Letters to the Editor

This article discusses the impact of using and maintaining soft contact lenses at Optik Mandiri Padang, the use of contact lenses has many negative impacts that users need to be aware of, especially if they do not follow the usage rules. This type of research is descriptive quantitative. The population in this study were all patients wearing soft contact lenses during the study. Sampling in this study is a total sampling technique. The data were collected through a questionnaire, then the data were discussed in accordance with the theory proposed in the literature review. The results showed that respondents did not understand the impact of improper use and care of soft contact lenses, this can be seen as many as 14 respondents (46.7%) knew about the correct use and care of soft contact lenses (soft lenses) for eye health and 16 respondents (53.3%) do not know about the correct way to use and care for soft contact lenses for eye health, 13 respondents (43.3%) know about the impact of wearing and caring for soft contact lenses (soft lenses) that are incompatible with standard and as many as 17 respondents (56.7%) do not know about the impact of wearing and caring for soft contact lenses (soft lenses) that are not in accordance with standards, 11 respondents (36.7%) know about the handling of the use and care of soft contact lenses ( contact lenses) and as many as 19 respondents (63.3%) did not know about the handling of the use and care of soft contact lenses (soft lenses. Based on the results of this study, there are several Several suggestions were conveyed, namely for the public when wearing and caring for contact lenses must pay more attention to proper use and care so as not to have an impact on eye health, RO provides information to patients about how to use and care for soft contact lenses (soft lenses) that are correct for health eyes and provide information about the impact of wearing and caring for soft contact lenses (soft lenses) that are not in accordance with standards.

BACKGROUND: An increase in corneal infiltrates and ulcers, especially among young contact lens users was noticed in our out-patient service over the last years. This prompted us to examine contact lens related corneal infiltrates and ulcers. PATIENTS AND METHODS: Retrospective study of 119 consecutive patients (134 eyes) who did wear contact lenses. 15 had problems in both eyes. We evaluated age of the patients, proportion of soft and hard contact lenses, number and location of infiltrates, the type of bacteria and the permanent corneal damage caused by scarring. RESULTS: Out of the 134 eyes evaluated 127 (94.8%) used soft contact lenses and 7 (5.2%) had used hard contact lenses for refractive correction. Mean age of patients was 28.4 years ± 12.9a. 80.6% (108 eyes) had central solitary infiltrates, 14.9% (20 eyes) had multiple peripheral infiltrates, and 4.5% (6 eyes) developed corneal ulcers. In 25.4% (34 eyes) we were able to isolate bacteria. Most of the bacteria were found in eyes with soft lenses (33 out of 34 eyes, 97%), in only one (3%) case a hard contact lens was used. Gram-negative bacteria such as serratia spp. (7 eyes), pseudomonas spp. (6 eyes), stenotrophomonas maltophilia (6 eyes) and klebsiella oxytoca (5 eyes) were predominantly isolated. 26 of 127 eyes (20.5%) with soft contact lens related keratitis healed with a corneal scar, resulting in permanent visual damage. CONCLUSION: The majority of keratitis was caused by wearing soft contact lenses. One fifth of these comparatively young patients retained a corneal scar. These findings should influence the information given to a patient concerning the choice of refractive correction.

This evaluation was conducted as part of a protocol entitled Evaluation of the Menicon Z Rigid Gas Permeable Contact Lens for up to 30 Days Extended Wear. The purpose of the protocol was to compare corneal endothelial morphology changes after wearing rigid gas-permeable (RGP) Menicon Z contact lenses, continuously for up to 30 days, with ACUVUE (Johnson & Johnson Vision Care) hydrogel contact lenses, worn for up to 6 nights of extended wear. Sixty patients, who were adapted to RGP daily wear and soft contact lens daily wear, were recruited at two study sites. The thirty subjects who wore RGP daily wear lenses were fitted with the Menicon Z (tisilfocon A, oxygen permeablility [Dk] = 163) RGP contact lens comprised the test group. The control group subjects (n = 30 former users of daily wear soft contact lenses) were fitted with ACUVUE (etafilcon A, Dk = 28) hydrogel contact lenses. After a 2-week adaptation period of daily wear, subjects began extended wear. Endothelial imaging was performed at the two study sites in this multicenter study (University Hospitals of Cleveland/Case Western Reserve University Department of Ophthalmology [CWRU] and The Ohio State University [OSU]). The hydrogel lens group was instructed to wear their lenses for 7 days and 6 nights before discarding the lenses and to sleep with no lenses on the seventh night. The RGP group was permitted to wear the lenses for up to 30 days and 29 consecutive nights before removing the lenses for cleaning and overnight soaking. CWRU had 24 patients (12 soft contact lens and 12 rigid contact lens) and OSU had 21 patients (12 soft contact lens and 9 rigid contact lens) who completed the study and were included in the analyses. Patients who were withdrawn from the study at CWRU included one RGP patient dropped out because of pregnancy; one RGP patient developed vascularized limbal keratitis and discomfort; one could not be fitted with a bitoric RGP; two soft lens patients moved from the area, and one dropped out because of dry eyes. At OSU, four patients dropped out due to discomfort (two in each lens type);one moved from the study area; one decided not to participate soon after the consent visit; one had worries of reduced vision at 6 months; one subject's attitude changed prior to the 6 month visit; and one subject was withdrawn for reasons of poor study schedule compliance. The Menicon Z lens wearers in this study did not show significant endothelial cell morphology changes after 1 year of nearly continuous contact lens wear. This finding is particularly important considering the RGP wearers in this study were older by a average of 10 years (mean age approximately 40) and had worn their contact lenses an average of almost 10 years longer than the soft contact lens wearers.

