Efron,N., Jones,L. W., Morgan,P. B., Nichols,J. J. On the art and science of rigid contact lens fitting Clinical and Experimental Optometry 2021;104(6):684-690 [ Show Abstract ]

Examination of the literature can help answer the age-old question of the extent to which rigid contact lenses can be considered an art versus a science.

Efron,N., Jones,L. W., Morgan,P. B., Nichols,J. J. Bibliometric analysis of the literature relating to silicone hydrogel and daily disposable contact lenses Journal of Optometry 2022;15(1):44-52 [ Show Abstract ]

Purpose
Publication metrics are derived for the fields of silicone hydrogel (SH) and daily disposable (DD) contact lenses.

Methods
A search of the Scopus database for papers in the fields of SH and DD contact lenses found 979 SH and 291 DD papers. Subject-specific h-indices for SH lenses (hSH-index) and DD lenses (hDD-index) were derived, in relation to five categories – authors, institutions, countries and journals – to serve as measures of impact. A short list of the most impactful entities was generated for each of the above five categories in the SH and DD fields.

Results
A paper entitled “Soft contact lens polymers: An evolution” by Nicholson and Vogt was the most highly cited article (495 citations) in both SH and DD fields. The most impactful entities for the SH and DD fields were: authors – Lyndon Jones (hSH = 33) and Philip Morgan (hDD = 15); institutions – the University of Waterloo (hSH = 37) and the University of New South Wales (hDD = 15); countries – the United States (hSH = 45) and the United Kingdom (hDD = 24); and journals – Optometry and Vision Science (hSH = 33) and Contact Lens and Anterior Eye (hDD = 17). Overall, the SH field (hSH = 64) is far more impactful than the DD field (hDD = 34).

Conclusions
Impactful papers, authors, institutions, countries and journals in the SH and DD fields are identified. Optometry is revealed as the leading profession in relation to SH and DD publications.

Efron,N., Jones,L., Bron,A. J., Knop,E., Arita,R., Barabino,S., McDermott,A. M., Villani,E., Willcox,M. D. P., Markoulli,M. The TFOS International Workshop on Contact Lens Discomfort: Report of the contact lens interactions with the ocular surface and adnexa subcommittee Investigative Ophthalmology and Visual Science 2013;54(11):TFOS98-TFOS122

Efron,N., Morgan,P. B., Helland,M., Itoi,M., Jones,D., Nichols,J. J., van der Worp,E., Woods,C. A. Daily disposable contact lens prescribing around the world Contact Lens and Anterior Eye 2010;33(5):225-227

Efron,N., Morgan,P. B., Helland,M., Itoi,M., Jones,D., Nichols,J. J., van der Worp,E., Woods,C. A. International rigid contact lens prescribing Contact Lens and Anterior Eye 2010;33(3):141-143

Efron,N., Morgan,P. B., Helland,M., Itoi,M., Jones,D., Nichols,J. J., van der Worp,E., Woods,C. A. Soft toric contact lens prescribing in different countries Contact Lens and Anterior Eye 2011;34(1):36-38

Efron,N., Morgan,P. B., Jones,L. W., Morgan,G. A., Nichols,J. J. Global optometrist top 200 research ranking Clinical and Experimental Optometry 2021;104(4):471-485 [ Show Abstract ]

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

Efron,N., Morgan,P. B., Jones,L. W., Nichols,J. J. 21st century citation analysis of the field of contact lenses Clinical and Experimental Optometry 2021;104(5):634-638 [ Show Abstract ]

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

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

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

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

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

Efron,N., Morgan,P. B., Jones,L. W., Nichols,J. J. Bibliometric analysis of the refractive error field Clinical and Experimental Optometry 2021;104(5):641-643 [ Show Abstract ]

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

Efron,N., Morgan,P. B., Jones,L. W., Nichols,J. J. Bibliometric analysis of the keratoconus literature Clinical and Experimental Optometry 2021;21(Sep):1-6 [ Show Abstract ]

Clinical Relevance
Clinicians, researchers funding agencies and indeed the general public can benefit from knowledge of the most highly cited papers and most impactful authors, institutions, countries and journals in the field of keratoconus.

Background
Bibliometrics relating to the keratoconus literature were derived to enable identification of the most impactful papers published, as well as the leading authors, institutions, countries and journals.

