Purpose: To understand soft contact lens (SCL) and gas-permeable (GP) lens wearers' behaviors and... more Purpose: To understand soft contact lens (SCL) and gas-permeable (GP) lens wearers' behaviors and knowledge regarding exposure of lenses to water. Methods: The Contact Lens Risk Survey (CLRS) and health behavior questions were completed online by a convenience sample of 1056 SCL and 85 GP lens wearers aged 20 to 76 years. Participants were asked about exposing their lenses to water and their understanding of risks associated with these behaviors. Chi-square analyses examined relationships between patient behaviors and perceptions. Results: GP lens wearers were more likely than SCL wearers to ever rinse or store lenses in water (rinsing: 91% GP, 31% SCL, P , 0.001; storing: 33% GP, 15% SCL P , 0.001). Among SCL wearers, men were more likely to store (24% vs. 13%, P = 0.003) or rinse (41% vs. 29%, P = 0.012) their lenses in water. Showering while wearing lenses was more common in SCL wearers (86%) than GP lens wearers (67%) (P , 0.0001). Swimming while wearing lenses was reported by 62% of SCL wearers and 48% of GP lens wearers (P = 0.027). Wearers who rinsed (SCL; P , 0.0001, GP; P = 0.11) or stored lenses in water (SCL; P , 0.0001, GP P = 0.007) reported that this behavior had little or no effect on their infection risk, compared with those who did not. Both SCL (P , 0.0001) and GP lens wearers (P , 0.0001) perceived that distilled water was safer than tap water for storing or rinsing lenses. Conclusions: Despite previously published evidence of Acanthamoeba keratitis' association with water exposure, most SCL, and nearly all GP lens wearers, regularly expose their lenses to water, with many unaware of the risk.
Contact lens-related complications are common, affecting around one third of wearers, although mo... more Contact lens-related complications are common, affecting around one third of wearers, although most are mild and easily managed. Contact lenses have well-defined anatomical and physiological effects on the ocular surface and can result in other consequences due to the presence of a biologically active material. A contact lens interacts with the tear film, ocular surface, skin, endogenous and environmental microorganisms, components of care solutions and other antigens which may result in disease specific to contact lens wear, such as metabolic or hypersensitivity disorders. Contact lens wear may also modify the epidemiology or pathophysiology of recognised conditions, such as papillary conjunctivitis or microbial keratitis. Wearers may also present with intercurrent disease, meaning concomitant or pre-existing conditions unrelated to contact lens wear, such as allergic eye disease or blepharitis, which may complicate the diagnosis and management of contact lens-related disease. Complications can be grouped into corneal infection (microbial keratitis), corneal inflammation (sterile keratitis), metabolic conditions (epithelial: microcysts, vacuoles, bullae, tight lens syndrome, epithelial oedema; stromal: superficial and deep neovascularisation, stromal oedema [striae/folds], endothelial: blebs, polymegethism/ pleomorphism), mechanical (corneal abrasion, corneal erosion, lens binding, warpage/refractive error changes; superior epithelial arcuate lesion, mucin balls, conjunctival epithelial flaps, ptosis, discomfort), toxic and allergic disorders (papillary conjunctivitis, solution-induced corneal staining, incomplete neutralisation of peroxide, Limbal Stem Cell Deficiency), tear resurfacing disorders/dry eye (contact lens-induced dry eye, Meibomian gland dysfunction, lid wiper epitheliopathy, lid parallel conjunctival folds, inferior closure stain, 3 and 9 o'clock stain, dellen, dimple veil) or contact lens discomfort. This report summarises the best available evidence for the classification, epidemiology, pathophysiology, management and prevention of contact lensrelated complications in addition to presenting strategies for optimising contact lens wear.
To compare the habits of United States (US) soft contact lens (SCL) wearers who bought SCLs from ... more To compare the habits of United States (US) soft contact lens (SCL) wearers who bought SCLs from their eye care practitioner (ECP), on the internet/telephone, or at retail (not where they were examined) to test the effect of proximity to the prescriber on SCL wear and care practices. Methods: Adult SCL wearers completed an adapted Contact Lens Risk Survey (CLRS) online that queried items related to risk factors for SCL-related complications. Responses from subjects who purchased at the ECP, via the internet/telephone, or at a retail store were compared (Chi-Square). Results: Purchase sources were: ECP 646 (67%, 44 AE 12 yrs, 17% male), Retail 104 (11%, 45 AE 13 yrs, 28% male), and Internet/telephone 218 (23%, 45 AE 12 yrs, 18% male); age (p = 0.51), gender (p = 0.021). Internet purchasers had fewer annual eye exams (79% ECP, 83% retail, 66% internet/telephone, p = 0.007), purchased more hydrogel SCLs (34% ECP, 29% retail, 45% internet/telephone, p = 0.0034), and paid for SCLs with insurance less often (39% ECP, 29% retail, 19% internet/telephone, p < 0.0001). Other behaviors were similar across groups (p > 0.05). Conclusions: In this sample, the purchase location of SCL wearers had limited impact on known risk factors for SCL-related complications. Internet purchasers reported less frequent eye exams and were more likely to be wearing hydrogel SCLs. Closer access to the ECP through in-office SCL purchase did not improve SCL habits or reduce the prevalence of risk behaviors. 2016 Published by Elsevier Ltd on behalf of British Contact Lens Association.