We report three atypical infiltrative keratitis events in patients that had successfully worn highly oxygen permeable (Dk) soft contact lenses on an extended wear (EW) schedule for at least 15 months. These cases highlight the role of patient/practitioner education, patient compliance, examination, and appropriate referrals that are required to reduce the risk of complications during lens wear. Each patient had been wearing high Dk soft lenses on an EW schedule with monthly replacement for at least 15 months and presented with severe pain, redness, and photophobia. The events were characterized by focal infiltrate(s) with an overlying epithelial defect in the superior periphery to mid-periphery of the cornea and extensive diffuse infiltration. The signs and symptoms of each case were more severe than is typically associated with contact lens-related infiltrative keratitis. Because of the slow progression of signs and relatively fast resolution, the cases were not found to be microbial keratitis. Although high Dk soft contact lenses overcome hypoxia-associated complications associated with extended wear, patients and practitioners must be vigilant as adverse events can still occur and in rare instances can be severe. Education and patient compliance are a crucial part of successful management of patients on EW schedules. Constant reinforcement is necessary to ensure patient compliance.

Purpose: Reasons for the lack of success for contact lens patients range from poor fit, to discomfort or to a less than optimum wearing schedule. This project was a preliminary investigation of customized soft toric contact lenses as an alternative for unsuccessful contact lens patients or potential drop-outs. Methods: Fifteen healthy non-compromised, previously unsuccessful contact lens wearing patients (13 women, 2 men) with ages from 21 to 33 years (25.1 ± 2.7 years) were the subjects for this study. They were empirically fitted with 15 astigmatic and 5 spherical customized SpecialEyes soft contact lenses. Visual acuities, comfort, lens movement, and rotation were evaluated. Results: Patients fitted with customized SpecialEyes soft contact lenses had statistically significant better visual acuities than with Phoropter Manifest Refraction. The lenses used in this study centered well and moved no more than 1 mm upon each blink. Lens rotation was less than 10 degrees for all toric lenses. Patients gave very positive vision and comfort ratings. Conclusion: This preliminary study supports the application of a software program to empirically design and manufacture Special Eyes custom soft lenses based upon corneal topographical parameters and subjective manifest refraction for those patients who either have challenging corneal parameters, high sphero-cylindrical prescriptions, or are currently dissatisfied with their contact lenses and are potential drop-outs.