Methods
A search was undertaken of the titles of papers on the Scopus database to identify keratoconus-related articles. The 20 most highly cited papers were determined from the total list of 4,419 papers found. Rank-order lists by count were assembled for the ‘top 20ʹ in each of four categories: authors, institutions, countries and journals. A subject-specific keratoconus-related h-index (hKC-index) was derived for each constituent of each category to serve as a measure of impact in the field. The top 10 constituents of each category were ranked by hKC-index and tabulated for consideration.

Results
The hKC-index of the keratoconus field is 125. The 4,419 papers have been cited a total of 98,010 times, and 18.5% of these papers have never been cited. The most highly cited paper is a general review of keratoconus by Yaron Rabinowitz, who is also the most impactful author in the field (hKC = 31). The Cedars Sinai Medical Center in the United States produces the most impactful keratoconus-related papers (hKC = 36), and the United States is the most impactful country (hKC = 91). The Journal of Cataract and Refractive Surgery is the most impactful journal (hKC = 55).

Conclusion
Keratoconus is a topic of high interest in the clinical and scientific literature. Highly cited papers and impactful authors, institutions, countries and journals are identified.

Efron,N., Morgan,P. B., Jones,L. W., Nichols,J. J. Bibliometric Analysis of the Emerging Field of Myopia Management Optometry & Vision Science 2021;98(9):1039-1044 [ Show Abstract ]

SIGNIFICANCE
Identification of the most impactful articles, authors, institutions, countries, and journals in myopia management provides a useful baseline reference for clinicians, researchers, and funding agencies in respect of this emerging field.

This work aims to assemble publication metrics for myopia management to identify the most impactful articles, authors, institutions, countries, and journals in this emerging field of research. A search of the titles of articles was undertaken on the Scopus database to identify myopia management–related articles. The 25 most highly cited articles were determined from the total list of 1064 articles found. Rank-order lists by count were assembled for the top 25 in each of four categories: authors, institutions, countries, and journals. A subject-specific myopia management–related h-index (hMM-index) was derived for the entire field, in addition to each of the four categories, to serve as measures of impact in the field. Top 15 lists were generated for each category ranked by hMM-index and tabulated for consideration. An article by Christine Wildsoet and colleagues, describing choroidal and scleral mechanisms of compensation for spectacle lenses in chicks, has generated the most citations (412); Earl Smith is the most impactful author (hMM = 19); the University of Houston produces the most impactful articles (hMM = 31); the United States is the most highly ranked country (hMM = 60); and Optometry and Vision Science is the most impactful journal. Although still in its infancy, myopia management is a topic of emerging interest in the clinical and scientific ophthalmic literature. Impactful authors, institutions, countries, and journals are identified. Optometry is revealed as the leading profession in relation to the publication of myopia management–related articles.

Efron,N., Morgan,P. B., Nichols,J. J., Walsh,K., Willcox,M. D., Wolffsohn,J. S. Jones,L. W. All soft contact lenses are not created equal Contact Lens Anterior Eye 2022;45(2):Article 101515 [ Show Abstract ]

Abstract
Soft contact lenses that have been prescribed by eye care practitioners are sometimes substituted for alternative lenses by unqualified, unregulated and sometimes even fully regulated lens suppliers, in the mistaken belief that there is essentially no difference between different soft lens types. This review considers the implications of inappropriately substituting soft contact lens types in terms of (a) lens properties: surface treatment, internal wetting agents, material, total diameter, back optic zone radius, thickness, edge profile, back surface design, optical design, power, colour (tint) and ultraviolet protection; and (b) lens usage: wearing modality (daily versus overnight wear) and replacement frequency. Potential aspects of patient dissatisfaction and adverse events when prescribed soft lenses are substituted for lenses with different properties or intended usage are considered. Substitution of 15 of the 16 lens properties considered (i.e. except for back surface design) was found to be related to at least one – and as many as six – potential sources of patient dissatisfaction and adverse ocular events. Contact lens are medical devices which are prescribed and fitted; they should never be substituted for another lens type in the absence of a new prescription further to a full finalised fitting, for the simple reason that all soft contact lenses are not created equal. A substituted lens may have properties that results in undesirable consequences in respect of vision, ocular health, comfort and cosmetic appearance, and may be incompatible with the lifestyle of the patient.

Efron,N., Morgan,P., Jones,L., Nichols,J. Who cites optometry journals? Journal of Optometry 2023;16(4):296-304 [ Show Abstract ]

Purpose
This work seeks to identify the most impactful journals, papers, authors, institutions, and countries that cite optometry journal articles.

