Download ARVO 2016 Annual Meeting Abstracts 217 Contact Lenses Monday

ARVO 2016 Annual Meeting Abstracts
217 Contact Lenses
Monday, May 02, 2016 8:30 AM–10:15 AM
Exhibit/Poster Hall Poster Session
Program #/Board # Range: 1450–1494/A0130–A0174
Organizing Section: Cornea
Program Number: 1450 Poster Board Number: A0130
Presentation Time: 8:30 AM–10:15 AM
Human Papillomavirus Detection by Next-Generation
Sequencing in Contact Lenses and Cases of Healthy Subjects
Dallin Andersen, Thuy Doan, Lakshmi Akileswaran,
Russell N. Van Gelder. Ophthalmology, University of Washington,
Seattle, Washington.
Purpose: Contact lens use is a significant risk factor for microbial
keratitis. Lens and case hygiene is an important factor in this risk.
Microbial studies in contact wearers have not been re-investigated
using deep DNA sequencing. Microbiome characterization in
healthy subjects is foundational to human disease studies. We
applied Whole Genomic Sequencing (WGS), 16S rDNA, and
Biome Representational in Silico Karyotyping (BRiSK) deep DNA
sequencing techniques to samples collected from the conjunctiva,
lenses, and cases of nine healthy subjects.
Methods: Purified DNA were analyzed by deep DNA sequencing.
DNA tags were cross-referenced to a comprehensive database for
taxa classification. Independent subject samples were cultured.
Directed PCR was used for HPV confirmation.
Results: 16S and BRiSK were applied to 71 samples from 9 subjects
and 65 samples from 8 subjects respectively (upper and lower
conjunctiva from each eye, right and left lenses, and right and left
cases). Of 12,729,963 16S reads, 3,441,833 (27%) were unclassified.
WGS was applied to 6 samples from one subject. Shannon diversity
and genera observed were both significantly higher in lenses and
cases compared to conjunctiva (p<0.001, p<0.001). Genera vary by
sample location. Cases are more dissimilar from conjunctiva and
lenses. Human Papillomavirus (HPV) was discovered by BRiSK
in 4 of eight subject cases and lenses. HPV serotypes were unique
to individuals by PCR confirmation. HPV was not recovered from
conjunctival samples. WGS correlated with BRiSk and 16s data.
Conclusions: Next-generation sequencing of conjunctival, lens,
and case samples demonstrate rich microbial environments. Contact
lens cases are a potential source of bacterial and viral ocular
contamination.
Commercial Relationships: Dallin Andersen, None; Thuy Doan,
None; Lakshmi Akileswaran, None; Russell N. Van Gelder, None
Support: NIH R01EY022038 to RVG, NIH P30EY001730 to UW,
and an Unrestricted Department Grant from Research to Prevent
Blindness.
Program Number: 1451 Poster Board Number: A0131
Presentation Time: 8:30 AM–10:15 AM
Evaluation of Acanthamoeba encystment against OPTI-FREE
contact lens care products
Monica J. Crary, Rhonda Walters, Jorge Silva, Manal M. Gabriel,
Stephen P. Shannon. Safety Microbiology, Alcon Laboratories, Grand
Prairie, Texas.
Purpose: Contact lens solutions with low antimicrobial activity
against Acanthamoeba trophozoites may induce encystment
during lens storage. The new issued ISO standard 19045 ‘Method
for evaluating Acanthamoeba encystment by Contact Lens Care
Products’ assesses the intrinsic encystment properties of contact lens
disinfecting solutions. The purpose of this study is to evaluate the
promotion of Acanthamoeba encystment by OPTI-FREE products
using a modified assay based on ISO 19045.
Methods: To determine the induction of encystment by OPTI-FREE
RepleniSH, OPTI-FREE Express, and OPTI-FREE PureMoist,
each solution was inoculated with two strains of Acanthamoeba
trophozoites (ATCC 50370 and 30461) at a density of 105 cells/mL
per ISO 19045. Acanthamoeba was also inoculated into Ringer’s
solution at Time 0 to determine initial cyst concentration. At 0 and 24
hours, encystment was determined by calculating total cell density
and cyst density using both a hemocytometer and a flow cytometer.
Prior to calculating cyst density, each solution was treated with 5%
SDS for 5 minutes to remove immature cysts and trophozoites. Each
solution was washed with Ringer’s solution to remove SDS and
either enumerated using a flow cytometer or treated with calcofluor
white to stain the cellulose wall of the cyst and counted with a
hemocytometer. The percent encystment was determined for each
condition.
Results: Initial cyst concentrations were < 0.5% for both
Acanthamoeba strains. Strong correlation between the flow cytometer
and hemocytometer counts was observed. The flow cytometer had
a lower limit of quantification (101) than the hemocytometer (103).
For OPTI-FREE RepleniSH, OPTI-FREE Express, and OPTI-FREE
PureMoist, Acanthamoeba ATCC 50370 and ATCC 30461 had <1.0%
encystment with both the hemocytometer and flow cytometer.
Conclusions: Evaluating the encystment of Acanthamoeba in a
contact lens disinfecting solution is important to determine the risk
of exposing users to drug and biocide resistant cysts during normal
contact lens wear. OPTI-FREE RepleniSH, OPTI-FREE Express and
OPTI-FREE PureMoist have sufficient antimicrobial activity against
Acanthamoeba trophozoites and do not induce encystment.
Commercial Relationships: Monica J. Crary, Alcon
Laboratories; Rhonda Walters, Alcon Laboratories; Jorge Silva,
Alcon Laboratories; Manal M. Gabriel, Alcon Laboratories;
Stephen P. Shannon, Alcon Laboratories
Program Number: 1452 Poster Board Number: A0132
Presentation Time: 8:30 AM–10:15 AM
Biocompatibility Evaluation of Contact Lens Multipurpose
Solutions through Novel Genotoxicity Assays
Ling C. Huang, Ronika S. Leang. R&D, Abbott Medical Optics, Inc.,
Santa Ana, California.
Purpose: Genotoxicity testing is necessary to address potential
mutagenic characteristics of pharmaceutical candidates and some
medical devices. Adapting such tests to contact lens multipurpose
solutions (MPS) may be required due to their anti-microbial nature
or regional regulatory requirements. We report the use of a novel
methodology for genotoxicity and biocompatibility evaluation of
MPS.
Methods: In a novel Miniscreen AMES test, Salmonella Hisdependent strains TA98 and TA100 were incubated with test articles
for 48 hr, then revertant, His-independent colonies counted. For
AMES assays, 3 additional bacterial strains (TA1535, TA1537,
Wp2uvrA-) were also tested. For Chromosome Aberration Assays,
CHO cells were exposed to test articles for 4 hrs, then analyzed
for chromosome breakage or loss. Each assay was conducted
with naive and S9-Arclor 1254-metabolically activated cells.
RevitaLens® MPDS or contact lens (Acuvue Advance® and Acuvue
2® brand) extracts prepared by 72 hr incubation at 37°C in controls
or MPS (3cm2 per 1ml) were tested in triplicate. Prior to assays
with the RevitaLens® MPDS disinfectant ingredient, Alexidine
Dihydrochloride (ALX), a 200 µg/ml stock of ALX was diluted for
dose range tests identifying TA100 or CHO cytotoxicity levels to
determine the amount of ALX appropriate for each assay.
Results: Miniscreen AMES and AMES show RevitaLens® MPDS
and the contact lens extracts did not increase the number of
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ARVO 2016 Annual Meeting Abstracts
revertant colonies compared to saline, suggesting nonmutagenicity
(n=3, p>0.7). The test articles also did not increase chromosome
aberrations, indicating they are non-clastogeneic. For assays on ALX,
cytotoxicity in TA100 was found above 50ug/ml and 12ug/ml, with
and without activation, respectively. Below these cytotoxic limits,
ALX did not increase the frequency of revertants in the AMES assay
above saline (n=3, p>0.3). Cytotoxicity in CHO cells was observed
above 20ug/ml and 2ug/ml when activated and not, respectively.
Non-cytotoxic concentrations demonstrated no chromosome changes
compared to saline (n=3, p>0.3).
Conclusions: Results from novel and standard genotoxicity assays
demonstrated that RevitaLens® MPDS and its disinfectants, ALX
and PQ-1 are not genotoxic or clastogenic. Novel miniscreens are
beneficial and accurate for future biocompatibility testing on MPS
and other medical devices requiring genotoxicity evaluation.
Commercial Relationships: Ling C. Huang; Ronika S. Leang,
Abbott Medical Optics, Inc.
Program Number: 1453 Poster Board Number: A0133
Presentation Time: 8:30 AM–10:15 AM
Performance of cationic peptide Mel4 as an antimicrobial agent
and contact lens coating
Debarun Dutta, Ajay Kumar Vijay, Janelle Tong, Wilson Luu,
Timothy Zhao, Kai B. Cheah, Mark D. Willcox. Optometry and Vision
Science, The University of New South Wales, Sydney, New South
Wales, Australia.
Purpose: There remains a need to reduce microbial contamination
of contact lenses, and thus the rate of adverse events during wear.
The purpose of the current study was to determine activity of the
antimicrobial peptide Mel4 against drug resistant and clinical isolates
of bacteria. In addition, the clinical performance of Mel4 as an
antimicrobial contact coating was evaluated in a human trial.
Methods: Antimicrobial activity of Mel4 (K-N-K-R-K-R-R-R-RR-R-G-G-R-R-R-R) was determined against Serratia marcescens
and drug-resistant Pseudomonas aeruginosa and Staphylococcus
aureus by evaluating minimum inhibitory concentration (MIC)
using a modified broth microdilution assay. Mel4 was covalently
incorporated into etafilcon A contact lenses and its performance was
evaluated in a prospective, randomized, contralateral, double masked
clinical trial with 1 week daily contact lens wear which assessed
subjective responses and ocular physiology.
Results: Mel4 showed high antimicrobial activity with MIC
ranging between 7 to 13 nmol/mL for drug resistant P. aeruginosa
strains and 7 nmol/mL for S. aureus strains respectively. MIC for
S. marcescens was 852 nmol/mL, indicating low activity. A total of
17 participants were recruited for clinical trial which determined no
differences between Mel4 coated and uncoated contact lenses for lens
performance indicators such as movement, lens wetting, deposition
and centration. Mel4 coated contact lenses were not associated
with increased corneal and conjunctival staining, bulbar, limbal or
palpebral hyperemia.
Conclusions: Mel4 has high antimicrobial activity against drug
resistant bacteria in addition to presenting no adverse effects for
human eyes as a contact lens coating, offering excellent potential for
development as an antimicrobial agent and contact lens coating.
Commercial Relationships: Debarun Dutta, None; Ajay
Kumar Vijay, None; Janelle Tong, None; Wilson Luu, None;
Timothy Zhao, None; Kai B. Cheah, None; Mark D. Willcox,
None
Clinical Trial: ACTRN12613000369729
Program Number: 1454 Poster Board Number: A0134
Presentation Time: 8:30 AM–10:15 AM
Efficacy a novel Povidone Iodine based contact lens disinfection
system against bacterial biofilm
Ajay Kumar Vijay, Lucy Liu, Tran Chau Nguyen Ly, Corrine Lam,
Jennifer F. Dang, Mark D. Willcox. School of Optometry and Vision
Science, Sydney, New South Wales, Australia.
Purpose: Contact lens cases become contaminated with bacteria
during use and this can lead to corneal infiltration or infection. A
novel contact lens disinfection solution containing Povidone Iodine
(PI) has been recently introduced. The study evaluated the solution’s
antimicrobial efficacy against ocular bacterial strains in planktonic
form and following biofilm formation in the lens case.
Methods: The antimicrobial efficacy of the MPDS against an ocular
strain of P.aeruginosa (071), S. aureus (031) S.epidermidis (019)
and an ATCC strain of S. marcescens (ATCC 13880) was determined
according to ISO 14729:2001. Bacterial biofilm was then grown on
contact lens cases for 24 hours and numbers of bacteria in biofilm
calculated by plate counting. Other biofilm-loaded lens cases were
disinfected for 4 hours (minimum recommended disinfection time)
and then either recapped wet, air-dried, or tissue wiped and air-dried.
The efficacy of these steps in removing the bacterial biofilm was
evaluated by plate counting.
Results: The PI solution performed exceptionally well against
planktonic forms of all the bacterial strains tested. No viable
organisms were recovered after the minimum recommended
disinfection time. There were 7.9 ± 0.7 and 6.6 ± 2.8 log units of
gram-negative and gram-positive bacteria respectively in untreated
lens cases. The PI solution was effective in removing bacterial
biofilm; air-drying or tissue wiping and air-drying the lens case was
very effective in reducing biofilm (71%, p<0.001) while recapping
the lens case wet removed 55% of the bacterial biofilm (p<0.001).
Conclusions: This study has shown that ocular strains of bacteria
are susceptible to povidone iodine in planktonic and biofilm form.
The results also highlight the importance of air-drying on lens case
hygiene.
Commercial Relationships: Ajay Kumar Vijay, None;
Lucy Liu; Tran Chau Nguyen Ly, None; Corrine Lam, None;
Jennifer F. Dang, None; Mark D. Willcox, Ophtecs Corporation (C)
Program Number: 1455 Poster Board Number: A0135
Presentation Time: 8:30 AM–10:15 AM
Microstructured materials for removing Acanthamoeba
castellanii from contact lens storage cases
Christine Selhuber-Unkel, Sören Björn Gutekunst. Biocompatible
Nanomaterials, University of Kiel / Institute for Materials Science,
Kiel, Germany.
Purpose: Acanthamoeba castellanii (A. castellanii) cause
acanthamoeba keratitis, which is a serious infection of the eye, and
85% of acanthamoeba keratitis cases are related to wrong contact
lens usage. Many cases have also been related to the resistance of A.
castellanii cysts to contact lens cleaning solutions. We hypothesize
that microporous hydrogels containing microchannels in combination
with larger cavities are able to capture A. castellanii.
Methods: Microporous polyacrylamide hydrogels were fabricated
by incorporating polyacrylamide into interconnected sacrificial ZnO
networks. The ZnO was dissolved by hydrochloric acid, leaving
behind seamlessly interconnected microchannels in combination with
larger cavities. Prior to biological experiments, the microchannelcontaining polyacrylamide was washed for at least five days in sterile
PYG 712 medium and incubated in cAMP for inducing A. castellanii
chemotaxis.
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ARVO 2016 Annual Meeting Abstracts
A. castellanii trophozoites were grown under axenic conditions
to establish a cyst-free culture. They were seeded onto the
polyacrylamide structure and incubated for at least 30 min. A.
castellanii migration was investigated using light microscopy. Image
processing tools (ImageJ) were used to analyze the migration speed
of A. castellanii trophozoites as a function of microchannel diameter
(number of investigated trophozoites: N=80). Control experiments
were carried out on bulk polyacrylamide (N=9).
Results: The speed of A. castellanii trophozoites inside the
microchannel network was significantly reduced compared to bulk
materials (v(channel) 155 µm ± 50 µm/sec; v(bulk)=255 µm ±
80 µm/sec). Furthermore, 55 % of A. castellanii trophozoites in
microchannel hydrogels were resting for at least 10 min (N=35) in
cavities, whereas no resting trophozoites have been observed on bulk
materials (N=18). A. castellanii trophozoites stayed alive for 6 days
(N=23), as verified by intracellular motion.
