[Practical tips and tricks in fitting soft contact lenses]. / Praktische Tipps und Vorgehensweise bei der Anpassung weicher Kontaktlinsen.

This review is intended to give supportive information for beginners in contact lens fitting who are interested in providing a quality-related service to customers and patients. In Germany the proportion of contact lens wearers is significantly lower than in most other countries; therefore, there is a potentially fast growing market. The aim of this paper is to provide comprehensive guidelines for practitioners to develop and improve contact lens fitting practice and minimize unnecessary or preventable complications. The fundamental requirement for starting in contact lens fitting is to have correct education in the field and for the practice to be appropriately equipped. The key to providing a safe a reliable contact lens fitting practice is to continually update knowledge in the field and to maintain the practice to the highest professional standards.

Non-contact meibography: keep it simple but effective.

PURPOSE: Meibography is reported to be important in Meibomian Gland Dysfunction (MGD) evaluation. Our purpose was to investigate the usefulness of a standard infra-red video security camera in meibography. METHODS: Meibographs were taken of the right lower lid of 17 subjects (female 10; age = 44.3 years ±13.3 SD), randomly selected from the patient pool of Horst Riede GmbH, Weinheim, Germany. Meibomian glands (MG) were photographed by an near adapted infra-red video security camera and extend of MG loss (MGL) was measured by digital image analyzes. Lipid-layer and non-invasive break-up time (NIBUT) was measured by tearscope, dry eye symptoms were evaluated by the Ocular Surface Disease Index (OSDI). Correlations between MGL scores and ocular signs, tearfilm and symptoms were analyzed by Pearsons, differences between gender by U-test. The ability of MGL to predict dry eye symptoms was evaluated by area under the receiver operative characteristic curve (AUC). RESULTS: MGL scores were significantly correlated to lipid-layer pattern (r = -0.68, p = 0.001) NIBUT (-0.46, 0.032) OSDI (0.89, 0.001) and age (0.61, 0.005). MGL was significantly larger in female (p = 0.001). AUC of MGL was 95.8% (p = 0.001; sensitivity = 88.9%; specificity = 87.5%; threshold = 32.3%). CONCLUSIONS: MGL is a predictive test of dry eye symptoms. The analyzed significant correlation between MGL and tearfilm and dry eye symptoms indicates the usefulness of the non-contact IR meibograph (PNCM).

A new modified fluorescein strip: Its repeatability and usefulness in tear film break-up time analysis.

PURPOSE: To (i) analyze the repeatability of fluorescein instillation from a modified fluorescein strip (MFS) compared to a standard fluorescein strip (FS), and to (ii) observe its usefulness in the measurement of the fluorescein break-up time (FBUT) in comparison to the Tearscope (NIBUT). METHODS: In-vitro: Intra- and inter-observer repeatability in fluorescein instillation from the MFS and FS was evaluated by fluorescence analysis (n=10, each). In-vivo: BUT of the right eye of 20 randomly selected subjects (mean age 43.3±11.5, range=21-60 years, 8 males, 12 females) was measured by use of the Tearscope and MFS. Subjects were grouped by the Ocular Surface Disease Index (OSDI) score into 8 OSDI+ and 12 OSDI- by a cut-off value of 15. RESULTS: In-vitro: Intra-observer 95% limit of agreement (LoA) of the MFS was similar to the FS LoA in observer 1 (O1), but better than the FS LoA in observer (O2) (MFS: O1: LoA=±1.98 mW; p=0.179; O2: ±2.71; 0.442; FS: O1: ±1.71; 0.246; O2: ±4.11; 0.512). Inter-observer LoA in fluorescence was better in MFS (±1.42; 0.111) than in FS (±3.71; 0.003). In-vivo: MFS-BUT was significantly shorter than the NIBUT (p=0.002), but significantly correlated (r=0.864, p<0.001). NIBUT and MFS-BUT were significant discriminators (p<0.001) of OSDI±(0.948/8s and 0.938/5s [AUC/cut-off value]; NIBUT and MFS-BUT, respectively). CONCLUSIONS: The MFS was better in the repeatability of fluorescein instillation than the FS. NIBUT and MFS-BUT were good discriminators of dry eye symptoms, but differ in their cut-off values.

