Abdi,B., Mofidfar,M., Hassanpout,F., Cilingir,E. K., Kalajahi,S., Milani,P. K., Ghanbarzadeh,M., Fadel,D., Barnett,M., Ta,C. N., Leblanc,R. M., Chauhan,A., Abbasi,F. Therapeutic contact lenses for the treatment of corneal and ocular surface diseases: Advances in extended and targeted drug delivery International Journal of Pharmaceutics 2023;638(May):122740 [ Show Abstract ]

The eye is one of the most important organs in the human body providing critical information on the environment. Many corneal diseases can lead to vision loss affecting the lives of people around the world. Ophthalmic drug delivery has always been a major challenge in the medical sciences. Since traditional methods are less efficient (∼5%) at delivering drugs to ocular tissues, contact lenses have generated growing interest in ocular drug delivery due to their potential to enhance drug bioavailability in ocular tissues. The main techniques used to achieve sustained release are discussed in this review, including soaking in drug solutions, incorporating drug into multilayered contact lenses, use of vitamin E barriers, molecular imprinting, nanoparticles, micelles and liposomes. The most clinically relevant results on different eye pathologies are presented. In addition, this review summarizes the benefits of contact lenses over eye drops, strategies for incorporating drugs into lenses to achieve sustained release, results of in vitro and in vivo studies, and recent advances in the commercialization of therapeutic contact lenses for allergic conjunctivitis.

Akbari,E., Imani,R., Shokrollahi,P., Keshel,S. H. Corneal sustained delivery of hyaluronic acid from nanofiber-containing ring-implanted contact lens Journal of Biomaterials Application 2023;37(6):992-1006 [ Show Abstract ]

Dry eye syndrome, as a persist corneal epithelial defect (PED), is an inconvenient ocular disorder that is generally treated by high-dosage, conventional eye drops. Addressing low efficacy and rather restricted bioavailability of the conventional eye drops, drug-eluting contact lenses (CLs) are widely used as alternatives in ophthalmic drug delivery applications. In the present study, a nanofiber-containing ring implant poly (vinyl alcohol) (PVA) hydrogel is designed as a carrier for hyaluronic acid (HA) delivery. hyaluronic acid is physically encapsulated in a nanofiber-containing ring-shaped hydrogel with a 2 mm width that is implanted in the final CLs hydrogel. The designed CL has 59% porosity, 275% swelling ratio and undergoes no weight loss at physiological conditions in14 days. In-vitro release studies were performed on the CLs with and without nanofibers. The results showed that nanofiber incorporation in the designed CL was highly influential in decreasing burst release and supported sustained release of HA over 14 days. In addition, nanofiber incorporation in the designed system strengthened the lens, and the young modulus of the PVA hydrogel increased from 6 to 10 kPa. Cell viability study also revealed no cell cytotoxicity and cell attachment. Overall, the study demonstrated the effective role of nanofibers in the physical strengthening of the CL. Also, the designed system holds promise as a potential candidate for HA delivery over an extended period for treating dry eye syndrome.

Caffery,B., Pucker,A., Chidi-Egboka,C., Obinwanne,C. J., Karkness,B., Carnt,N. A., Ng,A. Y. Lubricating drops for contact lens discomfort in adults Cochrane Database of Systematic Reviews 2023 (5):CD015751 [ Show Abstract ]

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To determine the efficacy and safety of lubricating drops for ocular discomfort associated with contact lens wear in adults.

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

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

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

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

Efron,N., Morgan,P., Jones,L., Nichols,J. Who cites optometry journals? Journal of Optometry 2023;Online ahead of print [ 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.

Huynh,C. B., Nagaarudkumaran,N., Kalyaanamoorthy,S., Ngo,W. In Silico and In Vitro Approach for Validating the Inhibition of Matrix Metalloproteinase-9 by Quercetin Eye & Contact Lens 2023;49(5):193-198 [ Show Abstract ]

Purpose:
To validate the mechanism and inhibitory activity of quercetin against matrix metalloproteinase-9 (MMP-9) using a hybrid in silico and in vitro approach.

Methods:
The structure of MMP-9 was obtained from the Protein Data Bank, and the active site was identified using previous annotations from the Universal Protein Resource. The structure of quercetin was obtained from ZINC15. Molecular docking was performed to quantify the binding affinity of quercetin to the active site of MMP-9. The inhibitory effect of various concentrations of quercetin (0.0025, 0.025, 0.25, 1.0, and 1.5 mM) on MMP-9 was quantified using a commercially available fluorometric assay. The cytotoxicity of quercetin to immortalized human corneal epithelial cells (HCECs) was quantified by obtaining the metabolic activities of the cells exposed to various concentrations of quercetin for 24 hr.