August 24-28, 2015, marks the second annual Contact Lens Health Week. In collaboration with partn... more August 24-28, 2015, marks the second annual Contact Lens Health Week. In collaboration with partners from clinical, public health, industry, and regulatory sectors, CDC is promoting healthy contact lens wear and care practices to reduce the risk for eye infections and complications associated with poor contact lens hygiene. Research following outbreaks of rare but serious eye infections in the United States showed that these types of infections occur most often in contact lens wearers who do not take proper care of their contact lenses and cases. This finding signaled that action needed to be taken to promote safer contact lens wear and care. A report in this issue of MMWR provides an updated population-based estimate of the number of contact lens wearers in the United States. The report finds that there are 40.9 million contact lens wearers aged ≥18 years. It also includes results of a survey that found more than 99% of contact lens wearers report at least one contact lens hygiene habit that could put them at risk for an eye infection, with the majority of respondents reporting behaviors that can raise the risk for eye infection. Nearly one third of contact lens wearers reported ever experiencing a contact lens-related red or painful eye that required a doctor's visit. Contact lens wearers represent a significant proportion of the U.S. population, and their contact lens hygiene habits put them at risk for painful, costly eye infections that could lead to vision problems. This year's observance targets teenage contact lens wearers, who have been associated with lower contact lens compliance and higher risk for serious eye infections. Proper contact lens hygiene habits, supplies, and regular visits to the eye doctor are all essential to keeping contact lens wearers' eyes healthy. Additional information on Contact Lens Health Week and the proper wear and care of contact lenses is available at http://www. cdc.gov/contactlenses.
Background: Understanding the factors associated with myopic progression is critical to properly ... more Background: Understanding the factors associated with myopic progression is critical to properly recruit subjects into clinical trials for control of myopia. The purpose of this study is to describe the rate of change in soft contact lens (SCL) power and the associated predictive factors in a young clinical population from the Contact Lens Assessment in Youth study. Methods: Data from a retrospective chart review of myopic SCL wearers aged eight to 22 years were analysed for rate of progression of myopia and associated characteristics using multivariate methods. Results: Myopic subjects (n = 912) with at least six months of follow-up were observed (4,341 visits, mean follow-up 25 months, 37 per cent hydrogel and 63 per cent silicone hydrogel SCLs). During observation, 36 per cent of subjects experienced a change in soft contact lens power of À0.50 D or more. Significant predictors of future increase in minus lens power were: ages eight to 13 years, shorter time to the first increase in minus power and hydrogel soft contact lens material. The mean annualised increase in minus decreased with age (À0.31D per year for eight to 13 year olds to À0.10 D per year for 20 to 22 year olds, p < 0.0001). Increases in minus were less common among users of silicone hydrogel materials than hydrogel daily disposable lenses after controlling for age (p = 0.039). Conclusion: In this retrospective chart review of young soft contact lens wearers, the mean annualised rate of increase in minus soft contact lens power decreased with age, longer time to first increase in power and was greater with hydrogel soft contact lenses. The rates observed were similar to progression rates in prospective myopia clinical trials that employed cylcoplegic autorefraction.
To describe the baseline findings in patients enrolled in the Collaborative Longitudinal Evaluati... more To describe the baseline findings in patients enrolled in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study. This is a longitudinal observational study of 1209 patients with keratoconus enrolled at 16 clinical centers. Its main outcome measures are corneal scarring, visual acuity, keratometry, and quality of life. The CLEK Study patients had a mean age of 39.29+/-10.90 years with moderate to severe disease, assessed by a keratometric-based criterion (95.4% of patients had steep keratometric readings of at least 45 D) and relatively good visual acuity (77.9% had best corrected visual acuity of at least 20/40 in both eyes). Sixty-five percent of the patients wore rigid gas-permeable contact lens, and most of those (73%) reported that their lenses were comfortable. Only 13.5% of patients reported a family history of keratoconus. None reported serious systemic diseases that had been previously reported to be associated with keratoconus. Many (53%) reported a history ...
The purpose of this study is to compare the efficacy of usual care to an intervention emphasizing... more The purpose of this study is to compare the efficacy of usual care to an intervention emphasizing patient education targeted at a multicultural adult patient population with diabetes seeking eye care in an academic health center. Methods Ninety patients were randomized to usual care or to the intervention. All patients received a comprehensive eye health and vision examination and completed a demographic survey, a patient satisfaction survey, and a diabetes eye health pretest and posttest administered by a masked examiner at 1 week and 3 months. A multidisciplinary (optometry, pharmacy, endocrinology) patient education curriculum was developed for patients randomized to the intervention. Because the dependent variable was measured at 3 points on a nominal scale, a binary generalized estimating equation was employed. Results The assessment of patient knowledge at baseline revealed misconceptions about diabetic eye disease. While most patients recognized that people with diabetes should have regularly scheduled eye examinations through dilated pupils (90.0%), most patients incorrectly reported that diabetic eye disease usually has early warning signs (75.6%). While controlling for age, gender, race, education, and HbA1c level, subjects who participated in the intervention were 2 times more likely to score higher on the posttest (χ 2 = 45.51, P > .00). No differences between pretest and posttest scores were found for patients who did not participate in the intervention (χ 2 = 11.67, P > .11).
