Jennifer Harthan

Review of Azithromycin Ophthalmic 1% Solution (AzaSite®) for the Treatment of Ocular Infections

AzaSite® (azithromomycin 1.0%) ophthalmic solution was approved in 2007 by the US Food and Drug Administration (FDA) as the first commercially available formulation of ophthalmic azithromycin for the treatment of bacterial conjunctivitis. AzaSite® utilizes a vehicle delivery system called DuraSite®, which stabilizes and sustains the release of azithromycin to the ocular surface, leading to a longer drug residence time, less frequent dosing, and an increase in patient compliance. AzaSite® is a broad spectrum antibiotic, effective against Gram-positive, Gram-negative, and atypical bacteria. AzaSite® has been studied for the treatment of ocular conditions beyond its clinical indication. A number of clinical studies have evaluated its efficacy and safety in the management of ocular conditions such as bacterial conjunctivitis and blepharitis on both the pediatric and adult populations. This article aims to evaluate the peer-reviewed published literature on the use of azithromycin 1.0% ophthalmic for current and possible future ophthalmic uses.

Contact Lens-induced Limbal Stem Cell Deficiency

Limbal stem cell deficiency (LSCD) is a pathologic condition caused by the dysfunction and/or destruction of stem cell precursors of the corneal epithelium, typified clinically by corneal conjunctivalization. The purpose of this review is to critically discuss a less well-known cause of limbal stem cell disease: contact lens (CL) wear. A literature search was conducted to include original articles containing patients with CL-induced LSCD. This review describes epidemiology, diagnostic strategies, pathogenesis, differential diagnosis, and treatment modalities for this condition.

Demographic Characteristics and Prescribing Patterns of Scleral Lens Fitters: The SCOPE Study

Objectives: This study reports demographic characteristics of scleral lens providers and indications for scleral lens prescription as assessed by a worldwide online survey. Methods: The Scleral Lenses in Current Ophthalmic Practice: an Evaluation (SCOPE) study group designed the online survey regarding current scleral lens prescription and management practices. The Mayo Clinic Survey Research Center administered the survey, which was open from January 15 to March 31, 2015. Data from 989 responses were collated by the Survey Research Center and deidentified before analysis. Responses of individuals who had fit at least five patients with scleral lenses were analyzed in detail. Results: Most lens fitters were men (61%, n=800). Of survey respondents, 29% were 25 to 34 years; 22%, 35 to 44 years; 22%, 45 to 54 years; and 26%, more than 55 years (n=806). For 29% of all respondents, professional training was completed between 2009 and 2014 (n=804). Most (54%) fit their first patient between 2010 and 2015, with the earliest lens fit reported in 1956 (n=634). Most respondents (63%) worked primarily in private, group, or retail practice (n=811). Scleral lenses were most often prescribed for corneal irregularity (74%), followed by ocular surface disease (16%) and uncomplicated refractive error (10%) (n=673). Conclusions: Eye care providers of all ages are fitting scleral lenses. The number of individuals who fit this lens modality has increased during the past decade. Scleral lenses are being fit by providers in a wide range of practice settings. Most scleral lenses are prescribed for corneal irregularity.

Peripheral ulcerative keratitis in association with sarcoidosis.

Peripheral ulcerative keratitis (PUK) is a sight-threatening condition characterized by an epithelial defect, crescent-shaped stromal inflammation, and progressive stromal thinning. Peripheral ulcerative keratitis as a purely inflammatory entity is most commonly associated with collagen vascular diseases, including rheumatoid arthritis, polyarteritis nodosa, Wegener granulomatosis, systemic lupus erythematosus, and relapsing polychondritis. PUK can also be associated with infectious and inflammatory conditions such as hepatitis, syphilis, herpes simplex keratitis, fungal keratitis, Mooren ulcer, and marginal keratitis. We describe a case report of PUK associated with the inflammatory condition of sarcoidosis.

Diagnosis and management of meibomian gland dysfunction: optometrists' perspective

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Clinical Optometry 2015:7 59–69 Clinical Optometry Dovepress

Clinical Evaluation of Large Diameter Rigid-gas Permeable Versus Soft Toric Contact Lenses for the Correction of Refractive Astigmatism. A Multicenter Study

Purpose: This study aims to address the clinical performance of a large diameter rigid gas permeable lens (LRGP) in a group of subjects with low-to-moderate (0.75–2.75 D) refractive astigmatism. An additional goal was to determine whether soft toric or LRGP contact lenses performed better objectively in the correction of astigmatism and to determine which modality is preferred by subjects. Methods: This was a multisite prospective cross-over clinical study. Ten asymptomatic contact lens wearers per site (four university clinics) were recruited and randomly assigned to group A or group B. Group A was assigned to start wearing Comfilcon A soft toric lens first, for two weeks, and then crossed over to LRGP lenses (Boston XO, 14.3 mm diameter miniscleral lens). Group B initially wore LRGP lenses and then crossed over to soft toric lenses. For each type of lens worn, low-contrast and high-contrast visual acuity (VA) were evaluated at distance. At the conclusion of the study, after two months, all subjects completed a questionnaire in which they were asked to indicate their preference for one type of lens (soft toric or LRGP) and to rate the quality of vision in day-to-day activities. Results: Thirty-six of 38 (94.7%) subjects completed the study with 75% preferring the vision of the LRGP lens as compared to the soft toric lenses worn in the study. 52.7% expressed a preference to continue with this modality despite only 38.8% reporting that these LRGP lenses are easy or very easy to handle. Wear time, subjective comfort, and subjective vision ratings exhibited no significant difference between the two groups. Conclusions: In a population of asymptomatic contact lens wearers, LRGP lenses can be considered as a good alternative to soft toric lenses for the correction of refractive astigmatism.