Methods
The Scopus database was searched for papers citing at least one article published in any of the 18 optometry journals included in that database (i.e. ‘optometry articles’). The 10 most highly cited papers that cite optometry journal articles were determined from 82,830 papers found. A h-index for “optometry journal citations” (the hOJC-index) was derived for each entity in the categories of journals, papers, authors, institutions and countries to serve as a measure of impact.

Results
The hOJC-index of the body of papers citing optometry journal articles is 370. Papers citing optometry journal articles have themselves been cited 2,054,816 times. Investigative Ophthalmology & Visual Science (hOJC = 154) is the most impactful journal citing optometry articles and Optometry and Vision Science the most prolific (5310 papers). The most impactful paper citing optometry journal articles (5725 citations) was published in Journal of Clinical Epidemiology. Ophthalmologist Seang Mei Saw (hOJC = 69) is the most impactful author and optometrist Nathan Efron is the most prolific (288 papers). Harvard University (hOJC = 127) is the most impactful and UNSW Sydney is the most prolific institution (1761 papers). The United States is the most impactful and prolific nation (hOJC = 313; 28,485 papers).

Conclusions
Optometry journal articles are cited extensively by optometrists, ophthalmologists, and vision scientists world-wide, as well as authors from a broad spectrum of non-ophthalmic research domains. This work confirms the utility and influence of optometry journals.

Efron,N., Morgan,P., Woods,C. A., Jones,D. A., Jones,L., Nichols,J. International trends in rigid contact lens prescribing (2000–2023): An update Contact Lens Anterior Eye 2024;47(5):102255 [ Show Abstract ]

Purpose: Rigid contact lenses have an important role in contact lens practice. The purpose of this work is to update earlier surveys by describing global trends in rigid lens fitting between 2000-2023.

Method: An annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000 and 2023. Data relating to 342,500 fits undertaken in 20 countries returning reliable longitudinal data were analysed in respect of rigid lens fitting, defined as the fitting of any design of a contact lens manufactured in a rigid material.

Results: Overall, rigid lens prescribing increased slightly over time, from 14.2 % of lens fits in 2000 to 15.2 % in 2023 (p < 0.0001). However, post-hoc analysis shows that the change over time is best described as a decline between 2000 and 2012, followed by a steady increase subsequently. There were significant differences in rigid lens prescribing between countries (p < 0.0001). The difference between the percentage of males fitted with rigid lenses, as a proportion of all contact lenses (12.7 %), and females (12.0 %) is significant (p < 0.0001), although not clinically meaningful. Rigid lens wearers are older at fitting than soft lens wearers (38.7 vs 31.3 years,
respectively) (p < 0.0001). Analysis of 5,994 rigid lens fits prescribed currently (2019–2023) were categorised as: corneal sphere – 30 %; scleral and corneo-scleral – 28 %; corneal myopia control/orthokeratology – 21 %; and corneal complex (including toric, multifocal and monovision) – 16 %.

Conclusion: There has been a slight increase in rigid lens fitting during the second decade of this century. This increase is apparently due to a ‘repurposing’ of rigid lenses, with the growth of scleral/corneo-scleral and myopia control/orthokeratology lens fits essentially replacing conventional spherical corneal lens fits.

Efron,N., Morgan,P., Woods,C. A., Jones,D. A., Jones,L., Nichols,J. International trends in prescribing toric soft contact lenses to correct astigmatism (2000–2023): An update Contact Lens Anterior Eye 2024;47(5):102276 [ Show Abstract ]

Purpose
There have been significant advancements in toric soft contact lens design and manufacturing technology, and increased product availability, over the past half a century. The purpose of this work is to update earlier surveys by describing international trends in toric soft lens fitting between 2000 and 2023, inclusive.

Method
An annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000 and 2023, inclusive. Data relating to 220,934 standard soft daily wear single vision lens fits undertaken in 20 countries returning reliable longitudinal data were analysed in respect of toric soft lens fitting.

