The acceptability of contact lens wear to children and teenagers

The acceptability of contact lens wear to children and teenagers

Abstracts / Contact Lens & Anterior Eye 35S (2012) e33–e50 These were all transient in nature, with predominantly mild to moderate severity. Trial I ...

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Abstracts / Contact Lens & Anterior Eye 35S (2012) e33–e50

These were all transient in nature, with predominantly mild to moderate severity. Trial I Mean age (±SD) (years) Male SCS VAS

46.9 ± 16.9 50% 7.6 ± 2.0

Trial II

Trial III

63.3 ± 11.7 58%

54.6 ± 16.5 61%

24.3 ± 19.0

25.5 ± 18.6

Conclusion: IOP monitoring by means of a CLS is well tolerated for up to 24-hour in healthy volunteers, glaucoma suspects and glaucoma patients. Overnight CLS wear may have an effect on CCT, that is however not significantly different from the contralateral eye. SATURDAY MAY 26, 2012 CONFERENCE SESSION 19: STAR GAZING, HALL 4, 09:00–12.25 Barriers to drug delivery via contact lenses Noel Brennan Johnson & Johnson Vision Care, Jacksonville, USA E-mail address: [email protected] Drug delivery by contact lenses has been a goal since Wichterle and Lim first made mention of the possibility in their original hydrogel lens patent. Many ophthalmic drugs could be better delivered through a contact lens modality to achieve a therapeutic dose without toxic overload. The ophthalmic pharmaceutical market globally is more than double the size of the contact lens market, so there is a financial incentive for the contact lens industry to develop this concept. Why then have we yet to see mass commercialisation of such products? One of the key reasons is the regulatory environment. The FDA classifies products that combine a medical device (such as a contact lens) and drugs as combination products, and the Medicines and Healthcare products Regulatory Authority (MHRA) in the UK classifies them as Class III combination medical devices, which are then subject to review by both the Notified Body and MHRA for the medicinal component. Combination products comprise components that are regulated by different centres, so they raise challenging approval, policy, and review management challenges. Differences in regulatory pathways for each component can impact the regulatory processes for all aspects of product development, including preclinical testing, manufacturing and quality control, adverse event reporting, promotion and advertising. This area of contact lens research is so new that departments to deal with these combination products have only recently been established, so the guidelines for obtaining approval are still in their infancy. Differences in requirements between different countries across the globe as well as differences in education levels between eye practitioners add to the complexity. Other barriers to the development of combination products include the difficulties in achieving desired elution rates from lenses. Soaking lenses in a solution containing a drug does not necessarily provide prolonged consistent dosing.


The future of refractive surgery Dan Reinsteindzr 1,2,3,4 1

London Vision Clinic, United Kingdom Columbia University Medical Centre, New York, United States 3 Centre Hospitalier National d’Ophtalmologie des Quinze Vingts, Paris, France 4 Thomas’ Hospital, Kings College, London, UK E-mail address: [email protected] 2

My predictions about the future of refractive surgery will span a number of areas that are already close to end-stage development which I will cover during the lecture. Firstly, surgeons will have an understanding of and be able to control not only the reduction but also the induction of (beneficial) higher order aberrations. Currently, laser refractive surgery devices allow surgeons to enter the refraction to be corrected, some also allow the asphericity of the ablation profile to be adjusted, and some allow asphericity to be used together with the preoperative wavefront higher order aberration data. In the future, refractive surgeons will feel as comfortable with modifying the quatrefoil as they are today with modifying cylinder data entry. They will have the ability to change individual aberrations to optimize visual function by targeting aberrations that provide a visual benefit. This will also enable higher myopic refractions to be treated safely with minimal visual quality side effects, greatly diminishing the number of patients for whom phakic IOLs are currently the only option. Secondly, improvements in ablation profile design will mean that all lasers will be able to treat hyperopia up to at least +6.00 D safely by laser refractive surgery (only some can at the present time) and clear lens exchange will become obsolete for these patients. Thirdly, the majority of myopic patients will be treated by a ‘keyhole’ version of LASIK called ReLEx SMILE (small incision lenticular extraction) which brings the advantages of virtually no postop dry eye and improved biomechanical stability. Finally, work which is already in final stages of completion involving the incorporation of the epithelial thickness profile of the cornea into custom therapeutic refractive surgery profiles will enable virtually any complication to be corrected with extreme precision; this will be the key to expand the market penetrance of laser refractive surgery by filling the gaps in public confidence about “what if it all goes wrong?”. SATURDAY MAY 26, 2012 CONFERENCE SESSION 20: INFORMATION AND CONTACT LENSES, HALL 4, 14:00–15.30 CHAIR: PROFESSOR JAMES WOLFFSOHN The acceptability of contact lens wear to children and teenagers Debbie A. Jones 1,∗ , Lindsay C. Paquette 1 , Krithika Nandakumar 1 , Craig A. Woods 2 1

