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Concept: Contact lens

170

PURPOSE: To investigate the normative data of ocular axial length and its associations in Chinese. METHOD: The population-based Beijing Eye Study 2011 is a cross-sectional study performed in Greater Beijing. The study included 3468 individuals (1963 (56.6%) women) with a mean age of 64.6±9.8 years (range: 50-93 years). A detailed ophthalmic and medical examination was performed. Axial length was measured by optical low-coherence reflectometry. RESULTS: Axial length measurements were available for 3159 (91.1%) study participants. Mean axial length was 23.25±1.14 mm (range: 18.96-30.88 mm). In multivariate analysis, axial length was significantly associated with the systemic parameters of higher age (P<0.001), higher body height (P = 0.003), higher level of education (P<0.001) and urban region of habitation (P<0.001), and with the ocular parameters of thicker central cornea (P = 0.001), higher corneal curvature radius (P<0.001), deeper anterior chamber (P<0.001), thicker lens (P<0.001), more myopic refractive error (P<0.001), larger pupil diameter (P = 0.018), and higher best corrected visual acuity (P<0.001). It was additionally and negatively associated with the lens vault (P<0.001). In highly myopic eyes, axial length was significantly associated with lower level of education (P = 0.008), more myopic refractive error (P<0.001), and lower best corrected visual acuity (P = 0.034). CONCLUSIONS: Mean ocular axial length in the older adult population of Greater Beijing (23.25±1.14 mm) was similar to the value measured in other urban populations and was higher than in a rural Central Indian population. The association between axial length and older age may potentially be associated with a survival artifact. The association between axial length and body height agrees with the general association between anthropomorphic measures and eye globe size. The association with the level of education and urban region of habitation confirms with previous studies. In contrast in highly myopic eyes, axial length was negatively associated with educational level and best corrected visual acuity.

Concepts: Refractive error, Contact lens, Length, Myopia, Pupil, Visual acuity, Eye, Cornea

169

To compare the performance of two novel multipurpose disinfecting solutions (MPDS) in preventing silicone hydrogel contact lens dehydration, provide higher scores of subjective comfort and stable optical quality during a month of lens wear in neophyte volunteers.

Concepts: Contact lenses, Oxygen permeability, Intraocular lens, Myopia, Cornea, Contact lens, Lens, Corrective lens

169

Combination of riboflavin/UVA cross-linking (CXL) and excimer laser ablation is a promising therapy for treating corneal ectasia. The cornea is strengthened by cross-linking, while the irregular astigmatism is reduced by laser ablation. This study aims to compare the efficacy of excimer laser ablation on porcine corneas with and without cross-linking.

Concepts: LASIK, Contact lens, Keratoconus, Corneal transplantation, Refractive surgery, Laser, Cornea, Excimer laser

168

We present an overview of currently available toric intraocular lenses (IOLs) and multifocal toric IOLs. Relevant patient selection criteria, IOL calculation issues, and surgical techniques for IOL implantation are discussed. Clinical outcomes including uncorrected visual acuity, residual refractive astigmatism, and spectacle independency, which have been reported for both toric IOLs and multifocal toric IOLs, are reviewed. The incidence of misalignment, the most important complication of toric IOLs, is determined. Finally, future developments in the field of toric IOLs are discussed. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Concepts: Refractive error, Lens, Ophthalmology, Contact lens, Presbyopia, Cataract, Toric lens, Intraocular lens

168

PURPOSE: To investigate differences in ocular aberrations induced by centre-near multifocal soft contact lenses (SCL) relative to single vision SCLs and their effect on contrast sensitivity function (CSF). METHODS: Ocular aberrometry was measured in 18 cyclopleged subjects (19-24 years) while wearing Ciba Air Optix low (AOlow) and high (AOhigh) add, Bausch & Lomb PureVision low (PVlow) and high (PVhigh) add multifocals, and a Bausch & Lomb PureVision single vision (PVsv) control with the same -3.00D distance back vertex power. Zernike polynomials were scaled to 4, 5 and 6mm pupils. CSF was measured at equivalent distances of 6m, 1m and 40cm while fully corrected with spherical trial lenses at 6m. RESULTS: AOlow, AOhigh and PVhigh induced a negative shift in primary spherical aberration (Z12) from PVsv and all multifocal SCLs induced a positive shift in secondary spherical aberration (Z24) (all p<0.01), without significantly increasing coma. Area under the CSF (AUCSF) reduced at 40cm for all multifocals relative to PVsv (p<0.05), but was not significantly different at 6m or 1m. A moderate correlation (r=-0.80, p<0.005) was found between changes in Z12 and AUCSF at 40cm for AOhigh, with an increase in negative Z12 reducing multifocal-induced loss of CSF. CONCLUSIONS: Centre-near multifocal SCLs induced a negative shift in Z12 and a positive shift in Z24. Although CSF was unaffected at 6m and 1m it was reduced at 40cm, possibly because changes in Z12 and Z24 were not great enough to induce a significant shift in centre of focus and increase in depth of field.

