Fonn,D. What goes around comes around Eye and Contact Lens 2010;36(6):323

Fonn,D., Anderson,R., Sorbara,L., Callender,MGE A survey of optometric contact lens use in Canada Canadian Journal of Optometry 1990;52(3):90-95 [ Show Abstract ]

A questionnaire was mailed to all optometrists in Canada for the purpose of conducting a national survey on the habits of prescribing contact lenses and care products. Optometrists were requested to complete the survey for each practice for the time period of April 1, 1987 - April 1, 1988. The results of the survey revealed a response from slightly more than 10% (221) of the optometric practices. The vast majority of patients fitted with contact lenses (81%) were in the 17-44 year age group and 50% of the patients fitted with contact lenses in that period had never worn lenses previously or had not worn lenses for five years prior to the survey period. A high proportion of soft lenses (85%) were prescribed compared to rigid lenses (14%). Hydrogen peroxide was the preferred method of disinfection and extended wear was moderately popular.

Fonn,D., Bruce,A. S. A review of the Holden-Mertz criteria for critical oxygen transmission Eye and Contact Lens 2005;31(6):247-251 [ Show Abstract ]

Purpose. Holden and Mertz established the foundations for the new generation of silicone hydrogel contact lenses for daily and extended wear in 1984. Absence of lens-induced corneal swelling was their premise and although this was possible with daily wear, the goal with extended wear seemed almost impossible because of the limitation of hydrogel materials. Experience with extended and daily wear of disposable contact lenses during the last 2 decades and, more recently, with silicone hydrogels has led to the reconsideration of the validity of the findings of Holden and Mertz. Results. A pivotal influence on the Holden and Mertz critical Dk/t value for closed-eye lens wear was exerted by two numbers: the no-lens wear corneal edema level (4%) and the silicone lens data point (Dk/t of 182 × 10-9, closed-eye edema level of 2.6%). Subsequent publications appear to give a more accurate assessment of the no-lens closed-eye corneal edema level, and there are also more recent measurements of silicone hydrogel lens Dk/t and corneal edema responses. Conclusions. It now appears that the Holden and Mertz criteria for extended-wear critical Dk/t should be revised upwards to at least 125 × 10 -9. © 2005 Contact Lens Association of Ophthalmologists, Inc.

Fonn,D., Du Toit,R., Simpson,T. L., Vega,J. A., Situ,P., Chalmers,R. L. Sympathetic swelling response of the control eye to soft lenses in the other eye Investigative Ophthalmology and Visual Science 1999;40(13):3116-3121 [ Show Abstract ]

PURPOSE. To compare central corneal swelling and light scatter after 8 hours of sleep in eyes wearing high- and low-Dk hydrogel lenses and to the contralateral control eyes. METHODS. Twenty neophyte subjects wore a Lotrafilcon A (Dk, 140; Ciba Vision, Duluth GA) silicone hydrogel lens and an Etafilcon A (Dk, 18; Acuvue; Vistakon, Jacksonville, FL) 58% water content hydrogel lens of similar center thickness in random order in the right eye only, for overnight 8-hour periods. The contralateral nonwearing left eyes served as controls. Central corneal thickness was measured using an optical pachometer and light scatter using a Van den Berg stray-light meter before lens insertion, after lens removal on waking, and every 20 minutes for the next 3 hours. RESULTS. Central corneal swelling induced by the Etafilcon A lens on eye opening was significantly higher than with the Lotrafilcon A lens (8.66% ± 2.84% versus 2.71% ± 1.91%; P < 0.00001). Light scatter induced by the Etafilcon A lens on eye opening was significantly higher than with the Lotrafilcon A lens (46.09 ± 5.62 versus 42.78 ± 6.07 Van den Berg units, P = 0.0078). The swelling of the control eyes paired with the Etafilcon A lens- wearing eyes was also slightly but significantly higher than that of the control eyes paired with the Lotrafilcon A lens-wearing eyes (2.34% ± 1.26% versus 1.44% ± 0.91%; P = 0.0002). Light-scatter measurements were not significantly different between control sets of eyes but showed the same trend. CONCLUSIONS. In neophyte subjects, corneal swelling of the contralateral control eyes appears to be influenced by the swelling of the fellow lens-wearing eyes - that is, the swelling of the contralateral control eye was significantly lower when there was less swelling of the fellow eye wearing the high-Dk lens. Although there was no statistically significant difference in light-scatter measurements between the control sets of eyes, a trend similar to the corneal swelling results was observed, which could be used to support the suggestion that this may he a sympathetic physiological response rather than an unusual sampling coincidence.