Purpose. To identify factors associated with rigid contact lens comfort in keratoconus. Methods. ... more Purpose. To identify factors associated with rigid contact lens comfort in keratoconus. Methods. Baseline data from the 16 Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study clinical sites were analyzed for all patients wearing a rigid contact lens in their more severely keratoconic eye (as determined by steep keratometry). Corneal transplant patients, patients who did not wear a rigid contact lens in either eye, patients who did not wear a rigid lens in their worse eye, and patients with missing contact lens comfort data were excluded from the sample. A total of 751 eyes were included. Variables assessed included measures of disease severity, visual acuity through the patients' habitual rigid contact lenses, contact lens wearing time, the apical fitting relationship of the contact lens, the degree of peripheral clearance, and the presence of corneal scarring and staining. Comfort was measured by asking the patients "In general, how comfortable are your contact lenses?" (1 ؍ very comfortable through 5 ؍ very irritating). Results. Measures of disease severity (steep keratometry and the first definite apical clearance lens) were not associated with lens comfort. There was no difference in self-reported contact lens comfort between patients fitted with apical touch vs. apical clearance. Patients with a peripheral clearance rating of "minimal unacceptable" (more common among patients with milder keratoconus) were approximately half as likely to report good contact lens comfort compared with patients with "average" peripheral clearance (unadjusted odds ratio, 0.39; 95% confidence interval, 0.19 to 0.79). There was no association between contact lens comfort and the other peripheral clearance ratings compared with ratings of average. Conclusions. There does not appear to be an association between decreasing patient-reported rigid lens comfort and increasing disease severity as measured by steep keratometry or first definite apical clearance lens in this sample. The apical fitting relationship (flat vs. steep) does not appear to be associated with patient-reported comfort. Minimal peripheral clearance may contribute to decreased rigid contact lens comfort in keratoconus. (Optom Vis Sci 2004;81:182-188) Key Words: contact lens fitting, cornea, keratoconus, rigid gas-permeable contact lens T he Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study is a multicenter, longitudinal, observational study. The purpose of the CLEK Study is to prospectively characterize vision, corneal changes, and quality-of-life findings in keratoconus patients and to describe the progression of these changes with time. Sixteen CLEK clinics enrolled 1209 eligible keratoconus patients between May 31, 1995 and June 29, 1996. Keratoconus is a progressive, asymmetric, 1 noninflammatory disease of the cornea characterized by steepening and distortion of the cornea, apical thinning, and central scarring.
Purpose. To describe the Contact Lens Assessment in Youth (CLAY) Study design and report baseline... more Purpose. To describe the Contact Lens Assessment in Youth (CLAY) Study design and report baseline data for a multicenter, retrospective, observational chart review of children, teenagers, and young adult soft contact lens (SCL) wearers. Methods. Clinical charts of SCL wearers aged 8 to 33 years were reviewed at six colleges of optometry. Data were captured retrospectively for eye care visits from January 2006 through September 2009. Patient demographics, SCL parameters, wearing schedules, care systems, and biomicroscopy findings and complications that interrupted SCL wear were entered into an online database. Results. Charts from 3549 patients (14,276 visits) were reviewed; 78.8% were current SCL wearers and 21.2% were new fits. Age distribution was 8 to Ͻ13 years (n ϭ 260, 7.3%), 13 to Ͻ18 years (n ϭ 879, 24.8%), 18 to Ͻ26 years (n ϭ 1,274, 36.0%), and 26 to Ͻ34 years (n ϭ 1,136, 32.0%). The sample was 63.2% females and 37.7% college students. At baseline, 85.2% wore spherical SCLs, 13.5% torics, and 0.1% multifocals. Silicone hydrogel lenses were worn by 39.3% of the cohort. Daily wear was reported by 82.1%, whereas 17.9% reported any or occasional overnight wear. Multipurpose care systems were used by 78.1%, whereas another 9.9% indicated hydrogen peroxide solutions use. Conclusions. This data represent the SCL prescribing and wearing patterns for children, teenager, and young adult SCL wearers who presented for eye care in North American academic clinics. This will provide insight into SCL utilization, change in SCL refractive correction, and risk factors for SCL-related complications by age group.
Purpose. To present a case in which the Corneal Refractive Therapy (CRT) lens, a reverse-geometry... more Purpose. To present a case in which the Corneal Refractive Therapy (CRT) lens, a reverse-geometry contact lens designed specifically for overnight orthokeratology, was prescribed for daily wear in the treatment of a patient after radial keratotomy. Methods. Case report. Results. The CRT lens provided adequate visual acuity and satisfactory daily wearing time without an adverse physiologic response. Conclusions. This case illustrates an offlabel use of the CRT lens to facilitate lens centration and provide a functional vision correction that enhanced a patient's ability to participate in activities of daily living. Although further study regarding the long-term safety and efficacy of this lens modality is needed, the findings suggest that these lenses provide a viable vision correction for patients who are dissatisfied with their postsurgical vision, particularly when satisfactory visual acuity cannot be achieved through conventional means.