Conclusions: The obtained results are consistent with our hypothesis
that microstructured hydrogels are able to attract A. castellannii, thus
providing a novel strategy to remove these human pathogens with the
hydrogel material from contact lens storage cases.
Commercial Relationships: Christine Selhuber-Unkel; Sören
Björn Gutekunst, University of Kiel (P)
Support: Vistakon Contact Lens Research Fellowship 2014
Program Number: 1456 Poster Board Number: A0136
Presentation Time: 8:30 AM–10:15 AM
The Threshold of Light Energy to Eliminate Acanthamoeba
Ahmara G. Gibbons Ross1, 2, Regis P. Kowalski2,
Deepinder Dhaliwal2, Lisa M. Karenchak2. 1Ophthalmology,
University of Pennsylvania, Philadelphia, Pennsylvania;
2
Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh,
Pennsylvania.
Purpose: Acanthamoeba keratitis is a contact lens-related infection
that may result in significant visual impairment. Treatment of
Acanthamoeba keratitis can be difficult due to a lack of good medical
therapy. Acanthamoeba can survive in contact lens storage cases and
on the surface of contact lenses for extended periods of time. The
aim of this study was to determine the threshold of Ultraviolet energy
(UVE) to eliminate Acanthamoeba from contact lens and cases. We
hypothesize that UVE with and without riboflavin will eradicate
Acanthamoeba while maintaining the clarity of the lens.
Methods: The Stratagene UV Stratalinker 2400 Crosslinker™
was used to administer UVE in pulses to eliminate Acanthamoeba
castellanii. Multiple modes of energy delivery were administered in
a dose-dependent manner in microjoules/cm2 x 100. Three groups
were tested: 1) Acanthamoeba castellanii (106 cysts in saline)exposed
to UVE alone; 2) Acanthamoeba castellanii (106 cysts in saline) plus
soft contact lens exposed to UVE alone; 3) Acanthamoeba castellanii
(106 cysts) plus soft contact lens exposed to UVE in a saline solution
of 0.01% Riboflavin. Acanthamoeba castellanii viability was
monitored for growth using non-nutrient agar with Enterobacter
aerogenes overlay. The soft contact lenses were for evaluated for
clarity by spectrophotometry.
Results: A total UVE of 89,991 microjoules/cm2 x 100for a total
of 180 min (3 hours) were required to eliminate Acanthamoeba
castellanii from all three groups. One large dose in this amount of
UVE did not affect the clarity of soft contact lenses in the time-frame
of this study.
Conclusions: A very large dose of UVE has the potential to eliminate
Acanthamoeba from contact lens and cases. A one time exposure
of contact lens to 89,991 microjoules x 100/cm2 UVE may produce
minimal damage to soft contact lens.
Commercial Relationships: Ahmara G. Gibbons Ross,
None; Regis P. Kowalski, None; Deepinder Dhaliwal, None;
Lisa M. Karenchak, None
Program Number: 1457 Poster Board Number: A0137
Presentation Time: 8:30 AM–10:15 AM
Nile Red in different solvents can simulate contact lens wetting
performance under different environments
Robert Tucker, Newton Samuel, Peter Lackey. R&D, Alcon, Johns
Creek, Georgia.
Purpose: Silicone hydrogel (SiHy) lenses generally use one of two
strategies to mask the hydrophobic silicone bulk and improve surface
wettability: applying a true surface modification (i.e. delefilcon A,
lotrafilcon B) or relying on embedded wetting agents to populate
the lens surface (i.e. senofilcon A, narafilcon A). The effectiveness
of each strategy for sustained wettability can be probed using the
hydrophobic dye Nile Red (NR) to simulate contact lens surface
interaction with hydrophobic materials (i.e. lipids). A high amount of
staining could indicate potential areas for deposits and poor longterm surface wettability. To simulate a hydrophobic environment (i.e.
after tear break-up), NR was dissolved in silicone oil. To simulate a
hydrophilic environment (i.e. covered by tears), NR was suspended in
an aqueous buffer. Ideally, a contact lens surface should be evaluated
in both environments to fully understand the dynamics of its surface
chemistry.
Methods: NR was dissolved in 1-propanol to make a stock solution.
The stock was placed either in silicone oil (5 cSt, hydrophobic
environment) or cholesterol assay buffer solution (aqueous
environment) to make a NR suspension. Each lens type was rinsed
in PBS, and dyed for 1 minute (NR/silicone) or 20 seconds (NR/
aqueous). Each lens type was imaged using a fluorescent microscope
and analyzed for NR surface coverage.
Results: Control (non-surface modified silicone hydrogel lenses or
silicone rubber sheets) showed high levels of staining. Lenses with
a plasma surface treatment (i.elotrafilcon B) or a water gradient
structure (i.e. delefilcon A) showed no staining in either environment.
Products with embedded wetting agents (i.e. senofilcon A, narafilcon
A) showed a moderate level (up to 20% surface coverage) of
staining under silicone and aqueous conditions, indicating strong dye
interaction in either environment.
Conclusions: Understanding the interaction of a contact lens surface
with its environment is important. Both NR staining methods can be
used to evaluate if a lens masking technique prevents silicone domain
exposure when covered by tears, as well as when the surface has been
exposed to a hydrophobic environment, such as after tear breakup. Both methods could be used to help predict long term surface
performance.
Commercial Relationships: Robert Tucker, Alcon;
Newton Samuel, Alcon; Peter Lackey, Alcon
Program Number: 1458 Poster Board Number: A0138
Presentation Time: 8:30 AM–10:15 AM
Contact lens surface modification utilizing fluorous chemistry
Guoting Qin1, Zhiling Zhu2, Siheng Li2, Chengzhi Cai2,
Alison M. McDermott1. 1College of Optometry, University of
Houston, Houston, Texas; 2Chemistry, University of Houston,
Houston, Texas.
Purpose: Surface modification of contact lenses to improve comfort
or deliver ophthalmic drugs has been explored extensively. However,
current approaches are not satisfactory due to unstable lens surfaces
(due to polymer chain rearrangement) and/or poor lens quality (such
as low transparency) after modification. The goal of this study is to
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ARVO 2016 Annual Meeting Abstracts
develop a simple and effective method to modify contact lenses using
fluorous chemistry, which overcomes the above limitations.
Methods: The presence/absence of fluorine in the formulation
of several commercial contact lenses was determined by x-ray
photoelectron spectroscopy (XPS). A model fluorinated fluorescent
compound (F-FITC) was tested for incorporation/release by
commercial lenses by fluorescence detection. The un-modified
compound FITC and contact lenses without fluorine in their
formulation were also tested as controls (n=3). Ciprofloxacin was
used as a model drug and modified with various fluorinated carbon
chain lengths. The antimicrobial activity of four different chain
lengths of fluorinated ciprofloxacin (F-Cip) as well as F-Cip loaded
comfilcon A lenses was tested against Pseudomonoas aeruginosa
(PA) strain ATCC 19660 using a bacterial inhibition assay (n≥3).
Results: XPS analysis showed the presence of fluorine in comfilcon
A lenses, but not in narafilcon A, delefilcon A, or ocufilcon D lenses.
The fluorinated fluorescent compound F-FITC showed a 17 fold
increase in incorporation into comfilcon A lenses compared to the
control molecule FITC. Furthermore, comfilcon A lenses incorporated
2.3-7.4 fold more F-FITC molecules compared to non fluorinecontaining lenses. The release of F-FITC from comfilcon A lenses
showed sustained release over a period of 8 h, while FITC exhibited a
typical burst release pattern. Two of the four F-Cips tested in solution
inhibited the growth of PA19660 with IC50 values of 0.69 ± 0.62 and
0.85 ± 0.45 μM. These two F-Cips as well as Cip were loaded onto
Comfilcon A lenses, which exhibited 84%, 99%, and 33% killing of
PA19660.
Conclusions: Fluorous chemistry facilitated the incorporation of
fluorinated materials into fluorine-containing contact lenses. In
contrast to the burst release of drug commonly found with other
incorporation methods, this approach resulted in a sustained release
profile, which permits longer therapeutic effects.
Commercial Relationships: Guoting Qin; Zhiling Zhu, None;
Siheng Li, None; Chengzhi Cai, None; Alison M. McDermott,
None
Program Number: 1459 Poster Board Number: A0139
Presentation Time: 8:30 AM–10:15 AM
Depth profiling of an internal wetting agent in etafilcon A contact
lenses
Donald E. Riederer, Shivkumar Mahadevan, Charles Scales,
Kathrine O. Lorenz. Johnson & Johnson Vision Care, Inc.,
Jacksonville, Florida.
Purpose: Soft contact lens (CL) materials are developed using a
variety of methods to help minimize ocular environment impact,
maximize comfort and maintain excellent vision. One such method is
incorporating internal wetting agents, such as poly-vinyl pyrrolidone
(PVP), into the CL matrix. The addition of PVP to etafilcon A CLs
has been shown to reduce coefficient of friction and improve comfort
compared to etafilcon A without PVP, and it has been demonstrated
that the PVP is not released from the CL during a day’s wear.
Confirmation as to the placement and distribution of a wetting
agent within a CL material is important to understand its impact on
performance.
Methods: Etafilcon A (1-DAY ACUVUE® MOIST) daily disposable
(DD) CLs (test) were exposed to PVP K90 in a borate-buffered
packing solution and sterilized via the normal manufacturing process.
PVP location within the CL was determined using a TOF-SIMS depth
profiling technique. The depth profiles were obtained by etching a
channel through the lens’ optic zone using an argon cluster ion beam.
TOF-SIMS spectra were acquired at 300 depth intervals, etching
from front curve to base curve. The depth profiles were constructed
by plotting the normalized intensity of fragment ions from PVP and
the etafilcon A CL substrate as a function of depth. Etafilcon A DD
CLs without PVP (1-DAY ACUVUE®) was the control.
Results: The depth profile showed PVP was found throughout
bulk of the test CL with the highest concentration residing at the
surface. The profile shows a sharp gradient from highest to a lower
concentration in the first 20um, followed by a flatter profile across the
CL center. Comparison with the control confirmed PVP was present
throughout the test CL at levels significantly above the detection limit
of the method (p<0.05). Signals from etafilcon A substrate showed
uniform composition for both the test (1-DAY ACUVUE® MOIST)
and control (1-DAY ACUVUE®) DD CLs as expected.
Conclusions: The test etafilcon A CLs were shown to have PVP
throughout the lens’ matrix, with the highest concentration near the
lens’ surface. It is likely that this enhanced surface concentration
contributes to the improved comfort performance relative to etafilcon
A without PVP.
Commercial Relationships: Donald E. Riederer, Johnson &
Johnson Vision Care, Inc.; Shivkumar Mahadevan, Johnson &
Johnson Vision Care, Inc.; Charles Scales, Johnson & Johnson
Vision Care, Inc.; Kathrine O. Lorenz
Program Number: 1460 Poster Board Number: A0140
Presentation Time: 8:30 AM–10:15 AM
Effects of MPS on SCL wettability, protein uptake, friction-drag
in vitro and on lens-wear comfort and tear film stability in vivo
Tatyana F. Svitova1, Michael Sommerschuh2, 1, Meng C. Lin1.
1
School of Optometry, University of California Berkeley, Berkeley,
California; 2Chemical and Biomolecular Engineering, University of
California Berkeley, Berkeley, California.
Purpose: To study the influences of modern multi-purpose solutions
(MPS) on in vitro model tear-protein uptake and surface properties of
Acuvue2 lenses and lens-wear comfort and tear film stability in vivo.
Methods: Dynamic water-advancing (Θadv) angles on Acuvue2
(AV2) pre-soaked for a week in saline and MPS [Cleanoz (CN);
ClearCare (CC); BioTrue (BT); PureMoist (PM); Revitalens (RL)]
was measured by sessile-bubble method. Model proteins uptake
(2-hour exposure) was evaluated using BCA assay. The contact line
propagation rates (CLPR) of a mineral oil drop on the lens surface
were measured; friction-drag on AV2 was calculated as a ratio of the
CLPR measured after MPS-exposure divided by the CLPR in the
absence of MPS. 40 subjects (20 males and 20 females) completed
the clinical trial in which pre-corneal and pre-lens NITBUTs
were measured using Medmont instrument. Pre-soaked lenses
in designated MPS were worn bilaterally; comfort and pre-lens
NITBUTs were evaluated after 0.5 and 2 hours of lens-wear.
Results: For lenses pre-soaked in CN, Θadv was 83±4°; adhesion
tension (γadh = γa-w cos Θadv) was 5.7±2.7 mN/m; for pre-soaked in
MPS, Θadv became 3±2° and γadh became 34±4 mN/m, close to the
surface tension of corresponding MPS. CC, BT and PM did not
change friction-drag between oil and lens-surfaces. However, for
lenses soaked in RL, the contact-line propagation rate was 24±3%
higher than the initial rate, indicating a reduction of friction-drag
between oil and lens surfaces after exposure to RL. No statistically
significant differences in lens-wear comfort ratings were reported
among all MPS-soaked lenses. Values of the normalized pre-lens tear
film stability (NITBUT/pre-corneal NITBUT) were similar among
pre-soaked lenses in all MPS except for the lenses soaked in RL, for
which normalized pre-lens tear film stability values were 23±2 %
higher than for CN and other MPS. Protein uptake for lenses soaked
in CN, CC, BT, PM, and RL were 173±3, 177.4±5, 168±1.7, 168±2.4,
164±1.3 µg, respectively.
Conclusions: No significant correlation was found between lens γadh
or Θadv after exposure to MPS and NITBUTs or lens-comfort ratings.
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ARVO 2016 Annual Meeting Abstracts
However, a statistically significant increase (p=0.001) of NITBUTs
after soaking in RL is associated with a decrease in both model
protein uptake and friction-drag (p=0.0001) between oil drop and lens
surfaces.
Commercial Relationships: Tatyana F. Svitova, None;
Michael Sommerschuh, None; Meng C. Lin
Program Number: 1461 Poster Board Number: A0141
Presentation Time: 8:30 AM–10:15 AM
Quantification of contact lens wettability after prolonged visual
device use under low humidity conditions
Kathryn Dumbleton1, Michel Guillon1, 2, Trisha Patel1, Kishan Patel1,
Cecile A. Maissa3. 1OCULAR TECHNOLOGY GROUP International, London, United Kingdom; 2School of Life and Health
Sciences, Aston University, Aston, United Kingdom; 3Alcon Research
Ltd., Fort Worth, Texas.
Purpose: Discomfort complaints remain the major cause of contact
lens drop out despite the growth of the daily disposable (DD)
modality and the advent of many new materials. Loss of comfort is
associated with longer wearing time, demanding visual tasks, and dry
environments. In order to better understand the problem, this study
investigated the impact of challenging conditions on wettability of
current DD contact lenses.
Methods: Habitual DAILIES®TOTAL1® (DT1, n=29) and
clariti®1day (c1d, n=31) DD wearers were tested with their habitual
lenses and with MyDayTM (MD) and 1-DAY ACUVUE® TruEye®
(TE) DD lenses. Digital videos were captured using non-invasive
Tearscope illumination after 3 hrs of conventional wear and a
subsequent 3 hrs of computer use in a controlled environment of
20% humidity (20%H), with each lens type. The Tear Film Kinetics
(TFK), non-invasive break up time (NIBUT) and minimum protected
area (MPA) of the lens surface by the tear film, were analyzed over
the entire interblink period post hoc by masked investigators.
