BCLA CLEAR Presbyopia: Management with contact lenses and spectacles.

This paper seeks to outline the history, market situation, clinical management and product performance related to the correction of presbyopia with both contact lenses and spectacles. The history of the development of various optical forms of presbyopic correction are reviewed, and an overview is presented of the current market status of contact lenses and spectacles. Clinical considerations in the fitting and aftercare of presbyopic contact lens and spectacle lens wearers are presented, with general recommendations for best practice. Current options for contact lens correction of presbyopia include soft simultaneous, rigid translating and rigid simultaneous designs, in addition to monovision. Spectacle options include single vision lenses, bifocal lenses and a range of progressive addition lenses. The comparative performance of both contact lens and spectacle lens options is presented. With a significant proportion of the global population now being presbyopic, this overview is particularly timely and is designed to act as a guide for researchers, industry and eyecare practitioners alike.

Evidence-based teaching in contact lenses education: Teaching and learning strategies.

INTRODUCTION: Contact lens (CL) practice is an ever-changing field with clinical knowledge, techniques and equipment continuously evolving. These new developments are backed with clinical trials and research to ensure that practitioners feel confident that there is an evidence base to support these advances. Evidence-based practice is now a crucial part of CL practice, and its importance also filters down to CL education. For example, lectures are one of the most popular tools for an educator but, is standing at the front of a lecture theatre full of students a more effective way of teaching than providing the same material for students to read by themselves? What evidence exists specific to CL education? METHOD: An expert panel of educators completed a comprehensive literature review of current evidence of teaching methods in CL training, or if not available then what can be learnt from other health care professional training that could be potentially applicable to CL education. RESULTS: Due to the amount of evidence available in the overall subject area relating to healthcare education, the initial plan of compiling evidence into one narrative review paper was discarded in favour of producing two linked papers. Here, the first paper details definitions of terminology, and also teaching methods. The second paper focuses on assessment and specific clinical training required to attain CL practice competency. In this first paper, no direct evidence of the spreading and benefit of new education strategies evidence such as flipped classrooms, spaced learning, test-enhanced learning, group work, CBL, PBL, TBL, and reflective practice in CL education was found. The only technique that was widely used in the CL field was case reports and the group discussion of them. Nevertheless, the authors found a consensus of opinion from other disciplines that are transferable to CL teaching and could help students meet the intended learning outcomes. CONCLUSION: There is a small amount of evidence supporting CL education, but most of this seems to be related to the practical element of the training. However, there is a lot of evidence in the field of healthcare education from related disciplines which provides additional but important learning tools that may be effectively implemented in CL education.

CLEAR - Effect of contact lens materials and designs on the anatomy and physiology of the eye.

This paper outlines changes to the ocular surface caused by contact lenses and their degree of clinical significance. Substantial research and development to improve oxygen permeability of rigid and soft contact lenses has meant that in many countries the issues caused by hypoxia to the ocular surface have largely been negated. The ability of contact lenses to change the axial growth characteristics of the globe is being utilised to help reduce the myopia pandemic and several studies and meta-analyses have shown that wearing orthokeratology lenses or soft multifocal contact lenses can reduce axial length growth (and hence myopia). However, effects on blinking, ptosis, the function of Meibomian glands, fluorescein and lissamine green staining of the conjunctiva and cornea, production of lid-parallel conjunctival folds and lid wiper epitheliopathy have received less research attention. Contact lens wear produces a subclinical inflammatory response manifested by increases in the number of dendritiform cells in the conjunctiva, cornea and limbus. Papillary conjunctivitis is also a complication of all types of contact lenses. Changes to wear schedule (daily disposable from overnight wear) or lens materials (hydrogel from SiHy) can reduce papillary conjunctivitis, but the effect of such changes on dendritic cell migration needs further study. These changes may be associated with decreased comfort but confirmatory studies are needed. Contact lenses can affect the sensitivity of the ocular surface to mechanical stimulation, but whether these changes affect comfort requires further investigation. In conclusion, there have been changes to lens materials, design and wear schedules over the past 20+ years that have improved their safety and seen the development of lenses that can reduce the myopia development. However, several changes to the ocular surface still occur and warrant further research effort in order to optimise the lens wearing experience.

Expanding your use of silicone hydrogel contact lenses: using lotrafilcon A for daily wear.

OBJECTIVE: The purpose of this study was to profile contact lens (CL) experience among patients in eyecare practitioner (ECP) offices and the response to daily wear (DW) of lotrafilcon A silicone hydrogel CLs. METHODS: Patients at ECP offices were surveyed for their vision correction modality and experience with CLs. Adapted, new, and former CL wearers who were interested in trying CLs were dispensed lotrafilcon A (NIGHT & DAY, CIBA VISION, Duluth, GA) lenses for a 1 month trial of DW. RESULTS: One thousand eight hundred sixty-five surveys were returned with 60% indicating current CL use averaging 6.4 days/week, 13.6 hr/day with 92% satisfied with their current lenses and 58% comfortable all day. Two hundred sixteen patients (59% adapted hydroxyl-ethylmethacrylate or rigid gas permeable CL wearers, 21% new/former, 20% no answer) were enrolled to wear lotrafilcon A CLs. Lens care systems were chosen for new and former wearers by the ECPs from among those approved and available in the countries and were primarily multipurpose systems. Among adapted CL wearers, statistically significant improvements were found within 2 weeks for conjunctival redness (P = 0.023), limbal redness (P< 0.001), corneal neovascularization (P < 0.001), during the day and end-of-day dryness (P = 0.02 for each) and early removal because of dryness (P = 0.02). Seventy-two percent reported comfort all day with lotrafilcon A CLs. New and former wearers at 2 weeks showed increased epithelial microcysts (P = 0.048). New and former wearers at 2 weeks compared with adapted wearers at baseline had less frequent early removal during the day, burning or stinging, uncomfortable lenses, and photophobia while reporting more problems inserting and removing lenses. No adverse events were reported with lotrafilcon A CLs. Adapted CL wearers showed improved clinical signs, subjective symptoms, and comfort when changed to lotrafilcon A for DW. New or former wearers showed few significant changes from baseline in clinical signs and had symptoms similar to nonsilicone hydrogel wearers. CONCLUSIONS: Lotrafilcon A lenses can be successfully dispensed for DW.