To assess the effects of gender and hormone status on the severity and progression of keratoconus... more To assess the effects of gender and hormone status on the severity and progression of keratoconus in patients enrolled in the Collaborative Longitudinal Evaluation of Keratoconus Study. Methods: The severity and progression of keratoconus in both men (M) and women were evaluated over a 4-year period that encompassed menopausal transition for hormone-active women (HA) and hormone-inactive women (HI). Four outcome measures were selected as indicators of the severity of keratoconus: highcontrast best-corrected visual acuity, low-contrast best-corrected visual acuity, the steep keratometric measurement, and corneal scarring (yes/no). Results: There were no statistically significant differences among the 3 groups (M, HA, and HI) in race, history of atopic disease, family history of keratoconus, or rigid contact lens wear in the right and left eyes. At baseline, there were no significant differences among the 3 groups in high-contrast best-corrected visual acuity, low-contrast best-corrected visual acuity, or steep keratometric reading. Progression of keratoconus, as assessed by changes in these 3 continuous variables, was equal for the 3 groups. M had more corneal scarring than did HA or HI; however, there was no progression of scarring for any of the groups. Conclusion: Keratoconus progressed in both men and women, aged 48-59 years; however, there were no differences among the groups in progression.
Clinical Trial Consultant, Atlanta, GA, USA Ohio State University College of Optometry, Columbus,... more Clinical Trial Consultant, Atlanta, GA, USA Ohio State University College of Optometry, Columbus, OH, USA Pacific University College of Optometry, Forest Grove, OR, USA Nova Southeastern University, Ft. Lauderdale, FL, USA Indiana University School of Optometry, Bloomington, IN, USA Southern California College of Optometry, Fullerton, CA, USA State University of New York, College of Optometry, New York, NY, SA -mail address: [email protected] (R.L. Chalmers).
Purpose: To describe baseline and longitudinal findings of the Collaborative Longitudinal Evaluat... more Purpose: To describe baseline and longitudinal findings of the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study. Methods: The CLEK Study is an 8-year, multi-center, natural history study of 1209 patients with keratoconus who were examined annually for 8 years. Its goals are to prospectively characterize changes in vision, corneal curvature, corneal status, and vision-specific quality of life. Results: CLEK Study subjects had a mean age at baseline of 39.3 AE 10.9 years. At study entry, 65% of the patients wore rigid contact lenses, and 14% reported a family history of the disease. Subjects exhibited a 7-year decrease in high-(2.03 letters) and low-(4.06 letters) contrast, best-corrected visual acuity, with 19% demonstrating decreases of 10 or more letters in high-contrast, best-corrected acuity and 31% of subjects demonstrating decreases of 10 or more letters in low-contrast, best-corrected acuity in at least one eye. Subjects exhibited an average 8-year increase in corneal curvature of 1.60 D in the flat corneal meridian, with 24% demonstrating increases of 3.00 D or more. The 8-year incidence of corneal scarring was 20%, with younger age, corneal staining, steeper baseline corneal curvature, contact lens wear, and poorer low-contrast visual acuity predictive of corneal scarring. Data from the National Eye Institute Visual Function Questionnaire suggest that the effect of keratoconus on vision-specific quality of life is disproportionate to its low prevalence and clinical severity. Conclusion: Although we report measures of disease severity and visual function across the CLEK sample, clinicians can begin to envisage the course of keratoconus in individual patients by determining whether factors predictive of disease progression are present in those patients.
Purpose. The purpose of this study was to describe age and other risk factors for ocular events t... more Purpose. The purpose of this study was to describe age and other risk factors for ocular events that interrupt soft contact lens (SCL) wear in youth. Methods. A retrospective chart review of SCL wearers aged 8 to 33 years at the first observed visit was conducted at six academic eye care centers in North America. Data were extracted from all visits during the observation period (Ͼ3 years). Clinical records that documented conditions resulting in an interruption of SCL wear "events" were scanned, masked for age and SCL parameters, and then adjudicated to consensus diagnosis. Generalized estimating equations were used to examine the effect of selected covariates, including age, on the risk of an event. Results. Chart review of 3549 SCL wearers yielded 522 events among 426 wearers (12%). The risk of an event increased from ages 8 to 18 years, showed modest increases between ages 19 and 25 years, and then began to decline after age 25 years. New lens wearers (Ͻ1 year) were less likely to experience events (p ϭ 0.001). Lens replacement schedule and material were also predictive of interruptions to SCL wear with the lowest risk in daily replacement and hydrogel lens wearers (both p Ͻ 0.0001). Conclusions. These results suggest that the risk of events that interrupt SCL wear peaks in late adolescence and early adulthood and reflects risk factors identified in prospective contact lens studies. Relative to older teens and young adults, patients younger than 14 years presented with significantly fewer events resulting in interrupted lens wear.
Objectives. To investigate how add power affects binocular distance visual acuity in subjects wea... more Objectives. To investigate how add power affects binocular distance visual acuity in subjects wearing simultaneous vision, balanced progressive, multifocal contact lenses. Methods. Twenty-five young normally sighted subjects were fit binocularly, according to the ...