Results: For habitual DT1 wearers, NIBUT was similar after 3 hrs
of wear with all lens types, but longer after exposure at 20%H with
DT1 than with MD and TE (Mean: DT1 9.2s, MD 6.3s, TE 5.1s; p =
0.052 and p = 0.006 respectively; upper confidence limit = 0.03). The
greatest difference in MPA between lenses was after 20%H with DT1
achieving greater protection than MD and TE (Mean DT1 95.4%,
MD 84.4%, TE 83.0%, p = 0.002 and p < 0.001 respectively; upper
confidence limit < 0). For habitual c1d wearers, TFK were similar for
all lens types with the exception of greater MPA for c1d and MD than
for TE after 20%H (c1d 89.0%, MD 88.4%, TE 76.2%, p = 0.001 and
p = 0.002 respectively).
Conclusions: Quantification of the TFK after prolonged, intense
visual device use under controlled low humidity conditions is a
highly discriminant methodology that can be used to differentiate
between in vivo contact lens wettability of different contact lenses.
The technique allows quantification of the resistance of the surface
to dehydrate under demanding wear conditions, which are more
representative of wearing conditions associated with the greatest
symptomatology.
Commercial Relationships: Kathryn Dumbleton, Alcon Research
Ltd. (F), Alcon Research Ltd. (R); Michel Guillon, Alcon Research
Ltd. (R), Alcon Research Ltd. (F); Trisha Patel, Alcon Research Ltd.
(F); Kishan Patel, Alcon Research Ltd. (F); Cecile A. Maissa, Alcon
Research Ltd.
Clinical Trial: NCT02388763
Program Number: 1462 Poster Board Number: A0142
Presentation Time: 8:30 AM–10:15 AM
Evaluation Polyethylene Glycol Surface Coating on Gas
Permeable Lenses to Improve Wearability and Wettability
Christine W. Sindt. Ophthalmology, University of Iowa, Iowa City,
Iowa.
Purpose: Contact lens surface dryness, deposit accumulation, and
discomfort are crucial factors leading to patient dissatisfaction while
wearing gas permeable (GP) contact lenses. Polyethylene glycol
(PEG)-based polymer mixture can be covalently (permanently)
bonded to the surface of the contact lens to create a wet surface
on the lens material, separating it from the ocular surface and tear
film. We performed a randomized, double masked, contralateral eye
clinical study to determine if bonded PEG improves wettability, tear
breakup time, deposit resistance and overall comfort of GP contact
lenses compared to non-PEG lens surfaces.
Methods: 50 adapted bilateral habitual GP wearers at the University
of Iowa, were randomized to wear PEG-treated lens in one eye and an
untreated in the contralateral eye for 4 consecutive weeks. Tear break
up time, surface deposits, comfort scores and lens preference were
recorded with their habitual lenses, at dispensing with the new lenses
and after 1 month of wear. Both patient and clinician were masked to
which lens had the surface treatment. Participants rated lens vision,
comfort and preference on analogue scales along with symptoms
of ocular discomfort and dryness using the Contact Lens Dry Eye
Questionnaire-8.
Results: There was a clinically significant improvement in the
performance of the GP lenses with the PEG surface as evidenced by a
longer tear breakup time, a reduction in lens deposits and an increase
in subjective comfort. There was also a significant difference in
overall lens preference favoring the PEG surfaced GP’s.
Conclusions: Covalently bonded Polyethylene glycol provides
a clinically significant improvement on GP lens surface dryness,
deposit accumulation and comfort. These results indicate that PEG
surface is preferred among patients wearing GP lenses and may result
in improved GP tolerability
Commercial Relationships: Christine W. Sindt, None
Program Number: 1463 Poster Board Number: A0143
Presentation Time: 8:30 AM–10:15 AM
Impact of packaging saline wetting agents on wetting
substantivity and lubricity
Leroy Muya1, Jessie Lemp1, Jami R. Kern1, Karen B. Sentell1,
Jennifer Lane1, Scott S. Perry2. 1Vision Care, Alcon, Duluth,
Georgia; 2Materials Science and Engineering, University of Florida,
Gainesville, Florida.
Purpose: Four in vitro studies evaluated an investigational lens
packaged in a saline solution containing copolymer 845 (CO845) and
a novel wetting agent EOBO (polyoxyethylene-polyoxybutylene) for
improved wetting substantivity and lubricity.
Methods: Lotrafilcon B lenses with and without EOBO added
to the packaging saline solution already containing CO845 were
evaluated for wetting substantivity via the sessile drop technique
(VCA Optima system). Study 1: Contact angle measurements were
obtained after 0x, 3x, 5x and 10x successive saline/air exposure
cycles to capture changes in contact angle over time. Study 2:
Contact angle measurements were obtained out-of-pack and after 16
hours of incubation in 1mL saline/lens at 35°C. Lotrafilcon B lenses
in 4 packaging saline solutions (a. PBS, b. CO845, c. EOBO, d.
CO845+EOBO) were evaluated for coefficient of friction (CoF) outof-pack using a colloidal probe attached to a microfabricated AFM
cantilever (study 3) and using a microtribometer with a borosilicate
glass probe (study 4).
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ARVO 2016 Annual Meeting Abstracts
Results: Lotrafilcon B lenses packaged in saline containing
EOBO+CO845 were associated with significantly lower contact
angles after ten successive saline/air exposure cycles compared
to lenses without EOBO (13°± 9 vs. 35°± 9; p<0.0001). After 16
hours’ incubation in saline, the contact angles of the investigational
lenses containing EOBO in the packaging solution were maintained
significantly lower relative to control lenses (8°± 2 vs. 21°± 2;
p<0.001). CoF of the investigational lenses as measured by AFM
showed significant improvement over lotrafilcon B packaged in
PBS (0.255 ± 0.100 vs. 1.120±0.360; p<0.05); however only the
more sensitive microtribometer could distinguish differences in CoF
among all 4 packaging saline solutions with the rank order PBS>
EOBO>CO845 ≥ CO845 +EOBO.
Conclusions: The addition of EOBO to the saline of the lotrafilcon
B lens containing CO845 improved wetting substantivity and
lubricity of the lotrafilcon B lens when measured by multiple in vitro
techniques.
Commercial Relationships: Leroy Muya, Alcon; Jessie Lemp;
Jami R. Kern, Alcon; Karen B. Sentell, Alcon; Jennifer Lane,
Alcon; Scott S. Perry, University of Florida (F)
Program Number: 1464 Poster Board Number: A0144
Presentation Time: 8:30 AM–10:15 AM
Surface friction modification of lotrafilcon B contact lenses by
commercial drops
Jami R. Kern2, Scott S. Perry1, Jessica Rex1, Alexander Rudy1.
1
Materials Science & Engineering, University of Florida, Gainesville,
Florida; 2Global Medical Affairs, Alcon Research, Ltd, Fort Worth,
Texas.
Purpose: To understand the modification of the Air Optix Aqua
(lotrafilcon B) contact lens surface after exposure to commercial
drops as a function of time with atomic force microscopy (AFM)
measurements of sliding friction.
Methods: The kinetic friction between lotrafilcon B lenses presoaked
24hrs in PBS and a 5 micron diameter colloidal silica probe was
measured on the micron length scale and nanometer force scale.
Employing a colloidal sphere for the counterface aimed to manage
interfacial pressures, matching contact pressures found in the eye, and
to avoid massive deformation of the soft lenses and corresponding
displacement of adsorbates. Measurements were made again after
lens exposure to 1 drop of Systane Ultra or Refresh Contacts at
10 min, 1 hr or 6 hrs post-drop to evaluate the persistence of any
measured change in friction. All AFM measurements were measured
under PBS solutions. Measured friction values for each drop were
compared with results from the neat lotrafilcon B lenses prepared by
a 24-hour PBS soak.
Results: Systane Ultra produced a sustained measurable change in
interfacial friction for the lotrafilcon B lenses; friction of neat lenses
was significantly reduced 61% at 10 min, 81% at 1hr, and 73% at
6 hrs post-drop instillation (p<0.001 for all). In contrast to Systane
Ultra, Refresh Contacts drops proved to have less effect on the
frictional properties of the lotrafilcon B lenses, showing a smaller
decrease in friction (26%) at only the 1 hr time point (p=0.008).
Conclusions: These results depict the impact of polymer adsorption
found within commercial drop solutions on the frictional response of
lotrafilcon B lenses. They indicate the active ingredients in Systane
Ultra can have a positive, sustained impact on lubrication properties
of lotrafilcon B silicone hydrogel lenses.
Commercial Relationships: Jami R. Kern, Alcon Research, LTD;
Scott S. Perry, Alcon Research, LTD (F); Jessica Rex, Alcon
Research, LTD (F); Alexander Rudy, Alcon Research, LTD (F)
Support: This research was supported by Alcon Research, Ltd.
Program Number: 1465 Poster Board Number: A0145
Presentation Time: 8:30 AM–10:15 AM
Validity of Oxygen Permeability determined with a Coulometric
Method
Terin Dupre, William J. Benjamin. Optometry, UAB, Birmingham,
Alabama.
Purpose: Samples of silicone-hydrogel (SiHy) contact lens materials
are in most cases available only in finished lenses having refractive
powers. We evaluated the ability of a coulometric method to achieve
a linear relationship between oxygen resistance and sample thickness
of powered contact lenses, and to thereby determine the oxygen
permeability of SiHy materials using production contact lenses as test
samples.
Methods: Assessment of oxygen permeability of hydrogel lens
materials using a coulometric method requires placement of a
reservoir of deionized water against the sample, resulting in a
boundary layer. The determination of oxygen permeability (Dk) of
a contact lens material therefore depends on a linear relationship
between oxygen resistance (t/Dk) and thickness (t), from which the
inverted slope of the line is Dk. We found the preliminary oxygen
transmissibility (Dk/t) of 3 SiHy lens materials (Balafilcon A,
Comfilcon A, and Lotrafilcon A) with a coulometric method using
commercially available contact lenses in refractive powers of -3,
-2, -1, +1, +2, +3, +4, and +6 D. Three samples of each power in
each material were assessed, or 72 test lenses in all. Calibration was
performed by evaluation of additional Lotrafilcon A lenses of -1 D
power assuming a reference of 95 Fatt Dk units. Thickness (t) was the
mean harmonic central thickness of a sample over the area of oxygen
exposure derived from the center thickness measured with a lowforce gauge, refractive index, base curve, and refractive power.
Results: The coefficients of determination (R2) of linear relationships
were derived from the 24 data points for each material. They were
0.835 (Balafilcon A), 0.650 (Lotrafilcon A), and 0.981 (Comfilcon A).
The R2 values for curved plots were slightly greater, at 0.853, 0.658,
and 0.983.
Conclusions: To correct for the boundary layer, acceptable linear
R2 values are at least 0.960 for the coulometric and polarographic
methods measuring uniform thicknesses, and for the polarographic
method measuring powered samples. Here, a sufficient linear
relationship was not achieved for 2 of the 3 SiHy materials when
the coulometric method was used with powered samples. Use of the
coulometric method was made questionable by the required sample
equilibration in deionized water, which preserved the sensitivity of
the detector that can be rendered inoperable by contact with saline,
but that may also alter the permeability of hydrogel materials.
Commercial Relationships: Terin Dupre, None;
William J. Benjamin, Material Performance Assessments, LLC (F),
Material Performance Assessments, LLC (S)
Program Number: 1466 Poster Board Number: A0146
Presentation Time: 8:30 AM–10:15 AM
A Biological Model of Contact Lens Wear
Alison M. McDermott1, Guoting Qin1, Hasna Baidouri1,
Adrian Glasser1, Chris Kuether1, Carol A. Morris2, Inna Maltseva2.
1
University of Houston, Houston, Texas; 2CooperVision, Pleasanton,
California.
Purpose: To analyze changes in protein expression after ocular
surface cells are repeatedly exposed to a mechanical model in which
a contact lens is swept over the cells under dynamic conditions that
mimic the force and speed of the blink.
Methods: A computer controlled mechanical device was developed
to hold a dish containing 3D cultured human corneal epithelial cells
across which an arm bearing a contact lens was swept back and forth
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ARVO 2016 Annual Meeting Abstracts
at a speed and force mimicking the human blink. The entire device
was housed in an incubator to maintain temperature and humidity.
Cells were subjected to sweep cycles of 20, 30, 40 and 60 minutes
at a speed of 100 mm/sec and 2g applied force, after which the cells
were harvested, lysed and analyzed by protein kinase arrays. The
response of the cells to their perturbed environment was compared
to control cells, which had not been subjected to the sweep of the
arm or which were subjected to the sweeping motion but without
applied force (n=3). A custom developed Matlab program was used
to analyze the arrays. Data for some kinases was confirmed and
quantitated by ELISA (n=3).
Results: The phosphorylation state of several protein kinases
increased in response to the sweep cycles. Quantitation by ELISA
showed that the relative increase in phosphorylation levels for cells
exposed to sweep cycles with applied force compared to untreated
control cells were 3.91+/-0.87; 19.80+/-14.66 and 1.16+/-0.13 for
HSP27, JNK and CREB respectively. For cells exposed to sweep
cycles but no applied force the relative increases were 2.08+/-0.34;
5.93+/-4.03 and 1.33+/-0.24.
Conclusions: Exposure of human corneal epithelial cells to sweep
cycles increased the phosphorylation of a variety of important
cellular proteins including HSP27 and JNK. These effects were
due to both shear stress (sweep but no force) and mechanical stress
(sweep with force) of the cells. The data show that perturbation of a
cell’s environment in the presence of a contact lens and conditions
mimicking blinking leads to activation of signaling pathways
expected to lead to a functional change in the cell. Such responses
may contribute to discomfort and other unwanted sequelae of contact
lens wear.
Commercial Relationships: Alison M. McDermott, CooperVision
(F); Guoting Qin, CooperVision (F); Hasna Baidouri, CooperVision
(F); Adrian Glasser, CooperVision (F); Chris Kuether,
CooperVision (F); Carol A. Morris, CooperVision; Inna Maltseva,
CooperVision
Support: CooperVision
Program Number: 1467 Poster Board Number: A0147
Presentation Time: 8:30 AM–10:15 AM
Complications of Scleral Lens Wear
Muriel Schornack1, Jennifer Harthan2, Joseph T. Barr3,
Ellen Shorter5, Amy Nau4, Cherie B. Nau1. 1Ophthalmology, Mayo
Clinic, Rochester, Minnesota; 2Illinois College of Optometry,
Chicago, Illinois; 3The Ohio State University, Columbus, Ohio; 4Korb
and Associates, Boston, Massachusetts; 5University of Illinois at
Chicago, Chicago, Illinois.
Purpose: Corneal rigid gas permeable lenses are associated with a
low risk of complications. Although scleral lenses are also fabricated
from rigid gas permeable materials, their unique fitting characteristics
may give rise to a different complication profile. This study describes
prescriber-reported complications associated with scleral lens wear.
Methods: A 19-question survey regarding scleral lens prescription
and management practices was electronically administered by the
Mayo Clinic Survey Research Center using Qualtrics (Provo, UT)
from 1/12/15 to 3/31/15. Members of professional optometric and
ophthalmologic organizations with self-reported interest in contact
lenses were invited to participate via e-mail, and a link to the
survey was included in two issues of a monthly contact lens-related
international electronic newsletter. All identifying information was
removed prior to data distribution and analysis. Respondents who
had fit 5 or more patients with scleral lenses were asked to report the
number of their patients who had experienced specific complications
due to scleral lens wear.