Customary practices in the monitoring of dry eye disease in Sjogren's syndrome

Purpose Diagnostic testing for dry eye disease (DED) in Sjogrens syndrome (SS) is well described. Little is published about monitoring this systemic autoimmune DED. We analyzed the SS related DED tests used in North American optometric practices and compared academic settings to private practice settings. Methods A retrospective chart review of 123 SS charts from 6 optometric practices in North America was conducted. Testing done during the first examination following a SS diagnosis was recorded on Research Electronic Data Capture (REDCap) database. The complete data file was reviewed and testing type and methodology were compared. Results Symptoms of DED (98.4% of charts),meibomian gland dysfunction (76.4% of charts), corneal staining with fluorescein (75.6% of charts) and anterior blepharitis (73.2% of charts) were the most frequently recorded variables. Clinicians used different methodologies to measure and grade these variables. Private practitioners were more likely to use symptom questionnaires and grading scales and to describe anterior blepharitis. Academic settings were more likely to record TBUT and tear meniscus height. Conclusions The monitoring of DED in SS is not uniform in optometric offices across North America. Creating accepted standards of testing will improve the ability of clinicians and researchers to communicate and understand the course of DED in SS.

Sjogren’s syndrome in optometric practices in North America

PURPOSE To describe the presentation of dry eye in Sjogrens syndrome (SS) in optometric practices, to report on the methodology used in dry eye monitoring and to explore the level of corneal staining versus age and time of disease. METHODS Records of SS patients were reviewed in 6 optometric sites. A standardized abstraction tool was developed to collect data from the records including: health history, medications and symptoms and signs of dry eye. The methods of testing symptoms and signs of dry eye were recorded. Variables were recorded at each site and collated at the University of Waterloo. The first visit after January 1, 2000 was selected for description in this paper. RESULTS 123 charts were included. The average time since diagnosis was 7.2 years ±5.1 years. Symptoms of dryness were present in 110/123 = 89.4% of charts. Corneal fluorescein staining was present in 96/123 = 78% of charts. MGD was present in 52% of charts. There were significant differences in the protocols and grading systems used in these 6 sites. Corneal staining levels did not change with greater age or length of disease. CONCLUSION These 123 SS patients presented with a large variation in their symptoms and signs. Symptoms of dryness and corneal fluorescein staining were the most commonly recorded presentations. There was a great deal of inconsistency in dry eye protocols among offices. Future prospective research with standardized testing will contribute to our understanding of the best dry eye protocols for SS patients.

Visual and physiological outcomes of scleral lens wear

PURPOSE To describe patient-specific outcomes of scleral lens wear utilizing a variety of lens designs across multiple practice settings as reported in an international practitioner survey. METHODS An electronic survey was administered to eye care providers who prescribe scleral lenses in which they were asked to describe their most recently examined established scleral lens patient. Data was collected on patient characteristics, lens designs, wearing schedules, care products, and visual and physiological outcomes of lens wear. Descriptive analysis of data was performed. RESULTS A total of 292 responses were received. Participants represented 26 countries. The most commonly reported indication for scleral lens wear was corneal irregularity (87%) followed by ocular surface disease (8%), refractive error (4%) and 1% with multiple indications. Visual acuity improved from 0.4 ± 0.4 (mean ± SD) to 0.1 ± 0.2 in eyes with corneal irregularity (p < 0.001), from 0.3 ± 0.3 to 0.1 ± 0.3 in eyes with ocular surface disease (p < 0.001), and from 0.1 ± 0.1 to 0.0± [0.1] in eye with refractive error (p = 0.01). Prior to scleral lens wear, corneal staining was present in 55% of patients; staining was present in only 35% of patients following scleral lens wear. The number of topical ophthalmic drops needed decreased from 1.7 ± 0.9 to 0.8 ± 0.8 in patients with corneal irregularity (p < 0.001) and from 3.5 ± 1.7 to 1.1 ± 1.0 in patients with ocular surface disease (p < 0.001). The number of drops used by patients with refractive error remained stable, with these patients using an average of 2.0 ± 1.0 drops prior to scleral lens wear and 1.7 ± 1.5 drops following scleral lens wear. CONCLUSIONS Patients with corneal irregularity experienced the greatest improvement in visual acuity, but patients with ocular surface disease and refractive error also achieved better visual acuity with scleral lenses. Ocular surface condition improved in patients with both corneal irregularity and ocular surface disease; patients with ocular surface disease experienced the most dramatic improvement. Patients who wore scleral lenses to correct uncomplicated refractive error did not experience an improvement in signs or symptoms of ocular surface disease.

Therapeutic uses of scleral contact lenses for ocular surface disease: patient selection and special considerations

Scleral lenses are being prescribed for the management of corneal irregularity, uncomplicated refractive error, and ocular surface disease. There are many potential therapeutic uses of scleral lenses in addition to providing similar benefits as corneal gas permeable lenses. Scleral contact lenses are a valuable therapeutic tool for patients with ocular surface disease as these lenses protect the ocular surface, provide continuous corneal hydration while providing optimal visual correction, and are often used in conjunction with other therapies.