Increasing the safety and comfort of contact lens wear
1
S8 Abstracts of the 2011 BCLA Annual Clinical Conference / Contact Lens & Anterior Eye 34, Supplement 1 (2011) S1–S43 CONFERENCE SESSION 9 – Scientific Paper Session on Care Systems Training day for medics: contact lens fitting for ophthalmologists Sarah Janikoun, Andrena McElvanney, Ursula Vogt This day will be dedicated to teaching and promoting the latest develop- ments in medical contact lens practice. We shall start with Dr Sarah Janikoun and a “Mini guide to contact lenses”, which takes a look at medical contact lens treatments. She will then discuss: “Is the problem the solution?” Dr Ur- sula Vogt will then examine the challenge of “Fitting irregular corneas” with contact lenses. During the workshop you will have the opportunity to han- dle lenses, and learn which lenses to use, when and for whom. Consultant ophthalmologist Andrena McElvanney will talk you through the very impor- tant subject of “Therapeutic contact lenses”. The morning session will con- clude with an examination of “Coloured contact lenses”. This course gives you the opportunity to exchange views and engage in discussion in a friendly at- mosphere with other ophthalmologists. CONFERENCE SESSION 10 – Peer Review Group for Therapeutics Prescribers Peer Review Group for therapeutics prescribers Susan Bowers During the peer review group AS, SP and IP therapeutic drug prescribers will each present one interesting case for their peers to discuss. This will take place in small groups and involve cases taken from the Clinical Management Guidelines. CONFERENCE SESSION 11 – Are You Comfortable? The BCLA and me; a contact lens autobiography Kathy Dumbleton E-mail address: [email protected] 1977 saw the foundation of the British Contact Lens Association and, coin- cidentally, was the year that I started to wear contact lenses! Little did I know at the time that I would end up pursuing a career in contact lens re- search. This presentation will review contact lens types worn during the past 30+ years and report the trials and tribulations associated with them, in the context of one patient’s wearing experiences (mine!). We will take a jour- ney over time, starting with non-disposable HEMA lenses disinfected with thimerosal and arriving at the current day and the wonders of presbyopia and multifocal silicone hydrogels. Moments of contact lens nostalgia will be visited along the way, including such milestones as GPC, RGPs and daily dis- posables, just to mention a few. Comfort, can we really measure it and what do we need to look for? Brian Tighe It is useful to identify two distinct influences on contact lens comfort. The first is the mismatch of individual patient tear chemistry and contact lens material. This is avoidable and guidelines enabling the practitioner to recog- nize and remedy such mismatches will be described. The second – the inter- ference of the lens with ocular dynamics – is more complex and not linked to any single universally applicable discomfort marker. It appears to be a cu- mulative burden which frequently increases with wear time. There is grow- ing evidence that links the dynamics of lenseye interaction with biochemical consequences that are known to induce discomfort in other body sites. These relate to sites of tissue-material interactions involving anterior and posterior lens surfaces separately. Comfort: the key clinical factors. What to ask and what to look for Noel Brennan E-mail address: [email protected] Lens comfort is the major determinant of soft contact lens success, with dis- comfort accounting for some 50% of dropouts. Yet there remains some con- fusion among clinicians as to differences in comfort between lens types and the parameters that drive comfort; for example, it is considered that silicone- hydrogels as a rule are more comfortable than hydrogels and that higher Dk/t is the driving force behind this. Recently, we have worked hard to refine the measurement system for assessing comfort and have derived a sophisticated sensitive methodology that produces results consistent with the rate of lens discontinuation. We have found that, while a silicone-hydrogel lens is indeed the most comfortable lens, many hydrogel lenses are more comfortable than some silicone-hydrogel types. Examination of the lens characteristics that correlate with comfort shows that comfort is inversely related to modulus, surface coefficient of friction and lower water content but not at all with lens Dk/t. Comfort: can patients help themselves? Daniela Nosch E-mail address: [email protected] Are our patients aware of how much influence they have on the success of their contact lens wear? There is a multitude of measures they can ap- ply in order to improve or contain good comfort with their contact lenses: those involving compliance (hygiene, correct use of solutions and CL cases, CL exchange intervals, sleeping/napping with CLs, regular aftercares etc.), im- proving the tearfilm (artificial tears, nutrition, lid hygiene, makeup etc.) and improving the environment (humidifying