Fonn,D., Dumbleton,K. Dryness and discomfort with silicone hydrogel contact lenses. Eye & contact lens 2003;29(1 Suppl):S101-104; discussion S115-118, S192-194 [ Show Abstract ]

PURPOSE: The purpose of this study was to determine whether symptoms of dryness and discomfort are experienced differently with silicone hydrogel lenses compared to conventional hydrogels, in symptomatic and asymptomatic subjects. METHODS: Thirty-nine symptomatic and asymptomatic subjects wore four types of lenses: Focus NIGHT & DAY (CIBA Vision), Focus DAILIES (CIBA Vision), ACUVUE 2 (Johnson & Johnson Visioncare) and Proclear Compatibles (CooperVision) contralaterally for 7 hours and rated comfort and dryness on a zero-to-100 point visual analog scale at 0, 1, 3, 5 and 7 hours. RESULTS: In both groups, no lens differences were found for comfort and dryness, but the comfort and dryness ratings of the symptomatic group decreased significantly (became worse) over the 7-hour period. CONCLUSIONS: These results demonstrate that dryness and comfort is the same over time with silicone hydrogel as with the other three lenses.

Fonn,D., Gauthier,C. Prevalence of superficial fibrillary lines of the cornea in contact lens wearers and nonwearers Cornea 1991;10(6):507-510 [ Show Abstract ]

Superficial corneal epithelial striations described as fibrillary lines have been documented as a common finding in normal and keratoconic eyes. We first noticed these fine white structures in both soft and rigid contact lens wearers. This prompted us to investigate whether the prevalence of these lines was greater in contact lens wearers than in non-lens wearers. Our results indicated that although the lines were more frequently observed in lens wearers (35.7% of 42 patients) than in the controls (19.0% of 42 patients), the difference was not statistically significant (p = 0.0867, χ2 analysis). We speculate that lens wear makes fibrillary lines more visible but is not responsible for their presence.

Fonn,D., Gauthier,C. A., Pritchard,N. Patient preferences and comparative ocular responses to rigid and soft contact lenses Optometry and Vision Science 1995;72(12):857-863 [ Show Abstract ]

Patient preferences and ocular responses were compared between rigid and soft contact lenses by randomly fitting 32 neophyte subjects with a rigid lens in 1 eye and a soft lens in the contralateral eye. Twenty-seven of 32 subjects completed the 3-month study and 16 subjects were willing to continue for an additional 3-month extension. Subjects preferred the comfort and handling of the soft lens but preferred the vision provided by the rigid lens and initially its ease of maintenance. There was also a marked preference for the soft lens when all aspects of lens wear were compared. Objectively, the rigid lenses were responsible for more ocular changes than the soft lenses. Palpebral aperture sizes of the rigid gas permeable (RGP) wearing eyes decreased significantly (0.5 mm; p < 0.05) compared to the soft lens wearing eyes. The incidence of corneal staining was significantly greater in the rigid lens wearing eye (50% RGP vs. 22% soft) but limbal injection was greater in the soft lens wearing eye (18% soft vs. 6% RGP). Refractive sphere, cylinder, and corneal astigmatism decreased in the rigid lens wearing eye after 3 months. This daily wear clinical trial has shown a marked subjective preference for wearing soft lenses with fewer short-term ocular effects.

Fonn,D., Holden,B. A. Rigid gas-permeable vs. hydrogel contact lenses for extended wear American Journal of Optometry and Physiological Optics 1988;65(7):536-544 [ Show Abstract ]

A clinical trail was conducted to compare the extended wear performance of rigid gas-permeable (RGP) contact lenses with that of soft lenses. Subjects were fitted with a RGP lens (Boston IV) in one eye and a soft lens (Bausch & Lomb 'O' series) in the other eye, and wore them on an extended wear basis for up to 3 months. No subjects developed any acute adverse reactions in the RGP lens-wearing eye. After the initial adaptation period, subject acceptance of RGP extended wear in terms of vision and comfort was superior. The RGP lenses also induced less chronic hypoxic stress than hydrogel lenses of comparable Dk/L, as evidenced by the presence of epithelial microcysts. Several complications of RGP extended wear were observed including lens binding, blepharoptosis, transient pupil size increases, and corneal staining. As hypoxia-induced corneal changes, such as microcysts and striae, were observed in the RGP lens-wearing eyes, we consider that these particular RGP lenses do not have adequate oxygen transmissibility for successful long-term extended wear. However, if RGP lens materials of higher oxygen transmissibility and better designs can be attained, the potential of RGP extended wear would appear promising.

