Peer-reviewed Articles

Please use the year list below to look at past peer-reviewed articles.


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

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

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

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

Efron,N., Brennan,N. A., Chalmers,R. L., Jones,L. W., Lau,C., Morgan,P. B., Nichols,J. J., Szczotka-Flynn,L. B., Willcox,M. D. Thirty years of ‘quiet eye’ with etafilcon A contact lenses Contact Lens Anterior Eye 2020;43(3):285-297 [ Show Abstract ]

Frequent replacement contact lenses made from the etafilcon A hydrogel lens material were introduced onto the market over 30 years ago, and etafilcon A remains the most widely used hydrogel lens material today. Although the prescribing of silicone hydrogel lenses is increasing, millions of lens wearers globally have been wearing hydrogel lenses for many years and exhibit a physiologically-stable ‘quiet eye’, with a low profile of adverse events. Hydrogel lenses are demonstrated to maintain a low inflammatory response and infection risk profile during daily wear, which in the case of etafilcon A, may be related to its low modulus, and the naturally-protective, anti-microbial, non-denatured lysozyme absorbed into the lens from the tear fluid. Although improved corneal physiology from decreased hypoxia with silicone hydrogel lenses is well accepted, equivalent levels of corneal oxygenation are maintained during daily wear of low to medium powered hydrogel lenses, which do not impede the daily corneal de-swelling process, and do not induce clinically significant changes in ocular health. Therefore, hydrogel lenses remain an important alternative for daily wear in modern contact lens practice.

Jones,L., Walsh,K., Willcox,M., Morgan,P., Nichols,J. The COVID-19 pandemic: Important considerations for contact lens practitioners Cont Lens Anterior Eye 2020;43196-203 [ Show Abstract ]

A novel coronavirus (CoV), the Severe Acute Respiratory Syndrome Coronavirus - 2 (SARS-CoV-2), results in the coronavirus disease 2019 (COVID-19). As information concerning the COVID-19 disease continues to evolve, patients look to their eye care practitioners for accurate eye health guidance. There is currently no evidence to suggest an increased risk of contracting COVID-19 through contact lens (CL) wear compared to spectacle lens wear and no scientific evidence that wearing standard prescription spectacles provides protection against COVID-19 or other viral transmissions.

During the pandemic there will potentially be significant changes in access to local eyecare. Thus, it is imperative CL wearers are reminded of the steps they should follow to minimise their risk of complications, to reduce their need to leave isolation and seek care. Management of adverse events should be retained within optometric systems if possible, to minimise the impact on the wider healthcare service, which will be stretched. Optimal CL care behaviours should be the same as those under normal circumstances, which include appropriate hand washing (thoroughly with soap and water) and drying (with paper towels) before both CL application and removal. Daily CL cleaning and correct case care for reusable CL should be followed according to appropriate guidelines, and CL exposure to water must be avoided. Where the availability of local clinical care is restricted, practitioners could consider advising patients to reduce or eliminate sleeping in their CL (where patients have the appropriate knowledge about correct daily care and access to suitable lens-care products) or consider the option of moving patients to daily disposable lenses (where patients have appropriate lens supplies available). Patients should also avoid touching their face, including their eyes, nose and mouth, with unwashed hands and avoid CL wear altogether if unwell (particularly with any cold or flu-like symptoms).

Luensmann,D., Omali,N. B., Suko,A., Drolle,E., Heynen,M., Subbaraman,L. S., Scales,C., Fadli,Z., Jones,L. Kinetic Deposition of Polar and Non-polar Lipids on Silicone Hydrogel Contact Lenses Current Eye Research 2020;Online ahead of print [ Show Abstract ]

Purpose: This study investigated kinetic lipid uptake to four silicone hydrogel (SiHy) lenses over a period of four weeks, using an in-vitro radiolabel method.

Methods: Four contemporary monthly replacement SiHy lenses (lotrafilcon B, senofilcon C, comfilcon A, samfilcon A) were incubated in three different solutions: 1) An artificial tear solution (ATS) containing 14C-labeled phosphatidylcholine (PC), 2) an ATS containing 14C-cholesteryl oleate (CO) and 3) an ATS containing four 14C-radiolabeled lipids (PC, phosphatidylethanolamine, CO, and cholesterol (total lipid)). After 16 hours, lipids were extracted twice from the lenses with chloroform:methanol and the radioactive counts determined the lipid quantities to simulate 1 day of wear. OPTI-FREE PureMoist (Alcon) was used to clean and disinfect the remaining lenses daily and the lipid quantities were further determined after 2 weeks and 4 weeks.

Results: The amount of total lipid increased for all lenses over time (p < .01). After four weeks, total lipid accumulated was 20.26 ± 0.15 µg/lens for senofilcon C, which was significantly higher (p < .01) than all other lens materials (samfilcon A - 17.84 ± 0.21; comfilcon A - 16.65 ± 0.12; lotrafilcon B - 7.41 ± 0.56 µg/lens). CO was highest on lotrafilcon B (1.26 ± 0.13 µg/lens) and senofilcon C attracted the most PC (3.95 ± 0.12 µg/lens) compared to the other materials.

