A comparison of spectacle and contact lens wearing times in the ACHIEVE study.

PURPOSE: The aim was to compare vision correction wearing time between myopic children and teenagers in a clinical trial of contact lenses and spectacles. METHODS: Parents of subjects in the Adolescent and Child Health Initiative for Vision Empowerment (ACHIEVE) study provided wearing times for spectacle and contact lens wear. Hours wearing primary correction and total correction were compared between the two treatment groups. Other factors hypothesised to be associated with wearing time were analysed. RESULTS: The average wearing time of the primary correction differed significantly with the wearing time for the spectacles group being 91.5 hours per week compared to 80.3 hours per week for the contact lens wearers (p < 0.0001). Total correction time was slightly higher for the contact lens wearers, 97.5 hours per week, after accounting for time wearing spectacles. Higher refractive error was strongly related to longer wearing times (p < 0.0002). Age and treatment group were associated with wearing time (p = 0.005). Young contact lens wearers wore their lenses less than young spectacle wearers and older contact lens wearers. Low scores on an appearance quality-of-life scale were associated with longer wearing time in spectacle wearers compared to the low- and high-scoring contact lens wearers. Gender, spectacle satisfaction and activities were not related to wearing time. CONCLUSIONS: While contact lens wearers, on average, wear their contact lenses less than spectacle wearers, they spend roughly the same amount of time wearing a refractive correction. Higher refractive error resulted in longer wearing times for both spectacle and contact lens wearers. Younger contact lens wearers wore their contact lenses for shorter periods than the spectacle wearers, but still wore them, on average, 74.4 hours per week (about 10 hours per day), suggesting that contact lenses are a viable alternative mode of correction for children.

Vision specific quality of life of pediatric contact lens wearers.

PURPOSE: Several studies have shown that children are capable of wearing and caring for contact lenses, but it is not known whether the benefits outweigh the risks associated with contact lens wear. The purpose of this article is to compare the vision-related quality of life benefits of children randomized to wear spectacles or contact lenses for 3 years using the Pediatric Refractive Error Profile. METHODS: The Pediatric Refractive Error Profile was administered to 484 children who wore glasses at baseline. The children were then randomly assigned to wear contact lenses (n = 247) or spectacles (n = 237) for 3 years. The survey was administered at the baseline examination, at 1 month, and every 6 months for 3 years. RESULTS: During 3 years, the overall quality of life improved 14.2 +/- 18.1 units for contact lens wearers and 2.1 +/- 14.6 units for spectacle wearers (p < 0.001). In all scales except the visual performance scales (Distance Vision, Near Vision, and Overall Vision), the quality of life improved more for older subjects than younger subjects. The three scales with the largest improvement in quality of life for contact lens wearers were Activities, Appearance, and Satisfaction with Correction. CONCLUSIONS: Myopic children younger than 12 years of age report better vision-related quality of life when they are fit with contact lenses than when they wear glasses. Older children, children who participate in recreational activities, children who are motivated to wear contact lenses, and children who do not like their appearance in glasses will benefit most.

Randomized trial of the effect of contact lens wear on self-perception in children.

PURPOSE: To determine whether contact lens wear affects children's self-perceptions. METHODS: The Adolescent and Child Health Initiative to Encourage Vision Empowerment Study was a randomized, single-masked trial conducted at five clinical centers in the United States. Subjects were 8- to 11-year-old myopic children randomly assigned to wear spectacles (n = 237) or soft contact lenses (n = 247) for 3 years. The primary endpoint was the Self-Perception Profile for Children Global Self-Worth scale. Secondary outcomes included the Physical Appearance, Athletic Competence, Scholastic Competence, Behavioral Conduct, and Social Acceptance Self-Perception Profile for Children scales. RESULTS: Global self-worth was not affected by contact lens wear [analysis of variance (ANOVA), difference = 0.06; 95% CI, -0.004 to 0.117]. Physical appearance (ANOVA, difference = 0.15; 95% CI, 0.07 to 0.22), athletic competence (ANOVA, difference = 0.08; 95% CI, 0.01 to 0.15), and social acceptance (ANOVA, difference = 0.10; 95% CI, 0.03 to 0.17) were all greater for contact lens wearers. CONCLUSIONS: Although contact lens wear does not affect global self-perceptions of 8- to 11-year-old myopic children their physical appearance, athletic competence, and social acceptance self-perceptions are likely to improve with contact lens wear. Eye care practitioners should consider the social and visual benefits of contact lens wear when choosing the most appropriate vision correction modality for children as young as 8 years of age.

Reproducibility of ultrasound pachymetry using the Sonogage Corneo-Gage Plus 2.