Concepts: Redox, Keratitis, Optics, Lens, Bausch & Lomb, Contact lens

167

PURPOSE: To compare the visual outcomes of additional multifocal intraocular lenses (IOLs) for sulcus fixation with those of standard multifocal IOLs in the capsular bag. SETTING: Department of Ophthalmology, Rudolf-Virchow-Klinikum Glauchau, Glauchau, Germany. DESIGN: Prospective controlled clinical trial. METHODS: Eyes had phacoemulsification and implantation of a monofocal IOL in the capsular bag and an additional aberration-free diffractive IOL in the ciliary sulcus (multifocal add-on IOL group). Measurements of uncorrected and distance-corrected distance, intermediate, and near visual acuities; contrast sensitivity; and defocus curve were performed 3 months postoperatively. Results were compared with those in eyes with an aberration-correcting diffractive posterior chamber IOL (multifocal PC IOL group). RESULTS: The multifocal add-on IOL group comprised 34 eyes of 20 patients and the multifocal PC IOL group, 31 eyes of 17 patients. Cataract surgery, IOL implantation, and the postoperative course were uneventful in all cases. There were no statistically significant differences in uncorrected and distance-corrected distance, intermediate, or near visual acuities between the 2 groups. The median uncorrected distance visual acuity was 0.00 logMAR in both groups, and the median uncorrected near visual acuity was 0.10 logMAR in both groups. Contrast sensitivity testing yielded significantly better results in the multifocal add-on IOL group, especially at spatial frequencies over 1.5 cycles per degree. Defocus curves were similar in the 2 groups. CONCLUSION: Visual performance with a multifocal diffractive add-on IOL was equivalent to that achieved with a commonly used multifocal diffractive PC IOL. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Concepts: Eye surgery, Statistical significance, Contact lens, Ophthalmology, Lens, Visual acuity, Cataract, Intraocular lens

153

Keratitis (inflammation of the cornea) can result from contact lens wear or other causes. Keratitis from all causes, including contact lens wear, results in approximately 1 million clinic and emergency department visits annually, with an estimated cost of $175 million in direct health care expenditures in 2010 (1). Approximately 41 million U.S. residents wear contact lenses, and in 2014, >99% of contact lens wearers surveyed reported at least one behavior that puts them at risk for a contact lens-related eye infection (2). The Center for Devices and Radiological Health at the Food and Drug Administration (FDA) regulates contact lenses as medical devices, and certain adverse events related to contact lenses are reported to FDA’s Medical Device Report (MDR) database. To describe contact lens-related corneal infections reported to the FDA, 1,075 contact lens-related MDRs containing the terms “ulcer” or “keratitis” reported to FDA during 2005-2015 were analyzed. Among these 1,075 reports, 925 (86.0%) were reported by a contact lens manufacturer and 150 (14.0%) by an eye care provider or patient. Overall, 213 (19.8%) reports described a patient who had a central corneal scar, had a decrease in visual acuity, or required a corneal transplant following the event. Among the reports, 270 (25.1%) described modifiable factors known to be associated with an increased risk for contact lens-related corneal infections, including sleeping in contact lenses or poor contact lens hygiene; the remainder did not provide details that permitted determination of associated factors. Continued efforts to educate contact lens wearers about prevention of contact lens-related eye infections are needed.

Concepts: Ophthalmology, Optometry, Contact lenses, Visual acuity, Keratitis, Eye, Cornea, Contact lens

113

Wearing contact lenses has been identified as a risk factor for the development of eye conditions such as giant papillary conjunctivitis and keratitis. We hypothesized that wearing contact lenses is associated with changes in the ocular microbiota. We compared the bacterial communities of the conjunctiva and skin under the eye from 58 subjects and analyzed samples from 20 subjects (9 lens wearers and 11 non-lens wearers) taken at 3 time points using a 16S rRNA gene-based sequencing technique (V4 region; Illumina MiSeq). We found that using anesthetic eye drops before sampling decreases the detected ocular microbiota diversity. Compared to those from non-lens wearers, dry conjunctival swabs from lens wearers had more variable and skin-like bacterial community structures (UniFrac;P value = <0.001), with higher abundances ofMethylobacterium,Lactobacillus,Acinetobacter, andPseudomonasand lower abundances ofHaemophilus,Streptococcus,Staphylococcus, andCorynebacterium(linear discriminant analysis [LDA] score = >3.0). The results indicate that wearing contact lenses alters the microbial structure of the ocular conjunctiva, making it more similar to that of the skin microbiota. Further research is needed to determine whether the microbiome structure provides less protection from ocular infections.

Concepts: Bacteria, Contact lenses, Conjunctiva, Keratitis, Cornea, Contact lens, Eye, Conjunctivitis

101

Recent advances in wearable electronics combined with wireless communications are essential to the realization of medical applications through health monitoring technologies. For example, a smart contact lens, which is capable of monitoring the physiological information of the eye and tear fluid, could provide real-time, noninvasive medical diagnostics. However, previous reports concerning the smart contact lens have indicated that opaque and brittle components have been used to enable the operation of the electronic device, and this could block the user’s vision and potentially damage the eye. In addition, the use of expensive and bulky equipment to measure signals from the contact lens sensors could interfere with the user’s external activities. Thus, we report an unconventional approach for the fabrication of a soft, smart contact lens in which glucose sensors, wireless power transfer circuits, and display pixels to visualize sensing signals in real time are fully integrated using transparent and stretchable nanostructures. The integration of this display into the smart lens eliminates the need for additional, bulky measurement equipment. This soft, smart contact lens can be transparent, providing a clear view by matching the refractive indices of its locally patterned areas. The resulting soft, smart contact lens provides real-time, wireless operation, and there are in vivo tests to monitor the glucose concentration in tears (suitable for determining the fasting glucose level in the tears of diabetic patients) and, simultaneously, to provide sensing results through the contact lens display.

Concepts: Myopia, Tears, Corrective lens, Wireless energy transfer, Contact lens, Eye, Lens, Cornea

66

There is increasing interest in fitting children with soft contact lenses. This review collates data from a range of studies to estimate the incidence of complications, specifically corneal infiltrative events and microbial keratitis, in patients under the age of 18 years.

Concepts: The Age, Orthokeratology, Bausch & Lomb, Corneal ulcer, Keratitis, Cornea, Contact lens