Results
Overall, toric soft lens prescribing almost doubled over the time-course of this survey, from 24.4 % of standard soft daily wear single vision lens fits in 2000 to 46.2 % in 2023 (p < 0.0001). There were significant differences between countries in toric soft lens prescribing (p < 0.0001). Of all standard soft daily wear single vision contact lenses prescribed to males, 32.0 % were toric soft lenses, compared with 28.7 % for females (p < 0.0001). The mean age of toric soft lens wearers was 30.5 ± 12.5 years, compared to 27.9. ± 12.1 years for spherical soft lens wearers (p < 0.0001). Analysis of 13,582 recent toric soft lens fits (2019–2023, inclusive), in terms of material type and replacement frequency, revealed the following proportions: reusable silicone hydrogel – 51 %; daily disposable silicone hydrogel – 27 %; daily disposable hydrogel – 12 %; and reusable hydrogel – 10 %.

Conclusion
There has been a substantial increase in toric soft lens fitting throughout the 24 years of this survey, to a point whereby almost all clinically significant astigmatism is being corrected among those wearing standard soft daily wear single vision lenses.

Efron,N., Morgan,P., Woods,C. A., Jones,D. A., Jones,L., Nichols,J. International trends in prescribing silicone hydrogel contact lenses for daily wear (2000–2023): An update Contact Lens Anterior Eye 2024;Online ahead of print [ Show Abstract ]

Purpose
Introduced around the turn of the 21st century, silicone hydrogel contact lenses alleviated hypoxic anterior eye complications due to their high oxygen transmissibility. The purpose of this work is to update earlier surveys by describing international trends in silicone hydrogel daily wear contact lens fitting between 2000 and 2023.

Method
An annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000 and 2023. Data relating to 260,144 daily wear soft contact lens fits undertaken in 20 countries returning reliable longitudinal data were analysed in respect of silicone hydrogel daily wear contact lens fitting.

Results
There has been a dramatic increase in silicone hydrogel daily wear lens fits (p < 0.0001), increasing from 2.8 % of all daily wear soft lens fits in 2000 to 73.7 % in 2023. Of all daily wear soft contact lenses prescribed to males, 44.6 % were silicone hydrogel lenses, compared with 43.5 % for females (p = 0.0146). The mean age of those wearing silicone hydrogel daily wear lenses was 32.0 ± 14.5 years, compared to 30.4 ± 13.6 years for those wearing daily wear hydrogel lenses (p < 0.0001). Between 2019–2023, the average percentage of fits was – (a) material type: silicone hydrogel – 73 %; mid-water content hydrogels – 13 %; high water content hydrogels – 9 %; and low water content hydrogels – 5 %, and (b) lens design: spherical – 44 %, toric – 32 %, multifocal – 17 %, monovision – 4 %, and ‘other’ – 3 %.

Conclusion
The dramatic increase in silicone hydrogel contact lens prescribing for daily wear has been commensurate with the introduction of multiple lens brands and an ongoing expansion of lens designs, parameters and replacement frequency options. The balance between silicone hydrogel and hydrogel lens prescribing is perhaps starting to approach an equilibrium.

Elliott,D. B., Fonn,D., Flanagan,J., Doughty,M. Relative sensitivity of clinical tests to hydrophilic lens-induced corneal thickness changes Optometry and Vision Science 1993;70(12):1044-1048 [ Show Abstract ]

The relative sensitivity of the van den Berg Straylightmeter, slitlamp biomicroscopy, a modified optical pachometer, Bailey-Lovie logMAR visual acuity (VA), and two glare tests (The Brightness Acuity Tester used with 10% contrast VA and Pelli-Robson contrast sensitivity) to hydrophilic contact lens-induced edema was assessed in 19 subjects (mean age 25.9 +/- 4.5 years). After baseline assessments, subjects wore thick hydrogel lenses on one eye which was patched tightly for 3 h. Assessments were repeated at frequent intervals after lens removal to assess recovery. None of the pachometer measurements returned to baseline within the 2-h monitoring period, although the majority were within 2% of baseline corneal thickness. The average time for the Straylightmeter scores to recover to baseline values after the lens removal was 90 min, which was similar to the time when visible edema at the slitlamp disappeared. The average time for return to baseline of logMAR VA and the two glare tests was consistently two to three times shorter than the time for the Straylightmeter score. The Straylightmeter therefore provided assessments of corneal edema similar to slitlamp examination and was more sensitive than VA or glare testing.

