Southern College of Optometry

Abstract Amblyopia is a neurodevelopmental condition of vision affecting 2-4% of children. Patching therapy is marred by low adherence; over half of patients carry residual functional deficits into adulthood. Luminopia, a prescription digital treatment that incorporates therapeutic modifications into children’s programming via a head-mounted display, was shown to improve visual acuity in a randomized clinical trial (RCT) for amblyopia and led to FDA-clearance, available by prescription. This multicenter registry study compared real-world outcomes to RCT results. Among 40 registry patients, similar in age and amblyopia characteristics, amblyopic eye best-corrected visual acuity improved 1.7 lines (95% CI: 1.2-2.2) after 12 weeks, equivalent to RCT gains (1.8 lines; p=0.0375). Real-world adherence (73%) exceeded that for patching. No adverse events were reported. These findings demonstrate Luminopia's effectiveness in clinical practice, offering a binocular alternative to traditional treatments with high adherence and meaningful visual improvements. Trial Registration: NCT06429280

The purpose of this work was to determine the comfort performance of a toric, monthly, silicon hydrogel CL (lehfilcon A; TOTAL30 for Astigmatism) over a long day of wear. This was a 1-month, 3-visit, prospective, single-arm study. Adult, 18- to 45-year-old CL wearers with good vision who were minimally symptomatic (CLDEQ-8 scores ≤12) were enrolled. Subjects were required to have astigmatism ranging from -0.75 D to -2.50 D in each eye and were required to wear the study CLs from about 8:00 AM until 12:00 AM each day. Comfort data with the study CL throughout the wear day were collected via text messaging. A total of 47 subjects who had a mean ± SD age of 29.5 ± 7.0 years were analyzed. Within a specified time point across the month of wear, CL comfort did not vary (all p-value ≥ 0.82), yet CL comfort did decrease across the wear day for all days evaluated (all p-value <0.001). Most subjects found their CLs to be comfortable with only 1.8% of subjects reporting an uncomfortable score at CL application and only 8.5% of subjects reporting an uncomfortable score after 16hours of CL wear. A high level of consistency and predictability in comfort was found within the first month of wearing lehfilcon A CLs. This suggests that patients with minimal CL-related discomfort at initial fitting of a lehfilcon A CL may likely tolerate longer wear time with minimal discomfort across the entire month of wear. NCT06052046.

Background COVID-19, caused by the novel coronavirus SARS-CoV-2, has affected over 519 million people worldwide. COVID-19 has not only been associated with significant respiratory illness, but also substantial systemic inflammatory, hypercoagulable, and thrombotic states. The ocular effects of COVID-19 have not been well identified at this time; however, there have been established associations of COVID-19 related retinopathy with systemic comorbidities, including yet not limited to hypertension, diabetes, and cardiovascular conditions. Case Presentation A 75-year-old male presented for a routine eye examination 20 days after developing symptoms of COVID-19. He was found to have numerous parapapillary cotton wool spots. After extensive testing to rule out other potential etiologies, it was concluded that the cotton wool spots were caused by his recent COVID-19 infection. The systemic differential diagnoses and possible mechanisms by which the cotton wool spots developed in this case are discussed. Conclusions Understanding the impacts of COVID-19 on ocular health and inclusion of COVID-19 as a differential in a patient with retinopathy and a positive case history for COVID-10 is essential for eyecare professionals. CE Notification This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com) Please check COPE course expiry date prior to enrollment. The COPE course test must be taken before the course expiry date.

IntroductionTribology is known as the science of friction, lubrication and the determination of what occurs when two surfaces slide against one another. The required partners in this science are a minimum of two surfaces and relative motion. Tribology could be a key factor in dissecting the issues that surround and confound dry eye in patients as well as contact lens discomfort and intolerance. Specifically, it is this issue that is a potential causative underlying factor that could lead to conditions like lid wiper epitheliopathy (LWE).MethodsPeer-reviewed literature was reviewed as It pertains to ocular tribology and the application to the ocular anatomy. A PubMed review was performed using the keywords: tribology, friction, lid wiper epitheliopathy, contact lens, and dry eye. All manuscripts were reviewed for mentions of tribology and friction. The exact same process was performed with The Association for Research in Vision and Ophthalmology (ARVO) abstracts.ResultsIn relation to the ocular surface, tribology describes the mechanical interactions between the upper and lower lid wipers and the globe. The Stribeck curve can be applied, as the sliding partners are separated by a complex, lubricating tear film. The surface brush anatomy at the eye to eyelid juncture reduces friction and alters the Stribeck curve in favor of the hydrodynamic regime, allowing for high velocity movement with minimal wear. Changes to the tear film or the introduction of a contact lens can displace the Stribeck curve, increase friction, and induce wear thus leading to patient symptomology.ConclusionFurther studies may provide new insight into contact lens discomfort and ocular surface disease, including LWE; however, adaptation of tribology work performed in vitro to in vivo patient care is challenging.

This is the first large-scale randomized clinical trial evaluating the effectiveness and safety of overminus spectacle therapy for treatment of intermittent exotropia (IXT). To evaluate the effectiveness of overminus spectacles to improve distance IXT control. This randomized clinical trial conducted at 56 clinical sites between January 2017 and January 2019 associated with the Pediatric Eye Disease Investigator Group enrolled 386 children aged 3 to 10 years with IXT, a mean distance control score of 2 or worse, and a refractive error between 1.00 and -6.00 diopters (D). Data analysis was performed from February to December 2020. Participants were randomly assigned to overminus spectacle therapy (-2.50 D for 12 months, then -1.25 D for 3 months, followed by nonoverminus spectacles for 3 months) or to nonoverminus spectacle use. Primary and secondary outcomes were the mean distance IXT control scores of participants examined after 12 months of treatment (primary outcome) and at 18 months (3 months after treatment ended) assessed by an examiner masked to treatment group. Change in refractive error from baseline to 12 months was compared between groups. Analyses were performed using the intention-to-treat population. The mean (SD) age of 196 participants randomized to overminus therapy and 190 participants randomized to nonoverminus treatment was 6.3 (2.1) years, and 226 (59%) were female. Mean distance control at 12 months was better in participants treated with overminus spectacles than with nonoverminus spectacles (1.8 vs 2.8 points; adjusted difference, -0.8; 95% CI, -1.0 to -0.5; P < .001). At 18 months, there was little or no difference in mean distance control between overminus and nonoverminus groups (2.4 vs 2.7 points; adjusted difference, -0.2; 95% CI, -0.5 to 0.04; P = .09). Myopic shift from baseline to 12 months was greater in the overminus than the nonoverminus group (-0.42 D vs -0.04 D; adjusted difference, -0.37 D; 95% CI, -0.49 to -0.26 D; P < .001), with 33 of 189 children (17%) in the overminus group vs 2 of 169 (1%) in the nonoverminus group having a shift higher than 1.00 D. Children 3 to 10 years of age had improved distance exotropia control when assessed wearing overminus spectacles after 12 months of overminus treatment; however, this treatment was associated with increased myopic shift. The beneficial effect of overminus lens therapy on distance exotropia control was not maintained after treatment was tapered off for 3 months and children were examined 3 months later. ClinicalTrials.gov Identifier: NCT02807350.