Purpose: To understand soft contact lens (SCL) and gas-permeable (GP) lens wearers' behaviors and... more Purpose: To understand soft contact lens (SCL) and gas-permeable (GP) lens wearers' behaviors and knowledge regarding exposure of lenses to water. Methods: The Contact Lens Risk Survey (CLRS) and health behavior questions were completed online by a convenience sample of 1056 SCL and 85 GP lens wearers aged 20 to 76 years. Participants were asked about exposing their lenses to water and their understanding of risks associated with these behaviors. Chi-square analyses examined relationships between patient behaviors and perceptions. Results: GP lens wearers were more likely than SCL wearers to ever rinse or store lenses in water (rinsing: 91% GP, 31% SCL, P , 0.001; storing: 33% GP, 15% SCL P , 0.001). Among SCL wearers, men were more likely to store (24% vs. 13%, P = 0.003) or rinse (41% vs. 29%, P = 0.012) their lenses in water. Showering while wearing lenses was more common in SCL wearers (86%) than GP lens wearers (67%) (P , 0.0001). Swimming while wearing lenses was reported by 62% of SCL wearers and 48% of GP lens wearers (P = 0.027). Wearers who rinsed (SCL; P , 0.0001, GP; P = 0.11) or stored lenses in water (SCL; P , 0.0001, GP P = 0.007) reported that this behavior had little or no effect on their infection risk, compared with those who did not. Both SCL (P , 0.0001) and GP lens wearers (P , 0.0001) perceived that distilled water was safer than tap water for storing or rinsing lenses. Conclusions: Despite previously published evidence of Acanthamoeba keratitis' association with water exposure, most SCL, and nearly all GP lens wearers, regularly expose their lenses to water, with many unaware of the risk.
Contact lens-related complications are common, affecting around one third of wearers, although mo... more Contact lens-related complications are common, affecting around one third of wearers, although most are mild and easily managed. Contact lenses have well-defined anatomical and physiological effects on the ocular surface and can result in other consequences due to the presence of a biologically active material. A contact lens interacts with the tear film, ocular surface, skin, endogenous and environmental microorganisms, components of care solutions and other antigens which may result in disease specific to contact lens wear, such as metabolic or hypersensitivity disorders. Contact lens wear may also modify the epidemiology or pathophysiology of recognised conditions, such as papillary conjunctivitis or microbial keratitis. Wearers may also present with intercurrent disease, meaning concomitant or pre-existing conditions unrelated to contact lens wear, such as allergic eye disease or blepharitis, which may complicate the diagnosis and management of contact lens-related disease. Complications can be grouped into corneal infection (microbial keratitis), corneal inflammation (sterile keratitis), metabolic conditions (epithelial: microcysts, vacuoles, bullae, tight lens syndrome, epithelial oedema; stromal: superficial and deep neovascularisation, stromal oedema [striae/folds], endothelial: blebs, polymegethism/ pleomorphism), mechanical (corneal abrasion, corneal erosion, lens binding, warpage/refractive error changes; superior epithelial arcuate lesion, mucin balls, conjunctival epithelial flaps, ptosis, discomfort), toxic and allergic disorders (papillary conjunctivitis, solution-induced corneal staining, incomplete neutralisation of peroxide, Limbal Stem Cell Deficiency), tear resurfacing disorders/dry eye (contact lens-induced dry eye, Meibomian gland dysfunction, lid wiper epitheliopathy, lid parallel conjunctival folds, inferior closure stain, 3 and 9 o'clock stain, dellen, dimple veil) or contact lens discomfort. This report summarises the best available evidence for the classification, epidemiology, pathophysiology, management and prevention of contact lensrelated complications in addition to presenting strategies for optimising contact lens wear.
To compare the habits of United States (US) soft contact lens (SCL) wearers who bought SCLs from ... more To compare the habits of United States (US) soft contact lens (SCL) wearers who bought SCLs from their eye care practitioner (ECP), on the internet/telephone, or at retail (not where they were examined) to test the effect of proximity to the prescriber on SCL wear and care practices. Methods: Adult SCL wearers completed an adapted Contact Lens Risk Survey (CLRS) online that queried items related to risk factors for SCL-related complications. Responses from subjects who purchased at the ECP, via the internet/telephone, or at a retail store were compared (Chi-Square). Results: Purchase sources were: ECP 646 (67%, 44 AE 12 yrs, 17% male), Retail 104 (11%, 45 AE 13 yrs, 28% male), and Internet/telephone 218 (23%, 45 AE 12 yrs, 18% male); age (p = 0.51), gender (p = 0.021). Internet purchasers had fewer annual eye exams (79% ECP, 83% retail, 66% internet/telephone, p = 0.007), purchased more hydrogel SCLs (34% ECP, 29% retail, 45% internet/telephone, p = 0.0034), and paid for SCLs with insurance less often (39% ECP, 29% retail, 19% internet/telephone, p < 0.0001). Other behaviors were similar across groups (p > 0.05). Conclusions: In this sample, the purchase location of SCL wearers had limited impact on known risk factors for SCL-related complications. Internet purchasers reported less frequent eye exams and were more likely to be wearing hydrogel SCLs. Closer access to the ECP through in-office SCL purchase did not improve SCL habits or reduce the prevalence of risk behaviors. 2016 Published by Elsevier Ltd on behalf of British Contact Lens Association.
