Kathryn A. Dumbleton

The impact of contemporary contact lenses on contact lens discontinuation.

Objectives: Discontinuation or “dropout” from contact lens (CL) wear continues to afflict the CL industry. This study was conducted to determine whether the advent of new CL materials and designs has impacted the dropout rate and the reasons for discontinuation. Methods: Current and lapsed CL wearers residing in Canada were recruited using Facebook to take part in an on line survey investigating CL wearing experiences during 2008 to 2010 and to establish the percentage of participants who temporarily and permanently discontinued CL wear during the period surveyed. Results: Four thousand two hundred seven eligible surveys were received (64% female; median age 27 years). Forty percent had lapsed from lens wear for at least 4 months; however, 62% of the lapsed wearers (LWs) resumed wear. There were no differences between LWs and nonlapsed wearers (NLWs) with respect to gender; however, LWs were older, started lens wear when older, and had not worn lenses for as long as NLWs (all P<0.001). More NLWs than LWs wore silicone hydrogel CLs (49% vs. 38%, P<0.001) and more LWs than NLWs wore daily disposable lenses and hydrogel CLs (24% vs. 19% and 22% vs. 18%, respectively, P⩽0.001). Primary reasons for discontinuation were discomfort (24%), dryness (20%), red eyes (7%), and expense (7%). Compliance with lens replacement was no different between LWs and NLWs (48% vs. 45%). Conclusions: About 23% of those surveyed had discontinued CL wear permanently. The primary reasons for dropping out continue to be discomfort and dryness. Dropout rates were lower in silicone hydrogel wearers.

Compliance with contact lens replacement in Canada and the United States.

Purpose. To assess eye care practitioners (ECPs) recommendations for replacement frequency (RF) of silicone hydrogel (SH) and daily disposable (DD) lenses in Canada and the U.S. and to compare noncompliance (NC) with manufacturer recommended RF by the ECP and patient, and the reasons given for NC. Methods. Invitations to participate were sent by e-mail to ECPs in Canada and the U.S. Twenty patient surveys were sent to 420 ECPs, and 2232 eligible surveys were received from 216 ECPs (26% Canada, 74% U.S.). Questions related to patient demographics, lens type, wearing patterns, ECP instructions for RF, and actual patient RF. ECPs provided lens information and their recommendation for RF after the surveys were completed and sealed in envelopes. Responses were anonymous. Results. DD accounted for 18% (Canada) vs. 16% (U.S.) of wearers (p > 0.05); 35% (Canada) vs. 45% (U.S.) wore 2-week replacement SH (2WR; p = 0.011); and 47% (Canada) vs. 39% (U.S.) wore 1-month replacement SH (1MR) lenses (p = 0.025). Thirty-four percent (Canada) vs. 18% (U.S.) of ECPs recommended longer RFs than the manufacturer recommended RF for 2WR lens wearers (p < 0.001); 6% (Canada) vs. 4% (U.S.) for DD wearers; and 2% (Canada) vs. 1% (U.S.) for 1MR lens wearers. NC rates for actual RFs reported by patients were not different between countries (p > 0.05) and were lowest for DD (13% Canada, 12% U.S.), followed by 1MR (33% Canada, 28% U.S.). The highest NC rates were with 2WR (50% Canada, 52% U.S.). The most frequent reason for NC with 2WR and 1MR was “forgetting which day to replace lenses” (54% Canada, 53% U.S.) and in DD wearers “to save money” (56% Canada, 29% U.S., p < 0.001). Conclusions. 1MR lenses are more frequently prescribed in Canada. ECPs in Canada were NC with 2WR lenses more frequently than U.S. ECPs, but patient NC rates were the same in both countries for all lens types. ECP and patient NC rates were highest for 2WR lens wearers.