PURPOSE: The aim of this study was to determine the reproducibility of measurements made using the Sonogage Corneo-Gage Plus 2 (Cleveland, Ohio) ultrasound pachymeter of total corneal and corneal epithelial thickness in 5 different regions of the cornea. METHODS: Twenty-seven subjects at the New England College of Optometry (NECO) and 20 subjects at the Southern College of Optometry (SCO) were enrolled in this study. Measurements were taken of the central cornea as well as the nasal and temporal regions of the midperipheral and peripheral regions of the right cornea of each subject. Identical measurements were again taken in these subjects 1 week later at approximately the same time of day. Within-subject variations were then assessed using paired t tests. RESULTS: The only significant measurement differences that were found between visits were for full corneal thickness at both the nasal and temporal midperipheral locations. The mean differences for these locations were 13.5 microm and 13.7 microm, respectively. CONCLUSIONS: Epithelial corneal thickness and central and peripheral total corneal thickness measurements using the Corneo-Gage Plus 2 pachymeter were reproducible; however, midperipheral total corneal thickness measurements showed poor reproducibility.

The Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) study design and baseline data.

PURPOSE: The purpose of this study was to describe the baseline characteristics of subjects and methods for a multicenter, randomized clinical trial to compare the effects of contact lens wear and spectacle wear on children's self-perception. METHODS: Eligible subjects are randomly assigned to wear glasses or contact lenses throughout the 3-year study. Self-perceptions are measured 1 month after randomization and every 6 months using the Self-Perception Profile for Children (SPPC). Children's satisfaction with spectacles and refractive error-related visual quality of life are also measured using surveys developed for the study. Visual acuity, cycloplegic autorefraction, corneal curvature, and axial dimensions are measured annually. RESULTS: Five clinical sites enrolled 484 subjects with a mean (+/- standard deviation [SD]) age of 10.4 +/- 1.1 years. Approximately three-fifths of the subjects are girls, 47.1% of the subjects are white, 21.5% are black, and 21.5% are Hispanic. The mean (+/- SD) cycloplegic spherical equivalent autorefraction of the right eye is -2.38 +/- 1.04 D, and the average (+/- SD) axial length of the right eye is 24.32 +/- 0.77 mm. The average (+/- SD) Global Self-Worth score on the SPPC is 3.20 +/- 0.62 on a scale from one (low perceived competence) to 4 (high perceived competence). The average (+/- SD) spectacle satisfaction is 59.1 +/- 26.6 on a scale from zero (no satisfaction) to 100 (perfect satisfaction). The average refractive error-related quality of life score is 63.5 +/- 12.8 on a scale from zero (poor quality of life) to 100 (excellent quality of life). CONCLUSIONS: Subjects enrolling in the ACHIEVE Study are an ethnically diverse group of young myopic children. Ocular characteristics of the sample are consistent with data presented in other randomized clinical trials evaluating treatments for myopic children. The data reported here represent the baseline data for a 3-year randomized clinical trial to investigate the effects of contact lens vs. spectacle wear on children's self-perceptions.

Orthokeratology and corneal refractive therapy: a review and recent findings.

PURPOSE: To review the past and current literature and present recent findings on orthokeratology and corneal refractive therapy. METHODS: Various articles on contact lens corneal reshaping were analyzed. Common clinical procedures and interference measurement of tear-film thickness were also used. RESULTS: Although the numbers of patients tested to date do not allow conclusions of great certainty, based on a review of the current literature, our recent study of 60 patients, and the Food and Drug Administration approval of overnight contact lens corneal refractive therapy, there is a low incidence of complications, and unaided visual acuity of 20/20 in the morning is possible in most (74%) successful cases. Refractive error change of 2.25diopter (D) +/- 1.00D is common. A presumed iron ring may appear in some patients in the midperipheral corneal epithelium. CONCLUSION: Overnight orthokeratology and corneal refractive therapy with modern design reverse-return zone lenses in high-Dk rigid gas-permeable contact lens materials is an option for transient vision correction for some myopic patients.

Overnight orthokeratology: preliminary results of the Lenses and Overnight Orthokeratology (LOOK) study.

BACKGROUND: The Lenses and Overnight Orthokeratology (LOOK) study is a pilot study designed to learn the procedures of orthokeratology lens fitting in preparation for a planned larger clinical trial and to obtain data with which to calculate a sample size for that larger study. Data are presented for the first 3 months of the LOOK study. METHODS: Sixty subjects were enrolled in this multicenter pilot study to evaluate the success and safety of treatment with overnight orthokeratology contact lenses. Refractive error, corneal topography, and biomicroscopic data were collected to determine the amount of refractive error change achieved, corneal changes, and a safety profile of overnight wear of reverse geometry rigid gas permeable lenses for orthokeratology. RESULTS: Of the 60 subjects enrolled, 46 completed the 1-month visit, and 31 completed the 3-month visit. The mean change in spherical equivalent manifest refraction from baseline to the morning 3-month visit was 2.08 +/- 1.11 D in the right eye and 2.16 +/- 1.05 D in the left eye. At the 3-month morning visit, 74% of right eyes and 61 % of left eyes had 20/20 unaided visual acuity. No corneal infiltrates or ulcers were noted in any subjects. Observations of fluorescein staining of the cornea, imprinting, and microcysts were noted in some patients at the 3-month visit. CONCLUSIONS: The preliminary results of the LOOK study indicate that improvement in unaided visual acuity can be attained for at least 6 h after lens removal. The short-term safety and efficacy of the procedure appear to be favorable; however, future studies are needed to determine the long-term outcomes of treatment.