August 24-28, 2015, marks the second annual Contact Lens Health Week. In collaboration with partn... more August 24-28, 2015, marks the second annual Contact Lens Health Week. In collaboration with partners from clinical, public health, industry, and regulatory sectors, CDC is promoting healthy contact lens wear and care practices to reduce the risk for eye infections and complications associated with poor contact lens hygiene. Research following outbreaks of rare but serious eye infections in the United States showed that these types of infections occur most often in contact lens wearers who do not take proper care of their contact lenses and cases. This finding signaled that action needed to be taken to promote safer contact lens wear and care. A report in this issue of MMWR provides an updated population-based estimate of the number of contact lens wearers in the United States. The report finds that there are 40.9 million contact lens wearers aged ≥18 years. It also includes results of a survey that found more than 99% of contact lens wearers report at least one contact lens hygiene habit that could put them at risk for an eye infection, with the majority of respondents reporting behaviors that can raise the risk for eye infection. Nearly one third of contact lens wearers reported ever experiencing a contact lens-related red or painful eye that required a doctor's visit. Contact lens wearers represent a significant proportion of the U.S. population, and their contact lens hygiene habits put them at risk for painful, costly eye infections that could lead to vision problems. This year's observance targets teenage contact lens wearers, who have been associated with lower contact lens compliance and higher risk for serious eye infections. Proper contact lens hygiene habits, supplies, and regular visits to the eye doctor are all essential to keeping contact lens wearers' eyes healthy. Additional information on Contact Lens Health Week and the proper wear and care of contact lenses is available at http://www. cdc.gov/contactlenses.
Background: Understanding the factors associated with myopic progression is critical to properly ... more Background: Understanding the factors associated with myopic progression is critical to properly recruit subjects into clinical trials for control of myopia. The purpose of this study is to describe the rate of change in soft contact lens (SCL) power and the associated predictive factors in a young clinical population from the Contact Lens Assessment in Youth study. Methods: Data from a retrospective chart review of myopic SCL wearers aged eight to 22 years were analysed for rate of progression of myopia and associated characteristics using multivariate methods. Results: Myopic subjects (n = 912) with at least six months of follow-up were observed (4,341 visits, mean follow-up 25 months, 37 per cent hydrogel and 63 per cent silicone hydrogel SCLs). During observation, 36 per cent of subjects experienced a change in soft contact lens power of À0.50 D or more. Significant predictors of future increase in minus lens power were: ages eight to 13 years, shorter time to the first increase in minus power and hydrogel soft contact lens material. The mean annualised increase in minus decreased with age (À0.31D per year for eight to 13 year olds to À0.10 D per year for 20 to 22 year olds, p < 0.0001). Increases in minus were less common among users of silicone hydrogel materials than hydrogel daily disposable lenses after controlling for age (p = 0.039). Conclusion: In this retrospective chart review of young soft contact lens wearers, the mean annualised rate of increase in minus soft contact lens power decreased with age, longer time to first increase in power and was greater with hydrogel soft contact lenses. The rates observed were similar to progression rates in prospective myopia clinical trials that employed cylcoplegic autorefraction.
To describe the baseline findings in patients enrolled in the Collaborative Longitudinal Evaluati... more To describe the baseline findings in patients enrolled in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study. This is a longitudinal observational study of 1209 patients with keratoconus enrolled at 16 clinical centers. Its main outcome measures are corneal scarring, visual acuity, keratometry, and quality of life. The CLEK Study patients had a mean age of 39.29+/-10.90 years with moderate to severe disease, assessed by a keratometric-based criterion (95.4% of patients had steep keratometric readings of at least 45 D) and relatively good visual acuity (77.9% had best corrected visual acuity of at least 20/40 in both eyes). Sixty-five percent of the patients wore rigid gas-permeable contact lens, and most of those (73%) reported that their lenses were comfortable. Only 13.5% of patients reported a family history of keratoconus. None reported serious systemic diseases that had been previously reported to be associated with keratoconus. Many (53%) reported a history ...
The purpose of this study is to compare the efficacy of usual care to an intervention emphasizing... more The purpose of this study is to compare the efficacy of usual care to an intervention emphasizing patient education targeted at a multicultural adult patient population with diabetes seeking eye care in an academic health center. Methods Ninety patients were randomized to usual care or to the intervention. All patients received a comprehensive eye health and vision examination and completed a demographic survey, a patient satisfaction survey, and a diabetes eye health pretest and posttest administered by a masked examiner at 1 week and 3 months. A multidisciplinary (optometry, pharmacy, endocrinology) patient education curriculum was developed for patients randomized to the intervention. Because the dependent variable was measured at 3 points on a nominal scale, a binary generalized estimating equation was employed. Results The assessment of patient knowledge at baseline revealed misconceptions about diabetic eye disease. While most patients recognized that people with diabetes should have regularly scheduled eye examinations through dilated pupils (90.0%), most patients incorrectly reported that diabetic eye disease usually has early warning signs (75.6%). While controlling for age, gender, race, education, and HbA1c level, subjects who participated in the intervention were 2 times more likely to score higher on the posttest (χ 2 = 45.51, P > .00). No differences between pretest and posttest scores were found for patients who did not participate in the intervention (χ 2 = 11.67, P > .11).
