Contact Lens & Anterior Eye最新文献

Antibiotic eyedrops typically require frequent instillation due to the eye's defensive mechanisms limiting drugs from reaching target sites. This may risk patient non-adherence and treatment inefficacy. The aim of this study was to develop a biocompatible and fully soluble ocular film insert to enhance the delivery of levofloxacin, as well as the handling procedure for its administration; based on the anatomical dimensions and physiological conditions of the human eye. Inserts were prepared by solvent casting method, using HPMC, sodium alginate, gelatin, PEG 400, and levofloxacin solution, and characterised for various physicochemical properties (e.g., uniformity of weight and thickness, loss on dryness, swelling index, water uptake and surface pH). Mechanical properties were assessed and compared against a commercially available buccal film formulation. Uniformity of content and release profile of inserts were assessed by means of a validated analytical method. Antibacterial effectiveness was studied by adapted disc diffusion method on Staphylococcus aureus and Pseudomonas aeruginosa. The formulation including HPMC E15 (1250 mg), low viscosity sodium alginate (750 mg), type A gelatin (250 mg) and PEG 400 (2.5 mL) and 0.1% levofloxacin solution, resulted in high quality inserts, exhibiting uniformity of mass, thickness, and levofloxacin content, that comply with Pharmacopeial standards. Inserts were able to withstand unilinear and repeated mechanical stresses, suggesting suitability for manipulation linked to eye administration. The fully soluble levofloxacin-loaded inserts exhibited good physicochemical and mechanical characteristics, indicating good compatibility with ocular environment and administration procedure. Consistent levofloxacin content and biphasic release pattern showed immediate and sustained antimicrobial efficacy, consistently above the minimum inhibitory concentrations for the model species tested. This work also presents an experimental framework that can be adapted for designing and testing ocular drug delivery systems accounting for anatomical and physiological characteristics of the eye.

Purpose: To evaluate the screen time habits, associated symptoms and clinical characteristics of an older population (60 years and older) drawn from primary care optometry.

Methods: Consecutive patients aged 60 years and older, who used a digital device for at least 1 hour per day, attending for an eye examination at a primary care optometric practice in Dublin, Ireland, were invited to participate. The study gathered information regarding the participant's use of digital devices, the types of devices used and duration of use. Best corrected distance acuity and near vision adequacy for reading and device use was recorded.

Results: 401 responses were included in the analysis. Based on a Computer Vision Syndrome Questionnaire (CVS-Q) score ≥6, the occurrence of DES in this population was high at 51.6 % with females having a higher median score than males. The mean number of hours devices were used for was 4 hours. 71 % of participants reported symptoms of digital eye strain (DES) when using digital devices. Smart phones were the device type used most by participants but tablets were the device type used for the longest duration. Single vision spectacles were the most commonly used method of visual correction when using digital devices. Participants with better levels of acuity used devices for longer periods than those with poorer acuity.

Conclusion: This study provides a valuable insight into the screen habits and likelihood of symptoms of DES in an older population and, is to date, the first of its kind. It shows that the prevalence of DES in older age adult device users is high, at 51.6 %, with a clear link between dry eye and symptoms of DES. Its results will enable optometrists to provide specific advice to this age group on how best to reduce symptoms of DES.

Purpose: The stability of the tear film is crucial for maintaining good ocular health. Its assessment provides valuable insights into paediatric eye conditions. This study investigates the stability of the tear film in children and its association with predictive factors such as age and sex, for a better understanding of tear film dynamics in a paediatric population.

Methods: A cross-sectional study was conducted in a semi-urban area in northern Portugal. Tear film stability was evaluated using non-invasive tear break-up time (NIBUT) measured with Tearscope Plus. The evaluation was conducted subjectively, with measurements obtained exclusively in the right eye. The mean of three consecutive measures of the NIBUT was considered in the statistical analysis.

Results: A total of 2094 children (1072 females, 1022 males), with a mean age of 8.6 ± 1.3 years, were included. It was found a mean NIBUT of 14.8 ± 5.4 s (s), with no statistically significant difference between females (14.9 ± 5.4 s) and males (14.7 ± 5.4 s) (p = 0.407). Around 20 % of the children had a NIBUT < 10 s, and about 7 % had a NIBUT ≤ 5 s. A significant increase in NIBUT with age during the middle childhood stage (6 to 11 years old) was also found (p = 0.019), with NIBUT increasing from 14.1 ± 5.7 s in 6-year-olds to 16.3 ± 4.8 s in 11-year-olds (p = 0.006). However, when results were separated by the participants' sex, only the male group showed statistically significant differences (p = 0.021).