CCLR, University of Waterloo, Waterloo, Canada Deakin University, Geelong, Australia E-mail address: [email protected] (D.A. Jones). 2

Purpose: To determine the acceptance of soft contact lenses (SCL’s) by children and teens. Method: 177 children aged 8–16 years with no prior experience of SCL wear were recruited and fit with lotrafilcon B lenses. Following initial screening, fitting and training, follow up visits were scheduled for 1-week, 1-month and 3-months. At each visit Quality of Life (PREP) surveys were completed and a final study exit survey was completed at the 3-month visit. The PREP surveys were


Abstracts / Contact Lens & Anterior Eye 35S (2012) e33–e50

scored in accordance with previous work. Accompanying parents were also asked to complete a study exit survey. Results: Of the 177 children recruited, 162 completed the study. The reasons for the discontinuations were varied; there were no discontinuations due to contact lens related adverse events. The overall PREP score at the exit visit was higher (p < 0.001) with contact lenses compared to baseline (spectacles). In response to the statement “I would like to continue to wear contact lenses” in the exit survey, over 90% of participants agreed or strongly agreed. Parents were asked whether contact lens wear had been a positive or negative experience for their child. 161 parents responded with 159 (98.8%) reporting that contact lens wear had been a positive experience. Conclusions: The majority of children in the study successfully wore their contact lenses and found the experience positive. Most of the children expressed a desire to continue with contact lens wear after the conclusion of the study. Parents felt that the experience was, in general, a positive one. Demonstrating cylinder correction for lowastigmats Kathrine Osborn Lorenz ∗ , Ross J. Franklin, Terri L. Henderson, Danielle L. Boree Johnson & Johnson Vision Care, Inc, Jacksonville, USA E-mail address: [email protected] (K.O. Lorenz). Purpose: To determine whether subjects with low amounts of astigmatism (0.75–1.00 DC) find it useful to choose between spherical and spherocylindrical correction using an astigmatism demonstrator. Method: An astigmatism demonstrator with rotatable lenses (+0.25 DS/−0.75 DC) was used to allow subjects to compare the correction of spherocylinder to the best sphere refraction in a trial frame. The subjects completed a questionnaire before and after the astigmatism demonstration. 46 subjects (25 spherical CL wearers, 21 spectacle wearers) completed the study across three US sites. Results: Questionnaire results showed that 46% of the astigmatic subjects did not really know what astigmatism was prior to the study. 94% of subjects thought that the demonstration was helpful in deciding between spherical or astigmatic correction. For 26 subjects (57%), the vision improvement was most noticeable with binocular viewing, while 17 subjects (37%) found the vision improvement more obvious with monocular viewing, and 3 subjects (6%) saw no improvement. The use of +0.25DS compensation with the −0.75DC trial lens was supported by the study data, since the average sphere shift from the spherocylinder refraction to the best sphere refraction was −0.34 ± 0.1DS for eyes with −0.75DC refraction, and −0.41 ± 0.24 DS for eyes with −1.00DC refraction. Conclusions: The astigmatism demonstrator with rotatable +0.25 DS/−0.75 DC lenses was found to be appropriately powered for use with low cylinder patients. Most subjects responded that the demonstration of astigmatism correction was helpful, suggesting this could be beneficial in upgrading astigmatic patients from spherical to toric contact lenses. SATURDAY MAY 26, 2012 CONFERENCE SESSION 20: INFORMATION AND CONTACT LENSES, HALL 4, 14:00–15.30