Results:
Quercetin interacts with MMP-9 by binding within the active site pocket and interacting with residues LEU 188, ALA 189, GLU 227, and MET 247. The binding affinity predicted by molecular docking was −9.9 kcal/mol. All concentrations of quercetin demonstrated significant inhibition of MMP-9 enzyme activity (all P<0.03). There was little to no reduction of HCEC metabolic activity after a 24-hr exposure to all concentrations of quercetin (P>0.99).

Conclusions:
Quercetin inhibited MMP-9 in a dose-dependent manner and was well-tolerated by HCECs, suggesting a potential role in therapy for diseases with upregulated MMP-9 as part of its pathogenesis.

Jones,L., Efron,N., Bandamwar,K., Barnett,M., Jacobs,D. S., Jalbert,I., Pult,H., Rhee,M. K., Sheardown,H., Shovlin,J. P., Stahl,U., Sranila,A., Tan,J. Tavazzi,S., Ucakhan,O. O., Willcox,M. D. P., Downie,L. TFOS lifestyle: Impact of contact lenses on the ocular surface Ocular Surface 2023;29(July):175-219 [ Show Abstract ]

Several lifestyle choices made by contact lens wearers can have adverse consequences on ocular health. These include being non-adherent to contact lens care, sleeping in lenses, ill-advised purchasing options, not seeing an eyecare professional for regular aftercare visits, wearing lenses when feeling unwell, wearing lenses too soon after various forms of ophthalmic surgery, and wearing lenses when engaged in risky behaviours (e.g., using tobacco, alcohol or recreational drugs). Those with a pre-existing compromised ocular surface may find that contact lens wear exacerbates ocular disease morbidity. Conversely, contact lenses may have various therapeutic benefits. The coronavirus disease-2019 (COVID-19) pandemic has impinged upon the lifestyle of contact lens wearers, introducing challenges such as mask-associated dry eye, contact lens discomfort with increased use of digital devices, inadvertent exposure to hand sanitizers, and reduced use of lenses. Wearing contact lenses in challenging environments, such as in the presence of dust and noxious chemicals, or where there is the possibility of ocular trauma (e.g., sport or working with tools) can be problematic, although in some instances lenses can be protective. Contact lenses can be worn for sport, theatre, at high altitude, driving at night, in the military and in space, and special considerations are required when prescribing in such situations to ensure successful outcomes. A systematic review and meta-analysis, incorporated within the review, identified that the influence of lifestyle factors on soft contact lens dropout remains poorly understood, and is an area in need of further research. Overall, this report investigated lifestyle-related choices made by clinicians and contact lens wearers and discovered that when appropriate lifestyle choices are made, contact lens wear can enhance the quality of life of wearers.

Nichols,J. J., Morgan,P. B., Jones,L. W., Efron, N Bibliometric Analysis of Ophthalmic Journals JAMA Ophthalmology 2023;141(7):651-657 [ Show Abstract ]

KEY POINTS
Question: What articles, journals, authors, institutions, and countries in the ophthalmic literature are the most highly cited and prolific and have the highest h-index for ophthalmic journal articles?

Findings: In this qualitative study, the h-index for ophthalmic journal articles was determined to be 494, which appeared comparable with the journal literature of other medical disciplines.

Meaning: While these analyses excluded ophthalmology articles in general medical journals, they suggest a strong ophthalmic research base underpins eye care, with ophthalmology having the highest h-index across a range of ophthalmic and vision disciplines contributing to this literature.

ABSTRACT
Importance: The primary vehicle for reporting and testing advances in eye care is refereed ophthalmic journals, which can be characterized using targeted bibliometric analyses.

Objective: To identify all ophthalmic journals and evaluate citation metrics relating to articles, journals, authors, institutions, and countries published therein.

Design and Setting: A bibliometric analysis was undertaken of all ophthalmic journals included in the Scopus database (Elsevier). The search was restricted to all article types published in ophthalmic journals in English from inception through November 18, 2022. After excluding general medical journals, journals published in a language other than English, and spurious titles unrelated to the ophthalmic field, the Scopus database was found to list 335 ophthalmic journal titles that have published 471 184 articles, constituting the data set for this analysis. The 20 most highly cited articles were identified. Rank-order lists by article count were assembled for journals, authors, institutions, and countries.