Elliott,D. B., Situ,P. Visual acuity versus letter contrast sensitivity in early cataract Vision research 1998;38(13):2047-2052 [ Show Abstract ]

Large and small letter contrast sensitivity and visual acuity were assessed in 37 elderly eyes (mean VA -0.01 logMAR, Snellen 6/6) and their lens opacities were categorised and graded using the LOCS III system. Large letter contrast sensitivity was often not reduced in cataract from age-matched normal values and provided limited information. Small letter contrast sensitivity was shown to be a more sensitive measure of early cataract than visual acuity and large letter contrast sensitivity. Its usefulness may be limited by its strong correlation with visual acuity (r2 = 0.70), which is the standard and traditional measure of vision in cataract.

Elliott,D. B., Yang,K. C. H., Dumbleton,K., Cullen,A. P. Ultraviolet-induced lenticular fluorescence: Intraocular straylight affecting visual function Vision research 1993;33(13):1827-1833 [ Show Abstract ]

Ultraviolet radiation (UVR) excitation of fluorophores within the crystalline lens results in intraocular straylight. These fluorescent emissions are known to increase with age. The visual effect of this increase in fluorescent straylight has not previously been published. In this study, the visual deficit associated with UV-induced lenticular fluorescence was measured for 61 normal subjects between the ages of 21 and 80 yr of age using the Regan visual acuity charts at varying levels of contrast. UVR was shown to decrease low contrast acuity and this loss increased linearly with age.

Elliott,M., Fandrich,H., Simpson,T., Fonn,D. Analysis of the repeatability of tear break-up time measurement techniques on asymptomatic subjects before, during and after contact lens wear Contact Lens and Anterior Eye 1998;21(4):98-103 [ Show Abstract ]

This study assessed the repeatability of various methods of measuring tear break-up time (TBUT) with and without soft contact lenses (CLs).TBUT was measured on 22 subjects with the tearscope, videokeratoscope and slit-lamp before and after 30 min of soft CL wear, and immediately after CL removal. Slit-lamp corneal TBUT was measured with fluorescein and without fluorescein while wearing CLs. TBUT was measured three times on the right eye only, using each technique in randomised order. TBUT measurements on CLs were repeated a second day. TBUT measurements were highly variable under all conditions and our results indicated a lack of correlation between techniques. The videokeratoscope was the least repeatable; while the tearscope was the most repeatable technique.

Elliott,M., Simpson,T., Richter,D., Fonn,D. Repeatability and accuracy of automated refraction: A comparison of the Nikon NRK-8000, the Nidek AR-1000, and subjective refraction Optometry and Vision Science 1997;74(6):434-438 [ Show Abstract ]

This study assessed the repeatability of the Nikon NRK-8000, the Nidek AR-1000, and subjective refraction. In addition, the accuracy of the Nikon and the Nidek were evaluated in comparison to subjective refraction. Measurements were taken with all 3 techniques on 2 separate occasions with a test-retest separation of at least 24 h. The right eyes of 30 normal subjects were used. Repeatability and accuracy statistics and plots were generated using matrix representations of dioptric power. Subjective refraction was the most repeatable method, with the coefficient of repeatability (COR) found to be 0.611, 0.224, and 0.490 in the vertical, torsional, and horizontal meridians. The autorefractors' COR was found to range from 0.712 to 0.826 for the vertical and horizontal meridians, whereas the torsional meridian ranged from 0.224 to 0.319.

Elliott,M., Simpson,T., Richter,D., Fonn,D. Repeatability and comparability of automated keratometry: The Nikon NRK-8000, the Nidek KM-800 and the Bausch and Lomb keratometer Ophthalmic and Physiological Optics 1998;18(3):285-293 [ Show Abstract ]

This study assessed the repeatability of the Nikon NRK-8000, the Nidek KM-800 and the Bausch and Lomb keratometer. In addition, the comparability of the Nikon NRK-8000 and the Nidek KM-800 are evaluated relative to the Bausch and Lomb keratometer. Measurements were taken with all three techniques on two separate occasions with a test-retest separation of at least 24 hr. The right eyes of 30 normal subjects were used. Repeatability and comparability statistics and plots were generated using matrix representations of dioptric power. The Nidek KM-800 coefficient of repeatability values were found to be 0.345, 0.187, and 0.321 in the vertical, torsional, and horizontal meridians while the Nikon NRK-8000 values were 0.346, 0.232, and 0.276 respectively.