Comfort and Adaptation to Silicone Hydrogel Lenses for Daily Wear

Objectives. To investigate initial comfort and adaptation of currently successful low oxygen transmissibility soft lens wearers refitted with silicone hydrogel (SH) lenses for daily wear. Methods. Fifty-five subjects were enrolled in a subject-masked 5-month clinical trial in which they wore 5 SH lenses in a randomized, crossover design. Comfort, burning, and dryness were rated on scales of 0 to 100 immediately on insertion and the time for lens settling was recorded. Symptoms were then rated at various times, using BlackBerry wireless communication devices (Research in Motion, Waterloo, Canada), during the day for 2 cycles of 2 weeks wear for each lens type. Results. Comfort immediately on insertion varied between lens types (P=0.002). All lens types were reported by the subjects to have settled within 30 to 45 sec of insertion (P=0.14) and “settled” comfort was greater than comfort immediately on insertion (P<0.001). Comfort within the first hour of wear also varied between lens types (P=0.02). Comfort during the day decreased significantly for all lenses (P=0.001), but there was no difference between lenses (P=0.19) and no effect of lens age (P=0.15). The wearing times were greater with the SH lenses than the habitual lenses worn before study commencement (P=0.001). Overall performance of the lenses after 4 weeks was high, with no difference between lenses (P=0.45). Conclusions. Initial comfort and adaptation to all SH lenses were good and no differences in the overall ratings were found between the 5 SH lenses investigated. Decreased comfort was noted later in the day with all lens types, but longer wearing times were reported with the SH lenses than previous hydroxyethyl methacrylate-based lenses.

The relationship between compliance with lens replacement and contact lens-related problems in silicone hydrogel wearers

PURPOSEnTo evaluate the relationship between compliance with replacement frequency (RF) and contact lens (CL)-related problems in silicone hydrogel (SiHy) wearers.nnnMETHODSn501 SiHy wearers from seven optometry offices completed surveys regarding their lens wear and any CL related problems which they may have experienced in the preceding 12 months. File review was subsequently conducted at their optometry offices to confirm the information provided.nnnRESULTSn49% of respondents were wearing 2-week replacement (2WR) and 51% 1-month replacement (1MR) SiHy lenses. 67% wore their lenses for longer than the manufacturers recommended RF (MRRF) and 60% for longer than their optometrists recommended RF (ORRF). The mean RF was 2.6× the MRRF for 2WR and 1.5× for 1MR wearers (p<0.001) with median values of 31 and 37 days, respectively. Twenty-three percent reported signs or symptoms consistent with potential complications relating to CL wear. This rate was significantly higher for wearers who were non-compliant with the ORRF than compliant wearers (26% versus 18%, p=0.028). It was also higher for those multipurpose solution users who reported never/almost never rubbing and rinsing their lenses when compared with those who did this every night (29% versus 17%, p=0.007).nnnCONCLUSIONSnTwo thirds of the SiHy wearers did not comply with the MRRF and 2WR wearers stretched the replacement interval of their lenses to a greater degree than 1MR wearers. Failing to replace lenses when recommended and failing to rub and rinse lenses were associated with a higher rate of patient-reported CL problems.

Clinical performance of different care systems with silicone hydrogel contact lenses

PURPOSEnTo assess the clinical and subjective performance of a one-step hydrogen peroxide (H2O2) lens care system compared to a multi-purpose disinfecting system (MPDS) when used with silicone hydrogel (SiH) lenses.nnnMETHODSnThis was an eight-week, contralateral (lens type) clinical trial with a randomized, cross-over (care system) design. The H2O2 system was Clear Care ((AO Sept Plus) CIBA VISION) and the MPDS was OPTI-FREE RepleniSH (Alcon) and the SiH materials were lotrafilcon B (Air Optix; CIBA VISION) and senofilcon A (Acuvue OASYS, Johnson & Johnson Vision Care). Investigators and subjects were masked to lens care and lens type, respectively. Clinical variables and ocular health assessments were conducted at a baseline, two-week and four-week visit for each cross-over phase. Comfort, dryness and vision were rated on 0-100 scales. Wearing times and comfortable wearing times were also recorded.nnnRESULTSnTwenty-six subjects were enrolled: nine male, 17 female, mean age (+/-standard deviation) 31+/-12 years (range 17-59 years) and 24 subjects completed the study. Clinical variables showed no difference between solutions (all p > 0.05), however one subject exhibited solution-induced corneal staining with both lens materials and the MPDS. There was no difference between solutions in subjective overall ratings of comfort, dryness or vision (p > 0.05). The H2O2 resulted in longer reported comfortable wearing times than the MPDS (10.93 +/- 1.71 vs 9.84 +/- 1.47 h; repeated measures ANOVA, p < 0.01).nnnCONCLUSIONSnWhile both lens care systems performed well with the SiH lenses used, the H2O2 resulted in a longer reported comfortable wearing time then the MPDS.