Main Outcomes and Measures: An h-index for ophthalmic journal articles was derived from citations and article counts for each constituent of each category.

Results: The h-index for ophthalmic journal articles was determined to be 494. The journal with the highest h-index was Ophthalmology (h-index, 297). The journal with the greatest number of articles was American Journal of Ophthalmology (38 441 articles). The most highly cited article was by Quigley and Broman, 2006 (5147 citations), concerning the epidemiology of glaucoma. The author with the highest h-index for ophthalmic journal articles was Ronald Klein, MD (h-index, 126), and the most prolific was Carol L. Shields, MD (1400 articles). Johns Hopkins University (h-index, 215) was the institution with the highest h-index for ophthalmic journal articles, and Harvard University was the most prolific (10 071 articles). The United States was the nation with the highest h-index for ophthalmic journal articles (h-index, 444) and was the most prolific (180 017 articles).

Conclusions and Relevance: In this study, the most highly cited articles published in ophthalmic journals were revealed, as well as the leading journals, authors, institutions, and countries. While excluding ophthalmology articles in general medical journals, this investigation affords a means of identifying highly cited authors, institutions, and countries which individuals or institutions can use as a guide regarding contributions to the field.

Pereira-da-Mota,A. F., Vivero-Lopez, M., Garg,P., Phan,C-M., Concheiro,A., Jones,L., Alvarez-Lorenzo,C. In vitro–in vivo correlation of drug release profiles from medicated contact lenses using an in vitro eye blink model Drug Delivery and Translational Research 2023;13(4):1116-1127 [ Show Abstract ]

There is still a paucity of information on how in vitro release profiles from drug-loaded contact lenses (CLs) recorded in 3D printed eye models correlate with in vivo profiles. This work aims to evaluate the release profiles of two drug-loaded CLs in a 3D in vitro eye blink model and compare the obtained results with the release in a vial and the drug levels in tear fluid previously obtained from an animal in vivo study. In vitro release in the eye model was tested at two different flow rates (5 and 10 µL/min) and a blink speed of 1 blink/10 s. Model CLs were loaded with two different drugs, hydrophilic pravastatin and hydrophobic resveratrol. The release of both drugs was more sustained and lower in the 3D eye model compared to the in vitro release in vials. Interestingly, both drugs presented similar release patterns in the eye model and in vivo, although the total amount of drugs released in the eye model was significantly lower, especially for resveratrol. Strong correlations between percentages of pravastatin released in the eye model and in vivo were found. These findings suggest that the current 3D printed eye blink model could be a useful tool to measure the release of ophthalmic drugs from medicated CLs. Nevertheless, physiological parameters such as the composition of the tear fluid and eyeball surface, tear flow rates, and temperature should be optimized in further studies.

Phan,C. M., Ross,M., Fahmy,M., McEwen,B., Hofmann,I., Chan,V. Clark-Baba,C., Jones,L. Evaluating Viscosity and Tear Breakup Time of Contemporary Commercial Ocular Lubricants on an In Vitro Eye Model Translational Vision Science & Technology 2023;12(6):29 [ Show Abstract ]

Purpose: To evaluate the link between the viscosity of ophthalmic formulation and tear film stability using a novel in vitro eye model.

Methods: The viscosities and noninvasive tear breakup time (NIKBUT) of 13 commercial ocular lubricants were measured to evaluate the correlation between viscosity and NIKBUT. The complex viscosity of each lubricant was measured three times for each angular frequency (ranging from 0.1 to 100 rad/s) using the Discovery HR-2 hybrid rheometer. The NIKBUT measurements were performed eight times for each lubricant using an advanced eye model mounted on the OCULUS Keratograph 5M. A contact lens (CL; ACUVUE OASYS [etafilcon A]) or a collagen shield (CS) was used as the simulated corneal surface. Phosphate-buffered saline was used as a simulated fluid.

Results: The results showed a positive correlation between viscosity and NIKBUT at high shear rates (at 10 rad/s, r = 0.67) but not at low shear. This correlation was even better for viscosities between 0 and 100 mPa*s (r = 0.85). Most of the lubricants tested in this study also had shear-thinning properties. OPTASE INTENSE, I-DROP PUR GEL, I DROP MGD, OASIS TEARS PLUS, and I-DROP PUR had higher viscosity in comparison to other lubricants (P < 0.05). All of the formulations had a higher NIKBUT than the control (2.7 ± 1.2 seconds for CS and 5.4 ± 0.9 seconds for CL) without any lubricant (P < 0.05). I-DROP PUR GEL, OASIS TEARS PLUS, I-DROP MGD, REFRESH OPTIVE ADVANCED, and OPTASE INTENSE had the highest NIKBUT using this eye model.