Purpose. To identify factors associated with rigid contact lens comfort in keratoconus. Methods. ... more Purpose. To identify factors associated with rigid contact lens comfort in keratoconus. Methods. Baseline data from the 16 Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study clinical sites were analyzed for all patients wearing a rigid contact lens in their more severely keratoconic eye (as determined by steep keratometry). Corneal transplant patients, patients who did not wear a rigid contact lens in either eye, patients who did not wear a rigid lens in their worse eye, and patients with missing contact lens comfort data were excluded from the sample. A total of 751 eyes were included. Variables assessed included measures of disease severity, visual acuity through the patients' habitual rigid contact lenses, contact lens wearing time, the apical fitting relationship of the contact lens, the degree of peripheral clearance, and the presence of corneal scarring and staining. Comfort was measured by asking the patients "In general, how comfortable are your contact lenses?" (1 ؍ very comfortable through 5 ؍ very irritating). Results. Measures of disease severity (steep keratometry and the first definite apical clearance lens) were not associated with lens comfort. There was no difference in self-reported contact lens comfort between patients fitted with apical touch vs. apical clearance. Patients with a peripheral clearance rating of "minimal unacceptable" (more common among patients with milder keratoconus) were approximately half as likely to report good contact lens comfort compared with patients with "average" peripheral clearance (unadjusted odds ratio, 0.39; 95% confidence interval, 0.19 to 0.79). There was no association between contact lens comfort and the other peripheral clearance ratings compared with ratings of average. Conclusions. There does not appear to be an association between decreasing patient-reported rigid lens comfort and increasing disease severity as measured by steep keratometry or first definite apical clearance lens in this sample. The apical fitting relationship (flat vs. steep) does not appear to be associated with patient-reported comfort. Minimal peripheral clearance may contribute to decreased rigid contact lens comfort in keratoconus. (Optom Vis Sci 2004;81:182-188) Key Words: contact lens fitting, cornea, keratoconus, rigid gas-permeable contact lens T he Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study is a multicenter, longitudinal, observational study. The purpose of the CLEK Study is to prospectively characterize vision, corneal changes, and quality-of-life findings in keratoconus patients and to describe the progression of these changes with time. Sixteen CLEK clinics enrolled 1209 eligible keratoconus patients between May 31, 1995 and June 29, 1996. Keratoconus is a progressive, asymmetric, 1 noninflammatory disease of the cornea characterized by steepening and distortion of the cornea, apical thinning, and central scarring.
Purpose. To describe the Contact Lens Assessment in Youth (CLAY) Study design and report baseline... more Purpose. To describe the Contact Lens Assessment in Youth (CLAY) Study design and report baseline data for a multicenter, retrospective, observational chart review of children, teenagers, and young adult soft contact lens (SCL) wearers. Methods. Clinical charts of SCL wearers aged 8 to 33 years were reviewed at six colleges of optometry. Data were captured retrospectively for eye care visits from January 2006 through September 2009. Patient demographics, SCL parameters, wearing schedules, care systems, and biomicroscopy findings and complications that interrupted SCL wear were entered into an online database. Results. Charts from 3549 patients (14,276 visits) were reviewed; 78.8% were current SCL wearers and 21.2% were new fits. Age distribution was 8 to Ͻ13 years (n ϭ 260, 7.3%), 13 to Ͻ18 years (n ϭ 879, 24.8%), 18 to Ͻ26 years (n ϭ 1,274, 36.0%), and 26 to Ͻ34 years (n ϭ 1,136, 32.0%). The sample was 63.2% females and 37.7% college students. At baseline, 85.2% wore spherical SCLs, 13.5% torics, and 0.1% multifocals. Silicone hydrogel lenses were worn by 39.3% of the cohort. Daily wear was reported by 82.1%, whereas 17.9% reported any or occasional overnight wear. Multipurpose care systems were used by 78.1%, whereas another 9.9% indicated hydrogen peroxide solutions use. Conclusions. This data represent the SCL prescribing and wearing patterns for children, teenager, and young adult SCL wearers who presented for eye care in North American academic clinics. This will provide insight into SCL utilization, change in SCL refractive correction, and risk factors for SCL-related complications by age group.
Purpose. To present a case in which the Corneal Refractive Therapy (CRT) lens, a reverse-geometry... more Purpose. To present a case in which the Corneal Refractive Therapy (CRT) lens, a reverse-geometry contact lens designed specifically for overnight orthokeratology, was prescribed for daily wear in the treatment of a patient after radial keratotomy. Methods. Case report. Results. The CRT lens provided adequate visual acuity and satisfactory daily wearing time without an adverse physiologic response. Conclusions. This case illustrates an offlabel use of the CRT lens to facilitate lens centration and provide a functional vision correction that enhanced a patient's ability to participate in activities of daily living. Although further study regarding the long-term safety and efficacy of this lens modality is needed, the findings suggest that these lenses provide a viable vision correction for patients who are dissatisfied with their postsurgical vision, particularly when satisfactory visual acuity cannot be achieved through conventional means.