Fonn,D., Jones,L. Hand hygiene is linked to microbial keratitis and corneal inflammatory events Cont Lens Anterior Eye 2019;42(2):132-135 [ Show Abstract ]

Lack of or inadequate hand washing is a risk factor in the development of contact lens related microbial keratitis and corneal inflammatory events. In the public health domain there is compelling evidence that proper hand washing with soap can save lives. The purpose of this review is to draw attention to some of the public health literature in support of hand washing and how education can influence patients’ hand hygiene behavior. Contact lens wearers are also guilty of poor hand washing behavior but there is scant evidence that education of hand washing procedures of lens wearers alters patient non-compliance. It is well known that pathogenic microbial contamination of contact lenses, lens cases, care solutions and anterior ocular components have been found with contact lens wear. However while the originating source may be hands or water, it is most likely both of these. Besides proper hand washing this paper will include mitigating strategies for avoiding microbial contamination.

Fonn,D., MacDonald,K. E., Richter,D., Pritchard,N. The ocular response to extended wear of a high Dk silicone hydrogel contact lens Clinical and Experimental Optometry 2002;85(3):176-182 [ Show Abstract ]

Purpose: A four-month extended wear clinical trial was conducted to compare the ocular effects of a high Dk Balafilcon A silicone hydrogel lens and a low Dk HEMA 38.6 per cent H2Osoft lens. Method: Twenty-four subjects who were adapted to daily wear of soft lenses wore a high Dk lens in one eye and a low Dk HEMA lens in the other eye for four months on an extended wear basis after one week of daily wear. Thirteen progress evaluations were conducted using standard clinical procedures. Results: Eighteen subjects (75 per cent) completed the study. The high Dk lens induced significantly less bulbar and limbal injection and corneal vascularisation than the low Dk HEMA lens (p < 0.05). Epithelial microcysts were observed only in the eyes wearing the low Dk lens. A significant increase in myopia was found in the eyes wearing the low Dk HEMA lens (mean = 0.50 D, p < 0.01) compared to the insignificant myopic increase of 0.06 D in the eyes wearing the high Dk lens. Three subjects developed small infiltrates in the high Dk lens wearing eyes and significantly more post-lens debris was observed under the high Dk lens. Six subjects developed papillary conjunctivitis in the eye wearing silicone hydrogel lenses but only two of those were discontinued from the study. Conclusion: No hypoxia-related effects were observed with extended wear of the high Dk Balafilcon A silicone hydrogel lens.

Fonn,D., Peterson,R., Woods,C. Corneal staining as a response to contact lens wear Eye and Contact Lens 2010;36(5):318-321 [ Show Abstract ]

Objective: To review the effects of contact lenses on the corneal surface. Methods: A review of the literature and in-house research of corneal staining and its various forms of presentation. Results: Corneal staining manifests in many different forms. The severity of staining or insult of the cornea is usually determined by the extent (area of coverage), density, and depth. The cause of staining is multifactorial, and its location is often linked to the type of lens that is being worn, the solution used to clean/disinfect the lens, the state of hydration of the soft lens, and the state of the cornea that has been affected by the lens. Conclusions: Sodium fluorescein dye effectively highlights corneal integrity changes referred to as corneal staining. This review describes the manifestations, the cause, the mechanisms, and the methods of remediation of corneal staining. © 2010 Lippincott Williams & Wilkins.