Results: A total of 989 individuals responded to the survey, of
whom 723 reported fitting 5 or more patients. A total of 84,735
scleral lens patients were represented by these respondents.
Corneal complications included edema (n=385, 0.45% of
patients), neovascularization (n=238, 0.28% of patients), infiltrates
(n=147, 0.17% of patients), toxic keratopathy (n=142, 0.17%
of patients), bullae (n=86, 0.10% of patients), and microbial
keratitis (n=70, 0.08% of patients). Conjunctival complications
included giant papillary conjunctivitis (n=138, 0.16% of patients),
conjunctivochalasis (n=16, 0.02% of patients) and hyperemia
(n=11, 0.01% of patients). Other complications reported included
limbal stem cell compromise (n=13, graft rejection (n=2), elevated
intraocular pressure (n=1), uveitis (n=1) and retinal detachment
(n=1). Handling error was reported as a cause of complication in 448
patients (0.53%).
Conclusions: Despite the fact that these lenses are often prescribed
manage corneal and ocular surface disease, the overall incidence of
complications associated with scleral lens wear appears to be low.
Corneal complications, which could potentially threaten vision, were
reported in 1.25% of patients represented by respondents to this
survey. Conjunctival complications were reported in less than 0.05%
of patients.
Commercial Relationships: Muriel Schornack; Jennifer Harthan;
Joseph T. Barr, None; Ellen Shorter, None; Amy Nau, None;
Cherie B. Nau, None
Support: Mayo Clinic Department of Ophthalmology, unrestricted
grant from Research to Prevent Blindness
Program Number: 1468 Poster Board Number: A0148
Presentation Time: 8:30 AM–10:15 AM
A fourteen year large scale follow-up study into the distribution
of astigmatic axis in Japan. - The result of analysis of
approximately 550,000 eyes of Japanese patients by spherical
surface power Masao Yoshida1, Nobuhisa Mizuki2, Akira Meguro2, Takuto Sakono2,
Eiichi Okada3. 1Department of Public Health, Kyorin University
School of Medecine, Mitaka, Japan; 2Department of Ophthalmology,
Yokohama City University School of Medicine, Yokohama, Japan;
3
Okada Eye Clinic, Yokohama, Japan.
Purpose: There have been no studies based on large scale research
that analyze the distribution of the prescribed astigmatic axis
according to spherical surface power. Therefore, we under took a
fourteen year large scale follow-up study of 550,000 eyes of Japanese
patients who had been prescribed glasses or contact lenses to correct
ametropia. The distribution of astigmatic axis, according to spherical
surface power, was analyzed.
Methods: The subjects of this study are the 549,985 eyes (glasses:
216,971 eyes, contact lenses: 333,014 eyes) of patients in the 10 to
40 year age range, with astigmatism, which were prescribed glasses
or contact lenses to correct ametropia. Prescriptions were given at
the Okada eye clinic in Kanagawa, Japan from January, 2001 to
December, 2014.
Results: As a result of analysis, among the glasses users, the most
common axis was 180° (96,389 eyes (44.4%)), with the next common
being 90 ° (30,495 eyes (14.1%)), followed by 170° (15,739 eyes
(7.3%)). Also, among the contact lens users, the most common axis
was 180° (237,932 eyes (71.4%)), followed by 90° (45,904 eyes
(13.8%)), and 160° (18,552 eyes (5.6%)). In this study, spherical
surface power was divided into 5 groups (High myopia (S < -6.00D);
medium myopia (-6.00D ≤ S < -3.00D); low myopia (-3.00D ≤ S
< -0.25D); emmetropia (-0.25D ≤ S ≤ +0.25D); and hypermetropia
(S > +0.25D)). The 180 ° and 90 ° axes were analyzed according
to spherical surface power. As a result, for both glasses and contact
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ARVO 2016 Annual Meeting Abstracts
lens wearers, 180 ° was the most common axis in myopia and
hypermetropia, however 90 ° was most common in emmetropia.
Also, for both glasses and contact lens wearers, as the myopia got
stronger the percentage of the 180° axis significantly increased
(glasses: P for trend < 0.0001, contact lens: P for trend < 0.01).
However, with high myopia, especially in the contact lens wearers,
this tendency slows down.
Conclusions: The two main axes, 180 and 90, accounted for 58.5%
of the glasses wearers and 85.2% of the contact lens wearers. It
is hypothesized that the reason for the slowing of the increase of
axis 180° in the high myopia group (especially among contact lens
wearers), was because the prescription of astigmatic contact lenses
relatively decreased by the correction of spherical equivalent power.
Commercial Relationships: Masao Yoshida; Nobuhisa Mizuki,
None; Akira Meguro, None; Takuto Sakono, None; Eiichi Okada,
None
Program Number: 1469 Poster Board Number: A0149
Presentation Time: 8:30 AM–10:15 AM
A thirteen year, large scale, follow-up study on the number of
prescriptions of hard contact lenses in Japan. - The result of age
group analysis of approximately 178,000 Japanese subjects eyesEiichi Okada1, Nobuhisa Mizuki2, Akira Meguro2, Takuto Sakono2,
Masao Yoshida3. 1Okada Eye Clinic, Yokohama, Japan; 2Department
of Ophthalmology, Yokohama City University School of Medicine,
Yokohama, Japan; 3Department of Public Health, Kyorin University
School of Medicine, Mitaka, Japan.
Purpose: There have been few detailed large scale studies which
have analyzed the prescription of hard contact lenses (HCL) to
Japanese subjects by age. Therefore, a 13 year large scale followup study was undertaken to analyze approximately 178,000 eyes of
Japanese subjects by age group.
Methods: The subjects of this study are the 177,894 eyes of Japanese
subjects in the age range 6 to 100, prescribed HCL to correct
ametropia (single vision: 170,058 eyes, age 10 to 100; bifocal vision:
5,124 eyes, age 38 to 81; orthokeratology: 2,712 eyes age 6-65). The
prescriptions were made at the Okada eye clinic in Kanagawa, Japan
from April, 2002 to December, 2014.
Results: The 30-39 year age group was prescribed HCL most
frequently (53,897 eyes [30.3%]). This was followed by the 40-49
year group (46,325 eyes [26.0%]) and the 20-29 year group (32,934
eyes [18.5%]). Next are the results were analyzed by age group and
HCL type. The 30-39 year age group were prescribed the most single
focus HCL (53,492 eyes [31.5%]), followed by the 40-49 year group
(44,276 eyes [26.0%]); 20-29 years old (32,334 eyes [19.0%]). On
the other hand, the users of bifocal HCL increased substantially from
a low rate in the under 40s (12 eyes [0.2%]); to a high rate in those
between 40 and 60 years old: 40-49 years old (1,843 eyes [36.0%])
and 50-59 years old (2,723 eyes [53.1%]). However, post 60 years old
the rate began to fall sharply again (546 eyes [10.6%]). In addition,
half of the wearers of the orthokeratology lenses were between 10-19
years old (1,355 eyes [50.0%]). This was followed by those 20-29
years old (600 eyes [22.1%]); 30-39 years old (393 eyes [14.5%]).
The number of wearers significantly decreased as age increased (P for
trend <0.0001).
Conclusions: Analyzing the number of prescriptions of HCL
and SCL by age group, it is suggested that the age distribution of
prescriptions of HCL was approximately 10 years older. 94.5%
of SCL wearers were aged between 10-49 years old (the majority
being 20-29 years old [35.4%]). However, 91.7% of the HCL users
were between 20-59 years old (the majority being 30-39 years old
[30.5%]). In addition, in the 10-19 year age group, the prescription
of HCL was only 3.5%, whereas the prescription of SCL was 22.6%.
Thus, the number of prescriptions of HCL was extremely low
compared to SCL.
Commercial Relationships: Eiichi Okada, None;
Nobuhisa Mizuki, None; Akira Meguro, None; Takuto Sakono,
None; Masao Yoshida, None
Program Number: 1470 Poster Board Number: A0150
Presentation Time: 8:30 AM–10:15 AM
Effects of the peripheral thickness of soft contact lenses on tears
and eye dryness during soft contact lens wear
Norihiko Yokoi1, Rieko Sakai2, Hiroyuki Yamaguchi2,
Shigeru Kinoshita3. 1Ophthalmology, Kyoto Prefectural Univ of Med,
Kyoto, Japan; 2Menicon Co., Ltd., Nagoya, Japan; 3Frontier Medical
Science and Technology for Ophthalmology, Kyoto Prefectural Univ
of Med, Kyoto, Japan.
Purpose: The tear meniscus is separated by the peripheral area of a
soft contact lens (SCL), and this factor may be related to thinning and
instability of the pre-SCL tear film and to eye dryness. To test this
hypothesis, the effects of the peripheral thickness of a SCL on tears
and eye dryness were investigated.™
Methods: This study involved 10 daily SCL wearers without dry
eye (5 males and 5 females; mean age: 34.9 years). In bilateral eyes,
the subjects wore a different commercially available hydrogel SCL
design (SCL-1 and SCL-2) made of the same material and with a
similar central thickness (SCL-1: 0.12mm, SCL-2: 0.11mm) but a
different peripheral thickness (SCL-1: 0.11mm, SCL-2: 0.23mm).
One of the eyes was then evaluated before SCL wear, at 15 minutes
and 1-, 2-, 3-, and 6-hours during SCL wear, and at 15-minutes
post SCL removal. Examination involved the measurement of the
tear meniscus radius (TMR) by video-meniscometry at the central
(C-TMR, mm) and temporal [T-TMR, mm (outside the SCL)] portion
of the lower lid margin, measurement of non-invasive breakup
time (NIBUT, seconds) of the precorneal and pre-SCL tear film by
video-interferometry, and the evaluation of eye dryness using a visual
analogue scale (VAS, mm).
Results: In either SCL, C-TMRs during SCL wear were significantly
less than those before the SCL wear and C-TMRs at 15-minutes and
6-hours during SCL-2 wear were significantly less than those for
SCL-1 wear (p<0.01). There were no significant differences in the
T-TMRs among before, during, and after the removal of either SCL,
or between SCL-1 and SCL-2. In either SCL, NIBUTs during SCL
wear were significantly shorter than those before SCL wear except
for 15-minutes during SCL-1 wear. At 1-, 2-, 3-, and 6-hours during
SCL wear, NIBUTs for SCL-2 were significantly shorter than those
for SCL-1 (p<0.01). VAS scores were significantly greater at 6-hours
during SCL-1 wear, and 3- and 6-hours during SCL-2 wear than those
before each SCL was worn. VAS scores were greater in SCL-2 than
those in SCL-1 at 6-hours during SCL wear (p<0.05).
Conclusions: The findings of this study may prove the hypothesis
that SLCs with greater peripheral thickness may result in a greater
decrease of meniscus tear volume where the SCL is inserted, as well
as less stability of the pre-SCL tear film which leads to greater eye
dryness during SCL wear.
Commercial Relationships: Norihiko Yokoi, None; Rieko Sakai,
None; Hiroyuki Yamaguchi, None; Shigeru Kinoshita, None
Program Number: 1471 Poster Board Number: A0151
Presentation Time: 8:30 AM–10:15 AM
Risk Factors for Contact Lens-Related Microbial Keratitis : A
Case-Control Multicenter Study
Pierre-Henri Becmeur, Tristan Bourcier, Arnaud Sauer. NHC
Strasbourg, Strasbourg, France.
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ARVO 2016 Annual Meeting Abstracts
Purpose: Actually the most feared complication by ophthalmologists
of contact lens (CL) wear is microbial keratitis (MK), even though
its incidence remains low. It’s also a huge financial burden for the
society. This study aimed to identify the risk factors of CL-related
MK especially for hygiene and type of use, in a large prospective,
multi center case-control study.
Methods: A multicenter case-control study was designed. The CL
related MK subpopulation (Case) was compared with healthy CL
wearers (Control) using a 52-item anonymous questionnaire designed
to determine subject demographics, lens wear history, lens type and
disinfection solution. Univariate logistic regression analyse was
performed to compare both groups.
Results: The study enrolled 497 cases and 364 controls.
Conclusions: The risk factors associated with the greatest increased
odds of CL-related MK were as follows: extended wear, adaptation
by an ophthalmologist, no follow-up, use of optician’s disinfection
solution, no case replacement. The protective factors associated with
the greatest reduction in OR were fitting by an ophthalmologist,
female gender, hypermetropia and written and oral informations.
Acanthamoeba Keratitis due to hygiene errors in Contact lens wear
Commercial Relationships: Pierre-Henri Becmeur, None;
Tristan Bourcier, None; Arnaud Sauer, None
Program Number: 1472 Poster Board Number: A0152
Presentation Time: 8:30 AM–10:15 AM
Influence of cosmetically tinted contact lenses on contrast
sensitivity, light scattering, and higher-order aberrations
Takahiro Hiraoka1, Toshiya Yamamoto2, Junko Kotsuka1,
Fumiki Okamoto1, Tetsuro Oshika1. 1Dept of Ophthalmology,
University of Tsukuba, Tsukuba, Japan; 2Department of
Ophthalmology, Ushiku Aiwa General Hospital, Ushiku, Japan.
Purpose: There have been several reports showing visual disturbance
such as declines in contrast sensitivity after wearing cosmetically
tinted contact lenses. However, little is known about the mechanism.
Some studies showed the relationship between loss of visual function
and increases in higher-order wavefront aberrations (HOAs) in tinted
contact lens wearers, but the influence of light scattering on visual
function has not been examined in detail. Our hypothesis is that
tinted contact lenses increase forward light scattering (FLS), thereby
reducing visual function. In this study, we investigated the influence
of cosmetically tinted soft contact lenses on visual function and FLS
as well as HOAs.
Methods: Twenty-seven eyes of 27 healthy volunteers were
examined. The subjects’ age was 33.9 ± 9.6 (mean ± SD) years.
Visual acuity, contrast sensitivity, FLS, and HOAs were measured
after wearing the tinted contact lens (Freshlook® Dailies®, Alcon).
The same examinations were repeated after wearing a normal clear
contact lens without tinted designs (Dailies® Aqua, Alcon).
Contrast sensitivity was evaluated with the Optec 6500 vision
tester (Stereo Optical), and area under the log contrast sensitivity
(AULSCF) was calculated. FLS was measured with the C-Quant
80000 (Oculus), and log straylight parameter (log(s)) was evaluated.
HOAs were assessed with the KR-1W (Topcon), and the RMS of
coma-like, spherical-like, and total HOAs was calculated for a 4-mm
pupil. The obtained data were compared between the two lenses.
Results: AULCSF after wearing the tinted lens was significantly
lower than that after wearing the clear lens in both photopic and
mesopic conditions (p < 0.05).
FLS after wearing the clear and tinted contact lenses was 0.98 ± 0.18
and 0.98 ± 0.17 log(s), showing no significant difference.
Coma-like and total HOAs after wearing the tinted lens were
significantly larger than those after wearing the clear lens (p < 0.05),
but spherical-like aberration was not. However, neither HOAs nor
FLS were correlated with contrast sensitivity after wearing the tinted
contact lens.
Conclusions: The declines in contrast sensitivity after the wear of
tinted contact lenses were confirmed, but the mechanism could not
be explained by changes in HOAs and/or FLS in this study. Further
studies are needed to elucidate the underlying mechanism especially
regarding the role of light scattering.