Conclusions: The results show that the viscosity is correlated with NIKBUT, but further work is necessary to determine the underlying mechanisms.

Ramaswamy,M., Ho,B., Phan,C. M., Qin,N., Ren,C. L., Jones,L. Inexpensive and rapid fabrication of PDMS microfluidic devices for biological testing applications using low cost commercially available 3D printers Journal of Micromechanics and Microengineering 2023;Online ahead of print [ Show Abstract ]

Polydimethylsiloxane (PDMS) elastomers have been extensively used in the development of microfluidic devices, capable of miniaturizing biomolecular and cellular assays to the microliter and nanoliter range, thereby increasing the throughput of experimentation. PDMS has been widely used due to its optical clarity and biocompatibility, among other desirable physical and chemical properties. Despite the widespread use of PDMS in microfluidic devices, the fabrication process typically requires specialized facilities, instruments, and materials only available in a limited number of laboratories. To expand microfluidic research capabilities to a greater scientific population, we developed and characterized a simple and robust method of fabricating relatively inexpensive PDMS microfluidic devices using readily available reagents and commercially available 3D printers. The moulds produced from the 3D printers resolve designed microfluidic channel features accurately with high resolution ( >100 µm). The critical physical and chemical post-processing modifications we outline here are required to generate functional and optically clear microfluidic devices.

Spafford,M. M., Chow,A. H. Y., Labreche,T., Jones,D. A., Christian,L. W. T., Furtado,N. M., MacIver,S., Irving,E. L. Trust and Access: Eye Information-seeking Practices and Preferences among Canadians Optometry and Vision Science 2023;100(7):467-474 [ Show Abstract ]

SIGNIFICANCE
This study highlights the value that the public places on obtaining trusted and accessible health-related information and their preference for obtaining it from their health care practitioners. Previous research has not been specific to Canadians or vision. Findings can be used to increase eye health literacy and eye care utilization.

PURPOSE
Canadians underuse eye care and underestimate the occurrence of asymptomatic eye disease. This study explored eye information-seeking practices and preferences among a group of Canadians.

METHODS
Using snowball sampling, a 28-item online survey collected respondent perceptions about their eye and health information-seeking practices and preferences. Questions examined electronic device access, information source use, and demographics. Two open-ended questions examined information-seeking practices and preferences. Respondents were at least 18 years old and living in Canada. Individuals working in eye care were excluded. Response frequencies and z scores were computed. Written comments were assessed using content analysis.

RESULTS
Respondents searched for less eye than health information (z scores ≥ 2.25, P < .05). For eye and health information, primary care providers were the used and preferred source, and reliance on Internet searches was greater than desired. Trust and access drove information-seeking practices. Respondent comments suggested that a hierarchy of trust operates across My Health Team, My Network, and My External Sources, with a persistent threat posed by Discredited Sources. Access to information sources seemed mediated by enablers (Convenience and Accessible Features) and barriers (Unreachable Health Team and Absent Systems). Eye information was seen as more specialized and harder to find. There was a high regard for health care practitioners who provide their patients with curated trusted information.

CONCLUSIONS
These Canadians value trusted and accessible health-related information. They prefer eye and health information from their health care practitioners and value when their health team provides online curated information, particularly regarding eyes.

Stapleton,F., Abad,J. C., Barabino,S., Burnett,A., Iyer,G., Lekhanont,K., Li,T., Liu,Y., Navas,A., Obinwanne,C. J., Qureshi,R., Roshandel,D., Sahin,A., Shih,K., Tichenor,A., Jones,L. TFOS lifestyle: Impact of societal challenges on the ocular surface Ocular Surface 2023;28(April):165-199 [ Show Abstract ]

Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.

Sullivan,D., da Costa,A. X., Del Duca,E., Doll,T., Grupcheva,C. N., Lazreg,S., Liu,S-H., McGee,S. R., Murthy,R., Narang,P., Ng,A. Y., Nistico,S., O'Dell,L., Roos,J., Shen,J., Markoulli,M. TFOS lifestyle: Impact of cosmetics on the ocular surface Ocular Surface 2023;29(July):77-130 [ Show Abstract ]

In this report the use of eye cosmetic products and procedures and how this represents a lifestyle challenge that may exacerbate or promote the development of ocular surface and adnexal disease is discussed. Multiple aspects of eye cosmetics are addressed, including their history and market value, psychological and social impacts, possible problems associated with cosmetic ingredients, products, and procedures, and regulations for eye cosmetic use. In addition, a systematic review that critically appraises randomized controlled trial evidence concerning the ocular effects of eyelash growth products is included. The findings of this systematic review highlight the evidence gaps and indicate future directions for research to focus on ocular surface outcomes associated with eyelash growth products.