The ageing population will become one of the biggest issues affecting Singapore in the near future. Ophthalmic practitioners will need to be ready to deal with an increased prevalence of glaucoma, cataract, age related maculopathy and even presbyopia. As presbyopes lose their ability to accommodate at near vision, visual aids such as progressive lenses, bifocal lenses, reading glasses, monovision contact lenses and multifocal contact lenses are prescribed to help them with reading difficulties and improve their daily lives. Interestingly, an international survey in 2011 revealed zero percent soft multifocal contact lenses was prescribed in Singapore for presbyopia correction. Although there are improvements in multifocal lens design and material, no new research being conducted to investigate the presbyopic lens fitting status in Singapore. Nonetheless, recent studies have shown an increased in multifocal contact lenses prescribing trends, perhaps reflecting not just the availability of newer multifocal contact lenses, but also improvement in practitioners’ confidence and knowledge in multifocal contact lenses. However, in spite of the available guides on choosing multifocal contact lenses, there is no comprehensive way to help the practitioner in selecting the best option for an individual. As such, an examination of the simplest way of predicting the most suitable multifocal lens for a patient will only enhance and add to the current evidence available. A survey was conducted to understand the Singaporean practitioners’ attitude towards soft multifocal lenses and its prescribing trend. In this survey, an increase in the rate of soft multifocal contact lens fitting was observed, the perception of the unavailability of an ‘ideal’ multifocal contact lens, and increased chair time in fitting soft multifocal contact lenses were identified as significant barriers. However, enablers such as the increased in practitioners’ motivation, confidence and proactiveness in fitting soft multifocal contact lenses were gathered. Additionally, this study aimed to compare the relative performance of three daily-replacement soft contact lenses for presbyopic correction in an optometric practice population in Singapore. The three daily-disposable multifocal contact lenses included in this study were 1-day Acuvue® Moist Brand Multifocal Contact Lenses for Presbyopia (Johnson & Johnson Vision Care, Jacksonville, FL), Clariti 1-day Mulitfocal (Cooper Vision, NY) and Dailies AquaComfort Plus Multifocal (Alcon, Fort worth, TX). In this crossover study design, 35 presbyopic participants with myopia were fitted in a random order with three different types of multifocal contact lens. After 1 month, visual performance was quantified by high contrast distance, intermediate and near visual acuity, defocus curve under photopic and mesopic conditions, reading speed, Near Activity Visual Questionnaire rating and Photographic questionnaire for Photic Phenomena. The results showed comparable levels of binocular distance, intermediate and near visual acuity achieved with the three different types of multifocal contact lens at 1-month follow up. However, a better distance acuity at distance under mesopic condition for AquaComfortPlus. In terms of subjective participant lens preference, nine participants (26%) preferred Moist multifocal, 16 participants (46%) preferred Clariti multifocal and 10 participants (28%) preferred AquaComfortPlus multifocal. However, lens preference was not related to demographic factors relating to age, gender, refractive error and the magnitude of reading addition or physiological characteristic such as pupil size. In terms of the performance of participants with their preferred lens when observing the defocus curve under mesopic condition, it emerged that there was an interaction between lens types and acuity at different levels of defocus. From this, it seems that lens preference may perhaps be driven by a change in visual experience that only manifested in low illumination conditions, suggesting it may be important to conduct objective measure such as visual acuity under mesopic condition when fitting modern-day multifocal contact lenses. It remains a hope for the future that new clinical tests or more diverse lens designs would be valuable to help the practitioner to improve the chances of first time success when fitting a multifocal contact lens for presbyopic correction.

Value of routine evaluation in asymptomatic soft contact lens wearers

Complement activation fragments have been detected in the anterior segment during 1) eye closure, 2) contact lens wear, and 3) in some contact lens-associated pathologies. The decay-accelerating factor (DAF), a membrane-associated complement regulatory protein that inhibits the central C3 amplification convertases of the cascade, is present on both the ocular surface and in tears. In this study, we measured levels of tear DAF in asymptomatic contact lens patients and in patients who presented with contact lens-associated complications. Tears were collected from 55 patients using capillary pipettes. Subjects included normal non-contact lens wearing controls (N = 14), asymptomatic soft (N = 13) and rigid gas permeable (N = 5) wearers, and individuals with contact lens-induced acute red eye (CLARE) (N = 4), ulcerative keratitis (N = 3), giant papillary conjunctivitis (GPC) (N = 8), contact lens peripheral ulcers (N = 3), and infiltrative keratitis (N = 5). Levels of DAF were assessed using a two-site immunoradiometric assay using anti-DAF monoclonal antibodies. The mean concentration of DAF in normal controls was found to be 149+/-78 ng/ml, 117+/-59 ng/ml, and 111+/-86 ng/ml for noncontact lens patients, and asymptomatic soft and rigid gas permeable lens wearers, respectively. In the conditions of CLARE, infiltrative keratitis, and GPC, DAF concentrations were significantly reduced compared with normal noncontact lens controls. Compared with asymptomatic soft lens patients, the condition of infiltrative keratitis showed a significant reduction in tear DAF. This study documents a trend toward decreased levels of tear DAF in patients with the contact lens associated inflammatory conditions CLARE, GPC, and infiltrative keratitis. Tears of patients with infiltrates show the most significant reduction of tear DAF. The reductions may be associated with enhanced complement activation contributing to the pathogeneses of infiltrative keratitis and associated ocular surface diseases.

Global trends in prescribing contact lenses for extended wear

Plasmin, a proteolytic enzyme, has been detected in the tears of patients experiencing anterior ocular disease, and during contact lens wear. Using a radial caseinolysis procedure, we examined tear plasmin levels in 66 patients who were wearing soft and rigid lenses for daily and extended wear. Compared to non-contact lens wearers, patients wearing soft and rigid lenses for extended wear were significantly more likely to exhibit tear plasmin activity. Eight hours of open-eye thick HEMA lens wear did not induce tear plasmin activity in a group of 10 subjects. However, significant increases in tear plasmin activity were recorded after short-term (1 hour) eye closure with and without lens wear, and following overnight (8 hours) eye closure without lens wear. Overnight eye closure also resulted in significantly increased numbers of epithelial cells and leucocytes in the tear fluid. Our results suggest that increased tear plasmin activity during extended contact lens wear may be attributable to the effects of eye closure rather than hypoxia or the presence of the contact lens per se.