Comfort and vision with silicone hydrogel lenses: effect of compliance.

Purpose. Silicone hydrogel (SH) lenses are usually replaced after 2 weeks (2W) or 1 month (1M); however, many patients do not comply with the manufacturers recommended replacement frequency (MRRF). The purpose of this analysis was to investigate the effect of compliance with MRRF on comfort and vision in SH wearers. Methods. As a part of a larger study investigating compliance with MRRF, patients were asked to rate their subjective comfort and vision from 0 (very poor) to 10 (excellent) in the morning, at the end of the day (EVE), when lenses were new, and needed replacing (NR). Results. One thousand three hundred forty-four patients wore 2W replacement modality (2WR) (n = 717) or 1M replacement modality (1MR) (n = 617) SH lenses. Comfort and vision in the morning and when lenses are new were significantly higher than for EVE and NR (p < 0.001). Twenty-nine percent (95% confidence interval 25.3–32.4) of 1MR and 59% (95% confidence interval 55.5–62.7) of 2WR wearers were non-compliant with the MRRF. Compliance had a significant effect on EVE (p = 0.002, p = 0.008) and NR (p < 0.001, p < 0.001) comfort and vision. After accounting for compliance, EVE and NR comfort and EVE vision were higher for 1MR than 2WR (p = 0.015, p = 0.044, p = 0.019). Conclusions. Compliant patients had better EVE and NR comfort and vision than non-compliant patients, regardless of replacement modality. Optimal subjective performance with SH lenses seems to be facilitated by replacing lenses as recommended.

Patient use of smartphones to communicate subjective data in clinical trials.

Purpose. Various methods have been used in clinical trials to collect time-sensitive subjective responses, including study diaries, telephone interviews, and use of text messaging. However, all of these methods are limited by the uncertainty of when the participants enrolled in the study actually record their responses. This technical note reports on the utility of the BlackBerry smartphone to collect such data and why such a system provides advantages over other methods to report subjective ratings in clinical studies. Methods. The Centre for Contact Lens Research developed an on-line web-enabled system that permits participants to record and immediately transmit subjective rating scores in numerical form directly into a web-enabled database. This, combined with the utility of BlackBerrys, enabled time-specific e-mail requests to be sent to the study participants and then for that data to be simultaneously transmitted to the web-enabled database. This system has been used in several clinical trials conducted at the Centre for Contact Lens Research, in which data were collected at various times and in several specific locations or environments. Results. In the clinical trials conducted using this system, participants provided responses on 97.5% of occasions to the requests for data generated by the automated system. When the request was for data on a set date, this method resulted in responses of 84.1% of the time. Conclusions. The series of clinical trials reported here show the benefits of the utilization of the BlackBerry to collect time- or environment-sensitive data via a web-enabled system.

Ability of patients to recall habitual contact lens products and enhancement of recall using photographic aids.

PURPOSEnTo determine the proportion of soft contact lens (CL) wearers who are able to recall their habitual products (lenses and care system) correctly from memory, and to evaluate the value of using photographic aids (PAs) to improve recall.nnnMETHODSn103 soft lens wearers attended 2 visits to investigate their habitual CL product use. At the first visit they were asked to recall which products they were using and then to identify their products from PAs. They returned for a second visit with their products for confirmation.nnnRESULTSn51% correctly reported their lens brands from memory alone, which improved to 87% with the use of the PAs (p<0.001). 41% correctly reported their habitual care system from memory alone, which improved to 80% with the use of PAs (p<0.001). Females were better at recalling care system brand names than males (49% versus 27% correct, p=0.040) and wearers with more than 1 year experience with their habitual CLs had better recall than those with up to 1 year experience (63% versus 27%, p=0.014).nnnCONCLUSIONnLess than 50% of contact lens wearers were able to recall the names of their habitual lens and lens care products correctly from memory. PAs improved this recall significantly for both contact lenses and contact lens care systems.