the room, more frequent blinking during VDU work). Are we practitioners asking all the right questions and finding the correct answers? How can we motivate our patients so that they realise just how much they have an influence on the success of their CL wear? CONFERENCE SESSION 12 – BCLA Medal Address Increasing the safety and comfort of contact lens wear Mark Wilcox E-mail address: [email protected] Two of the biggest yet unmet issues for the contact lens, the clinician, the wearer and the industry, are the development of truly comfortable and safe contact lenses. Contact lens discomfort occurs in at least 30% of wearers and is responsible for many wearers discontinuing lens wear. Discomfort is most obvious during the evening. Comfort does change depending on the lens/multipurpose disinfecting solution combination – but different MPDS may work best with different lenses. However, even the comfort with the best lens/solution combination still degrades over the day. This degradation of comfort at the end of the day does not appear to be mediated by spoilation of the lens, but rather changes to the eye during lens wear. In particular, the lid and tear film play a role in changing comfort during lens wear. The de- velopment of safe contact lens wear has progressed. We know that wearing lenses on a daily disposable basis is the safest lens wear modality; for the risk of microbial keratitis, corneal inflammatory events and mechanical ad- verse events. Most people use lenses on a daily wear, perhaps even flexible wear, schedule. On this schedule, robust disinfection of lenses by solutions overnight is critical, as is maintaining the hygiene of lens cases. The advent of antimicrobial lens cases helps in reducing microbial colonisation of the cases, and providing evidence based lens case hygiene instructions for lens wear will, we hope, also be of benefit. The development of antimicrobial lenses should also provide an extra level of safety for wearers. Previous attempts at integrating improvements in lens comfort and safety by adding in various ex- cipients to multipurpose disinfecting solutions has met with mixed success – but this is certainly an avenue for future research and development. CONFERENCE SESSION 13 – Clinical Spotlight: Myopia Control . . . How Far Have We Gone? Clinical spotlight on myopia – part I Bernard Gilmartin, Jeff Walline, Chi Shing Fan Epidemiology studies around the world have demonstrated the growing prevalence that myopia is having on communities in the Far East. Several
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Transcript of Increasing the safety and comfort of contact lens wear
S8 Abstracts of the 2011 BCLA Annual Clinical Conference / Contact Lens & Anterior Eye 34, Supplement 1 (2011) S1–S43
CONFERENCE SESSION 9 – Scientific Paper Session on Care Systems
Training day for medics: contact lens fitting for ophthalmologists
Sarah Janikoun, Andrena McElvanney, Ursula Vogt
This day will be dedicated to teaching and promoting the latest develop-ments in medical contact lens practice.We shall start with Dr Sarah Janikounand a “Mini guide to contact lenses”, which takes a look at medical contactlens treatments. She will then discuss: “Is the problem the solution?” Dr Ur-sula Vogt will then examine the challenge of “Fitting irregular corneas” withcontact lenses. During the workshop you will have the opportunity to han-dle lenses, and learn which lenses to use, when and for whom. Consultantophthalmologist Andrena McElvanney will talk you through the very impor-tant subject of “Therapeutic contact lenses”. The morning session will con-clude with an examination of “Coloured contact lenses”. This course gives youthe opportunity to exchange views and engage in discussion in a friendly at-mosphere with other ophthalmologists.
CONFERENCE SESSION 10 – Peer Review Group for TherapeuticsPrescribers
Peer Review Group for therapeutics prescribers
Susan Bowers
During the peer review group AS, SP and IP therapeutic drug prescribers willeach present one interesting case for their peers to discuss. This will takeplace in small groups and involve cases taken from the Clinical ManagementGuidelines.
CONFERENCE SESSION 11 – Are You Comfortable?
The BCLA and me; a contact lens autobiography
Kathy Dumbleton
E-mail address: [email protected]
1977 saw the foundation of the British Contact Lens Association and, coin-cidentally, was the year that I started to wear contact lenses! Little did Iknow at the time that I would end up pursuing a career in contact lens re-search. This presentation will review contact lens types worn during the past30+ years and report the trials and tribulations associated with them, in thecontext of one patient’s wearing experiences (mine!). We will take a jour-ney over time, starting with non-disposable HEMA lenses disinfected withthimerosal and arriving at the current day and the wonders of presbyopiaand multifocal silicone hydrogels. Moments of contact lens nostalgia will bevisited along the way, including such milestones as GPC, RGPs and daily dis-posables, just to mention a few.