Commercial Relationships: Takahiro Hiraoka;
Toshiya Yamamoto, None; Junko Kotsuka, None;
Fumiki Okamoto, None; Tetsuro Oshika, None
Program Number: 1473 Poster Board Number: A0153
Presentation Time: 8:30 AM–10:15 AM
Diquafosol ophthalmic solution increases pre- and post-lens tear
film during contact lens wear in rabbit eyes
Shizuka Koh1, Yukiko Nagahara1, Yoshihiro Oshita2, Takashi Nagano2,
Hidetoshi Mano2, Hitoshi Watanabe1, Kohji Nishida1.
1
Ophthalmology, Osaka University Graduate School of Medicine,
Suita, Japan; 2Nara Research & Development center, Santen
Pharmaceutical Co., Ikoma, Japan.
Purpose: Decreased tear volume is a change related to contact lens
(CL) wear. Prolonged increases in pre-lens tear meniscus height after
instillation of 3% diquafosol ophthalmic solution during CL wear
was previously reported. However, the post-lens tear film dynamics
remain unknown. The aim of the present study was to investigate
the behaviors of pre-lens tear film (PLTF) and post-lens tear film
(PoLTF) after instillation of diquafosol by using an experimental
rabbit model of eyes with CL.
Methods: Cross-sectional anterior segment optical coherence
tomographic images of the inferior mid-peripheral cornea were
obtained at baseline, and 5, 15, 30, 60, 90, and 120 min after
instillation of 3% diquafosol ophthalmic solution in 10 Japanese
rabbits wearing CLs. From the obtained images, the area of the
PLTF and PoLTF were calculated. Both 0.1% sodium hyaluronate
ophthalmic solution and artificial tear solution were used as controls.
Results: Fluid accumulation in PoLTF was observed 5 min after
instillation of diquafosol and reached a peak at 15 min, followed
by gradual reduction up to 120 min. PoLTF after instillation of
diquafosol significantly increased from the baseline at 15 and 30 min
(both P < 0.01). No fluid accumulation in PoLTF was observed after
instillation of sodium hyaluronate and artificial tear. The increase in
PoLTF up to 60 min after instillation of diquafosol was significantly
higher (P < 0.01) than that after instillation of sodium hyaluronate
and artificial tear. PLTF also significantly increased from its baseline
value 30 min after diquafosol instillation (P < 0.05). The increase in
PLTF after diquafosol instillation was significantly higher (P < 0.01)
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ARVO 2016 Annual Meeting Abstracts
at 15 and 30 min than after instillation of sodium hyaluronate and
artificial tear.
Conclusions: Instillation of 3% diquafosol ophthalmic solution
increased PLTF and PoLTF in the rabbit eyes with CLs. Therefore, it
has potential as treatment option for CL-related dry eyes.
Commercial Relationships: Shizuka Koh, Santen (R);
Yukiko Nagahara, Santen (R); Yoshihiro Oshita, Santen;
Takashi Nagano, Santen; Hidetoshi Mano, Santen;
Hitoshi Watanabe, Santen (R); Kohji Nishida, Santen (R)
Program Number: 1474 Poster Board Number: A0154
Presentation Time: 8:30 AM–10:15 AM
Release of moxifloxacin from daily disposable contact lenses using
an in vitro eye model: Impact of artificial tear fluid composition
and mechanical rubbing
Chau-Minh Phan1, Magdalena Bajgrowicz2,
Lakshman N. Subbaraman1, Lyndon W. Jones1. 1School of Optometry
and Vision Science, University of Waterloo, Waterloo, Ontario,
Canada; 2Material Science and Engineering, Wroclaw University of
Technology, Wroclaw, Poland.
Purpose: The composition of tear fluid and the mechanical rubbing
produced by the eye lids are important factors that may influence
ocular drug delivery. The aim of this study was to evaluate and
compare the release of moxifloxacin from a variety of daily
disposable (DD) contact lenses (CLs) under various conditions using
a novel in vitro eye model.
Methods: Four commercially available DD conventional hydrogel
(CH) CLs (nelfilcon A, omafilcon A, etafilcon A, ocufilcon B) and
three silicone hydrogel (SH) CLs (somofilcon A, narafilcon A,
delefilcon A) were evaluated. These lenses (n=3 for each lens type)
were incubated in moxifloxacin (1mg/mL) for 24 h. The release
of the drug was measured using a novel in vitro model in three
experimental conditions: (1) phosphate buffered saline (PBS) (2)
artificial tear solution (ATS) containing a variety of proteins & lipids
and (3) ATS with mechanical rubbing produced by the device. The
flow rate was set to 2.1 µL/min (3 mL/24h). The drug was detected
using fluorescence spectrophotometry at excitation and emission
wavelengths of 296 nm and 471 nm respectively.
Results: Overall, CH CLs had a higher drug release than SH CLs
(p<0.05) under all conditions. Typically, a higher drug release was
observed in PBS than ATS (p<0.05). For CH, drug release was found
to be higher in ATS with rubbing than PBS or ATS (p<0.05). For
most lens types, ATS with rubbing produced higher drug release
than ATS alone (p<0.05). Total drug release in PBS varied between
27.9±4.0 - 111.3±12.9 µg/lens, in ATS drug release ranged between
7.0±3.2 - 96.2±4.4 µg/lens, and in ATS with rubbing the drug release
ranged between 18.1±4.3 - 164.3±15.5 µg/lens. Generally, the release
kinetics for all conditions were sustained over the 24 h testing period,
and no burst release was observed (p<0.05).
Conclusions: The release of drugs from a CL into ATS is lower
when compared to release into PBS. When mechanical rubbing is
introduced, the amount of drugs released is increased. These results
suggests that drug release from a CL can be significantly influenced
by these parameters, and thus sophisticated in vitro models are
necessary to adequately model on-eye drug release.
Commercial Relationships: Chau-Minh Phan, None;
Magdalena Bajgrowicz, None; Lakshman N. Subbaraman, None;
Lyndon W. Jones, None
Program Number: 1475 Poster Board Number: A0155
Presentation Time: 8:30 AM–10:15 AM
The Role of Scleral Lenses in the treatment of Corneal
irregularity and Ocular Surface Disease
Ellen S. Shorter1, Jennifer Harthan2, Cherie B. Nau3, Amy Nau4,
Joseph T. Barr5, Muriel Schornack3. 1University of Illinois at
Chicago, Chicago, Illinois; 2Illinois College of Optometry, Chicago,
Illinois; 3Mayo Clinic, Rochester, Minnesota; 4Korb and Associates,
Boston, Massachusetts; 5Ohio State University, Columbus, Ohio.
Purpose: Although scleral lenses are being prescribed for a variety of
indications, there is no established standard of care for their use. The
purpose of this study is to describe the role of scleral lenses in the
treatment of corneal irregularity and ocular surface disease.
Methods: A 19-item survey about scleral lens prescription and
management practices was administered electronically by the
Mayo Clinic Survey Research Center between 1/12/15 and
3/31/15. Members of professional optometric and ophthalmologic
organizations were invited to participate via e-mail. A link to the
survey was also distributed by an international contact lens-related
electronic newsletter. All responses were anonymous and identifying
information was removed prior to data analysis. Participants who had
fit 5 or more patients with scleral lenses were asked to describe the
type of optical correction they prescribe for corneal irregularity and
to rank therapeutic interventions they prescribe for the management
of ocular surface disease.
Results: A total of 989 practitioners responded to the survey, of
whom 723 reported fitting 5 or more patients with scleral lenses.
Practitioners (n=629) responded that the initial optical correction
they consider for corneal irregularity is a corneal gas permeable
lens (44%), a scleral lens (34.5%), a standard hydrogel or silicone
hydrogel lens (12.7%), a hybrid lens (4.9%), a custom hydrogel
or silicone hydrogel lenses (3.3%) followed by a piggyback lens
systems (0.5%). The majority of practitioners (n= 612, 84%) report
prescribing lubricant eye drops for the initial management of ocular
surface disease. The second recommendations were typically topical
steroids (25.8%), topical cyclosporine (21.9%) and punctal occlusion
(19.8%) followed by scleral lenses, systemic antibiotics and moisture
chamber goggles. The late interventions included topical antibiotics,
autologous serum tears, amniotic membrane grafts and lastly
tarsorrhaphy.
Conclusions: Corneal gas permeable lenses are the most commonly
prescribed optical correction for corneal irregularity; however, scleral
lenses are being prescribed as the initial correction by more than
a third of prescribers in this cohort. Scleral lenses are also being
prescribed for ocular surface disease after topical lubricants, topical
steroids, topical cyclosporine and punctal occlusion.
Commercial Relationships: Ellen S. Shorter; Jennifer Harthan,
None; Cherie B. Nau, None; Amy Nau, None; Joseph T. Barr,
None; Muriel Schornack, None
Support: Mayo Clinic Survey Research Center
Program Number: 1476 Poster Board Number: A0156
Presentation Time: 8:30 AM–10:15 AM
Cholesterol Penetration into Daily Disposable Contact Lenses
Using a Novel In Vitro Eye-Blink Model
Hendrik Walther, Chau-Minh Phan, Lakshman N. Subbaraman,
Lyndon W. Jones. School of Optometry, CCLR, University of
Waterloo, Waterloo, Ontario, Canada.
Purpose: The aim of this study was to evaluate the differences in
lipid uptake and penetration in daily disposable (DD) contact lenses
(CL) using the conventional “in-vial” method compared to a novel in
vitro eye model.
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ARVO 2016 Annual Meeting Abstracts
Methods: The penetration of NBD-cholesterol (7-nitrobenz-2oxa-1,3-diazol-4-yl-cholesterol) on three silicone hydrogel (SH)
(delefilcon A, somofilcon A, narafilcon A) and 4 conventional
hydrogel (CH) (etafilcon A, ocufilcon B, nesofilcon A, nelfilcon A)
DD CLs were investigated. The CLs were incubated for 4 and 12 hrs
in an artificial tear solution (ATS) containing fluorescently labeled
NBD-cholesterol at room temperature (21oC). For the vial condition,
the CLs were incubated in a vial containing 3.5 mL of ATS. In the in
vitro eye model, the CLs were mounted on our eye-blink platform,
designed to simulate physiological tear flow (2 mL/24 hrs), tear
volume, and ‘simulated’ blinking. After the incubation period, the
CLs were analyzed using a laser scanning confocal microscopy
technique (LSCM). Quantitative analysis for penetration depth and
relative fluorescence intensity values was determined using ImageJ.
Results: The depth of penetration of NBD-cholesterol varied
between the vial and the eye-blink platform. Using the traditional vial
incubation method, NBD-cholesterol uptake occurred equally on both
sides of all lens materials. However, employing our eye-blink model,
cholesterol penetration was observed primarily on the anterior surface
of the CLs. In general, SH lenses showed higher intensities of NBDcholesterol than CH materials. Fluorescence intensities also varied
between the incubation methods as well as the lens materials.
Conclusions: This study provides a novel in vitro approach to
evaluating deposition and penetration of lipids on CLs. We show that
the traditional “in-vial” incubation method exposes the CLs to an
excessively high amount of ATS on both the front and back surface of
the lens, which results in an overestimation for cholesterol deposition.
Our model, which incorporates important ocular factors such as
intermittent air exposure, small tear volume, and physiological tear
flow between blinks, provides a more natural environment for in
vitro lens incubation. Consequently, this will better elucidate the
interactions between CLs and tear film components.
Figure1: NBD-cholesterol depth of penetration on various lens
materials
Commercial Relationships: Hendrik Walther, None; ChauMinh Phan, None; Lakshman N. Subbaraman, None;
Lyndon W. Jones, None
Program Number: 1477 Poster Board Number: A0157
Presentation Time: 8:30 AM–10:15 AM
In vitro lipid deposition and extraction from two silicone
hydrogel contact lenses
Simin Masoudi1, Todd Mitchell2, Mark D. Willcox1. 1Optometry and
Vision Science, University of New South Wales, Sydney, New South
Wales, Australia; 2Illawarra Health and Medical Research Institute,
University of Wollongong, Wollongong, New South Wales, Australia.
Purpose: To determine the tenacity of lipid adsorption in vitro on
two silicone hydrogel contact lenses.
Methods: Unworn narafilcon A and senofilcon A contact
lenses (n = 10) were soaked in a lipid solution (containing
lysophosphatidylcholine [LPC], phosphatidylcholine [PC],
lysophosphatidylethanolamine [LPE], phosphatidylethanolamine
[PE], cholesterol ester [CE], wax ester [WE], (O-acyl)ω-hydroxy fatty acid [OAHFA], triacylglycerol [TAG],
phosphatidylethanolamine [PE], dihydrosphingomyelin [SM],
phosphatidylserine [PS], ceramide and free cholesterol [FC] –
based on levels of each lipid found in meibum) in methanol for
14 hours. Lipids were then extracted from contact lenses using a
MBTE:methanol solution (10:3 vol/vol) over time (1, 5, 30 and 45
minutes). The extract was washed with aqueous ammonium acetate,
before analysis by chip based nanoelectrospray ionization linear ion
trap-triple quadruple mass spectrometry.
Results: All twelve lipid classes were detected in extracts, but there were
differences between the lens types. Non-polar lipids were adsorbed more
than polar lipids to both lens types. Less lipid was desorbed from the
narafilcon A lenses compared to the senofilcon A lenses ([mean ± 95%
CI] 105,625 ± 47,379 vs. 486,079 ± 268,320 relative intensity, p = 0.03).
More ceramide, WE and CE desorbed from senofilcon A lenses (p<0.05).
Overall, all lipids were desorbed from narafilcon A lenses (≤30 min)
faster than from senofilcon A (≥45 min).
Conclusions: Narafilcon A lenses desorbed less lipids overall than
senofilcon A lenses. The difference in time of desorption suggests a
more tenacious binding of lipids or deeper penetration of lipids into
the senofilcon A lenses.
Commercial Relationships: Simin Masoudi, Alcon (F);
Todd Mitchell; Mark D. Willcox, Alcon (F), Alcon (C)
Support: Sponsored by Alcon
Program Number: 1478 Poster Board Number: A0158
Presentation Time: 8:30 AM–10:15 AM
Decreased Lens Clearance at 20 Minute Intervals Over 2 Hours
of 18.2mm-Diameter Lens Wear
Cherie B. Nau, Michael Helland, Muriel Schornack. Department of
Ophthalmology, Mayo Clinic, Rochester, Minnesota.
Purpose: Small-diameter scleral lenses were previously found to
settle by almost 50% after two hours of wear. The rate of lens settling
over time in larger-diameter lenses is evaluated in this study. We
examined the clearance between the lens and cornea at 20 minute
intervals during the first two hours of 18.2mm-diameter scleral lens
wear.
Methods: Thirty-five participants, fourteen men and twenty-one
women, age 20-44 years (29 ± 7 years, mean ± SD) with healthy eyes
(no history of eye disease or surgery and no previous scleral lens
wear), were fitted on one eye with a 18.2-mm diameter Jupiter scleral
lens (Visionary Optics, Front Royal, VA). Lenses were selected from
a diagnostic fitting set to provide 200-300-μm clearance between
the lens and central cornea immediately after application. Within 5
minutes after lens placement, slit images of the lens and cornea were
recorded by Scheimpflug photography (Pentacam, Oculus, Inc.). The
clearance between the posterior surface of the lens and the anterior
surface of the cornea was measured twice, over the central cornea,
in each of two vertical Scheimpflug images, using the caliper tool
in the Pentacam analysis software. Clearance was recorded as the
average of these four measurements. Scheimpflug photography was
repeated every 20 minutes for two hours, and the central clearance
was measured in the same manner. The corneal clearance for each
measurement was compared to the initial clearance and to the
previous time point by using a paired t-test.
