Effect of multipurpose care solutions upon physical dimensions of silicone hydrogel contact lenses.

Interactions between contact lens multipurpose solution (MPS) components and the contact lenses with which they are used are both lens and solution dependent. As such, lens dimensional changes may arise after cleaning and immersion cycling in different lens care solutions over different time courses. In this study, the dimensional stability of five planned-replacement silicone hydrogel lenses (lotrafilcon B, comfilcon A, senofilcon A, senofilcon C, and samfilcon A) over 30 cycles in three different MPSs (Biotrue, OPTI-FREE Express, and OPTI-FREE Puremoist) was evaluated. Measurements of diameter, sagittal depth, power, roundness, and center thickness were obtained prior to, during, and after 30 cycles of cleaning and storage. Diameters of all lenses increased when soaked in Express or Biotrue but held the International Standards Organization (ISO) tolerance over the full course of 30 disinfection cycles; however, the diameters of comfilcon A, senofilcon A, senofilcon C, and samfilcon A lenses soaked in Puremoist exceeded ISO tolerance after between 4 and 9 immersion cycles. In contrast, the diameter of lotrafilcon B held tolerance. Similarly, all lenses cycled in Express or Biotrue held tolerance for sagittal depth, while in Puremoist only lotrafilcon B held tolerance. All lenses became less round in all MPSs but held tolerance for both power and central thickness. Given the lack of reported clinical issues with Puremoist when used with lenses other than lotrafilcon B, we propose that it may be appropriate to revisit the ISO test methods and tolerances to determine if they are still applicable for silicone hydrogel lenses.

Evaluation of binocular function among pre- and early-presbyopes with asthenopia.

PURPOSE: Individuals approaching presbyopia may exhibit ocular symptoms as they contend with visual demands of near work, coupled with natural age-related changes in accommodation. Therefore, accommodation and vergence of 30- to 40-year-old, myopic, soft contact lens wearing subjects with symptoms of asthenopia and no history of using multifocal lenses were evaluated. PATIENTS AND METHODS: In this prospective, observational study, 253 subjects with asthenopia were evaluated by 25 qualified practitioners, each at a different clinical site. Subjects were 30-40 years in age, had symptoms of soreness, eyestrain, tired eyes, or headaches with near work, regularly performed 2-3 consecutive hours of near work, and were undiagnosed with presbyopia. Amplitude of accommodation (AC) and near point convergence (NPC) were measured with a Royal Air Force binocular gauge. Triplicate push up and push down AC and NPC measures were recorded, and average AC values were compared to those calculated using the Hofstetter formula (HF). RESULTS: The average AC push up/push down value was significantly better than the HF prediction for this age range (8.04±3.09 vs 6.23±0.80 D), although 22.5% of subjects had mean AC below their HF value (5.36±0.99 D). The average NPC push up/push down value was 12.0±4.69 cm. The mean binocular AC value using the push up measure was significantly better than the push down measure (8.5±3.4 vs 7.6±3.0 D). The mean NPC value using the push up measure was significantly worse than the push down measure (13.0±5.0 vs 11.0±4.7 cm). The most frequent primary diagnosis was ill-sustained accommodation (54%), followed by accommodative insufficiency (18%), and accommodative infacility (12%). CONCLUSION: Based upon a standardized assessment of accommodation and vergence, ill-sustained accommodation was the most frequent diagnosis among this population.

Use of a novel extended blink test to evaluate the performance of two polyvinylpyrrolidone-containing, silicone hydrogel contact lenses.

BACKGROUND: Sustained digital display viewing reduces eye blink frequency and tear film stability. To retain water and preserve a smooth optical surface, contact lens manufacturers have integrated the humectant polyvinylpyrrolidone (PVP) into silicone hydrogel contact lenses. In this study, extended blink time (EBT) was used to assess visual stability over a prolonged blink interval of two PVP-containing silicone hydrogel lenses, samfilcon A (SAM) and senofilcon A (SEN). MATERIALS AND METHODS: This randomized, bilateral, masked, crossover study assessed lens performance in ten subjects after 16 hours of wear. EBT, ie, the time elapsed between cessation of blinking and blur-out of a threshold letter on the acuity chart, was measured. At the end of the wear period, subjects reported duration of computer use and rated visual quality (VQ) and comfort while wearing the assigned lens, and the investigator evaluated lens surface wetting characteristics. Each lens was removed and immediately weighed to determine total water content. RESULTS: EBTs were 10.42 seconds for SAM and 8.04 seconds for SEN (p = 0.015). Subjective ratings of VQ after 16 hours of wear were 84.6 for SAM and 74.4 for SEN (p = 0.049). Comfort ratings were 85.9 for SAM and 80.2 for SEN (p > 0.05). Median times of computer use were 6-8 hours for both lens types. Post blink, 70.0% of SAM and 30.0% of SEN lenses were completely wet (p = 0.021). Total water content after wear was 43.7% for SAM and 35.5% for SEN (p < 0.001). CONCLUSION: EBT measurement indicated more stable vision with the PVP-containing SAM polymer compared with the PVP-containing SEN polymer. The SAM polymer also demonstrated better surface wetting and maintained higher water content after a prolonged period of wear. EBT can be valuable in assessing vision stability of patients after hours of computer use.