Conclusions: A significant increase in NIBUT was found during the middle childhood stage, primarily driven by male participants. These findings underscore the importance of considering age and sex in assessing tear film stability in paediatric populations.

Purpose: To investigate orthokeratology-related diurnal variations in visual acuity, contrast sensitivity, mesopic (twilight) vision, and glare sensitivity, and to verify compliance with requirements for driver licensing.

Methods: In this prospective, multicenter, controlled study, fifty myopic (range, -1.00 to -4.50 D) and non-presbyopic glasses or soft contact lens wearers (age range, 16-39 years) were fitted with orthokeratology (OK) contact lenses. Before and after completion of OK lens fitting, measurements of visual acuity, contrast sensitivity, mesopic vision and glare sensitivity were performed at three times of the day, morning, afternoon and evening using a standardized binocular vision testing device (Oculus Binoptometer 4P). Monocular and binocular visual acuity were tested according to ISO 8596 and compared to requirements of cars and motorcycles drivers in different countries.

Results: Compared to the prior correction, binocular visual acuity (logMAR) with orthokeratology was statistically significant better in the morning (0.04 ± 0.12; p < 0.05) and afternoon (0.04 ± 0.10; p < 0.05), while the difference was not statistically significant in the evening (p = 0.512). Furthermore, there was no statistically significant difference in contrast sensitivity in the morning (p = 0.813), afternoon (p = 0.742) or evening (p = 0.945). For both mesopic vision and glare sensitivity, there was no statistically significant difference between the contrast levels achieved with orthokeratology compared to the prior correction in the morning (p = 0.083; p = 1.000), afternoon (p = 0.054; p = 0.125) or evening (p = 0.195; p = 0.635). With orthokeratology, no statistically significant diurnal variation was found for binocular visual acuity, contrast sensitivity, mesopic vision or glare sensitivity (p > 0.05).

Conclusions: These results provide evidence, that visual functions of OK lens wearers are stable throughout the day and comparable to the prior correction. Although the visual standards for driving are not uniform within countries, the requirements for visual acuity are met in all of the countries. Mesopic vision and glare sensitivity, which are suggested as other aspects to influence driving performance, also appear to be constant over the course of the day.

Purpose: To explore the longitudinal changes in choroidal features in myopic children with low to moderate myopia under orthokeratology (ortho-k) treatment.

Methods: Children (n = 80) aged 8-12 years with spherical equivalent refraction of -1.00 to -6.00D were randomly assigned to the control (single vision spectacles) (n = 40) and ortho-k (n = 40) groups. OCT images were collected at the baseline, 1-, 6-, 12-, 18-, and 24-month visits. Choroidal structure parameters, including choroidal total area (TA), luminal area (LA), stromal area (SA), and choroidal vascularity index (CVI) were calculated. Axial length (AL) was measured as the primary indicator for myopic progression. The analysis followed the intention-to-treat criteria.

Results: Compared to the control, ortho-k significantly improved the choroidal structures in choroidal TA and LA at all follow-up points (all P < 0.05). Choroidal LA was the primary contributor to TA changes (85.8 %[control], 91.4 %[ortho-k]), with the most significant improvement within the first 6 months. While, the changes in SA and CVI over time were not significantly different between the two groups (all P > 0.05). Correlation matrices identified several noteworthy correlations between AL change and choroidal structure features. Further analysis showed a significant interaction effect between baseline choroidal LA and intervention type on subsequent AL change (P for interaction = 0.005), suggesting that ortho-k might be more effective in children with larger baseline choroidal LA.

Conclusions: This 2-year prospective study demonstrated that ortho-k can improve the choroidal structures, primarily manifested in choroidal LA, although this positive effect diminishes over time. Myopic children with larger baseline choroidal LA might benefit more from ortho-k.

Purpose: Numerous multifocal soft contact lenses have been introduced into clinical practice over the past half century. The purpose of this work is to update earlier surveys by describing international trends in multifocal and monovision soft lens fitting for presbyopia between 2000-2023, inclusive.