Results: Scleral lens clearance after initial application was 200
± 82 µm (range 84-436 µm). After two hours of wear, clearance
was reduced to 143 ± 89 µm (range 31 - 394 µm; p < 0.001), a
29% reduction in corneal clearance. Percent reduction in clearance
between successive time intervals was 14%, 7%, 5%, 3%, 6%,
and -2% at 20, 40, 60, 80, 100, and 120 minutes after application
respectively. Difference in clearance between initial and 20 minutes,
20 and 40 minutes, and 80 and 100 minutes were significant.
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ARVO 2016 Annual Meeting Abstracts
Conclusions: There is an initial reduction of central clearance within
the first 40 minutes of 18.2-mm scleral lens wear. The lens stabilized
after 100 minutes of lens wear. The potential for lens settling needs to
be considered when fitting these lenses.
Commercial Relationships: Cherie B. Nau, None;
Michael Helland, None; Muriel Schornack, None
Support: RBP, Mayo Foundation, Mayo Clinic CTSA through
NIH grant UL1 TR000135 from the National Center for Advancing
Translational Sciences (NCATS)
Program Number: 1479 Poster Board Number: A0159
Presentation Time: 8:30 AM–10:15 AM
Mini scleral contact lenses: settling period and its effect on
peripheral refraction
Rajini Peguda, Yona Kang, Alice Lim, Pauline Kang,
Helen A. Swarbrick. School of Optometry and Vision Science,
University of New South Wales, Sydney, New South Wales,
Australia.
Purpose: To compare the settling period or change in central corneal
clearance (CCC; μm) of two different diameter mini scleral contact
lens (MScCL) designs with spherical and toric peripheral curves and
to determine the effect of CCC on peripheral refraction (PR; D).
Methods: Two MScCL designs (Katt, lens diameter 16.5 mm and
Epicon, lens diameter 13.5 mm; Capricornia Contact Lens, Australia)
with spherical and toric peripheral curves were fitted on 16 young
adults (Katt, n=16; Epicon, n=10). Each of the 4 lenses was fitted on
one eye only across four separate days. Subjects wore each lens for 8
hours and CCC (Tomey CASIA OCT; Japan), and PR (Shin-Nippon
NVision-K 5001 autorefractor; Japan) at 10° steps along horizontal (±
35°) and vertical meridians (± 30°) were obtained after 10 minutes, 1,
2, 4 and 8 hours of lens wear.
Results: The greatest change in CCC occurred during the first 4
hours of lens wear for Katt lenses (sphere, 149 ± 42 μm; toric, 134
± 41 μm; p<0.001) with no significant change in CCC measured
between 4-8 hours of lens wear (sphere, 12 ± 18 μm; toric, 12 ± 15
μm; p>0.05). The greatest change in CCC measured with Epicon
lenses was after 1 hour of lens wear (sphere, 54 ± 33 μm; toric, 84 ±
42 μm; p<0.0001) and no significant change in CCC was measured
between 1-8 hours of lens wear (sphere, 38 ± 24 μm; toric, 39 ± 28
μm; p>0.05). No significant difference in change in CCC was found
between spherical and toric peripheral curves for either lens design
(Katt, p=0.28; Epicon, p=0.33). The spherical equivalent (M) and
J45 did not change significantly over time with any lens along the
horizontal and vertical meridians (all p>0.05). With Epicon lens wear,
J180 values at all positions along the vertical meridian became more
positive compared to baseline. In contrast, no significant change in
J180 was measured with Katt lenses.
Conclusions: The greatest change in CCC occurred within 4 hours
for Katt lenses and 1 hour for Epicon lenses. This suggests lens
diameter influences MScCL settling period. MScCLs with different
peripheral curves do not seem to affect lens settling. Relative PR
profiles did not change over time with Katt MScCLs. However,
changes in the astigmatic component measured with Epicon lenses
are currently unexplained and need further investigation.
Commercial Relationships: Rajini Peguda; Yona Kang, None;
Alice Lim, None; Pauline Kang, Bausch + Lomb (F), Capricornia
Contact Lens (F), BE Enterprise (F); Helen A. Swarbrick, Bausch +
Lomb (F), Capricornia Contact Lens (F), BE Enterprise (F)
Support: Australian Government ARC Linkage Scheme
Program Number: 1480 Poster Board Number: A0160
Presentation Time: 8:30 AM–10:15 AM
Accommodative responses in myopic children wearing extended
depth of focus contact lenses
Daniel Tilia1, 2, Jennifer Sha1, Danny Kho1, Anna Munro1,
Shona Delaney1, Varghese Thomas1, Klaus Ehrmann1, 2,
Ravi C. Bakaraju1, 2. 1Clinical Research and Trials Centre, Brien
Holden Vision Institute, Sydney, New South Wales, Australia;
2
School of Optometry and Vision Science, University of NSW,
Sydney, New South Wales, Australia.
Purpose: Our group has previously reported accommodative
responses in non-presbyopic adult myopes wearing multifocal
contact lenses (MFCLs) compared to single vision (SV) lenses:
accommodative facility is reduced; center-near lenses induce
exophoria and produce more negative static accommodative response
(M) than center-distance lenses; accommodative adaptation is
unlikely to occur with long-term MFCL wear. This study compared
the accommodative responses in myopic children wearing extended
depth-of-focus (EDOF) CLs against a SV lens.
Methods: This was a prospective, cross-over, randomized, clinical
trial where 16 children (age<18 years) bilaterally wore 2 EDOF
designs (EDOFL/EDOFH) and 1 SV design. Participants were
fitted with refraction-matched lenses and measurements began 10
minutes after insertion. Study variables included binocular highcontrast visual acuity (HCVA, logMAR) at 6m and 40cm; phorias
(Howell-Phoria Card, positive=exo, negative=eso) at 3m and 33cm;
accommodative facility (monocular: ±2 flip spheres, CPD) at 33cm.
Static accommodative response was assessed with the BHVIEyeMapper in a fogged state (+1D) and at two object vergences (-3D
and -5D). Paraxial curvature matching of the wavefront aberration
map over a 4mm pupil yielded the spherical equivalent (M). Variables
were compared between lens types using a linear mixed model.
Results: Static accommodative responses (as gauged by M) were
significantly more negative with both EDOFL and EDOFH designs
compared to the SV lens at both -3D and -5D target vergences (range:
-0.42 to -1.05D, p ≤ 0.004), leaning towards an ideal accommodative
response. The SV lens was significantly better than both EDOFL/
EDOFH for HCVA at 6m (-0.09 ± 0.05 vs. -0.06 ± 0.05/-0.06 ± 0.05,
p = 0.004) but differences were not clinically significant. There
were no significant differences between SV and EDOFL/EDOFH for
HCVA at 40cm (-0.06 ± 0.10 vs. -0.04 ± 0.09/-0.08 ± 0.09, p = 0.56),
accommodative facility at 33cm (13.1 ± 2.9 vs. 13.1 ± 4.3/12.6 ± 4.7,
p = 0.634); phorias at 3m (0.56 ± 1.82 vs 0.06 ± 2.05/0.19 ± 1.17, p =
0.281) and 33cm (2.13 ± 3.81 vs. 1.88 ± 4.40/1.38 ± 3.59, p = 0.734).
Conclusions: In contrast to our previous findings with commercial
MFCLs in non-presbyopic adults, EDOF lenses worn by children
showed more favourable static accommodation responses than the SV
lens, without compromising accommodative facility or phorias
Commercial Relationships: Daniel Tilia, Brien Holden Vision
Institute; Jennifer Sha, Brien Holden Vision Institute; Danny Kho,
Brien Holden Vision Institute; Anna Munro, Brien Holden
Vision Institute; Shona Delaney, Brien Holden Vision Institute;
Varghese Thomas, Brien Holden Vision Institute; Klaus Ehrmann,
Brien Holden Vision Institute (P), Brien Holden Vision Institute;
Ravi C. Bakaraju, Brien Holden Vision Institute, Brien Holden
Vision Institute (P)
Clinical Trial: ACTRN12614000063617
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ARVO 2016 Annual Meeting Abstracts
Program Number: 1481 Poster Board Number: A0161
Presentation Time: 8:30 AM–10:15 AM
Real World Through Focus Curve of a New Multifocal Contact
Lens
Michel Guillon1, 2, Kathryn Dumbleton1, Kishan Patel1, Trisha Patel1,
Tom K. Karkkainen3, Kurt Moody3, Jing Xu3, Ron Clark3. 1Ocular
Technology Group International, London, United Kingdom; 2School
of Life and Health Sciences, Aston University, Aston, United
Kingdom; 3Johnson & Johnson Vision Care Inc., Jacksonville,
Florida.
Purpose: The Through Focus Curve (TFC) is often used to
characterise visual performance of multifocal contact lenses (MCL)
and intra ocular lenses over a range of defocus. Typically negative
lenses are used to produce vergences but this requires accurate
lens centration and trial lenses may interfere with binocularity.
The objective was to characterize a new MCL using a new clinical
test paradigm, measuring visual acuity (VA) at the actual distances
of interest, allowing normal convergence and both binocular and
monocular measurements.
Methods: Monocular, binocular (B) and binocular summation (BS)
TFCs were obtained by measuring logMAR VA at 6 distances (40cm,
50cm, 67cm, 1m, 2m & 4m) for 3 luminances (250cd/m2 daytime
and computer use, 50cd/m2 indoor evening & 2.5cd/m2 night
driving). The measurements were made with OTG-i Vision using a
4K screen at distance, an iPad 2 Air (retina) for intermediate and an
iPad mini (retina) for near, all driven by a dedicated App. The study
MCL was 1-DAY ACUVUE® MOIST Brand MULTIFOCAL. The
study population (age 51.7 ± 7.37) comprised 7 low, 10 medium and
13 high addition subjects.
Results: (i) Mean BVA at 250cd/m2 was < 0.0 logMAR (>20.20)
at all distances. The best BVA was achieved at 2m (-0.19 logMAR
20/13) and the lowest at 40cm (-0.04 logMAR 20/18);
(ii) Mean BVA at 50cd/m2 was lower than at 250cd/m2 by 1 line at
distance (+0.1 logMAR), 1.2 lines at intermediate (+0.12 logMAR)
and 1.4 lines at near (+0.14 logMAR) maintaining a balanced
performance for all distances;
(iii) Mean BVA at 2.5cd/m2 was biased for distance, with 2.5 lines
(0.25 logMAR) loss compared with 250cd/m2 giving a mean VA of
20/25;
(iv) Differences in VA between dominant and non-dominant eyes
were small, at most 1/3 of a line (mean differences -0.025 to + 0.029
logMAR); with a trend to favour the dominant eye at distance and the
non-dominant eye at near;
(v) BS was most marked at distance (mean -0.01 to -0.04 logMAR),
demonstrating that the MCL were not biased towards modified
monovision maintaining binocularity.
Conclusions: This novel “real world” clinical technique was able
to fully characterise the TFC performance of the study MCL,
demonstrating excellent performance at high luminance while
maintaining balanced VA at all distances at medium luminance and
a bias towards distance at low luminance (night driving). In addition
monocular and binocular VA measurements have confirmed binocular
summation with the MCL.
Commercial Relationships: Michel Guillon, Johnson & Johnson
Vision Care Inc. (R), Johnson & Johnson Vision Care Inc. (C),
Johnson & Johnson Vision Care Inc. (F); Kathryn Dumbleton,
Johnson & Johnson Vision Care Inc. (F); Kishan Patel, Johnson &
Johnson Vision Care Inc. (F); Trisha Patel; Tom K. Karkkainen,
Johnson & Johnson Vision Care Inc.; Kurt Moody, Johnson &
Johnson Vision Care Inc.; Jing Xu, Johnson & Johnson Vision Care
Inc.; Ron Clark, Johnson & Johnson Vision Care Inc.
Program Number: 1482 Poster Board Number: A0162
Presentation Time: 8:30 AM–10:15 AM
Binocular vision changes after short-term orthokeratology
Pauline Kang, Kathleen Watt, Tina Chau, Jenny Zhu,
Helen A. Swarbrick. Optometry and Vision Science, University of
New South Wales, Sydney, New South Wales, Australia.
Purpose: Following recent anecdotal reports of improvements
in binocular vision with orthokeratology (OK), this study aimed
to characterize the effects of short-term OK on accommodative
vergence functions and stereopsis.
Methods: 18 young adult myopes (23 ± 4 years of age) were fitted
with Paragon CRT lenses (Paragon Vision Sciences) in both eyes
and lenses were worn overnight for 28 days. Central refraction
(Shin-Nippon autorefractor), stereopsis (Randot test), distance and
near horizontal phorias (Howell card), fixation disparity (Saladin
near point card and Sheedy disparometer), accommodative facility
and AC/A ratios (Howell card with ±1 D and ±2 D flippers) were
measured at baseline before any lens wear, and after 7, 14 and
28 days of OK. Depending on normality of data, RM-ANOVA or
Friedman test were used to analyze changes in binocular vision over
the course of OK treatment.
Results: OK lens wear caused a significant hyperopic shift in central
M in both eyes (both p<0.001). There was no significant change in
stereopsis (p=0.095) or distance phoria (p=0.070) during 28 days
of OK. There was a significant change in near phoria in the exodirection which reached statistical significance after 14 days of OK
lens wear (p=0.011). However, neither horizontal nor vertical fixation
disparities at near showed significant change. Interestingly, distance
(p=0.019) and near (p=0.018) accommodative facility improved
with OK. However, AC/A ratio gradient with -2 D (p=0.076), -1 D
(p=0.730), +1 D (p=0.826) or +2 D (p=0.920) lens stimuli did not
significantly change during the 28 days of OK treatment.
Conclusions: Myopes with near esophoria may benefit most with
OK lens wear, in terms of binocular vision posture. Improvements in
accommodative facility at both distance and near may reflect overall
improved accommodative function. As reduced accommodative
facility has been linked to myopia progression in children, this may
be another mechanism involved in myopia control with OK.
Commercial Relationships: Pauline Kang, Capricornia Contact
Lens (F), BE Enterprise (F), Bausch + Lomb (F); Kathleen Watt,
None; Tina Chau, None; Jenny Zhu; Helen A. Swarbrick, BE
Enterprise (F), Capricornia Contact Lens (F), Bausch + Lomb (F)
Support: Australian Government ARC Linkage Scheme
Program Number: 1483 Poster Board Number: A0163
Presentation Time: 8:30 AM–10:15 AM
Impact of Electronic Device Use on Contact Lens Wearers
Justin T. Kwan1, Jennifer Harthan3, Leslie O’Dell5,
Scott G. Hauswirth4, Milton M. Hom2. 1Marshall B. Ketchum
University, Fullerton, California; 2Private Practice, Azusa, California;
3
Illinois College of Optometry, Chicago, Illinois; 4Minnesota Eye
Consultants, Minneapolis, Minnesota; 5Private Practice, York,
Pennsylvania.