Evaluation of surface water characteristics of novel daily disposable contact lens materials, using refractive index shifts after wear.

PURPOSE: Contact lens wearers today spend much time using digital display devices. Contact lens manufacturers are challenged to develop products that account for longer periods of time where blink rate is reduced and tear-film evaporation rate is increased, affecting both visual acuity and comfort. Two manufacturers recently introduced novel daily disposable contact lenses with high surface water content. The objective of the present study was to compare surface water characteristics before and after initial wear of recently introduced nesofilcon A and delefilcon A high surface water lenses with those of etafilcon A lenses. PATIENTS AND METHODS: Twenty healthy subjects wore each of the three lens types studied in a randomly determined order for 15 minutes. After each wearing, lenses were removed and the surface refractive index (RI) of each lens was immediately measured. RESULTS: The mean RI of the unworn delefilcon A lens was 1.34, consistent with water content in excess of 80%. After 15 minutes of wear, the surface RI shifted to 1.43, consistent with its reported 33% bulk water content. In contrast, the mean surface RI of the nesofilcon A lens was 1.38, both initially and after 15 minutes of wear, and that of the etafilcon A lens was 1.41 initially and 1.42 after 15 minutes of wear. CONCLUSION: The surface of the delefilcon A lens behaves like a high water hydrogel upon insertion but quickly dehydrates to behave like its low-water silicone-hydrogel bulk material with respect to surface water content during wear, while both nesofilcon A and etafilcon A lenses maintain their water content during initial wear. The nesofilcon A lens appears unique among high water lenses in maintaining high surface and bulk water content during wear. This is important because changes in surface RI due to dehydration are reported to lead to visual aberration affecting user experience.

Prevention and removal of lipid deposits by lens care solutions and rubbing.

PURPOSE: Despite the prevalence of silicone hydrogel (SiHy) contact lenses, there are relatively few studies that evaluate the efficacy of multipurpose lens care solutions (MPSs) in reducing lipid deposition on these lenses and the effect of rubbing on the removal. Therefore, we used an in vitro soaking and rubbing model to compare the effectiveness of borate buffered saline (BBS) and two commercial MPSs, PureMoist and Biotrue, in preventing sorption of representative polar and nonpolar lipids. METHODS: Radiolabeled cholesterol (CH) and dipalmitoylphosphatidylcholine (DPPC) were sorbed on two SiHy lenses (senofilcon A and balafilcon A) from an artificial tear fluid. Deposition and removal were evaluated by quantitative solvent extraction and scintillation counting. RESULTS: The efficiencies of the MPSs in reducing lipid deposition are somewhat dependent on lens material. Both DPPC and CH sorption on senofilcon A are greater when lenses are preconditioned in BBS compared with preconditioning in either MPS (p < 0.05). However, neither MPS affects lipid sorption on balafilcon A lenses (p > 0.05). As for removal of presorbed lipids, neither PureMoist, Biotrue, nor BBS removed CH in the absence of rubbing. When a simulated rubbing protocol was used, minimal but detectible CH was removed (p < 0.05) from senofilcon A and balafilcon A lenses (likely only from the lens surface). These commercial solutions were not substantially better than BBS in removing DPPC, with or without rubbing (p > 0.05). CONCLUSIONS: These data suggest that MPSs do not appreciably alter lipid sorption. Rubbing lenses removes a small amount of sorbed lipids. Yet, we recommend that MPSs be used as they may disinfect SiHy lenses and may clean their surfaces of large particles.

Quantitation of cholesterol and phospholipid sorption on silicone hydrogel contact lenses.

The introduction of silicone hydrogel (SiHy) contact lenses to the consumer marketplace necessitates study of the susceptibility of these lenses to spontaneous deposition by hydrophobic lipid components of ocular tears. The use of radioisotopes to measure lipid sorption on SiHy contact lenses gives precise and accurate results but requires institutional infrastructure and compels efficient lipid removal from the lens. This study compares three methods of quantitating phospholipid and cholesterol sorption on SiHy lenses using radiolabeled cholesterol and phosphatidylcholine that were sorbed on lenses from an artificial tear fluid. A triple extraction technique using n-propanol gives the most reliable results. Comparison of sorption on SiHy lenses shows that balafilcon A and senofilcon A lenses sorb similar amounts, while lotrafilcon B lenses sorb comparatively less.