William H. Ehlers

Contact lens complications.

Complications associated with contact lenses range from mild to severe and occur with all lens modalities. Contact lens wear can cause a change in corneal physiology, which can lead to epithelial, stromal, and endothelial compromise. Other complications include lens deposition, allergic conjunctivitis, giant papillary conjunctivitis, peripheral infiltrates, microbial keratitis, and neovascularization. Pre-existing conditions can contribute to these complications, or they can occur in association with contact lens wear and care regimens. Patient-related factors, such as alteration of the recommended wearing or replacement schedules and noncompliance with recommended contact lens care regimens for economic reasons, convenience, or in error, contribute to contact lens-related complications and have led to difficulty in accurate determination of complication rates among the various lens wear modalities. Complications may require discontinuation of contact lenses, topical therapy, and changes in contact lens wearing schedules, materials, and care solutions. On initial lens fitting and follow-up evaluations, practitioners should review contact lens replacement and cleaning regimens with patients and discuss complications. To avoid serious complications, patients should be reminded to remove their contact lenses as soon as ocular irritation occurs, and to call their eye care practitioner immediately if symptoms persist.

Giant Papillary Conjunctivitis

Contact lens wearers with giant papillary conjunctivitis report a variety of symptoms, including decreased lens tolerance, increased lens awareness, excessive lens movement, increased mucus production associated with ocular irritation, redness, burning, and itching. This article reviews the clinical signs and symptoms related to contact lens-induced giant papillary conjunctivitis. The epidemiology, histology, and pathophysiology are reviewed in depth. A variety of treatment strategies are discussed that enable patients with this condition to remain in contact lenses.

Strategies to better engage, educate, and empower patient compliance and safe lens wear: compliance: what we know, what we do not know, and what we need to know.

Purpose. To assess the extent of noncompliant behavior of contact lens wearers and to develop strategies of engaging and educating patients to increase compliance with safe contact lens practices. Methods. The literature regarding noncompliance with medical regimens, contact lens wear, and cleaning was reviewed. One hundred eleven contact lens wearers from a college campus, a dental clinic, and ophthalmology clinics were surveyed in a pilot study regarding their contact lens knowledge, attitudes, and practices. Statistical analysis of the results was performed with SPSS software. Results. A review of the literature found overall rates of noncompliance with medical regimens varies from 24.8% to 44%, and the rates reported for contact lens wearers varies from 50% to 99%. Noncompliant behavior affecting the safety of contact lenses is more common than behavior affecting lens comfort. This study found that many lens wearers thought they were compliant, but actually reported a wide variety of noncompliant behaviors. Conclusions. Although there have been remarkable advances in contact lens science, noncompliance with lens-wearing schedules, replacement schedules, and lens care regimens remains a significant problem of contact lens complications and lens failure. Noncompliant behavior is a complex phenomenon that involves knowledge, attitudes and beliefs, and available resources. Data regarding strategies for increasing compliance are scant. Noncompliance must be considered in the development of future lens care products and must be addressed by eye care professionals when patients are fitted with contact lenses and at each follow-up appointment.

Treatment Guidelines for Rheumatologic Manifestations of Sjögren's Syndrome: Use of Biologic Agents, Management of Fatigue, and Inflammatory Musculoskeletal Pain

The Sjögrens Syndrome Foundation clinical practice guidelines (CPGs) are designed to improve quality and consistency of care in Sjögrens syndrome by offering recommendations for management.

A comparative study of the impact of certified and noncertified ophthalmic medical personnel on practice quality and productivity.

