Publications

Showing 25 results out of 93 in total.

Walsh K. Lids and Dry Eye Interactive Webinar. April 14th, 2020

Walsh K. Artificial tears: preserved or non-preserved, that is the question New Zealand Optics 2020;September, : 26-27

Walsh K. Lids and Dry Eye Interactive Webinar. April 8th, 2020

Walsh K. Lids and Dry Eye BCDO conference, Vancouver, April, 2020

Walsh K, Jones L. Dry eye and contacts: Harmony or havoc? Global Specialty Lens Symposium, Las Vegas, USA, 2020

Walsh K, Jones L, Kojima R. Working smart: How to streamline your dry eye practice with new technology Global Specialty Lens Symposium, Las Vegas, USA, 2020

Walsh K, Jones L, Wolffsohn J. Dry Eye Workshop Global Specialty Lens Symposium, Las Vegas, USA, Jan, 2020

Walsh K, Schulze M. New Findings to Help Contact Lens Wearers in our New Normal Alberta Association of Optometrists, Webinar. November 3rd, 2020

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.

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, Craig JP, Jones L, Trave-Huarte S, Wang MTM. Global approaches to dry eye diagnosis The Association for Research in Vision and Ophthalmology, 2020 [ Show Abstract ][ PDF ]

Abstract
Purpose : Dry eye is a chronic and often debilitating disease, but understanding the prevalence and the effectiveness of management is hampered by differences in diagnosis and subclassification. This cross-sectional survey of eye care practitioners across the world aimed to identify the current approaches to dry eye diagnosis.

Methods : A Survey Monkey questionnaire was developed in consultation with dry eye specialists. Questions sought to determine the tests practitioners consider essential in the diagnosis of dry eye. Which aid the diagnosis? Which aid the subclassification into evaporative or aqueous deficient dry eye? Descriptive statistics were applied.

Results : 1,139 responses were received from 51 countries, 38% from ophthalmologists and 58% from optometrists, with a median of 11-15years of experience. The main tests reported as critical for a diagnosis of dry eye were verbal symptoms (69%), fluorescein breakup time (67%) and corneal staining (64%). In addition, reports of visual disturbance (57%), symptomology results from a validated questionnaire (48%), ocular redness (54%) and blink/lid closure analysis (54%) were commonly used to aid diagnosis. A median of 7 tests were deemed essential to diagnose dry eye (range 0-28). Tests that proved popular for differentiating dry eye subtypes were Schirmer/Phenol red thread test (32%), meibomian gland expression (32%) and orifice examination (32%) and blink/lid closure analysis (32%); use of verbal (38%) and questionnaire (30%) symptomatology, fluorescein breakup time (39%) and corneal staining (37%), for this purpose, were also noted.

Conclusions : In 2018 when the data were collected, dry eye disease diagnosis among practitioners was not standardised and there was little agreement on subclassification to inform the optimal treatment strategy. Future studies will determine whether recent global consensus reports and position papers unify diagnosis of the disease to improve the quality of epidemiological and treatment efficacy data.

This is a 2020 ARVO Annual Meeting abstract.

Wong S, Murphy P, Jones L. Impact of contemporary contact lens wear on tear evaporation measured using a novel evaporimeter The Association for Research in Vision and Ophthalmology, 2020 [ Show Abstract ][ PDF ]

Purpose : To determine whether a novel binocular evaporimeter is able to detect changes in tear evaporation rate (TER) before and while wearing delefilcon A and nesofilcon A contact lenses (CL).

Methods : The evaporimeter consists of a pair of swimming goggles modified with a temperature and relative humidity (RH) sensor embedded in both the right and left goggle lenses. For each measurement, the evaporimeter goggles were positioned and held tightly over the palpebral aperture of both eyes (to ensure an air-tight seal) for 20 seconds. There were two measurement conditions: Open Eye, during which the participants blinked every 3 seconds, and Closed Eye, when the eyes were closed. The difference between the Open and Closed Eye measurements was used to determine the TER from the ocular surface. TER was calculated as the slope of the change in RH in the period 5 to 13 seconds after the evaporimeter was placed over the eyes. Three repeated measurements were taken and averaged together. Two baseline TER measurements were recorded (15-minute interval) prior to CL insertion. Participants were randomized for delefilcon and nesofilcon CL lens wear in either eye. TER was measured after 15 minutes and ≥6 hours of CL wear. Measurements over time and between CL types were compared using repeated measures ANOVA with Bonferroni correction. (Mean±SD: Ambient temperature, 23.2±1.1°C; RH, 43.9±7.7%).