Conclusion: The amount of both polar and non-polar lipid deposition on monthly replacement SiHy lenses increased over 4 weeks, with significant differences being seen between lens materials.

Luensmann,D., van Doorn,K., May,C., Srinivasan,S., Jones,L. The Impact of Cosmetics on the Physical Dimension and Optical Performance of Contemporary Silicone Hydrogel Contact Lenses Eye & Contact Lens 2020;46(3):166-173 [ Show Abstract ]

Purpose: Contact lens wearers may inadvertently expose their lenses during the lens insertion and removal process or while wearing their lenses to cosmetic products being used. This study investigated the impact of
various cosmetics on the physical dimension and optical properties of three recently marketed monthly replacement silicone hydrogel contact lenses.

Methods: In this in vitro study, three monthly replacement silicone hydrogel lens types including senofilcon C (ACUVUE VITA, Johnson & Johnson), samfilcon A (Bausch+Lomb ULTRA, Bausch+Lomb), and lotrafilcon
B+EOBO (polyoxyethylene-polyoxybutylene) (AIR OPTIX plus HydraGlyde, ALCON), were individually coated with cosmetic products followed by a 1-hr soak in phosphate-buffered saline. Cosmetic products
included; three hand creams (HC1: Glysomed; HC2: Vaseline Healthy Hand & Nail Conditioning; and HC3: Intense Relieve), three make-up removers (MR1: Lid-Care Towelettes; MR2: Gentle waterproof eye and
Lip Makeup Remover; and MR3: Oil-Free Makeup Remover), and three mascaras (MA1: Great Lash—waterproof; MA2a: Wonder’Lash—waterproof, and MA3: Voluminous Original). The contact lens dimensions were
determined for diameter, sagittal depth, and base curve, using the Chiltern (Optimec Limited), whereas lens power and optical quality were assessed using the Contest Plus II (Rotlex). Six replicates for each lens/cosmetic combination were used. The impact of cosmetics was tested between lenses and compared with uncoated control lenses.

Results: For lens diameter, makeup removers (MR2 & MR3) demonstrated the largest impact, with an increase of up to 0.26 mm (MR2) and 0.35 mm (MR3) for senofilcon C and samfilcon A, respectively (P,0.01 compared to baseline), whereas lotrafilcon B+EOBO showed a decrease of 0.01 mm (P,0.01 between lens types). For sagittal depth, mascara MA1 demonstrated the greatest impact, followed by makeup removers MR2 & MR3. All lenses showed increases in sagittal depth after MA1 exposure (0.1660.06 mm in lotrafilcon B+EOBO, 0.2460.22, and 0.2660.09 mm in samfilcon A and senofilcon C, respectively; P,0.01 for all lenses compared with baseline). For base curve, the makeup removers (MR2 & MR3) caused increases for both senofilcon C (up to 0.36 mm) and samfilcon A (up to 0.35 mm), but lotrafilcon B+EOBO was unaffected. Lens power changes were generally minor (,0.25 D). However, senofilcon C showed a significant change of 21.1860.65 D (more minus) after MA1 exposure (P,0.001). Image quality was most affected by mascaras, although given that all lens types were adversely affected to similar degrees, none of the lenses performed better or worse after mascara application (P.0.05). The parameters of the different lens types were not significantly affected by the hand creams.

Conclusion: Makeup removers and mascaras changed the lens parameters to varying degrees, which may affect the fit and overall performance of the lens, whereas no such effect was noted with hand creams. Lotrafilcon B+EOBO was typically less affected compared with senofilcon C or samfilcon A.

Muntz,A., Subbaraman,L.N., Craig,J. P., Jones,L. Cytomorphological assessment of the lid margin in relation to symptoms, contact lens wear and lid wiper epitheliopathy Ocular Surface 2020;18(2):214-220 [ Show Abstract ]

Purpose: Lid wiper epitheliopathy (LWE) is insufficiently understood from a cytological perspective. This study explored the relationship between lid margin cytomorphology, LWE, contact lens wear, and lens-related symptoms. Methods: Habitual, symptomatic (n = 20) and asymptomatic (n = 20) soft, rigid gas permeable (n = 18) and non-contact lens wearers (n = 19) were enrolled. LWE was graded using lissamine green and the Korb scale. Subjective symptoms were assessed using the Ocular Surface Disease Index and the Contact Lens Dryness Evaluation Questionnaire. Impression cytology samples obtained from the central upper and lower lid margins of both eyes stained histologically to highlight keratinization and imaged using high-resolution microscopy. A masked investigator digitally delimited and measured the average sagittal width of the lid wiper conjunctiva and mucocutaneous junction using ImageJ. Results: The upper lid wiper conjunctiva measured 424 ± 171 μm, 404 ± 75, 667 ± 219 and 266 ± 64 in asymptomatic soft, symptomatic soft, rigid and non-contact lens wearers, respectively. The corresponding lower lid wiper conjunctivae measured 141 ± 57 μm, 232 ± 150, 519 ± 212 and 225 ± 102, which was significantly narrower than that of the upper eyelid in most cases (p < 0.05). Symptoms were not associated with lid margin changes; however, rigid lens wear and clinical LWE were associated with histologically enlarged lid wiper conjunctival areas and increased keratinization. Conclusion: A novel, exploratory account of histological measures of LWE and cytomorphological change associated with contact lens wear suggests mechanical or frictional cellular insult is occurring at the lid wiper conjunctiva.