Fonn,D., Pritchard,N., Garnett,B., Davids,L. Palpebral aperture sizes of rigid and soft contact lens wearers compared with nonwearers Optometry and Vision Science 1996;73(3):211-214 [ Show Abstract ]

Previous studies have shown that contact lens wear may affect palpebral aperture size (PAS). In this study, 74 wearers of rigid lenses were matched for sex and age with soft lens wearers and nonwearers. Partial face photographs were taken of all subjects, in the case of contact lens wearers, after lens removal. PAS was determined by measuring the resulting 35-mm transparencies on a Mitutoya profile projector. The mean PAS of the rigid lens wearers (9.76 ± 0.99 mm) was found to be significantly smaller than that of the soft lens wearers (10.24 ± 0.94 mm) and the nonwearers (10.10 ± 1.11 mm) (p = 0.0154, analysis of variance). There was no significant difference between the PAS of soft lens wearers and nonwearers. This study supports the hypothesis that rigid lens wear causes a decrease in PAS.

Fonn,D., Simpson,T., Woods,J., Woods,C. New technologies to assess lens-mediated effects of the cornea Eye and Contact Lens 2007;33(6 PART 2 OF SUPPL 2):364-370 [ Show Abstract ]

Contact lenses can affect the cornea in a variety of ways. Corneal structure can be altered so that its thickness changes to involve the epithelium and the stroma. As a result, the curvature may be affected, but whether it is the front or the back surface that is affected depends on the type of lens used. If thickness increases sufficiently, corneal transparency may decrease. Contact lenses can also affect cellular structure of all layers of the cornea through mechanical trauma, hypoxia, or toxicity from solutions that are used in association with lenses. More serious complications, such as inflammation and infection, can arise. All these changes can be detected by clinicians using slitlamp biomicroscopes and keratometers if the changes are significant enough. Since the development of computers, optical instruments have become more sophisticated and have enabled the detection of subtle changes but have also facilitated more precise measurement of these conditions along with the ability to capture images of the alterations or defects. This article describes some of the newer techniques and, specifically, the application of optical coherence tomography, confocal microscopy, and esthesiometry. © 2007 Lippincott Williams & Wilkins, Inc.

Fonn,D., Situ,P., Simpson,T. Hydrogel lens dehydration and subjective comfort and dryness ratings in symptomatic and asymptomatic contact lens wearers Optometry and Vision Science 1999;76(10):700-704 [ Show Abstract ]

Purpose. To determine whether lens dehydration correlates with discomfort, dryness, and noninvasive tear break-up time in symptomatic and asymptomatic contact lens wearers and whether dehydration of the two lens types varies. Method. Twenty hydrogel contact lens wearers with dryness- related symptoms and 20 asymptomatic wearers wore an Etafilcon A lens (Acuvue; Vistakon, Inc., Jacksonville, Florida) in one eye and an Omafilcon A lens (Proclear; Biocompatibles, Norfolk, Virginia) in the contralateral eye for 7 h in a randomized, double-masked study. Lens water content was measured before and after 7 h of lens wear and prelens noninvasive tear film break-up time (NIBUT) was measured immediately after insertion and after 5 h of lens wear. Subjective comfort and dryness were rated at 0, 1, 3, 5, and 7 h of lens wear. Results. The symptomatic group had significantly reduced prelens NIBUT, decreased comfort, and increased dryness, but there was no difference between lenses for these variables. The Omafilcon-A lenses dehydrated significantly less than the Etafilcon A lenses, but there was no significant difference in lens dehydration between two subject groups. Conclusion. No correlation was found between lens dehydration and subjective dryness and comfort. Symptomatic hydrogel contact lens wearers with decreased wearing time had measurably decreased comfort, increased dryness ratings, and reduced NIBUT.

Fonn,D., Situ,P., Simpson,T. L. Oxygen and contact lens wear Chin J Optom and Ophthalmol 1999;1(3):185-189

Fonn,D., Sweeney,D., Holden,B. A., Cavanagh,D. Corneal oxygen deficiency Eye and Contact Lens 2005;31(1):23-27 [ Show Abstract ]

Objectives. To compare the ocular effects of low Dk hydrogel and high Dk silicone hydrogel contact lenses. Methods. A review of recent literature was conducted to determine the effects of wearing low and high Dk soft lenses on corneal swelling, vascular response, refractive error and the corneal epithelium. Results. High Dk silicone hydrogel contact lenses became available for research and clinical practice almost 10 and 5 years ago respectively. During that time many studies have been conducted and it has been demonstrated repeatedly how much improvement there has been to the physiological response of the eye particularly when wearing the lenses on an overnight basis. Conclusions. Although silicone hydrogels only constitute about 2% of current wearers, their positive effects on the eye compared with low Dk hydrogel lenses should make them the most dominant lenses in the near future. © 2005 Contact Lens Association of Ophthalmologists, Inc.