Results : Twenty habitual CL wearers (mean age: 28 years, range 18-71, 95% female) completed the study. Both evaporimeter sensors were able to detect a significant change in TER over time (right: p=0.003, left; p<0.0001). TER was significantly higher after 15 minutes (right: p=0.035, left: p<0.0001) and 6 hours of CL wear (right: p=0.002, left: p=0.001), compared to second baseline measurement. Both CLs showed a significant increase in TER between 15 minutes and 6 hours of lens wear (p=0.001). No significant difference in TER was observed between delefilcon and nesofilcon (p=0.770).

Conclusions : The novel evaporimeter was able to simultaneously measure TER from both eyes. TER significantly increased when CLs were worn and was highest after ≥6 hours of CL wear. No significant differences in TER were found between delefilcon A and nesofilcon A, which suggests that contemporary daily disposable CL materials behave in a similar manner with regards to their impact on TER, regardless of water content or material.

This is a 2020 ARVO Annual Meeting abstract.

Woods J, Guthrie S, Varikooty J, Jones L. Satisfaction of habitual wearers of reusable multifocal lenses when refitted with a daily disposable, silicone hydrogel multifocal lens Contact Lens Anterior Eye 2020 [ Show Abstract ][ PDF ]

Purpose: Visual performance with multifocal contact lenses (MFCL) can vary with lens design. This study simulated a real-world refit of habitual wearers of reusable MFCL with a silicone hydrogel (somofilcon A), daily disposable multifocal (DDMF) lens to assess visual and overall experience with the new design and modality.

Method: Subjects rated the DDMF and compared it with their habitual reusable MFCL. The habitual MFCL prescription was not reviewed or confirmed as optimal, though all reported having an eye-examination within 2-years. Subjects were masked to the DDMF brand. After 2 weeks of daily wear with the new lens, subjects reported their experience using 0-10 ratings and Likert scales.

Results: Twenty-eight subjects, spanning 14 habitual lens brands, completed the study. Visual acuity with DDMF was statistically better than with habitual MFCL for all four distances measured (all p<0.05); distance (≥6m): -0.040.09, long intermediate (1.5m): -0.110.11, short intermediate (0.75m): -0.100.09, and near (0.4m): 0.020.09. Subjective vision clarity was statistically better with the DDMF for distance tasks in the dark, long intermediate tasks, and when considering all visual needs (all p<0.05). There were no statistical differences (all p>0.05) for vision clarity performing tasks at distance, short intermediate and near. When asked for a preference, the DDMF was significantly preferred over habitual for long intermediate tasks (p=0.03), but not different for tasks at other distances. Ease of insertion was statistically better with the DDMF (p=0.03); ease of removal was not different. End of day comfort was not different from the habitual lenses (p=0.10), however the DDMF was rated better for end-of-day dryness (p=0.01) and overall satisfaction with lenses (p=0.04).

Conclusions: This daily disposable, silicone hydrogel (somofilcon A), multifocal lens provided good vision and overall performance. Many ratings showed it to provide statistically better performance than their habitual reusable MFCL, supporting the benefits of a trial wear period.

Xu,M., Sivak,J. G., McCanna,D. J. Ocular toxicology: synergism of UV radiation and benzalkonium chloride
Cutaneous and Ocular Toxicology 2020;39(4):370-379 [ Show Abstract ]

Purpose: To investigate the combined toxic effect of ultraviolet (UV) radiation and benzalkonium chloride (BAK), a common preservative in ophthalmic eye drops, on human corneal epithelial cells (HCEC).

Methods: Cultured HCEC were exposed to different combined and separate UV (280-400 nm) and BAK solutions at relevant human exposure levels. Human exposure to UV can occur before, during, or after eye drop installation, therefore, three different orders of ocular exposures were investigated: UV and BAK at the same time, UV first followed by BAK, and BAK first followed by UV. Control treatments included testing HCEC exposed to BAK alone and also HCEC exposed to UV alone. In addition, phosphate-buffered saline (PBS) was used as a negative control. After exposure, cell metabolic activity of the cultures was measured with PrestoBlue, and cell viability was determined using confocal microscopy with viability dyes.

Results: BAK alone reduced the metabolic activity and cell viability of HCEC in a dose- and time-dependent manner. UV alone at a low dose (0.17 J/cm2) had little toxicity on HCEC and was not significantly different from PBS control. However, UV plus BAK showed combined effects that were either greater than (synergistic) or equal to (additive) the sum of their individual effects. The synergistic effects occurred between low dose UV radiation (0.17 J/cm2) and low concentrations of BAK (0.001%, 0.002%, 0.003%, and 0.004%).