An instability of the visual correction is sometimes associated with soft hydrophilic contact lenses. However, this problem does not seem to have detracted from the commercial success of this form of refractive aid. To facilitate the quantification of visual performance during soft lens wear, a televised test system was developed and has been fully described elsewhere. Results are now presented of a clinical study using this television (TV) system. Visual performance scores, in conjunction with response latency and blink activity data, were obtained from the eyes of 27 experimentally naive subjects during the first month of adaptation to soft contact lens wear. The results suggest that the soft contact lens wearer has recourse to a strategy whereby he can optimize his level of visual performance when necessary.

<h3>To the Editor.</h3> —Microbial keratitis, especially that caused by gram-negative bacilli such as<i>Pseudomonas aeruginosa</i>, is known to be the most serious complication of the use of daily-wear, extended-wear, and therapeutic soft contact lenses. Factors that have been implicated in the pathogenesis of contact lens-associated microbial corneal ulceration include poor hygiene, poor compliance with instructions for proper lens care and sterilization, the use of contaminated lens care solutions, the development of contact lens deposits and coatings that facilitate the adherence of microorganisms to the contact lenses, and epithelial trauma, caused by either the removal or insertion of the lenses or by abnormalities of the lenses themselves.¹ Recently, disposable extended-wear contact lenses were introduced for the correction of myopia (Accuvue, Johnson &amp; Johnson, New Brunswick, NJ). It has been speculated that, because these lenses are packaged in sterile solutions, do not require the use of lens care solutions that can

AIMSA case-control study was performed to evaluate soft contact lens (SCL) wear modality as a risk factor for microbial keratitis.METHODSContact lens wearers presenting as new patients to Moorfields Eye Hospital...

PurposeIntroduced around the turn of the 21st century, silicone hydrogel contact lenses alleviated hypoxic anterior eye complications due to their high oxygen transmissibility. The purpose of this work is to update earlier surveys by describing international trends in silicone hydrogel daily wear contact lens fitting between 2000 and 2023. MethodAn annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000 and 2023. Data relating to 260,144 daily wear soft contact lens fits undertaken in 20 countries returning reliable longitudinal data were analysed in respect of silicone hydrogel daily wear contact lens fitting. ResultsThere has been a dramatic increase in silicone hydrogel daily wear lens fits (p < 0.0001), increasing from 2.8 % of all daily wear soft lens fits in 2000 to 73.7 % in 2023. Of all daily wear soft contact lenses prescribed to males, 44.6 % were silicone hydrogel lenses, compared with 43.5 % for females (p = 0.0146). The mean age of those wearing silicone hydrogel daily wear lenses was 32.0 ± 14.5 years, compared to 30.4 ± 13.6 years for those wearing daily wear hydrogel lenses (p < 0.0001). Between 2019–2023, the average percentage of fits was – (a) material type: silicone hydrogel – 73 %; mid-water content hydrogels – 13 %; high water content hydrogels – 9 %; and low water content hydrogels – 5 %, and (b) lens design: spherical – 44 %, toric – 32 %, multifocal – 17 %, monovision – 4 %, and ‘other’ – 3 %. ConclusionThe dramatic increase in silicone hydrogel contact lens prescribing for daily wear has been commensurate with the introduction of multiple lens brands and an ongoing expansion of lens designs, parameters and replacement frequency options. The balance between silicone hydrogel and hydrogel lens prescribing is perhaps starting to approach an equilibrium.

Refraction data of 644 Dutch Army and Air Force recruits wearing contact lenses or spectacles were statistically compiled and correlated with the type of lenses worn. Visual acuity with contact lenses was far from optimal because the power of the lenses was incorrect or the optical quality poor. This applied particularly to soft contact lenses. On the other hand, spectacle blur was rare with soft lenses and less evident with gas-permeable hard lenses compared with conventional hard lenses. Less corneal staining occurred with gas-permeable hard lenses compared with conventional hard lenses (P=0.02). Corneal neovascularization, conjunctival hyperaemia, papillary changes in the tarsal conjunctiva, corneal opacifications and ghost vessels were seen more often in wearers of soft rather than hard lenses. In this study, in which we examined objective parameters of contact lens efficiency, the gas-permeable hard lenses appeared most favourable.