Glasier,M. -A, Keech,A., Sheardown,H., Subbaraman,L. N., Jones,L. Conformational and quantitative characterization of lysozyme extracted from galyfilcon and senofilcon silicone hydrogel contact lenses Current eye research 2008;33(1):1-11 [ Show Abstract ]

PURPOSE: To compare two solvents for retrieval of lysozyme deposited on a silicone hydrogel (SH) contact lens material galyfilcon A (GA; Acuvue Advance). METHODS: Two buffers used were 50:50 acetonitrile/0.02% trifluoroacetic acid (buffer 1) and 50:50 acetonitrile/50 mM NaOH (buffer 2). RESULTS: Extraction efficiency from GA lenses was 74% (buffer 1) and 83% (buffer 2). Buffer 2 decreased lysozyme activity > buffer 1. Ex vivo GA lenses showed total protein deposition of 2-16 microg/lens with total lysozyme deposition of 0.3-3.9 microg/lens. CONCLUSIONS: We have developed a low acid strength extraction buffer that can be used to efficiently extract active lysozyme protein from novel siloxane-based contact lens materials.

Glasier,M. -A, Subbaraman,L. N., Senchyna,M., Jones,L. A solid-phase assay for the quantitation of total protein eluted from balafilcon, lotrafilcon, and etafilcon contact lenses Current eye research 2008;33(8):631-640 [ Show Abstract ]

PURPOSE: To compare two variations of a membrane-based protein assay utilizing Amido black (AB) detection with a commercially available 3-(4-carboxybenzoyl) quinoline-2-carboxaldehyde (CBQCA) assay for use in the quantitation of individual tear proteins, pooled human tear proteins, and protein extracted from ex vivo lotrafilcon A, balafilcon A, and etafilcon A contact lens materials. METHODS: Ex vivo contact lens extracts, pooled human tears, and individual tear proteins (human serum albumin (HSA), bovine lactoferrin, human secretory immunoglobulin A (sIgA), human lysozyme) were subjected to three solid-phase assays: AB on polyvinylidene difluoride (AB on PVDF) and AB on nitrocellulose (AB on NC) and the CBQCA assay. Micro-bicinchonic acid (micro-BCA) assay was also employed with lens extracts to determine total protein concentration. Individual and pooled tear proteins were referenced to a micro version of the quantitative ninhydrin protein assay. RESULTS: The CBQCA demonstrated the greatest overall sensitivity and lowest intra- and inter-assay variability. AB on NC demonstrated the most accurate ability to quantify total protein in pooled human tear samples, although it also displayed the greatest protein-to-protein variation using individual tear proteins. The CBQCA assay displayed the greatest cross-reactivity with unworn balafilcon and lotrafilcon lens extracts, whereas AB on NC demonstrated the least. AB on NC measured similar amounts of total protein in extracted ex vivo lenses as the CBQCA assay if background interference was subtracted from CBQCA values. AB on PVDF measured the lowest amount of deposited protein from ex vivo lenses. CONCLUSION: Both the AB on NC and CBQCA assays can be used to measure protein in extracts of lotrafilcon, balafilcon, and etafilcon lens materials.

Gorbet,M. B., Tanti,N. C., Crockett,B., Mansour,L., Jones,L. Effect of contact lens material on cytotoxicity potential of multipurpose solutions using human corneal epithelial cells Molecular Vision 2011;173458-3467 [ Show Abstract ]