Mission: Impossible—Ghost Protocol-ameliorating the visibility of ghosting in presbyopic contact lens corrections Pete S. Kollbaum ∗ , Arthur Bradley, Larry N. Thibos Indiana University, Bloomington, USA E-mail address: [email protected] (P.S. Kollbaum). Purpose: The double-images or “ghosting” inherent to bifocal and multifocal designs may limit their acceptance by wearers. The current study investigated the effect of controlling spherical aberration in bifocal and multifocal lens designs to ameliorate the visibility of ghost images. Method: Computational Fourier optics was used to quantify the monochromatic PSF and OTF of modeled multifocal and bifocal contact lenses. Five subjects rated the overall image quality and ghosting of letter chart images convolved with these PSF’s. Additionally, phase plates containing positive and negative levels of SA were aligned, conjugate to the pupil plane while 9 subjects wearing bifocal contact lenses used a 101 point scale to rate the overall quality (100 indicated perfect quality) and the ghosting (0 indicated no observed ghosting) of letter charts. Results: Subjects viewing a distant target while wearing a bifocal lens containing a distance powered center (CD) and positive SA rated the overall quality as 88.0 ± 4.4 (average ± 95%CI) and ghosting of the simulated images as 10.0 ± 6.6. Alternatively, with a CD lens and negative SA, the overall quality and ghosting of the simulated images were rated as 64.6 ± 11.0 and 50.0 ± 12.6. While viewing a distant target through a CD lens and a phase plate containing positive SA, overall image quality was rated as 85.6 ± 3.3 and ghosting as 0.7 ± 0.5. However, reversing the sign of SA reduced quality to 66.0 ± 5.1 and increased ghosting to 30.4 ± 7.0. Conclusions: Controlling levels of SA in both bifocal and multifocal contact lenses reduces the noticeability of ghost images. What don’t your patients know about astigmatism? Anna L. Sulley 1,2,∗ , Sule Sencer 2 , Graeme Young 3 1

Johnson & Johnson Vision Care, Wokingham, UK Johnson & Johnson Vision Care, Instanbul, Turkey 3 Visioncare Research Ltd, Farnham, UK E-mail address: [email protected] (A.L. Sulley). 2

Purpose: Although toric soft contact lens (TSCL) prescribing is increasing, it falls short of levels expected if all astigmats are fully corrected. Method: Several studies were undertaken to gain insights into patient behaviour, awareness and needs: (1) Telephone questionnaire with vision corrected population in UK (n = 1311); (2) Open-label, daily wear study involving 200 non-toric wearing astigmats in UK; (3) Qualitative interviews in UK and Italy with 60 astigmats; 4) On-line survey in 9 countries across Europe (n = 3541). Results: Of the vision corrected population, 24% claim to have astigmatism, compared to 47% known astigmatism prevalence (0.75DC in at least one eye). Spherical wearing astigmats cited ‘lack of awareness’ as a reason for not wearing TSCLs (28% of TSCLs, 22% of having astigmatism); 12% stated practitioners had not offered TSCLs. For drop-outs, 31% lapsed because lenses did not meet vision needs. Spectacle-wearing astigmats’ reasons for not wearing reflected wider beliefs among non-lens wearers (spectacles more convenient, 39%; discomfort, 33%). There was a basic and misinformed understanding of astigmatism, and if aware, it was considered of little significance. There was low awareness of TSCLs as an option, although many would try TSCLs if offered. Satisfaction levels with vision correction for TSCL wearers (68%, n = 1018) was