Association Between Contact Lens Discomfort and Pre-lens Tear Film Kinetics

Purpose The relationship between contact lens wettability and comfort has been extensively evaluated; however, a direct correlation between the characteristics of the pre-lens tear film and the symptoms associated with contact lens discomfort has yet to be established. In addition, there is relatively limited knowledge relating to the entire tear film kinetics during the inter-blink period in contact lens wearers. The purpose of this analysis was to identify the characteristics of the pre-lens tear film kinetics that may be associated with the symptoms of contact lens discomfort. Methods The study population comprised 202 soft (hydrogel and silicone hydrogel) contact lens wearers attending pre-screening visits at the OTG-i research clinic. All participants completed the Ocular Surface Disease Index (OSDI) questionnaire and the tear film was quantified via post hoc, masked analysis of high definition digital Tearscope videos recorded at the visit. The tear film kinetics of the least symptomatic wearers (OSDI lowest quintile scores, n = 45) were compared to the tear film kinetics of the most symptomatic wearers (OSDI highest quintile scores, n = 43). The hypothesis tested was that the tear film kinetics of asymptomatic wearers were better than tear film kinetics of symptomatic wearers. Results The distribution of lens types worn was as follows: Daily Disposable 46.5%, 1-Month Replacement 39.6%, and 2-Week Replacement 13.6%. 48.2% of lenses were silicone hydrogel and 51.8% hydrogel. Symptomatic wearers had a shorter break-up time (4.7 s vs. 6.0 s; p = 0.003), lesser surface coverage by the tear film during the interblink period (95.1% vs. 98.5%; p < 0.001) and greater surface exposure at the time of the blink (9.4% vs. 3.9%; p = 0.001). Conclusions The current study demonstrated that the tear film kinetics of asymptomatic and symptomatic contact lens wearers were different, the findings supporting the hypothesis of poorer tear film kinetics for symptomatic than asymptomatic wearers in a general contact lens wearing population.

The Effects of Age, Refractive Status, and Luminance on Pupil Size.

Purpose Pupil size is critical for optimal performance of presbyopic contact lenses. Although the effect of luminance is well known, little information is available regarding other contributing factors such as aging and refractive status. Methods The cohort population comprised 304 patients (127 male, 177 female) aged 18 to 78 years. Pupils were photographed at three controlled luminance levels 250, 50, and 2.5 cd/m2 using an infra-red macro video camera. Measurements of pupil diameter were conducted after transforming pixel values to linear values in millimeters. Results Luminance was the most influential factor with pupil diameter increasing with decreased luminance (p < 0.001, all comparisons). Age was also found to be a significant factor with a smaller diameter in the older groups, but overall the difference was only significant between the pre-presbyopes and the established presbyopes (p = 0.017). Pupil diameter decreased significantly with increasing age, the effect being most marked at low luminance (<0.001). The smallest pupil diameters were measured for hyperopes and the largest for myopes and although refractive error was not a significant factor alone, there was a significant interaction between luminance and refractive error with the greatest differences in pupil diameter between myopes and emmetropes at low luminance (p < 0.001). Pupil diameter changes modeled by multilinear regression (p < 0.001) identified age, luminance, best sphere refraction, and refractive error as significant factors accounting for just over 70% of the average variation in pupil diameter. Conclusions Both age and refractive status were found to affect pupil size with larger pupils measured for younger patients and myopes. Designs for multifocal contact lens corrections should take both age and refractive status into consideration; a faster progression from distance to near corrections across the optical zone of the lens is expected to be required for established presbyopes and hyperopes than it is for early presbyopes, myopes, and emmetropes.