Method: An annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000-2023. Data relating to 52,580 soft daily wear lens fits to presbyopes (those ≥45 years of age) undertaken in 20 countries returning reliable longitudinal data were analysed in respect of multifocal and monovision soft daily wear lens fits.

Results: Overall, multifocal and monovision soft daily wear lens prescribing to presbyopes has more than doubled over the course of this survey, from 26.4 % of standard soft daily wear lens fits in 2000 to 61.1 % in 2023 (p < 0.0001). There were significant differences between countries in presbyopia soft daily wear lens prescribing (p < 0.0001). Of all soft daily wear fits to males, 45.1 % were multifocal and monovision soft lenses, compared with 52.7 % for females (p < 0.0001). When considered as the proportion of lenses fitted by age, multifocal soft lens fitting peaked between 50-65 years, followed by a precipitous drop until 85-90 years of age, and then an increase beyond 90 years of age. Analysis of 13,014 recent soft lens fits to presbyopes (2019-2023) revealed the following fitting proportions: multifocal lenses - 51 %; monovision - 10 %; and non-presbyopia fitting - 39 %.

Conclusion: There has been a substantial increase in soft contact lens correction of presbyopia using multifocal and monovision corrections throughout the 24 years of this survey. A significant number of soft contact lens-wearing presbyopes are not receiving a presbyopia contact lens correction.

Background: Meibomian gland dysfunction (MGD) is a leading cause of dry eye disease, affecting over a third of the global population. This disease is associated with ocular discomfort, reduced visual quality, and quality of life. Novel treatments like Intense Pulse Light (IPL) therapy and Low-Level Light Therapy (LLLT) have been reported to be useful in refractory MGD treatment. However, no systematic review has explored the utility of combining these two therapies.

Methods: Medline, Embase, and CENTRAL databases were searched for articles on LLLT + IPL therapy in MGD. A meta-analysis of single means was conducted to assess clinical endpoints.

Results: Analysis of 12 studies showed that LLLT + IPL therapy in MGD patients led to a significant decrease in Ocular Surface Disease Index score (MD: -22.8, 95 %CI: -29.1 to -16.5, I² = 97.5 %, p < 0.001), and a significant increase in both Tear Break-up Time (MD: 2.2 s, 95 %CI: 0.9 s to 3.4 s, I² = 98.6 %, p < 0.001) and Schirmer test (MD: 1.5 mm, 95 %CI: 0.6 mm to 2.5 mm, I² = 0.0 %, p = 0.001) at ≤ 3 months post treatment. These improvements were sustained in a sensitivity analysis at endpoints ≥ 6 months post treatment. While the percentage of loss of meibomian gland area (n = 4, MD: -3.8 %, 95 %CI: -7.2 % to -0.4 %, I² = 40.0 %, p = 0.031) was reported to be significantly reduced, this was not found to be sustained at endpoints ≥ 6 months post treatment (n = 2, MD: 5.9 %, 95 %CI: 1.8 % to 10.0 %, I² = 0.0 %, p = 0.005) in two studies.

Conclusions: This meta-analysis provides quantitative evidence supporting the clinical efficacy of LLLT + IPL therapy in MGD. Future research should evaluate its long-term safety and efficacy and compare it with alternative treatments.

Purpose: This systematic review, evaluated the role of epidermal growth factor (EGF) in corneal wound healing and the pathogenesis of ocular surface disorders (OSDs).

Methods: The clinical and experimental application of topical EGF therapy for OSDs was reviewed. This systematic research assessed articles published on PubMed/MEDLINE from 2000 to 2023 and summarized and discussed the findings of 38 experimental and 10 clinical studies. Reporting adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: The role of EGF and its receptor (EGFR) is indispensable in corneal wound healing after injury. The most important downstream molecular pathways are the MAPK/Erk and PI3K/Akt pathways, which lead to proliferation, migration, and differentiation of corneal epithelial cells. Other EGF-related pathways, such as Decorin and Erk signaling (decreasing Pax6), as well as upregulating VEGF, contribute to early and late remodeling after corneal healing. The effect of EGF on corneal wound healing is dose-dependent, and it interacts with other important pathways, such as TGF-β.

