones,L. W. Microbial contamination of contact lens storage cases during daily wear use Optometry and Vision Science 2016;93(8):925-932 [ Show Abstract ]

Purpose. To evaluate contact lens (CL) storage case contamination when used with four different CL care solutions during daily wear of three different CL materials. Methods. A parallel, prospective, bilateral, randomized clinical trial (n = 38) was conducted. Subjects were randomly assigned to use one of three CL materials (etafilcon A, senofilcon A, or galyfilcon A) on a daily wear basis. Subsequently, each subject randomly used one of four different CL care solutions (Biotrue, OPTI-FREE PureMoist, RevitaLens OcuTec, and CLEAR CARE) for 2 weeks, along with their respective storage cases. After every 2-week period, their storage cases were collected and the right and left wells of each storage case were randomized for two procedures: (1) microbial enumeration by swabbing the storage case surface and (2) evaluation of biofilm formation (multipurpose solution cases only) using a crystal violet staining assay. Results. More than 80% of storage cases were contaminated when used in conjunction with the four CL care solutions, irrespective of the CL material worn. Storage cases maintained with CLEAR CARE (mean Log colony forming units (CFU)/ well ± SD, 2.0 ± 1.0) revealed significantly (p < 0.001) greater levels of contamination, compared to those maintained with Biotrue (1.3 ± 0.8) and RevitaLens OcuTec (1.2 ± 0.8). Predominantly, storage cases were contaminated with Gram-positive bacteria (= 80%). There were significant differences (p = 0.013) for the levels of Gram-negative bacteria recovered from the storage cases maintained with different CL care solutions. Storage cases maintained withOPTI-FREE PureMoist (0.526 ± 0.629) showed significantly higher biofilm formation (p = 0.028) compared to those maintained with Biotrue (0.263 ± 0.197). Conclusions. Levels of contamination ranged from 0 to 6.4 Log CFU/storage case well, which varied significantly (p < 0.001) between different CL care solutions, and storage case contamination was not modulated by CL materials. © Copyright 2016 American Academy of Optometry.

Dantam,J., Subbaraman,L. N., Jones,L. Adhesion of Pseudomonas aeruginosa, Achromobacter xylosoxidans, Delftia acidovorans, Stenotrophomonas maltophilia to contact lenses under the influence of an artificial tear solution Biofouling 2020;36(1):32-43 [ Show Abstract ]

Corneal infection is a devastating sight-threatening complication that is associated with contact lens (CL) wear, commonly caused by Pseudomonas aeruginosa. Lately, Achromobacter xylosoxidans, Delftia acidovorans, and Stenotrophomonas maltophilia have been associated with corneal infection. This study investigated the adhesion of these emerging pathogens to CLs, under the influence of an artificial tear solution (ATS) containing a variety of components commonly found in human tears. Two different CL materials, etafilcon A and senofilcon A, either soaked in an ATS or phosphate buffered saline, were exposed to the bacteria. Bacterial adhesion was investigated using a radio-labeling technique (total counts) and plate count method (viable counts). The findings from this study revealed that in addition to P. aeruginosa, among the emerging pathogens evaluated, A. xylosoxidans showed an increased propensity for adherence to both CL materials and S. maltophilia showed lower viability. ATS influenced the viable counts more than the total counts on CLs.