Purpose: Multipurpose solutions (MPS) are used daily to clean and disinfect silicone hydrogel (SiHy) contact lenses. This in vitro study was undertaken to identify the potential for interaction between MPS, SiHy surface treatments, and lens materials, which may lead to changes in the response of human corneal epithelial cells (HCEC) to MPS-soaked lenses. Methods: The MPS tested were renu fresh (formerly known as ReNu MultiPlus; ReNu), OptiFree Express (OFX), OptiFree RepleniSH, SoloCare Aqua, and Complete Moisture Plus. The SiHy materials evaluated were lotrafilcon A, lotrafilcon B, comfilcon A, galyfilcon A, and balafilcon A (BA). MPS-soaked lenses were placed on top of adherent HCEC. The effect of MPS dilutions (0.1 to 10% final concentration in medium) was also characterized. Cell viability, adhesion phenotype and caspase activation were studied after 24-h cell exposure. OFX released from lenses was determined using UV absorbance. Results: A significant reduction in viability (between 30 to 50%) was observed with cells exposed to lenses soaked in ReNu and OFX. A significant downregulation of α3 and β1 integrins, with integrin expression ranging from 60% to 75% of control (cells with no lens), was also observed with OFX and ReNu-soaked lenses. With the exception of BA, all other lenses soaked in OFX resulted in significant caspase activation, whereby over 18% of cells stained positive for caspases. Minimal caspase activation was observed in cells exposed to ReNu and Solo soaked lenses. For both OFX and ReNu, exposing cells to at least a 5% dilution had a significant effect on viability and integrin expression. While Complete and Solo did not lead to reduction in viability, cells exposed to a 10% dilution showed reduced integrin expression down to less than 70% of control value. Comparing cell response to diluted MPS solutions and various MPS-soaked lenses showed that it is not possible to reliably use cell response to MPS dilution alone to assess MPS biocompatibility. Conclusions: Our results demonstrate that the reaction of HCEC to MPS are affected by the type of lenses the MPS is released from and may potentially be influenced by the surface treatment (or lack of it) of SiHy materials. © 2011 Molecular Vision.

Gorbet,M. B., Tanti,N. C., Jones,L., Sheardown,H. Corneal epithelial cell biocompatibility to silicone hydrogel and conventional hydrogel contact lens packaging solutions Molecular Vision 2010;16272-282 [ Show Abstract ]

Purpose: Although all contact lenses (CLs) are applied initially to the eye directly from a packaging solution, little is known about the effects of these solutions on human corneal epithelial cells (HCECs). Due to the porous nature of CL materials, they have the potential to sorb components of the packaging solution during storage, which could then be subsequently released upon insertion of the CL on the eye. The purpose of this study was to investigate the effect of various packaging solutions on HCECs, using an in vitro model. Methods: An in vitro assay was developed whereby various silicone hydrogels and conventional, poly-2-hydroxyethylmethacrylate (polyHEMA)-based lens materials were removed directly from their packaging and then incubated for up to 24 h with HCECs. The effect of the retained and released packaging solution components on HCECs was assessed by measuring cell viability, adhesion phenotype, and apoptosis. Results: Incubation of HCECs with CLs stored in borate-buffered packaging solutions resulted in a significant reduction in cell viability. Adherent cells incubated with these CLs also exhibited reduced levels of β1 and α3 integrin. Soaking borate-buffered packaged CLs in PBS before cell incubation resolved viability and integrin expression in all cases, with the exception of galyfilcon A and balafilcon A, from which a 20% reduction in cell viability was still observed. In comparison, CLs stored in phosphate-buffered packaging solutions had cellular viability and expression of integrins similar to control cells (cells incubated in the absence of a lens). When incubated with cells at a 10% concentration in serum-free medium, borate-buffered packaging solutions and borate-containing saline (Unisol 4) significantly reduced cell viability and integrin expression. Neither caspase activation nor annexin V binding was observed on cells following exposure to borate buffer solution. However, a significant decrease in reactive oxygen species was observed at 24 h. These latter results suggest that in vitro exposure to low concentration of borate/boric acid results in cell dysfunction, leading to necrosis rather than apoptosis. Conclusions: Borate-buffered packaging solutions were shown to adversely affect the viability and integrin expression of HCECs in vitro. When used in ophthalmic packaging solutions, the antimicrobial properties of borate buffer may be outweighed by its relatively cytotoxic effects on cells. © 2010 Molecular Vision.