To assess the effects of gender and hormone status on the severity and progression of keratoconus... more To assess the effects of gender and hormone status on the severity and progression of keratoconus in patients enrolled in the Collaborative Longitudinal Evaluation of Keratoconus Study. Methods: The severity and progression of keratoconus in both men (M) and women were evaluated over a 4-year period that encompassed menopausal transition for hormone-active women (HA) and hormone-inactive women (HI). Four outcome measures were selected as indicators of the severity of keratoconus: highcontrast best-corrected visual acuity, low-contrast best-corrected visual acuity, the steep keratometric measurement, and corneal scarring (yes/no). Results: There were no statistically significant differences among the 3 groups (M, HA, and HI) in race, history of atopic disease, family history of keratoconus, or rigid contact lens wear in the right and left eyes. At baseline, there were no significant differences among the 3 groups in high-contrast best-corrected visual acuity, low-contrast best-corrected visual acuity, or steep keratometric reading. Progression of keratoconus, as assessed by changes in these 3 continuous variables, was equal for the 3 groups. M had more corneal scarring than did HA or HI; however, there was no progression of scarring for any of the groups. Conclusion: Keratoconus progressed in both men and women, aged 48-59 years; however, there were no differences among the groups in progression.
Clinical Trial Consultant, Atlanta, GA, USA Ohio State University College of Optometry, Columbus,... more Clinical Trial Consultant, Atlanta, GA, USA Ohio State University College of Optometry, Columbus, OH, USA Pacific University College of Optometry, Forest Grove, OR, USA Nova Southeastern University, Ft. Lauderdale, FL, USA Indiana University School of Optometry, Bloomington, IN, USA Southern California College of Optometry, Fullerton, CA, USA State University of New York, College of Optometry, New York, NY, SA -mail address: [email protected] (R.L. Chalmers).
Purpose: To describe baseline and longitudinal findings of the Collaborative Longitudinal Evaluat... more Purpose: To describe baseline and longitudinal findings of the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study. Methods: The CLEK Study is an 8-year, multi-center, natural history study of 1209 patients with keratoconus who were examined annually for 8 years. Its goals are to prospectively characterize changes in vision, corneal curvature, corneal status, and vision-specific quality of life. Results: CLEK Study subjects had a mean age at baseline of 39.3 AE 10.9 years. At study entry, 65% of the patients wore rigid contact lenses, and 14% reported a family history of the disease. Subjects exhibited a 7-year decrease in high-(2.03 letters) and low-(4.06 letters) contrast, best-corrected visual acuity, with 19% demonstrating decreases of 10 or more letters in high-contrast, best-corrected acuity and 31% of subjects demonstrating decreases of 10 or more letters in low-contrast, best-corrected acuity in at least one eye. Subjects exhibited an average 8-year increase in corneal curvature of 1.60 D in the flat corneal meridian, with 24% demonstrating increases of 3.00 D or more. The 8-year incidence of corneal scarring was 20%, with younger age, corneal staining, steeper baseline corneal curvature, contact lens wear, and poorer low-contrast visual acuity predictive of corneal scarring. Data from the National Eye Institute Visual Function Questionnaire suggest that the effect of keratoconus on vision-specific quality of life is disproportionate to its low prevalence and clinical severity. Conclusion: Although we report measures of disease severity and visual function across the CLEK sample, clinicians can begin to envisage the course of keratoconus in individual patients by determining whether factors predictive of disease progression are present in those patients.
Purpose. The purpose of this study was to describe age and other risk factors for ocular events t... more Purpose. The purpose of this study was to describe age and other risk factors for ocular events that interrupt soft contact lens (SCL) wear in youth. Methods. A retrospective chart review of SCL wearers aged 8 to 33 years at the first observed visit was conducted at six academic eye care centers in North America. Data were extracted from all visits during the observation period (Ͼ3 years). Clinical records that documented conditions resulting in an interruption of SCL wear "events" were scanned, masked for age and SCL parameters, and then adjudicated to consensus diagnosis. Generalized estimating equations were used to examine the effect of selected covariates, including age, on the risk of an event. Results. Chart review of 3549 SCL wearers yielded 522 events among 426 wearers (12%). The risk of an event increased from ages 8 to 18 years, showed modest increases between ages 19 and 25 years, and then began to decline after age 25 years. New lens wearers (Ͻ1 year) were less likely to experience events (p ϭ 0.001). Lens replacement schedule and material were also predictive of interruptions to SCL wear with the lowest risk in daily replacement and hydrogel lens wearers (both p Ͻ 0.0001). Conclusions. These results suggest that the risk of events that interrupt SCL wear peaks in late adolescence and early adulthood and reflects risk factors identified in prospective contact lens studies. Relative to older teens and young adults, patients younger than 14 years presented with significantly fewer events resulting in interrupted lens wear.
Objectives. To investigate how add power affects binocular distance visual acuity in subjects wea... more Objectives. To investigate how add power affects binocular distance visual acuity in subjects wearing simultaneous vision, balanced progressive, multifocal contact lenses. Methods. Twenty-five young normally sighted subjects were fit binocularly, according to the ...
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