Purpose: The ubiquitous amount of electronic devices and
their frequent use throughout the day may very well impact the
symptomatology of patients especially with a less stable pre-lens
tear film in the contact lens wearing population compared to the tear
film of a non-contact lens wearer. This study attempted to study the
relationship between device use and contact lens symptoms.
Methods: A simple two page customized electronic device survey
paired with the OSDI and SPEED questionnaires were administered
to subjects at 7 clinical sites.
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ARVO 2016 Annual Meeting Abstracts
Results: This contact lens cohort (n = 243) had an average age of
36.43 +/- 14.40. When comparing the younger than 45 and older
than 45 years of age groups, the number of devices used (2.7 vs 2.6)
were the same (p = 0.52). Eye dryness at the beginning of the day
and after device use were also similar (p = 0.58, p = 0.22). What
was significant was that the younger cohort looked at their phones
more times in an hour than the older cohort at 8.08 +/- 5.68 times
compared to 3.66 +/- 3.91 times (p < 0.0001). Lastly, as an entire
contact lens cohort, comfortable wear time was 2.25 hours shorter
than total wear time (p < 0.0001) and was inversely correlated with
OSDI (-0.27, p < 0.0001) more than SPEED (-0.15, p = 0.011). There
was a stronger inverse correlation of comfortable wear time to OSDI
in the older group (-0.41, p < 0.0001) compared to the younger group
(-0.22, p = 0.0003).
Conclusions: Our findings are consistent with prior studies on
comfortable wear time being two hours shorter than total wear
time. Digital device use may modify the symptom status of younger
individuals differently than older individuals as hormonal or
autoimmune risk factors manifest with increasing age. Contact lens
wear further potentiates dry eye symptoms.
Commercial Relationships: Justin T. Kwan, Allergan (C), Johnson
& Johnson Vision Care, Inc. (F); Jennifer Harthan; Leslie O'Dell,
None; Scott G. Hauswirth, TearScience (C), Shire (C), BioTissue
(C), Bausch + Lomb (C), Allergan (C); Milton M. Hom, OptoVue
(R), Bausch + Lomb (F), Shire (C), AMO (F), Allergan (F)
Program Number: 1484 Poster Board Number: A0164
Presentation Time: 8:30 AM–10:15 AM
Determining the Frictional Energy of 1-day Contact Lens Wear
Olof Sterner1, Samuele Tosatti1, Charles Scales2,
Rudolf Aeschlimann1, Tawnya J. Wilson2, Kathrine O. Lorenz2.
1
SuSoS AG, Dübendorf, Switzerland; 2Johnson & Johnson Vision
Care, Inc, Jacksonville, Florida.
Purpose: Few in vitro tools exist to simulate the effects of wear on
contact lens (CL) material lubricity (CLml) despite the suggested
predictive potential of lubricity on end-of-day (EOD) comfort.
Additionally, an obstacle in the evaluation of CLml is the difficulty in
assigning a coefficient of friction to soft-soft and soft-hard contacts
since the ratio of lateral-to-normal forces may not be constant. The
purpose of this study was to evaluate whether the lubricity of two
commercially available CL materials were altered after exposure to
in vitro ageing, and in addition to derive a novel strategy to represent
CLml devoid of presumptions regarding linearity in the lateral-tonormal force ratio.
Methods: To simulate CL wear, senofilcon A (ACUVUE Oasys
1-day) (AO) and delefilcon A (DAILIES Total 1) (DT1) CLs were
cycled for different times (0/2/6/14 and 18 h) between a tear-like
fluid (TLF) and air at 20 seconds intervals to mimic the effect of the
opening and closing phase of a blink. The tribological properties were
characterized using an extended micro-tribometer of that presented
by Roba et al. in 2011. Mucin-coated glass counter surfaces in TLF
were used for all measurements. An optical microscope was used
to determine the effective contact area between counter surface and
CL. The applied normal force range varied between 0.25 and 4.0 mN
with a stroke length of 1.0 mm at a speed of 0.1 mm/s. CLml was
quantified in terms of the average of a non-linear equation fitted to
the lateral vs normal force data, multiplied with a sliding distance of
2 mm and reported in units of energy i.e. frictional energy.
Results: The frictional energy (mean ± 95% CI) expended during
sliding the counter-surface across the AO lens increased marginally
from 66±7 nJ to 86±11 nJ after 18 h of simulated wear, while the
frictional energy for DT1 increased from 71±8 nJ to 610±75 nJ
during the same time interval.
Conclusions: The lubricity of two CL materials has been found to be
susceptible to in vitro ageing, albeit to a significantly different extent.
A decrease in CLml with ageing may have clinical implications in
terms of reduced EOD comfort. Frictional energy is proposed as a
single figure-of-merit of CLml.
Commercial Relationships: Olof Sterner, Johnson & Johnson
Vision Care, Inc (F), SuSoS AG; Samuele Tosatti, SuSoS AG,
Johnson & Johnson Vision Care, Inc (F); Charles Scales, Johnson &
Johnson Vision Care, Inc; Rudolf Aeschlimann, Johnson & Johnson
Vision Care, Inc (F), SuSoS AG; Tawnya J. Wilson, Johnson &
Johnson Vision Care, Inc; Kathrine O. Lorenz, Johnson & Johnson
Vision Care, Inc
Program Number: 1485 Poster Board Number: A0165
Presentation Time: 8:30 AM–10:15 AM
Comparative assessment of visual performance of two daily
disposable multifocal soft contact lenses
Cecile A. Maissa1, Robert Montés-Micó2, José-Juan Esteve-Taboada2,
Teresa Ferrer Blasco2, Alberto Dominguez-Vicent2. 1Alcon
Research Ltd, Fort Worth, Texas; 2Dept. Óptica., Facultad de Física,
Universidad de Valencia, Valencia, Spain.
Purpose: The purpose of this study was to characterize the visual
performance of two daily disposable center-near design multifocal
contact lenses in a population of established presbyopes, in terms of
stereoacuity and areas-of-focus.
Methods: 70 established presbyopes (near add ≥+1.50) were enrolled
in this observer-masked, randomized, crossover-investigation
comparing nelfilcon A multifocal (DACP MF) with omafilcon A DD
multifocal (P1D MF). After 5 (± 1) days of wear, visual performance
measurements included stereoacuity with the Howard–Dolman
system at distances of 40 and 60cm, contrast sensitivity measured
using the VCTS test and binocular visual acuity measured with the
ETDRS high-contrast logMAR chart under photopic conditions (85
cd/m2) to generate defocus curves. Areas of focus for the distance,
intermediate, and near regions were calculated from the defocus
curves.
Results: In this population of established presbyopes, after 5(+/- 1)
days of wear, DACP MF was shown to provide a significantly better
stereoacuity at near (DACP MF: 30.7(12.96) P1D MF: 40.6(5.75)
sec arc; LSM Difference (DACP MF - P1 DMF) = -9.81 (95% onesided CI = -6.89)) and intermediate (DACP MF: 56.3(13.6) P1D
MF: 70.1(14.5) sec arc; p<0.0001). Further, using defocus curves, no
difference were recorded in the distance region, but larger areas-offocus in the intermediate (LSM Difference (DACP MF - P1D MF) =
0.04 (95% one-sided CI = 0.02)) and near regions (LSM Difference
(DACP MF - P1D MF) = 0.03 (95% one-sided CI = 0.02)) were
demonstrated for DACP MF compared to P1D MF correction.
Conclusions: Whereas both DACP MF and P1D MF performed
generally well in this study, near and intermediate stereopsis
measurements as well as the area-of-focus metrics assessed were
able to differentiate between these two multifocal center-near lenses
with different add designs. In the intermediate and near regions,
DACP MF contact lenses demonstrated greater depth perception/
less compromise in binocular function (better stereopsis) and greater
area-of- focus.
Commercial Relationships: Cecile A. Maissa, Alcon Research
Ltd; Robert Montés-Micó, Alcon (C), Alcon Research Ltd (F);
José-Juan Esteve-Taboada, Alcon Research Ltd (F); Teresa Ferrer
Blasco, Alcon Research Ltd (F); Alberto Dominguez-Vicent, Alcon
research Ltd (F)
Clinical Trial: NCT02403180
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to access the versions of record.
ARVO 2016 Annual Meeting Abstracts
Program Number: 1486 Poster Board Number: A0166
Presentation Time: 8:30 AM–10:15 AM
Diurnal Blink Tracking of Symptomatic Contact Lens Wearers
Endri Angjeli1, John D. Rodriguez1, Keith J. Lane1,
George W. Ousler2, Michael Watson2. 1Research and Development,
Ora, Inc., Andover, Massachusetts; 2Dry Eye, Ora, Inc., Andover,
Massachusetts.
Purpose: End-of-day discomfort and dryness are frequent complaints
associated with soft contact lens wear. Rapid blinking and other
changes in blink patterns have been shown to result from increased
ocular discomfort and dryness1. Using a blink tracking system,
this study compared subject-reported symptoms with diurnal blink
patterns in habitual contact lens wearers.
Nakamori K, Odawara M, Nakajima T, Mizutani T, Tsubota K.
Blinking is Controlled Primarily by Ocular Surface Conditions.
American J. of Ophthalmology 1997; 124(1): 24-30.
Methods: 9 habitual wearers of silicon hydrogel contact lenses
were enrolled in an IRB-approved clinical trial. Informed consent
and medical history were obtained from all subjects. Subjects were
required to have had reported actual contact lens wear duration
exceeding comfortable wear duration by at least 3 hours over the
previous month. Subjects had no prior diagnosis of ocular disease.
All subjects were fitted with an EKG-based blink tracking device
that recorded diurnal blinking (expressed as mean hourly interblink
interval (IBI)) for a minimum of ten hours while performing normal
daily activities. Subjects recorded ocular symptoms (0-4 scale) in a
take-home diary.
Results: During the day, mean ocular discomfort recorded in the
diary increased 0.034 units per hour (0-4 scale) based on linear
regression (r=0.63). Consequently, mean daily ocular discomfort was
relatively low (0.74 ± 0.20). Mean hourly IBI (seconds) decreased
at 0.109 seconds per hour (r=0.788) with mean IBI over the day at
(3.80sec ± 0.44sec). Ocular discomfort and mean hourly IBI were
negatively correlated over the day (r=-0.477).
Conclusions: Diurnal blink tracking may be an effective tool for
understanding patterns of lens wear intolerance. As this study
included only lens wearers with end-of-day discomfort, more work
must be completed with comfortable lens wearers to understand the
independent contribution of symptoms to blink pattern abnormalities.
Commercial Relationships: Endri Angjeli, Ora, Inc.;
John D. Rodriguez, Ora,Inc.; Keith J. Lane, Ora, Inc.;
George W. Ousler, Ora, Inc.; Michael Watson, Ora, Inc.
1
Program Number: 1487 Poster Board Number: A0167
Presentation Time: 8:30 AM–10:15 AM
Simulation of three-dimensional scenes through multifocal
contact lenses
William Duncan, Jim Schwiegerling. College of Optical Sciences,
University of Arizona, Tucson, Arizona.
Purpose: The purpose of this study is to develop optically correct
simulations of three dimensional scenes for use with multifocal and
extended depth of focus lenses.
Methods: The effects of blur and aberrations on objects such as
optotypes, eye charts and two dimensional scenes are often simulated
by convolving the point spread function (PSF) of an optical system
with the object. This technique captures the optical effects for
a certain object distance, but fails to account for changes in the
wavefront shape that result from the object being located at various
distances. Consequently, scenes viewed through multifocal optics are
typically analyzed serially where the object distance is changed and
the object blurred for each distance independently. Here, we have
developed a technique where a three dimensional scene is created.
The scene consists of multiple objects (a cell phone, a computer
screen, and the outdoors) each located at distinct distances. Each
of the objects is convolved with a depth-adjusted PSF and the three
objects are recombined to form a simulation of the whole scene.
Occlusion of the background objects by the foreground objects is also
taken into account.
Results: Three dimension scene simulation is computationally
expensive. In principal, each object point has a unique PSF that
independently needs to be added to the final simulation. The
processing can be greatly speeded by assuming several separate
depth layers within the scene where the PSF is slowly varying.
An additional complication is occlusion of background objects by
subsequent layers in the foreground. Occlusion is handled by blurring
the deepest layer first and then masking it by the near layers. The
process is then repeated for the next deepest layer. The resultant
image provides insight into effects such as multifocal and extended
depth of focus lenses.
Conclusions: Three dimensional scene simulation provides a useful
tool for analyzing the performance properties of various types of
presbyopic correction. The scenes provide realistic comparison of
common visual situations such as reading a cell phone or computer
screen and viewing distant objects. Such simulations may be useful
for patient education as well as for providing feedback to designers
regarding the effects of presbyopic corrections.
Commercial Relationships: William Duncan, Alcon Research, Ltd
(F); Jim Schwiegerling, Alcon Research, Ltd (F)
Program Number: 1488 Poster Board Number: A0168
Presentation Time: 8:30 AM–10:15 AM
A comparison of residual peroxide profiles after neutralization of
two marketed one-step 3% hydrogen peroxide systems
Jessie Lemp, Jami R. Kern, Amanda Shows, Huagang Chen. Alcon
Research, Ltd., Fort Worth, Texas.
Purpose: To compare the residual peroxide (H2O2) profiles of
Clear Care Plus (CCP) and PeroxiClear (PC) after neutralization in
laboratory-cycled cases and patient-used cases.
Methods: Residual H2O2 of neutralized CCP and PC (N=5 CCP
and PP cups/discs) was measured via UV spectroscopy in parts per
million (ppm) after 1, 15, 30, 45, 60, 75, 90, and 100 cycles at the
manufacturer-recommended neutralization time (NT; CCP=6hrs and
PC=4hrs) at ambient room temperature. Additionally, 132 subjects
used CCP and PC systems in a randomized order for 30 days each
to disinfect their silicone hydrogel lenses. Lens cases were collected
at Day 30, and the appropriate solution was added to each case
(10mL/case) to measure residual H2O2 via UV spectroscopy at NT.
Neutralization rates were also determined in triplicate single-cycled
cases at neutralization time points of 5, 15, 30, 45, 60, 120, 240, and
360 minutes and in ten 30-day used cases at 120, 180, 240 (CCP and
PC), and 360 (CCP only) minutes.
These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/
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ARVO 2016 Annual Meeting Abstracts
Results: At NT, the mean residual H2O2 for CCP was below 10ppm
after 30 cycles and 5ppm after 100 cycles, while PC averaged
55ppm and 72ppm after 30 and 100 cycles, respectively. In 30-day
used cases, residual H2O2 of CCP and PC at NT was 26.2±41.17
and 229.7±280.13, respectively (p<0.001). In the neutralization rate
studies, CCP had significantly lower residual H2O2 than PC at all
tested neutralization time points up to 120 min in unused cases and
up to 180 min in 30-day used cases (p<0.05 for both) with a trend
towards lower residual H2O2 in both studies at 240 min (p<0.10).
Conclusions: Both the CCP and PC H2O2 systems used by study
subjects resulted in slightly higher residual H2O2 concentrations
at NT compared to the systems cycled in the lab; however, the
manufacturer-recommended 6 hour NT of CCP allows for more
complete neutralization of H2O2 than the 4 hour NT recommended
with PC. 99% of the 30-day patient used CCP systems neutralized
H2O2 to a level of 100ppm or less, which is below the level
detectable by the ocular tissues.