Conclusions: There are several studies on animals and humans that showed promise for topical EGF therapy in the form of drops, ointments, or loaded contact lenses for a variety of OSDs, such as dry eye disease, neurotrophic ulcers, and pterygium excision. The reported OSDs after using EGFR inhibitors for oncology patients, and their favorable response to topical EGF therapy, further support the significance of EGF in the pathogenesis and treatment of OSDs. However, current clinical evidence is scarce, and high-quality studies are warranted to confirm the therapeutic role of EGF topical treatment for a variety of OSDs and determine the most effective yet safe concentrations.

Purpose: To explore the in vitro killing effect of water-soluble berberine and lipid-soluble niclosamide against ocular Demodex folliculorum.

Methods: Demodex with good vigor were collected from patients' eyelashes. These mites were randomly distributed into different groups with 20 mites in each group. Saline, Double Distilled Water (DDW), Polysorbate 80 (TWEEN 80), Polyethylene glycol 300 (PEG 300) and Castor Oil were used to screen solvents and cosolvents. 20 % Tea Tree Oil (TTO) and Anhydrous Ethanol (EtOH) were used as positive controls. 0.2 % Berberine, 0.25 % Niclosamide and 0.5 % Niclosamide, were designated as experimental groups. Following treatment, the analysis of Kaplan-Meier survival curves and survival time of mites and safety of drugs were then performed.

Results: The survival of Demodex in vitro in Saline and DDW, was not significant different. Therefore, DDW, which was more conducive to the dissolution of berberine, was chosen as the solvent for berberine. 0.2 % Berberine significantly inhibited the survival distribution and survival time (P < 0.001) of Demodex in vitro compared with the DDW group. Through the evaluation of several cosolvents, PEG300 had milder effects on Demodex. Hence, the proportion of PEG300 in the niclosamide solvent group was increased to reduce the irritability of the vehicle. Furthermore, niclosamide could significantly inhibit the survival of Demodex compared with the vehicle group, and the effect of 0.5 % Niclosamide was more obvious (P < 0.001), and was better than 20 %TTO (P < 0.001). In addition, after niclosamide administration, Demodex bodies exhibited gradual distortion along with increased transparency and the presence of blurred dark particles compared to those in the vehicle group. Moreover, both drugs showed good subjective tolerability and safety in a mouse model.

Conclusion: 0.2 % berberine and 0.5 % niclosamide effectively inhibited Demodex survival in vitro, with 0.5 % niclosamide superior to 20 % TTO. These two drugs, with anti-Demodex, anti-bacterial, and anti-inflammatory properties, may offer alternative treatment for Demodex blepharitis.

Purpose: Contact lens behaviours such as poor hand and lens hygiene are common and are associated with increased risk of microbial keratitis. Evidence for health promotion strategies to address this gap is required. The trial examined the effectiveness of a customised text-messaging intervention on compliance, discontinuation rate and wearer satisfaction in contact lens wearers.

Methods: The parallel group, double masked, randomised clinical trial was pre-registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12621001719820). Contact lens wearers were recruited using social media and optometry partners in clinical practice. Participants (n = 76) received the intervention and usual care. The control group (n = 75) received usual care. Intervention text messages (range 56-76) were customised, provided education, reminders, and motivation and were delivered over six months. Outcomes were validated self-report online surveys for compliance (0-100), satisfaction (0-100) and discontinuation (Y/N), at 3 months and 6 months. Secondary outcomes were intervention feasibility and acceptability.

Results: Participants mean age was 38 years, 105/151 (70 %) female and 83 % completed the trial (intervention 60/76, control 65/75). The intervention group demonstrated better compliance than control with an adjusted between-group-difference at 3 months of 5.2, 95 % confidence interval (CI), 1.6-8.7, P = 0.004 and at 6 months 3.9, 95 % CI 0.2-7.6, P = 0.04. This difference in compliance is clinically significant, equivalent to a single change in a behaviour such as starting to handwash or ceasing overnight wear. There was no adjusted between-group-difference in satisfaction at 3 months (0.8, 95 % CI -4.3-6.0, P = 0.75) or at 6 months (-0.4, 95 % CI -5.7-4.9, P = 0.89). Few participants (7/151, 4.6 %) discontinued contact lens wear (3 intervention, 4 control). The messages were delivered successfully (98 %), at A$11 per participant. Participants reported appropriate message content (75 %), language (80 %) and delivery timing (97 %).

Conclusion: This customised text message intervention was a feasible and acceptable method for improving contact lens compliance.