Gorbet,M., Peterson,R., McCanna,D., Woods,C., Jones,L., Fonn,D. Human corneal epithelial cell shedding and fluorescein staining in response to silicone hydrogel lenses and contact lens disinfecting solutions Current eye research 2014;39(3):245-256 [ Show Abstract ]

Purpose: A pilot study was conducted to evaluate human corneal epithelial cell shedding in response to wearing a silicone hydrogel contact lens/solution combination inducing corneal staining. The nature of ex vivo collected cells staining with fluorescein was also examined. Methods: A contralateral eye study was conducted in which up to eight participants were unilaterally exposed to a multipurpose contact lens solution/silicone hydrogel lens combination previously shown to induce corneal staining (renu® fresh™ and balafilcon A; test eye), with the other eye using a combination of balafilcon A soaked in a hydrogen peroxide care system (Clear Care®; control eye). Lenses were worn for 2, 4 or 6 hours. Corneal staining was graded after lens removal. The Ocular Surface Cell Collection Apparatus was used to collect cells from the cornea and the contact lens. Results: In the test eye, maximum solution-induced corneal staining (SICS) was observed after 2 hours of lens wear (reducing significantly by 4 hours; p < 0.001). There were significantly more cells collected from the test eye after 4 hours of lens wear when compared to the control eye and the collection from the test eye after 2 hours (for both; n = 5; p < 0.001). The total cell yield at 4 hours was 813 ± 333 and 455 ± 218 for the test and control eyes, respectively (N = 5, triplicate, p = 0.003). A number of cells were observed to have taken up the fluorescein dye from the initial fluorescein instillation. Confocal microscopy of fluorescein-stained cells revealed that fluorescein was present throughout the cell cytoplasm and was retained in the cells for many hours after recovery from the corneal surface. Conclusion: This pilot study indicates that increased epithelial cell shedding was associated with a lens-solution combination which induces SICS. Our data provides insight into the transient nature of the SICS reaction and the nature of fluorescein staining observed in SICS. © 2014 Informa Healthcare USA, Inc.

Guthrie,S. E., Jones,L., Blackie,C. A., Korb,D. R. A Comparative Study Between an Oil-in-Water Emulsion and Nonlipid Eye Drops Used for Rewetting Contact Lenses Eye and Contact Lens 2015;41(6):373-377 [ Show Abstract ]

OBJECTIVES: The purpose of this study was to determine the clinical impact of using SYSTANE BALANCE Lubricant Eye Drops (Alcon, Fort Worth, TX), an oil-in-water emulsion, as a rewetting eye drop in symptomatic contact lens wearers.
METHODS: Subjects who had previously experienced contact lens discomfort (CLD), with a mean lens wearing history of 18.6±12.8 years, were randomly assigned to use a Test (SYSTANE BALANCE Lubricant Eye Drops; n=76) or control (habitual nonlipid contact lens rewetting eye drop; n=30) drop over their contact lenses within 5 min of lens insertion and then subsequently at 2 hr intervals up to a maximum of 4 drops per eye daily for a 1-month period. Assessments of subjective comfort, comfortable wearing time, lid wiper epitheliopathy (LWE), and corneal staining were conducted at baseline and after 1 month, after 6 hr of lens wear.
RESULTS: Comfort, wearing time, LWE, and corneal staining all showed statistically significant improvements in the test group using SYSTANE BALANCE Lubricant Eye Drops at the 1-month visit compared with baseline data (all P<0.01) and compared with the control group at the 1-month visit (P<0.01, P=0.01, P<0.01, and P=0.03, respectively).
CONCLUSIONS: The use of SYSTANE BALANCE Lubricant Eye Drops as a rewetting drop in a group of wearers who experienced symptoms of CLD improved subjective comfort scores, increased comfortable wearing time, and reduced signs of LWE and corneal staining, when compared with the use of non–lipid-containing contact lens rewetting eye drops.

Guthrie,S., Ng,A. Y., Woods,J., Vega,J., Orsborn,G., Jones,L. Exploring the factors which impact overall satisfaction with single vision contact lenses Contact Lens Anterior Eye 2022;45(5):101579 [ Show Abstract ]

Purpose
To explore the impact of subjective factors (lens handling, comfort and vision) on overall single vision contact lens satisfaction.

Methods
Correlation analysis of a prospective, randomised, double-masked, bilateral crossover study involving 55 adapted lens wearers fitted with somofilcon A (SiHy) (clariti® 1 day, CooperVision) and etafilcon A (Hy) (1 DAY ACUVUE® MOIST, Johnson & Johnson Vision) was conducted. Subjective ratings of lens handling, comfort and vision collected after 1 week of lens wear for each lens type were correlated with overall satisfaction. Data were analysed by combining data for both lens types and also for each lens separately.