Conclusions: This investigation determined that at relevant human exposure levels, the combination of UV radiation (280-400 nm) and BAK can cause synergistic and additive toxic effects on human corneal epithelial cells. This finding highlights the importance of considering the combined ocular toxicity of BAK and solar radiation in the risk assessment of BAK-preserved ophthalmic solutions.

Yamasaki,K., Drolle,E., Nakagawa,H., Hisamuare,R., Ngo,W., Jones,L. W. Impact of a low molecular weight hyaluronic acid derivative on contact lens wettability Cont Lens Anterior Eye 2020;Online ahead of print [ Show Abstract ]

Purpose
To investigate the interaction of a novel low molecular weight hyaluronic acid derivative containing hydrophobic groups with soft contact lenses and its effect on lens hydrophilicity compared with a conventional form of hyaluronic acid.

Methods
This investigation studied the uptake of fluorescently-labelled hyaluronic acid and a low molecular weight hyaluronic acid derivative to four types of contact lenses using fluorescent microscopy and confocal laser scanning microscopy. Further, the four lens types were used to compare efficacy in improving hydrophilicity, as well as maintenance of contact angle measurements, in commercially available multipurpose solutions that contained either hyaluronic acid, the low molecular weight hyaluronic acid derivative, or an alternative wetting agent.

Results
The low molecular weight hyaluronic acid derivative was found to sorb more readily to silicone hydrogel lenses and exhibit a greater accumulation over time than conventional hyaluronic acid. Multipurpose solutions containing the low molecular weight hyaluronic acid derivative showed an increase in lens hydrophilicity through decreases in contact angle measurements when compared with those obtained from lenses treated with multipurpose solutions containing conventional hyaluronic acid or alternative wetting agents. This increase in lens hydrophilicity associated with the low molecular weight hyaluronic acid derivative was also maintained over multiple cycles in phosphate buffered saline, while alternative solutions with conventional hyaluronic acid did not.

Conclusion
Overall, lens treatment using a low molecular weight hyaluronic acid derivative-based solution lead to improved in vitro lens hydrophilicity.

Yee,A., Chan,V., Heynen,M., Phan,C. Jones,L. Uptake and release of a multipurpose solution biocide (MAP-D) from hydrogel and silicone hydrogel contact lenses using a radiolabel methodology Eye & Contact Lens 2020;Online ahead of print [ Show Abstract ]

Purpose:
The purpose of this study was to evaluate the uptake and release of radiolabelled myristamidopropyl dimethylamine (MAP-D) on reusable daily wear contact lenses (CLs) over 7 days.

Methods:
Three silicone hydrogel (SH) CL materials (lotrafilcon B, balafilcon A, senofilcon A) and two conventional hydrogel (CH) materials (etafilcon A, omafilcon A) were tested. A short-term (experiment 1, N=4) and a longer-term (experiment 2, N=3) study was conducted. In experiment 1, the CLs were incubated in 2 mL of phosphate buffered solution (PBS) containing 14C MAP-D (5 μg/mL) for 8 hrs. The release of 14C MAP-D was measured at t=0.25, 0.5, 1, 2, 4, 8, and 24 hr in PBS. In experiment 2, the CLs were incubated in the 14C MAP-D solution for 8 hrs followed by a 16-hr release in PBS. This cycle was repeated daily for 7 days. At the end of both experiments, lenses were extracted to determine the total uptake of MAP-D. The radioactivity was measured using a beta scintillation counter.

Results:
In experiment 1, all three SH lenses sorbed similar amounts of MAP-D (P=0.99), all of which were higher than the two CH materials (P<0.01). However, the CH materials released a greater amount of MAP-D than the SH materials (P<0.01). In experiment 2, the uptake of MAP-D in SH materials increased over 7 days, whereas the amount of MAP-D remained constant in the CH materials (P=0.99). Similar to experiment 1, the CH lenses released more MAP-D than SH lenses after 7 days (P<0.01).

Conclusion:
The SH materials absorbed greater amounts of MAP-D compared to CH materials. However, the CH materials released the greatest amount of MAP-D. Radioactive labelling of MAP-D offers a highly sensitive method of assessing the uptake and release profiles of biocides to CL materials.

Yee A, Phan CM, Heynen M, Walther H, Jones L. The uptake and release kinetics of myristamidopropyl dimethylamine (MAP-D) from contact lenses using radioactive labelling he Association for Research in Vision and Ophthalmology, 2020 [ Show Abstract ][ PDF ]

Purpose : Biocides are an important disinfecting component commonly found in contact lens (CL) multipurpose solutions (MPS). During the disinfection step, the uptake of biocides into CL materials can significantly reduce the efficacy of the MPS to disinfect the lens. An increased release of biocides from the CL can lead to clinical complications such as discomfort and corneal staining. However, detection methods using chromatography and spectrometry can be time-consuming and have low sensitivity. The purpose of this study was to evaluate the uptake and release of myristamidopropyl dimethylamine (MAP-D; ALDOX®) using a radiolabel method.

