TFOS lifestyle: Impact of societal challenges on the ocular surface.

Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.

Trends in myopia management attitudes and strategies in clinical practice: Survey of eye care practitioners in Africa.

PURPOSE: There remains a lack of information on the perception and adoption of myopia control strategies among African eye care practitioners (ECPs). This study provides an African perspective to similar previous studies conducted in other parts of the world. METHODS: A self-administered survey in English and French was distributed to ECPs across Africa. The items on the questionnaire assessed their level of concern about the increasing prevalence of paediatric myopia, perceived efficacy, opinions on, and adoption of various myopia management modalities. RESULTS: Responses were obtained from 330 ECPs working in 23 African countries. Respondents were highly concerned about the increasing prevalence of paediatric myopia in their clinic (median 8/10) and perceived approved myopia control soft contact lenses as the most effective at slowing myopia progression (mean perceived reduction in myopia progression ± SD; 53.9 ± 27.1%), followed by single vision spectacles (53.1 ± 30.9%), and orthokeratology (52.8 ± 28.0%). Multifocal soft contact lenses (40.4 ± 25.8%) and pharmaceutical agents such as topical atropine drops (39.5 ± 27.1%) were perceived as least effective in slowing myopia progression. Although ECPs reported being aware of various myopia control strategies, they still mainly prescribed single vision spectacles to a large proportion (64.3 ± 29.9%) of young progressing myopes. Nearly one-third (27%) of ECPs who prescribed single vision lenses stated they were concerned about the cost implications to patients. Other reported concerns included safety of, and inadequate information about myopia control options. CONCLUSIONS: African ECPs continue to prescribe single vision lenses for progressing myopes despite being aware of the various myopia control options. Practitioners' perceptions of the efficacy of several modalities to slow myopia progression do not align with the current best evidence. Clear practice guidelines and continuing education on myopia control are warranted to inform and guide the management of myopic patients in Africa.

Changes in Scleral Tonometry and Anterior Chamber Angle after Short-term Scleral Lens Wear.

SIGNIFICANCE: Scleral lens wear can alter aqueous fluid and anterior chamber angle dynamics, leading to changes in intraocular pressure (IOP). However, there is limited information supporting this relationship between scleral lens wear, anterior chamber angle (ACA), and IOP changes in an black African population. PURPOSE: The purpose of this study was to compare scleral IOP and ACA before, during, and after 4 hours of scleral lens wear in healthy neophyte scleral lens wearers from an black African population. METHODS: This was a prospective study involving 20 eyes of 20 subjects with a mean ± standard deviation age of 28.7 ± 4.3 years. The study was divided into a screening and experimental phase. Scleral lenses from a diagnostic trial set were fit on a randomly selected eye. Scleral IOP was measured using a Schiotz tonometer (Winters, Jungingen, Germany) (weight, 7.5 g) on the superior-temporal sclera, and ACA was assessed using anterior segment optical coherence tomography on the temporal angle before scleral lens wear; at 10 minutes, 2 hours, and 4 hours during wear; and 10 minutes after scleral lens removal. RESULTS: The mean ± standard deviation base curve of the scleral lens fit in the study eye was 43.4 ± 1.3 D with average tear reservoir thickness of 288.1 ± 122.0 µm at 4 hours. The mean scleral IOP before lens wear was 17.2 ± 3.5 mmHg, decreased to 16.4 ± 4.5 mmHg at 4 hours of scleral lens wear, and was 16.6 ± 3.5 mmHg 10 minutes after lens removal. The temporal ACA before scleral lens application was 43.0 ± 6.6° and varied during the 4 hours of scleral lens wear, ultimately increasing to 45.0 ± 5.4° at 10 minutes after scleral lens removal. The change in IOP and ACA was not statistically significant (F = 0.501, P = .74; and F = 2.399, P = .09, respectively). CONCLUSIONS: Results suggest that 4 hours of nonfenestrated scleral lens wear did not have a significant impact on IOP or ACA in most of our study population.