Prospective clinical evaluation of the Acuvue Bifocal contact lens.

PURPOSE: We conducted a 15-month prospective clinical studyto evaluate the performance of the Acuvue Bifocal contact lens and to determine the objective and subjective factors that influence patient success rates in a general presbyopic population presenting to a contact lens specialist's office. METHODS: The first 100 patients who were initially fit and dispensed the Acuvue Bifocal contact lens are included in this study data. At each follow-up visit, visual acuity, slit lamp evaluation of lens/cornea relationship, and any change in ocular surface characteristics were noted. The study population was a general population with an interest in wearing disposable multifocal contact lenses. Success was defined as the patient actually purchasing the lens for continual wear. RESULTS: The overall success rate with the lens in this diverse study group was 53%. The majority of the successful patients achieved 20/25 or better distance and near acuity with the Acuvue Bifocal. None of the study participants had any adverse effect of lens wear or changes in keratometry or ocular surface characteristics. Of the successful patients, 57% wore the lens in a binocular fashion, while the remainder used some form of monovision. Virtually all patients rated lens comfort as excellent or very good, with the major factor in success or failure being visual performance. CONCLUSIONS: This prospective study in an average group of presbyopic contact lens or spectacle wearers yielded valuable insights into the performance of a disposable multifocal contact lens in a general contact lens practice. The Acuvue Bifocal should prove to be a valuable addition to the contact lens fitter's practice.

Prospective clinical evaluation of Sunsoft Multifocal contact lens.

PURPOSE: We conducted a 3-month prospective clinical study to evaluate the clinical performance of the Sunsoft Multifocal contact lens as well as to determine the subjective factors that influence the decision to purchase a multifocal soft contact lens for the correction of presbyopia. METHODS: In this study, 215 patients at 16 sites were initially fit with the Sunsoft Multifocal contact lens. At 1 month, 179 patients were still wearing the lens successfully. Slit lamp evaluation of lens-cornea relationship, any change in ocular surface characteristics from initial fitting, and visual acuities were recorded at 1-month and 3-month follow-up visits. At the 1-month visit, patients completed evaluation forms to rate their perceptions of handling, comfort, visual performance, overall satisfaction, and whether they would purchase the lens if given the opportunity. RESULTS: Most patients who would choose to purchase lenses (80%) were in the group that achieved 20/25 or better binocular acuity both at distance and at near. Statistical analysis of all patients showed no difference in age, refractive error, comfort, handling, or near addition between those who would or would not purchase lenses; however, there was a significantly smaller monocular acuity imbalance in the purchase group. Analyzing just that subgroup of the population with 20/25 or better vision, the statistical analysis again showed the difference was in the binocularity of the patients. The closer together the right and left eye were in absolute acuity, the more likely the patients were to be satisfied with their lenses. There were no adverse reactions and the most common reason for failure to complete the study was inadequate near vision. CONCLUSIONS: This study yielded valuable insight into the performance of the Sunsoft Multifocal as well as those factors that influence the purchase of a soft hydrogel multifocal option.

A comparative study of eyelid cleaning regimens in chronic blepharitis.

PURPOSE: Blepharitis, an intrinsic eyelid inflammation with crusting and irritation, presents a great problem for patients wearing contact lenses. An important part of blepharitis therapy is eyelid hygiene, including the use of either soap, dilute baby shampoo, or commercial lid scrubs. In this study, a comparison was made between these three cleaning regimens in a group of 25 patients, 80% of whom (20/25) wore contact lenses. METHODS: Patients used commercial eyelid scrub on right eyelids and a hypo-allergenic bar soap on left eyelids. Patient symptoms, slit lamp findings, and overall preferences were determined at the end of 4 months. A subgroup of 10 patients using lid scrub on right eyelids and dilute baby shampoo on left eyelids was followed for an additional 3 months. RESULTS: At the end of 4 months, 24% (6/25) of the patients noted no difference between soap and lid scrub, but 89% (17/19) of the others preferred the lid scrub. In the group using baby shampoo, 50% (5/10) noted no difference in 3 months, but 80% (4/5) of the remaining patients preferred the lid scrub. CONCLUSIONS: All patients improved in slit lamp findings with all three regimens, and patient preference was overwhelmingly in favor of the lid scrub regimen for convenience and ease of use.

Comparative disinfectant efficacy of two disinfecting solutions against Pseudomonas aeruginosa.

PURPOSE: We compared the disinfecting efficacy of Pure Eyes Disinfectant and Opti-Free Rinsing, Disinfecting and Storage Solution, without recommended daily cleaning steps, against Pseudomonas aeruginosa. METHODS: Vifilcon A soft contact lenses were inoculated with the challenge organism, P. aeruginosa ATCC 15442, at a concentration of 1 x 10(8) colony forming units (CFU/mL) and disinfected with each solution for four and six hours, respectively. RESULTS: Pure Eyes eradicated P. aeruginosa after both four and six hour soak times. With all lots of Opti-Free, colony forming units were too numerous to count (> 200) for both soak times. CONCLUSIONS: We concluded that, because Pure Eyes disinfecting solutions can eradicate P. aeruginosa without the benefit of a daily cleaning step, this disinfecting process may offer protective benefits to noncompliant contact lens wearers.

Are hard lenses superior to soft? Arguments in favor of hard lenses.

The overriding consideration in choosing between soft contact lenses (SCLs) and rigid gas-permeable (RGP) lenses is the severity of the changes each induces in the corneal epithelium, endothelium, and conjunctival structures. Lens-related epithelial changes are largely the consequence of relative oxygen deprivation and consequent corneal edema. Factors such as lower oxygen transmissibility, minimal tear exchange capacity, and large diameters may explain why SCL wearers show a higher rate of corneal infiltrates, sterile ulcers, and irregular staining patterns than users of RGP lenses. The greater association of hydrogels with infectious keratitis may reflect their tendency to accumulate proteinaceous deposits, harbor bacteria in the polymer matrix, and resist easy disinfection. SCL wear has been linked to endothelial polymegethism, a largely irreversible condition that may cause more rapid corneal swelling and slower deswelling after periods of hypoxic stress. Among the conjunctival problems more often seen in SCL wearers are superficial neovascularization, contact lens-related superior limbic keratoconjunctivitis, and giant papillary conjunctivitis. Mechanical irritation from large-diameter lenses, a tendency to build up mucoproteinaceous deposits, corneal draping, and hypersensitivity to preservatives in SCL care products may play a role in these problems.

Paraperm EW lens for extended wear.

This paper reports the results of 372 patients fit with the Paraperm EW rigid gas permeable lens for extended wear. This lens material is a copolymer derived from siloxane and methylmethacrylate with an oxygen permeability (Dk) of 56 X 10(-11) at 37 degrees C. At the end of 1 year, 270 patients had completed the study with 94.8% achieving 20/25 or better vision. Complications included a 12.3% incidence of superficial limbal keratitis with staining, a 3.1% incidence of conjunctival injection, and a 1.5% incidence of observable corneal edema. The lens appears to be a significant addition to the possibilities available for fitting extended wear patients or those who desire occasional overnight lens wear.