Results
For the combined analysis, significant correlations (p < 0.01) were found between subjective ratings of overall satisfaction and ratings of handing for application (r = 0.64), handling for removal (r = 0.50), comfort upon application (r = 0.59), comfort at end of day (r = 0.61), overall satisfaction with comfort (r = 0.88) and overall satisfaction with vision (r = 0.64).

Correlation analysis of the per lens data showed that lens specific correlations of overall satisfaction with handling for lens application varied greatly with lens material (SiHy: r = 0.26, p = 0.05 vs Hy: r = 0.72, p < 0.01). Correlation strength of comfort upon application/at end of day with overall satisfaction also varied with lens material (Application: SiHy: r = 0.40 vs Hy: r = 0.61; End of day: SiHy: r = 0.76 vs Hy: r = 0.58; all p ≤ 0.01).

Conclusion
Overall satisfaction was significantly correlated with the specific subjective evaluations of handling, vision and comfort. Correlations of overall satisfaction and ease of handling for each lens type suggest that, for habitual contact lens wearers, dissatisfaction with handling at the time of lens application can play a major role in overall dissatisfaction with a lens. Handling for application had a similar correlation (r) value as vision, suggesting that handling for application should not be underestimated when considering overall patient satisfaction.

Hagedorn,S., Drolle,E., Lorentz,H., Srinivasan,S., Leonenko,Z., Jones,L. Atomic force microscopy and Langmuir-Blodgett monolayer technique to assess contact lens deposits and human meibum extracts Journal of Optometry 2015;8(3):187-199 [ Show Abstract ]

Purpose The purpose of this exploratory study was to investigate the differences in meibomian gland secretions, contact lens (CL) lipid extracts, and CL surface topography between participants with and without meibomian gland dysfunction (MGD). Methods Meibum study: Meibum was collected from all participants and studied via Langmuir-Blodgett (LB) deposition with subsequent Atomic Force Microscopy (AFM) visualization and surface roughness analysis. CL Study: Participants with and without MGD wore both etafilcon A and balafilcon A CLs in two different phases. CL lipid deposits were extracted and analyzed using pressure-area isotherms with the LB trough and CL surface topographies and roughness values were visualized using AFM. Results Meibum study: Non-MGD participant meibum samples showed larger, circular aggregates with lower surface roughness, whereas meibum samples from participants with MGD showed more lipid aggregates, greater size variability and higher surface roughness. CL Study: Worn CLs from participants with MGD had a few large tear film deposits with lower surface roughness, whereas non-MGD participant-worn lenses had many small lens deposits with higher surface roughness. Balafilcon A pore depths were shallower in MGD participant worn lenses when compared to non-MGD participant lenses. Isotherms of CL lipid extracts from MGD and non-MGD participants showed a seamless rise in surface pressure as area decreased; however, extracts from the two different lens materials produced different isotherms. Conclusions MGD and non-MGD participant-worn CL deposition were found to differ in type, amount, and pattern of lens deposits. Lipids from MGD participants deposited irregularly whereas lipids from non-MGD participants showed more uniformity. © 2014 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.

Hall,B. J., Jones,L. Contact lens cases: The missing link in contact lens safety? Eye and Contact Lens 2010;36(2):101-105 [ Show Abstract ]

Purpose: To summarize a variety of issues associated with contact lens case contamination and discuss appropriate methods that can limit this. Methods: A literature review was undertaken investigating the major factors associated with case contamination, with specific reference to the major pathogens associated with contamination, the role of bacterial biofilms, and methods that can limit contamination. Results: The use of antimicrobial cases, regular case cleaning and case replacement, avoidance of topping up solutions, and not using tap water to rinse cases all appear to be important in avoidance of significant case contamination. Conclusions: Contact lens case contamination is a significant public health concern and may contribute significantly to the development of microbial keratitis in contact lens wearers. Patients should be reminded that they must clean and disinfect their lens cases daily, should avoid the use of tap water for rinsing them, must not top up their solutions, must take into careful consideration where and how the cases are stored during the time that lenses are being worn and that they must be replaced regularly. The adoption of these methods will substantially reduce the levels of contamination of cases with pathogenic microbes. © 2010 Lippincott Williams & Wilkins.