The relationship between clinical signs and dry eye symptoms.

PURPOSE: To evaluate (i) the relationship between traditional and new clinical tests (lid-wiper epitheliopathy (LWE), lid-parallel conjunctival folds (LIPCOF)) and dry eye symptoms in non-contact lens wearers, and (ii) that a combination of these tests can improve predictive ability for the development of dry eye symptoms. METHODS: Tear meniscus height (TMH), non-invasive break-up time (NIBUT), ocular hyperaemia, LIPCOF, phenol red thread test (PRTT), corneal and conjunctival staining, and LWE grades were observed in a cohort of 47 healthy, non-lens wearers (male=17, female=30, median age=35 years, range=19-70). Symptoms were assessed using the Ocular Surface Disease Index (OSDI). RESULTS: LWE was significantly correlated to both temporal and nasal LIPCOF (0.537 -0.248, P < 0.001). Significant correlations were found between NIBUT and TMH (r=0.461, P=0.001) and PRTT (r = 0.640, P < 0.001). OSDI scores were significant correlated to NIBUT, TMH, PRTT, LIPCOF, and LWE (r>∣0.31∣; P<0.05). Significant discriminators of OSDI+/- were NIBUT (area under the receiver operative characteristic curve (AUC)=0.895), TMH (0.715), PRTT (0.781), LIPCOF (temporal/nasal/Sum 0.748/0.828/0.816), and LWE (0.749). Best predictive ability was achieved by combining NIBUT with nasal LIPCOF (AUC=0.944). CONCLUSIONS: The individual tests NIBUT, TMH, PRTT, LIPCOF, and LWE were significantly, but moderately, related to OSDI scores. The strongest relationship appeared by combining NIBUT with nasal LIPCOF.

The effectiveness of questionnaires in the determination of Contact Lens Induced Dry Eye.

PURPOSE: This study investigates how well the recently introduced Ocular Comfort Index (OCI) and the more established McMonnies Dry Eye Index are able to detect contact lens induced dry eye (CLIDE). METHODS: Seventy volunteer contact lens wearers (mean age = 28.7 +/- 8.0; 52 female, 18 male) were grouped as CLIDE positive or CLIDE negative depending on three sets of criteria: Method I: objective (tear meniscus height, lid parallel conjunctival folds, phenol red thread test and tear break-up time); Method II: objective and/or subjective [contact lens dry eye questionnaire (CLDEQ)] (i.e. being positive by Method I and/or Method III); Method III: subjective (CLDEQ). Symptoms were measured using the McMonnies Dry Eye Index and the OCI. Discrimination was analysed by the receiver operating characteristic (ROC) curves; positive predictive values (PPV) and cut-off values were calculated. RESULTS: ROC results for Methods I and II were statistically significant only for the McMonnies (p = 0.008; p < 0.001; respectively). In Method III ROC results were statistically significant for both the McMonnies (p = 0.001) and OCI (p = 0.005). The McMonnies showed the best prediction of Method I [0.646/10.5 (PPV/cut-off value)], while the OCI gave the best predictability in Method III only (0.518/30.6). CONCLUSION: A McMonnies scoring of > or = 10.5 or an OCI scoring of > or = 30.6 indicates CLIDE. The McMonnies performs better in prediction of CLIDE than the OCI.

[Correlation of cotinine level in amniotic fluid, umbilical artery blood and maternal blood]. / Korrelation des Cotininspiegels in Fruchtwasser, Nabelarterienblut und mütterlichem Blut.

The aim of the present study was to determine the correlation of cotinine levels in amniotic fluid and in fetal and corresponding maternal blood samples. Amniotic fluid samples (N = 130) were taken during second trimester amniocentesis, umbilical artery blood samples (N = 75) at birth, both together with corresponding maternal blood samples. Self-reported smokers showed maternal serum cotinine levels > 15 ng/ml in 93%, self-reported nonsmokers levels < 15 ng/ml in 89%. Correlation of corresponding values for cotinine was 0.81-0.92. Cotinine values were increased in fetal blood and amniotic fluid in comparison to maternal serum levels. Despite the fact that pathophysiology is not fully understood, an accumulation of nicotine and its metabolites both in the fetus and in the amniotic fluid appears to be evident.