Rangarajan,R., Ketelson,H. A., Do,R., McCanna,D. J., Suko,A., Enstone,D., Subbaraman,L., Dantam,J., Jones,L. W. Effect of Artificial Tear Formulations on the Metabolic Activity of Human Corneal Epithelial Cells after Exposure to Desiccation Journal of Visualized Experiments 2020 (159):e60812 [ Show Abstract ]

Artificial lipid-containing tear formulations are developed to reduce tear evaporation by the restoration of a deficient tear lipid layer. Artificial tear formulations that prevent cell desiccation will result in ocular surface protection and the maintenance of cell metabolic activity. During dehydration, cells undergo the process of loss of metabolic activity and subsequently cell death. This work describes a method for assessing the efficacy of artificial tear formulations. The metabolic dye (i.e., alamarBlue) changes from a low fluorescent molecule resazurin to a fluorescent molecule resorufin in viable cells. The biological performance of an artificial tear formulation is measured as the ability of the formulation to (a) maintain cell viability and (b) provide cell protection from desiccation. Growth media and saline are used as controls for the cell viability/desiccation tests. Cells are incubated with test solutions for 30 min and then desiccated for 0 or 5 min at 37 °C and 45% relative humidity. Cell metabolic activity after initial exposure and after cell desiccation is then determined. The results show the comparative effects of eye drop formulations on cell metabolic activity and desiccation protection. This method can be used to test dry eye formulations that are designed to treat individuals with evaporative dry eye.

van der Worp,E., Wolffsohn,J., Jones,L. When was the last time you fitted a soft lens? Cont Lens Anterior Eye 2020;Online ahead of print [ Show Abstract ]

A recent webinar “discussing the topic of soft lenses, examining dropout rates and putting forward suggestions for how eye care practitioners can ‘get control’ over their fitting” was hosted by the British Contact Lens Association (BCLA). However, the webinar and this editorial addresses much more than merely’ lens fitting’ and ‘dropouts.’ It seems that the profession is almost at a crossroads in which its future is defined by whether the profession stands as contact lens fitters and specialists or whether contact lenses are simply a commodity that can be sold over the internet.

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;Online ahead of print [ 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.

Yamasaki,K., Mizuno,Y., Kitamura,Y., McCanna,D. J., Ngo,W., Jones,L. W. The efficacy of povidone-iodine, hydrogen peroxide and a chemical multipurpose contact lens care system against Pseudomonas aeruginosa on various lens case surfaces Cont Lens Anterior Eye 2020;Online ahead of print [ Show Abstract ]

To determine the antimicrobial efficacy of a povidone-iodine system (PVP-I; cleadew, OPHTECS Corporation, Kobe, Japan), a peroxide system (AOSEPT Plus with HydraGlyde, Alcon, Fort Worth, TX), and a chemical multipurpose system (renu fresh, Bausch & Lomb, Rochester, NY) on contact lens case surfaces that are both in contact and not in contact with the solutions during lens disinfection.

The surfaces of the inner walls, underside of the lid, and lens holder (if applicable) of the cases were inoculated with P. aeruginosa ATCC 27853. The cases were disinfected with the solutions as per their manufacturer instructions. After disinfection, the inoculated surfaces were swabbed and the amount of surviving P. aeruginosa was determined. Following this experiment, separate cases were inoculated and disinfected as before. This time the cases were agitated after recommended disinfection time and the amount of P. aeruginosa in the disinfecting solution was quantified immediately, and again after resting for 7 days. Experiments were conducted in triplicate (n = 3).

Units are expressed in log CFU. All three solutions significantly reduced P. aeruginosa on direct-contact surfaces (all p < 0.039). On non-contact surfaces, the reduction of P. aeruginosa in the PVP-I system (pre-disinfection: 6.8 ± 0.5, post-disinfection: 1.0 ± 0.0; p < 0.001) was significant, but not for the hydrogen peroxide system (pre-disinfection: 6.3 ± 0.6, post: 5.5 ± 0.5; p = 0.194) and the chemical multipurpose system (pre-disinfection: 6.6 ± 0.1, post-disinfection: 5.6 ± 0.8; p = 0.336). After 7 days post-disinfection, no P. aeruginosa regrowth was observed in the PVP-I system (Day 1: 1.0 ± 0.0, Day 7: 1.0 ± 0.0; p = 1) and the chemical multipurpose system (Day 1: 4.2 ± 0.2, Day 7: 1.8 ± 0.9; p = 0.012), however regrowth was observed in the hydrogen peroxide system (Day 1: 3.4 ± 0.6, Day 7: 6.1 ± 0.4; p = 0.003).

The PVP-I system was more effective against P. aeruginosa on non-contact surfaces than the hydrogen peroxide system or the chemical multipurpose system and is capable of inhibiting regrowth of P. aeruginosa for at least 7 days post-disinfection.