Commercial Relationships: Jessie Lemp, Alcon Research Ltd;
Jami R. Kern, Alcon Research Ltd; Amanda Shows, Alcon
Research Ltd; Huagang Chen, Alcon Research Ltd
Support: This study was sponsored by Alcon Research Ltd.
Clinical Trial: NCT02413333
Program Number: 1489 Poster Board Number: A0169
Presentation Time: 8:30 AM–10:15 AM
Using Corneal elevation specific technology to anti-aberrate a
contact lens
David J. Slater1, Bruno Lay3, Christine W. Sindt2, 1. 1EyePrint
Prosthetics, Lakewood, Colorado; 2Ophthalmology, University of
Iowa, Iowa City, Iowa; 3ADCIS, Saint Contest, France.
Purpose: Zernike polynomial wavefront error can be deconstructed
to describe ocular surface elevation and is positively correlated to
visual acuity. Actual surface elevation fit error, however, is also
strongly positively correlated to visual acuity. The corneal front
surface contributes approximately half of the total aberrations of
the eye. This amount varies by age, surgical history, and disease.
A contact lens placed on the ocular surface to neutralizes the
front surface wavefront error. In many cases however posterior
corneal changes in elevation contribute to continued decrease in
visual acuity. In the past, XYZ rotational instability has prevented
placement of higher order optics on contact lenses. We hypothesize
elevation specific technology, utilizing an ocular surface impression
and registering it with the anterior elevation map of a Schiemflug
topography, we could anti aberrate residual back corneal surface
derived elevation fit error to improve vision.
Methods: Utilizing a low viscosity, addition polymerizing polyvinyl
siloxane precision impression material with hydrophilic properties,
an impression is obtained of the globe, creating a 1-2 micron accurate
representation of the true anterior surface elevation. Lenses designed
with elevation specific technology have been shown to be XYZ
rotationally stable while on the eye.
The true anterior surface elevation was aligned with the schiemflug
image of the corneal front surface to register the images. In this
manner, the back corneal surface of the schiemflug image was
registered to the front surface of the contact lens, aligning the lens
optics over the visual axis. The posterior corneal elevation fit error
was calculated to anti-aberrate the contact lens front surface.
A lens was generated utilizing a data points file, producing a surface
defined by elevations, not by symmetrical radius of curvatures.
Results: Posterior elevation fit error was successfully applied to
the front surface of an XYZ rotationally stable lens and provided
consistent optics.
Conclusions: Visual acuity is determined by aberrations on both
the front and back corneal wavefront fit errors. Contact lenses have
historically corrected the front surface wavefront error, however
residual aberrations have resulted in less than ideal visual quality.
Using elevation specific technology to design and register the contact
lens on the actual eye, allows the aberrations of the posterior corneal
surface to be isolated and corrected.
Commercial Relationships: David J. Slater, EyePrint Prosthetics;
Bruno Lay, EyePrint Prosthetics (C); Christine W. Sindt, EyePrint
Prosthetics (I), EyePrint Prosthetics (P)
Program Number: 1490 Poster Board Number: A0170
Presentation Time: 8:30 AM–10:15 AM
Visual rehabilitation using non-invasive methods in relation to
keratoconus stage
Paulina Camacho Choza, Oscar Fernandez. Cornea, Fundacion
Hospital Nuestra Señora de la Luz, Ciudad de Mexico, Mexico.
Purpose: Determine the visual rehabilitation using non-invasive
methods in patients diagnosed with keratoconus and his visual
prognosis in relation to keratoconus stage.
Methods: A cross-sectional, observational, prospective and analytical
study was performed. All patients diagnosed with keratoconus
rehabilitated by non-invasive methods were included.
Data collection was carried out through a logbook implemented in
the cornea department, information was corroborated with the clinical
files. Statistical analysis was performed by STATA 18, giving a
p=0.05.
The variables studied were age, keratoconus stage according to
Amsler Krumeich classification, visual acuity, visual capacity and
type of correction used: spectacles, soft toric contact lens or rigid gas
permeable.
Also the base curve of contact lens, visual acuity and the
improvement of the visual capacity was analyzed according to the
degree of keratoconus; expressed in logMAR. Visual rehabilitation
was defined as a visual capacity of 20/40 or better.
Results: 61 eyes were analyzed, with a mean age of 28.36 years
(11 to 62), the visual capacity improvement had a mean of 10.19
logMAR points (0 a 20). Regarding to the keratoconus stage it was
observed an average of 2.52, being 15 eyes stage 1, 16 eyes stage 2,
13 stage 3 and 17 stage 4.
The base curve of rigid contact lens was assessed in 22 eyes of
the 61 studied. It was found an average of 7.53 (6.30-8.50) in all
keratoconus stages. In grade 1, an average of 8.28, 7.58 in stage 2,
7.19 in stage 3 and 7.52 in stage 4.
Using Spearman test, a p value of 0.001 was found in the correlation
between keratoconus stage and visual capacity with the best
correction. 19 eyes were rehabilitated with spectacles, 6 with soft
toric contact lenses and 36 with rigid gas permeable contact lenses.
Fifteen eyes from the total did not reach a visual capacity of 20/40 or
better, from which one eye corresponds to stage 1, 3 eyes to stage 2, 3
to stage 3 and 8 to stage 4.
In keratoconus grade 4, eight from the 9 eyes rehabilitated with rigid
gas permeable contact lens.
Conclusions: In conclusion a significant correlation was found
between keratoconus stage and visual capacity, having a excellent
visual improvement the eyes with stage 1, very good stage 2 and 3;
and deficient in stage 4.
Rigid gas permeable contact lenses is the most used and the best way
to improve visual capacity in patients diagnosed with keratoconus.
Commercial Relationships: Paulina Camacho Choza, None;
Oscar Fernandez, None
These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/
to access the versions of record.
ARVO 2016 Annual Meeting Abstracts
Program Number: 1491 Poster Board Number: A0171
Presentation Time: 8:30 AM–10:15 AM
Mixed model analysis of corneal deswelling following overnight
wear of silicone hydrogel lenses
Amir M. Moezzi1, Desmond Fonn1, Natalie Hutchings2,
Trefford L. Simpson2. 1Centre for Contact Lens Research, School of
Optometry and Vision Science, University of Waterloo, Waterloo,
Ontario, Canada; 2School of Optometry and Vision Science,
University of Waterloo, Waterloo, Ontario, Canada.
Purpose: To model the random structure of corneal deswelling after
overnight wear of silicone hydrogel (SiHy) contact lenses.
Methods: Twenty nine neophyte subjects wore twelve SiHy
lenses with a central transmissibility range of 31 to 211 Dk/t units
on separate nights, in random order, and in one eye only. The
contra-lateral eye (no lens) served as the control. Central corneal
thickness was measured using a digital optical pachometer before
lens insertion, immediately after lens removal on waking, then 20,
40 minutes, 1, 2 and 3 hours later. Linear Mixed modelling was
conducted (using SPSS version 22) to analyze corneal deswelling
during this 3 hour period, controlling for oxygen transmissibility
and subject’s age as covariates, with gender as a fixed factor using
-2 Restricted Log Likelihood ratios and Hurvich and Tsai’s (AICC)
criteria to examine the fit.
Results: The best fit model for corneal deswelling was a random
intercept and slope model, with the average (±se) overnight corneal
swelling (CCS) of 6.26±0.35 % (intercept) and average deswelling
rate (slope) of -0.035±0.002 % per minute in the lens eye, and the
average CCS of 3.26±0.31 % and the deswelling rate of -0.023±0.001
% per minute in the control eye. More than 99% of inter-subject
variances of corneal deswelling was attributed to the intercept
(p<0.0001). The inter-subject slope variance contribution was less
than 1% but it was statistically significant (p<0.005).
Conclusions: Linear mixed modelling enabled us to analyze both
the inter-subject and the fixed effects of the corneal deswelling
simultaneously for the first time. Our novel analysis showed that
over the 3 hour period after eye opening the inter-subject variability
of corneal deswelling was mainly attributed to the inter-subject
variability of the overnight corneal swelling and it was minimally
impacted by the inter-subject differences in the individual deswelling
rates. Despite supporting the well documented phenomenon of high
inter-subject variability of the overnight CCS these novel findings
suggest small differences among individual corneal deswelling rates
after eye opening and irrespective of lens wear.
Commercial Relationships: Amir M. Moezzi, None;
Desmond Fonn; Natalie Hutchings, None; Trefford L. Simpson,
None
Program Number: 1492 Poster Board Number: A0172
Presentation Time: 8:30 AM–10:15 AM
Digital device user survey of eye fatigue
Pete S. Kollbaum1, Dawn Meyer1, Sandra Huenink1, Martin Rickert1,
Paul Chamberlain2, Lee Hall2. 1Optometry, Indiana University,
Bloomington, Indiana; 2R&D, COOPERVISION, Pleasanton,
California.
Purpose: Previous reports have indicated that “eyestrain” or “eye
fatigue” occurs in roughly 60% of both the student and working
populations using digital devices, and these symptoms were
demonstrated to cause a significant decrease in quality of life.
However, the symptoms that encompass these reports of eye fatigue
are poorly understood. The aim of the current study was to quantify
symptoms most frequently associated with reports of eye fatigue in
those using digital devices.
Methods: Three hundred and four naïve asymptomatic soft contact
lens (SCL) wearing subjects completed a preliminary questionnaire
providing a subset of common symptoms associated with habitually
experienced digital device related eye fatigue. These questions
explored the frequency and severity ratings of symptoms experienced
when choosing from ten predefined symptom terms.
Results: The survey items demonstrated good internal consistency
(alpha>0.70) and were found to differentiate groups based on
symptomology frequency. Based on the survey responses, overall,
88% of the subjects reported habitually experiencing eye fatigue once
or more per month, while 74% reported experiencing eye fatigue at
least once per week. Dryness, eye irritation, eye strain, and tired eyes
were the symptoms most frequently reported and reported with the
greatest severity. The symptoms clustered into 3 groups according to
their correlation with each other, and the within-symptom correlation
of severity and frequency. Principal component factor analysis found
a similar result. Specifically, strain, soreness, tiredness, and headache
compose a “primary sensations” factor, whereas burning, irritation,
and dryness compose a “secondary sensations” factor, and blurring/
doubling and moving/floating compose a “visual sensations” factor.
Conclusions: Frequent and severe eye fatigue is highly prevalent
amongst a population of SCL wearers using digital devices. Key
descriptors of eye fatigue have been identified and can be used
to help identify and evaluate specific causative, palliative, or
ameliorating factors.
Commercial Relationships: Pete S. Kollbaum, COOPERVISION
(F); Dawn Meyer, COOPERVISION (F); Sandra Huenink,
COOPERVISION (F); Martin Rickert, COOPERVISION (F);
Paul Chamberlain, COOPERVISION; Lee Hall
Support: COOPERVISION
Program Number: 1493 Poster Board Number: A0173
Presentation Time: 8:30 AM–10:15 AM
Internet Survey on Contact Lens Care
Margaret Wang1, Vidhya Gunasekaran5, Saba Nawazish4,
Don B. Kim2, Victoria Phan2, Christina Trinh2, Gloria Wu3. 1Harvard
University, Cambridge, Massachusetts; 2University of California,
Berkeley, Berkeley, California; 3University of California, San
Francisco, San Francisco, California; 4University of Missouri Kansas
City, Kansas City, Missouri; 5Aravind Eye Hospital, Chennai, India.
Purpose: Contact lens related problems are common in young
people. We want to assess the internet demographic and their
understanding of contact lens care.
Methods: A questionnaire of 10 questions created with Google
Forms then posted on internet forums such as on Craigslist, Reddit,
and Facebook. Informed consent was required prior to successful
access to survey. Participants 18 or older were allowed to participate.
Analysis was performed on Google Sheets.
Results: There were 733 responses. Range of correct responses
44.61%~91.68%. See table 1.
Conclusions: The majority of the responses suggest awareness
of contact lens hygiene. However according to the literature, such
high level of awareness, compliance may not match1. Despite the
availability of the internet, 53.21% get information from eye MDs
and optometrists. Thus, eye MDs and optometrists are important in
the education of eye patients. This suggests that eye health literature
may be funneled via eye MD and optometric practices.
These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/
to access the versions of record.
ARVO 2016 Annual Meeting Abstracts
Institute; Varghese Thomas, Brien Holden Vision Institute;
Ravi C. Bakaraju, Brien Holden Vision Institute
Commercial Relationships: Margaret Wang, None;
Vidhya Gunasekaran, None; Saba Nawazish; Don B. Kim, None;
Victoria Phan, None; Christina Trinh, None; Gloria Wu, None
Program Number: 1494 Poster Board Number: A0174
Presentation Time: 8:30 AM–10:15 AM
Impact of primary and secondary spherical aberrations of
multifocal soft contact lenses on vision
Cathleen Fedtke1, Klaus Ehrmann1, 2, Varghese Thomas1,
Ravi C. Bakaraju1, 2. 1Brien Holden Vision Institute, Sydney, New
South Wales, Australia; 2School of Optometry and Vision Science,
University of New South Wales, Sydney, New South Wales,
Australia.
Purpose: To investigate the impact of the primary (PSA) and
secondary (SSA) spherical aberration terms, as measured with
commercial bi-/multifocal (MFCL) soft contact lenses on eye, on
visual performance (VP).
Methods: Seventeen presbyopes (age: 55.1±6.9 years) wore 7
commercial study lenses (4 center-near (MFCL N), 1 centerdistance (MFCL D), 1 bifocal (BF) and 1 single vision (SV) control)
binocularly for up to 1 hour. At baseline (unaided) and with each
lens on eye, the PSA and SSA terms were measured with the BHVIEyeMapper (low illumination). High- and low-contrast distance
visual acuity, contrast sensitivity, high-contrast visual acuities at
intermediate and near, and range of clear vision were measured.
In addition, subjective VP variables included clarity of vision at
distance, intermediate and near, ghosting at distance and near, and
overall vision satisfaction. Linear mixed model was used to compare
lens groups for the PSA and SSA terms. Pearson’s correlation (PC)
was used to determine the association between the PSA and SSA
terms and the VP variables.
Results: PSA was significantly (p<0.05) more negative
with the MFCL N (mean PSA=-0.053±0.080µm) and BF
(PSA=0.005±0.067µm) lenses and more positive with the
MFCL D lens (PSA=0.208±0.160µm), compared to the control
(0.067±0.072µm). Conversely, SSA was significantly more positive
for the MFCL N lenses (mean SSA=0.025±0.029µm) and, although
not significant, more negative for the MFCL D lens (SSA=0.018±0.023µm), compared to the control (SSA=-0.001±0.017µm).
PSA and SSA terms were significantly (p<0.05) correlated to 77%
and 46% of VP variables, respectively, however the PC coefficients
were weak, i.e. ranging between |0.210| to |0.334|. While distance
variables showed improved VP with more positive PSA or negative
SSA, most intermediate/near variables showed improved VP with
more negative PSA and ghosting at near was improved with more
positive SSA terms. Range of clear focus was better for more
negative PSA terms.
Conclusions: The amount and direction of PSA and SSA, as
measured with the different MFCLs on eye, can affect VP at different
distances. Results of this study may provide useful information when
aiming to design new MFCLs for improved visual performance at
certain distances.
Commercial Relationships: Cathleen Fedtke, Brien Holden
Vision Institute; Klaus Ehrmann, Brien Holden Vision
These abstracts are licensed under a Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License. Go to http://iovs.arvojournals.org/
to access the versions of record.