Purpose. To compare ophthalmic practice productivity and performance attributes, as rated by employing ophthalmologists, of noncertified and three levels of certified ophthalmic medical personnel. Methods. Three hundred eighty-five American and Canadian ophthalmologists in a clinic-based, stratified, random sample were surveyed regarding productivity performance and attributes of the ophthalmic medical personnel they employ. Instrument scales assessed 14 desirable professional attributes and 10 practice productivity measures. The attributes were credibility, reliability, competence, quality assurance, quality of patient care, knowledge base to make adjustments, increased skills (expertise), ability to work independently, broader knowledge base, ability to detect errors, ability to be trained to perform multiple roles in the practice, professional image, good judgment, and initiative and drive. The productivity measures were patient satisfaction, doctor productivity, trouble-shooting rapport, triage screening, effective patient flow, reduced patient complaints, increased referrals, number of patients per hour, revenue per patient, and patient follow-up. Participants indicated whether certified personnel more often showed these attributes and contributed to practice productivity measures as compared to noncertified personnel or whether there was no difference. Results were analyzed with a chi-square goodness-of-fit test. Survey reliability and validity were evaluated. Results. Significantly more ophthalmologists responded that the three levels of certified personnel contributed more to 5 of the 10 practice productivity measures (i.e., doctor productivity, trouble-shooting rapport, triage screening, effective patient flow, and number of patients per hour). A statistically significant number of ophthalmologists also believed that certified personnel showed more of all 14 of the personal attributes considered desirable compared to noncertified ophthalmic medical personnel. Conclusions. Compared to noncertified personnel, the employment of certified ophthalmic personnel enhances the quality and productivity of an ophthalmic practice. Overall practice productivity is increased with certified ophthalmic medical personnel.

Disposable and frequent replacement contact lenses

Disposable and frequent replacement contact lenses dominate the marketplace. They are available in a wide variety of parameters for use in refractive errors, including myopia, hyperopia, astigmatism, and presbyopia. They are convenient and affordable and lend themselves to most wearing modalities, including daily wear, flexible wear, and extended wear for up to 30 days. In addition, they have been shown to be the most trouble-free contact lens wear modality for daily wear or extended wear. They are an appropriate choice for patients who desire occasional contact lens wear and have gained wide acceptance as therapeutic bandage contact lenses. Disposable and frequent replacement lenses will remain important modalities for some time to come as the variety of contact lenses and contact lens parameters that are offered continue to expand. New contact lens varieties, such as the high-Dk silicone hydrogel lenses, will further expand the role of these contact lenses in vision correction.

Update on lotrafilcon A contact lenses

Silicone hydrogel contact lenses were introduced in 1999 after polymer chemists were able to successfully copolymerize conventional hydrogel material with silicone polymers, creating a soft material with high oxygen permeability. Comfort has been achieved through surface modifications to improve the wettability of these hydrophobic copolymers. Lotrafilcon A was introduced in 2001 and had the highest oxygen permeability of any of the commercially available silicone hydrogel contact lenses. The popularity of silicone hydrogels has steadily increased since their introduction, and they now account for more than 50% of the soft contact lens market in the USA. The popularity of these contact lenses has been fueled by decades of research implicating relative hypoxia, one of the major complications of conventional hydrogel contact lens wear. The overall complication rate for conventional hydrogel contact lenses is low. However, with 38 million contact lens wearers in the USA, even a low complication rate can result in significant morbidity. Most contact lens-related complications are minor and do not cause visual loss. However, serious complications can occur, and this is particularly true for overnight lens wearers. High-Dk silicone hydrogels, including lotrafilcon A, have reduced complications related to hypoxia. Mechanical complications can still occur, but the rate appears to be low and the risk of microbial keratitis appears to be similar to the rate found with overnight wear of conventional hydrogel lenses.

Allergic diseases of the lids, conjunctiva, and cornea

Ocular allergies are very common, and familiarity with the typical complex of signs and symptoms, as well as the pathophysiology of these syndromes, is vital in recognizing and treating allergic individuals. Our allergic armamentarium has been expanded in recent months with the release of several medications with different mechanisms of action. Levocabastine (Livostin, IOLAB, Claremont, CA) is the first topical H, antihistamine not combined with a vasoconstrictor. Ketorolac tromethamine (Acular, Allergan, Irvine, CA) is a topical nonsteroidal anti-inflammatory agent, and Lodoxamine tromethamine (Alomide, Alcon, Fort Worth, TX) is a new mast cell stabilizer. Appropriate usage of these new agents, along with traditional therapeutic measures, should enhance our ability to minimize the distress of allergic eye disease.