Methods : Radioactive (14C) MAP-D was purchased from Moravek Inc. (CA, USA). Five soft CL materials (lotrafilcon B, balafilcon A, senofilcon A, etafilcon A, omafilcon A) were tested (N=4). The lenses were incubated in PBS (ISO 18369-3) solution containing 2mL of 14C radioactive MAP-D (5µg/mL) for 8 hours, followed by a release period in PBS for 16 hours. The cycle was continued over a 7-day period with a new replenishing solution for each day. The samples were counted for their radioactive signal (CPM) using the LS6500 Beckman Coulter liquid scintillation beta counter (ON, CA). A standard curve was used to convert CPM to µg of MAP-D.

Results : After 7-days, the silicone hydrogel (SH) lenses, lotrafilcon B (36.21±0.42µg), balafilcon A (36.29±1.15µg) and senofilcon A (35.54±1.37µg) had a significantly greater uptake of MAP-D compared to the conventional hydrogel (CH) lenses, etafilcon A (7.66±1.19µg) and omafilcon A (6.54±0.94µg) (p<0.01). However, the percent of MAP-D released was higher for CH lenses, etafilcon A (80%), omafilcon A (93%) compared to SH lenses, lotrafilcon B (25%), balafilcon A (19%) and senofilcon A (19%) over the 7-days (p<0.01).

Conclusions : Radioactive labelling offers a highly sensitive and accurate way of assessing the uptake and release kinetics of MAP-D to CL materials. Greater uptake of MAP-D occurs to SH materials, and the release of MAP-D is relatively minor. While CH materials take up only low amounts of MAP-D, the majority of it is easily released from these materials.

This is a 2020 ARVO Annual Meeting abstract.

Yeu,E., Silverstein,S., Guillon,M., Schulze,M., Galaretta,D., Srinivasan,S., Manoj,V. Efficacy and Safety of Phospholipid Nanoemulsion-Based Ocular Lubricant for the Management of Various Subtypes of Dry Eye Disease: A Phase IV, Multicenter Trial Clinical Ophthalmology 2020;14:2561-2570 [ Show Abstract ]

Purpose: To evaluate the clinical efficacy and safety of propylene glycol/hydroxypropylguar (PG-HPG)-based nanoemulsion (Systane ® Complete) lubricant eye drops in participants with dry eye disease (DED).

Participants and Methods: In this phase IV, open-label, single-arm, interventional, multicenter study, adult participants with DED – subtyped into aqueous deficient, evaporative, and mixed dry eye – were instructed to instill one drop of PG-HPG in each eye twice a day for 28 days. Endpoints included change from baseline in tear film break-up time (TFBUT) (primary) and ocular discomfort visual analog scale (VAS) score at Day 14 and TFBUT at Day 28 (secondary). Safety was assessed throughout the study. Data were analyzed for overall patient cohort and by DED subtypes. Results: A total of 134 participants received treatment (mean age: 56.6 years; female: 75.4%). At Day 14, the mean (standard deviation [SD]) TFBUT increased from 2.6 (1.00) seconds at baseline to 4.2 (2.92) seconds (mean change: 1.5 [2.80] seconds); median change was 0.8 seconds (95% CI: 0.52, 1.19) for the overall cohort; the change was maintained at Day 28 (mean change: 1.4 (2.80) seconds, median change: 0.8 seconds (95% CI: 0.49, 1.17). Subgroup analysis showed a mean change (SD) from baseline in TFBUT of 1.1 (2.41) seconds for aqueous deficient, 2.4 (3.17) seconds for evaporative, and 1.2 (2.63) seconds for mixed dry eye at Day 14, respectively. The ocular discomfort VAS score improved (decreased) from baseline at Day 14 (mean [SD] change: −17.3 [24.80]) for the overall cohort, −22.0 [21.73] for aqueous deficient, −17.6 [24.17] for evaporative and −13.1 [27.49] for mixed dry eye subgroups). Adverse events (AEs) were reported in 9 (6.7%) participants. No serious AEs were reported during the study.

Conclusion: Our study findings demonstrated that PG-HPG-based nanoemulsion lubricant eye drops were effective and well tolerated in participants with DED and all of its subtypes. Keywords: aqueous deficient dry eye, dry eye disease, evaporative dry eye, propylene glycol/hydroxypropyl guar-nanoemulsion ocular lubricant, mixed dry eye