Fadel,D. Medmont Meridia™: Much More Than a Corneal Topographer Clinical Optometry 2023;15 283-301 [ Show Abstract ]

In recent years, advanced diagnostic instruments have become widely available in optometric practices, offering various functions that optimize clinical information gathering. This article focuses on the Medmont Meridia™, a state-of-the-art multipurpose diagnostic device with corneal topography and cutting-edge features. Corneal topography is pivotal in the early diagnosis of corneal disorders, determining baseline ocular surface assessment, helping in contact lens fitting, and monitoring ocular health over time. The Medmont Meridia boasts Placido-disc-based imaging with extensive corneal coverage. Furthermore, the Meridia accurately measures the horizontal visible iris diameter, pupil diameter, and palpebral fissure width, which assists in making contact lens parameter decisions. Additionally, it offers sagittal height data for scleral lens design and first lens selection, streamlining the fitting process. Beyond its topography capabilities, the Meridia excels as a comprehensive dry eye assessment tool. With features like tear meniscus height, tear film surface quality, and meibography capabilities, it aids in diagnosing dry eye and monitoring its progression. The device also provides customizable dry eye reports with integrated grading scales and questionnaires, making dry eye management, patient education, and compliance more accessible. In conclusion, the Medmont Meridia consolidates a multitude of examination tools in a single instrument, enhancing practice efficiency and elevating patient care and communication. Its versatility and accuracy make it an invaluable asset in optometric practices worldwide.

Fadel,D., Gildea,C. Case Report: Remote Scleral Lens Fitting for High Toric Scleras in a Keratoconus Patient Optometry and Vision Science 2023;100(12):876-881 [ Show Abstract ]

SIGNIFICANCE
Technology plays a crucial role in customizing scleral lenses and improving lens alignment, especially in challenging scleral shapes. In addition, remote fitting technology allows optometrists to extend their expertise globally, empowering patients to access to customized lenses without travel expenses.

PURPOSE
The objective of this study was to document the difficulties encountered in fitting a scleral lens in a patient with keratoconus and pronounced scleral toricity. In addition, the study aimed to present the successful remote fitting achieved by using advanced technology.

CASE REPORT
An Irish male patient diagnosed with keratoconus exhibited high scleral toricity. Generally, keratoconus eyes often exhibit significant scleral asymmetry associated with cone decentration and disease severity. Improperly aligned scleral lenses can lead to regional changes in scleral shape, lens decentration, discomfort, and visual disturbances. Indeed, previous scleral lens fits were unsuccessful because of these issues. Corneoscleral profilometry was acquired in Ireland and then used in Italy to design customized lenses, which were then delivered to the patient's optometrist in Ireland. The first lenses designed and delivered demonstrated excellent overall performance without requiring adjustments.

CONCLUSIONS
This report highlights the importance of corneoscleral profilometry to increase efficiency and reduce lens reorders and chair time, and the remote fitting in overcoming barriers to accessing specialized lens fitting.

Fadel,D., Macedo-de-Araújo,R. J., Barnett,M. The Patient-Physician Relationship and Role of Empathic Communication in Contact Lens Practice Journal of Contact Lens Research and Science 2024;8(1):20-36 [ Show Abstract ]

Purpose: To assess the relationship between eye care practitioners and contact lens patients and to
determine how empathy is associated with patients’ overall satisfaction.


Methods: Multilingual electronic surveys shared by email and on social media in patients’ and practitioners’ groups. Ratings were converted to a numerical scale. The scores were compared using Wilcoxon rank sum tests.


Results: The survey had 804 responses: 68.4% were over 46 years old, and 58.1% were female. Only 770 reported the type of contact lens worn. Of all patients, 10.6% would not recommend their physician due to feeling excluded from decisions (55.3%), lack of personal interest (63.5%), no written recommendations (84%), and unmet expectations (77%). Scleral lens wearers were highly satisfied. Optometrists excelled in care, ratings, relationships, communication, symptom relief, and prevention.


Discussion: The findings highlight the importance of empathy in eye care and its impact on patient experiences. Factors such as contact lens type, physician recommendation, and physician type can influence the level of empathy perceived by patients. Satisfaction varied based on contact lens type, with soft and scleral lens wearers reporting better experiences. Patients valued physicians who listened, explained treatments, showed empathy, and had patient-centered communication and open-ended questions. Optometrists were scored higher than ophthalmologists in several aspects.


Conclusion: Patients, especially scleral lens patients, were generally satisfied with the services and care. Optometrists scored higher than ophthalmologists. Patients would not recommend their physicians mainly because of a lack of empathy.