Comfort, can we really measure it and what do we need to look for?
Brian Tighe
It is useful to identify two distinct influences on contact lens comfort. Thefirst is the mismatch of individual patient tear chemistry and contact lensmaterial. This is avoidable and guidelines enabling the practitioner to recog-nize and remedy such mismatches will be described. The second – the inter-ference of the lens with ocular dynamics – is more complex and not linkedto any single universally applicable discomfort marker. It appears to be a cu-mulative burden which frequently increases with wear time. There is grow-ing evidence that links the dynamics of lenseye interaction with biochemicalconsequences that are known to induce discomfort in other body sites. Theserelate to sites of tissue-material interactions involving anterior and posteriorlens surfaces separately.
Comfort: the key clinical factors. What to ask and what to look for
Noel Brennan
E-mail address: [email protected]
Lens comfort is the major determinant of soft contact lens success, with dis-
comfort accounting for some 50% of dropouts. Yet there remains some con-fusion among clinicians as to differences in comfort between lens types andthe parameters that drive comfort; for example, it is considered that silicone-hydrogels as a rule aremore comfortable than hydrogels and that higher Dk/tis the driving force behind this. Recently, we have worked hard to refine themeasurement system for assessing comfort and have derived a sophisticatedsensitive methodology that produces results consistent with the rate of lensdiscontinuation.We have found that, while a silicone-hydrogel lens is indeedthe most comfortable lens, many hydrogel lenses are more comfortable thansome silicone-hydrogel types. Examination of the lens characteristics thatcorrelate with comfort shows that comfort is inversely related to modulus,surface coefficient of friction and lower water content but not at all with lensDk/t.
Comfort: can patients help themselves?
Daniela Nosch
E-mail address: [email protected]
Are our patients aware of how much influence they have on the successof their contact lens wear? There is a multitude of measures they can ap-ply in order to improve or contain good comfort with their contact lenses:those involving compliance (hygiene, correct use of solutions and CL cases, CLexchange intervals, sleeping/napping with CLs, regular aftercares etc.), im-proving the tearfilm (artificial tears, nutrition, lid hygiene, makeup etc.) andimproving the environment (humidifying the room, more frequent blinkingduring VDU work). Are we practitioners asking all the right questions andfinding the correct answers? How can we motivate our patients so that theyrealise just howmuch they have an influence on the success of their CLwear?
CONFERENCE SESSION 12 – BCLA Medal Address
Increasing the safety and comfort of contact lens wear
Mark Wilcox
E-mail address:[email protected]
Two of the biggest yet unmet issues for the contact lens, the clinician, thewearer and the industry, are the development of truly comfortable and safecontact lenses. Contact lens discomfort occurs in at least 30% of wearersand is responsible for many wearers discontinuing lens wear. Discomfort ismost obvious during the evening. Comfort does change depending on thelens/multipurpose disinfecting solution combination – but different MPDSmay work best with different lenses. However, even the comfort with thebest lens/solution combination still degrades over the day. This degradationof comfort at the end of the day does not appear to bemediated by spoilationof the lens, but rather changes to the eye during lens wear. In particular, thelid and tear film play a role in changing comfort during lens wear. The de-velopment of safe contact lens wear has progressed. We know that wearinglenses on a daily disposable basis is the safest lens wear modality; for therisk of microbial keratitis, corneal inflammatory events and mechanical ad-verse events. Most people use lenses on a daily wear, perhaps even flexiblewear, schedule. On this schedule, robust disinfection of lenses by solutionsovernight is critical, as is maintaining the hygiene of lens cases. The advent ofantimicrobial lens cases helps in reducingmicrobial colonisation of the cases,and providing evidence based lens case hygiene instructions for lens wearwill, we hope, also be of benefit. The development of antimicrobial lensesshould also provide an extra level of safety for wearers. Previous attempts atintegrating improvements in lens comfort and safety by adding in various ex-cipients to multipurpose disinfecting solutions has met with mixed success– but this is certainly an avenue for future research and development.
CONFERENCE SESSION 13 – Clinical Spotlight: Myopia Control . . . HowFar Have We Gone?
Clinical spotlight on myopia – part I
Bernard Gilmartin, Jeff Walline, Chi Shing Fan
Epidemiology studies around the world have demonstrated the growingprevalence that myopia is having on communities in the Far East. Several