Watson,S. L., Jones,L. W., Stapleton,F., Hinds,M., Ng,A., Tan,J, Alster,Y., Bosworth,C., Rafaeli,O., DePuy,V, Efficacy and safety of AZR-MD-001 selenium sulfide ophthalmic ointment in adults with meibomian gland dysfunction: A vehicle-controlled, randomized clinical trial The Ocular Surface 2023;29(July):537-546 [ Show Abstract ]

Purpose
Meibomian gland dysfunction (MGD) is a chronic progressive disease with downstream effects on ocular signs and symptoms. AZR-MD-001 is a selenium sulfide ophthalmic ointment that was investigated as a potential treatment option for patients with MGD.

Methods
A Phase 2, multi-center, double-masked, parallel group study was conducted across 29 sites, with 245 patients randomized 1:1:1 to AZR-MD-001 0.5%, AZR-MD-001 1.0% or vehicle applied to the lower eyelid, twice weekly. Patients were eligible for the trial if they presented with signs and symptoms of MGD. Co-primary efficacy endpoints were the changes from baseline in number of open glands (Meibomian Glands Yielding Liquid Secretion [MGYLS] score) and patient-reported ocular surface symptoms (Ocular Surface Disease Index [OSDI] total score) at Month 3. Efficacy outcomes were captured at Day 14, Month 1.5 and Month 3. Safety and tolerability were assessed for treatment-emergent adverse events (TEAEs).

Results
AZR-MD-001 0.5% (n = 82 patients) treatment resulted in significant improvements in MGYLS score, with patients experiencing an average increase from baseline of 4.2 and 2.4 open glands secreting meibum for the drug and vehicle, respectively (p < 0.001) and from baseline a mean OSDI total score improvement of 7.3 and 3.8 for the drug and vehicle, respectively (p < 0.05). Most TEAEs were mild and transient, with 3 serious adverse events (SAEs) reported with AZR-MD-001 (none related to study drug).

Conclusions
Co-primary endpoints were met for AZR-MD-001 0.5% at Month 3, with a statistically significant improvement in the signs and symptoms of MGD. AZR-MD-001 was safe and well tolerated.

Woods,C., Naroo,S., Zeri,F., Bakkar,M., Barodawala,F., Evans,V., Fadel,D., Kalikivayi,L., Lira,M., Maseedupally,V., Trave Huarte,S., Eperjesi,F. Evidence for commonly used teaching, learning and assessment methods in contact lens clinical skills education Contact Lens Anterior Eye 2023;46(2):101821 [ Show Abstract ]

Introduction
Evidence based practice is now an important part of healthcare education. The aim of this narrative literature review was to determine what evidence exists on the efficacy of commonly used teaching and learning and assessment methods in the realm of contact lens skills education (CLE) in order to provide insights into best practice. A summary of the global regulation and provision of postgraduate learning and continuing professional development in CLE is included.

Method
An expert panel of educators was recruited and completed a literature review of current evidence of teaching and learning and assessment methods in healthcare training, with an emphasis on health care, general optometry and CLE.

Results
No direct evidence of benefit of teaching and learning and assessment methods in CLE were found. There was evidence for the benefit of some teaching and learning and assessment methods in other disciplines that could be transferable to CLE and could help students meet the intended learning outcomes. There was evidence that the following teaching and learning methods helped health-care and general optometry students meet the intended learning outcomes; clinical teaching and learning, flipped classrooms, clinical skills videos and clerkships. For assessment these methods were; essays, case presentations, objective structured clinical examinations, self-assessment and formative assessment. There was no evidence that the following teaching and learning methods helped health-care and general optometry students meet the intended learning outcomes; journal clubs and case discussions. Nor was any evidence found for the following assessment methods; multiple-choice questions, oral examinations, objective structured practical examinations, holistic assessment, and summative assessment.

Conclusion
Investigation into the efficacy of common teaching and learning and assessment methods in CLE are required and would be beneficial for the entire community of contact lens educators, and other disciplines that wish to adapt this approach of evidence-based teaching.