Natural course of lid wiper epitheliopathy (LWE) in symptomatic contact lens wearers

PurposeTo establish the time course of lid wiper epitheliopathy (LWE) in established CL wearers after a single day (6–10 h) of daily disposable contact lens (CL) wear, the following day post-CL removal and 1-week after CL discontinuation.MethodsTwenty-one symptomatic (CLDEQ-8 score ≥ 12) habitual wearers of MyDay® silicone hydrogel daily disposable were included. LWE staining was assessed prior to CL wear (Visit 1, V1) using semi-automated analysis after instillation of two drops of 1 % lissamine green (10 μL) that were applied to the superior bulbar conjunctiva. LWE measurements were repeated after 6–10 h of continuous CL wear (Visit 2, V2), post-CL removal the following day (Visit 3, V3) and after 1-week CL discontinuation (Visit 4, V4). At each visit, ocular symptoms were evaluated using the SPEED-8 questionnaire and set of 0–100 visual analogue scales (VAS).ResultsLWE showed no significant changes after 6–10 h of continuous CL wear (p = 0.536), post-CL removal the following day (p = 0.677) or following 1-week of CL discontinuation (p = 0.478). Analysis revealed a significant improvement in symptomatology between V1 and V2 (SPEED-8, p < 0.01) and also improvements in the 0–100 VAS scores between V2 and V4 for average daily dryness (p < 0.01), end-of-day dryness (p < 0.01) and frequency of end-of-day dryness (p < 0.05).ConclusionThe present data suggest that the etiology of LWE is multifactorial and the sole intervention of temporarily discontinuing CL wear does not lead to resolution of these clinical signs.     

The effect of hydroxypropyl-guar nanoemulsion on signs and symptoms of dry eye

PurposeTo examine the effect of hydroxypropyl-guar nanoemulsion (HP-Guar nanoemulsion, Alcon Laboratories Ltd, Fort Worth, TX, USA) versus saline (0.9% sodium chloride; Pfizer Inc., Bentley WA Australia) on the comfort and tear film properties of people with dry eye disease both in the short-term (up to 2 h post-drop instillation) and longer-term (after 4 weeks of 4-times daily use), and to examine the effect on tear inflammatory markers after 4 weeks.MethodsThis was a prospective, investigator-masked, randomised, cross-over dispensing study. Twenty participants with dry eye disease (5 males: 15 females) with average age 46.9 ± 14.4 (range 26 to 70) years were randomized to either HP-Guar nanoemulsion, or saline eye drops. Ocular symptoms, lipid layer thickness, tear evaporation, tear osmolarity and non-invasive break-up time were measured pre-drop instillation, 1 h and 2 h post-eye drop instillation, and after 4-weeks of 4-times daily drop use. Tear inflammatory mediators were measured pre-drop instillation and after 4-weeks. After 4-weeks, patients had a 4-week washout period and then crossed over to the alternate drop.ResultsWith HP-Guar nanoemulsion, participants reported less grittiness/burning/stinging 1 h post eye drop instillation compared to baseline (79.5 ± 23.3 vs. 66.8 ± 27.7, p = 0.02); less dryness 1 h and 2 h post eye drop instillation compared to baseline (77.8 ± 23.0 and 76.2 ± 23.7 vs. 61.0 ± 27.1 respectively, p < 0.01 for both); and greater overall satisfaction 1 h post drop instillation and after 4 weeks of daily use compared to baseline (80.4 ± 21.6 and 83.4 ± 16.6 vs. 68.6 ± 26.0 respectively, p ≤ 0.011 for both). With saline, participants reported less dryness after 4 weeks of daily use compared to baseline (74.2 ± 23.8 vs. 60.2 ± 24.0, p < 0.01). For HP-Guar nanoemulsion, average lipid layer thickness was significantly thicker 2 h post drop-instillation (79.5 ± 21.7 nm) compared to baseline (63.7 ± 18.9 nm) and the 4-week assessment (62.4 ± 23.1 nm, p < 0.01 for both). For saline, average lipid layer thickness was significantly thicker at 1 h and 2 h post eye drop instillation (76.0 ± 23.8 nm and 80.4 ± 24.8 nm) compared to baseline (61.0 ± 15.6 nm, p < 0.01 for both). There was no difference in inflammatory mediators or other tear variables between drops or visits.ConclusionHP-Guar nanoemulsion was more effective for improving a range of subjective dry eye symptoms both in the short and long-term compared to saline. Both HP-Guar nanoemulsion and saline transiently increased lipid layer thickness.     

Clinical factors associated with positive corneal culture in suspected microbial keratitis

AimsDetermine demographic and clinical characteristics associated with positive culture in suspected microbial keratitis.MethodsRetrospective audit of patients that had corneal scrapings between October 1999-September 2004 at Princess Alexandra Hospital. Clinical information was gathered from medical records, smear and culture results from the local microbiology database. Univariate and multivariate analyses of variables associated with positive cultures and calculation of population attributable risk percentage (PAR).ResultsUnivariate analysis showed that positive cultures were associated with patients over 60 years (81% vs 55%; p < 0.001), presenting visual acuity (VA) of 6/24 or worse (74% vs 57%; p = 0.012) or contact lens-related keratitis (CLK 77% vs 62%; p = 0.08). Analysis of patients’ clinical presentation showed that positive culture was associated with a central epithelial defect (74% vs 57%; p = 0.012), anterior chamber reaction of 2 + cells or worse (73% vs 56%; p = 0.03), an epithelial defect of 2 mm or more in diameter (71% vs 50%; p = 0.006) or no prior treatment with antibiotics (68% vs 56%; p = 0.053). Multivariate analysis showed the independent variables associated with positive cultures were VA of 6/24 or worse on presentation, contact lens-related keratitis, age greater than 60 years, an anterior chamber reaction of 2 + cells or worse and no prior treatment with antibiotics. The factor with the highest attributable risk (PAR%) for a positive corneal scraping was VA of 6/24 or worse on presentation (21%).ConclusionsIn this series positive cultures were associated with poor presenting VA contact lens keratitis (CLK), older age, anterior chamber reaction and no prior treatment with antibiotics.     

Safety and efficacy of lotilaner ophthalmic solution, 0.25% for the treatment of blepharitis due to demodex infestation: A randomized,controlled, double-masked clinical trial

PurposeTo evaluate the safety and efficacy of lotilaner ophthalmic solution, 0.25% for the treatment of blepharitis due to Demodex infestation compared to vehicle control.MethodsIn this phase II, randomized, controlled, double-masked clinical trial, 60 eligible participants with Demodex blepharitis were randomly assigned in a 1:1 ratio to receive either topical lotilaner ophthalmic solution, 0.25% (Tarsus Pharmaceuticals, Inc., Irvine, CA) (study group) or the vehicle without lotilaner (control group) bilaterally twice a day for 28 days. Participants were followed at Days 7, 14, 28, 60 and 90. The efficacy parameters were change in collarette grade and Demodex density at Day 28. Safety parameters were adverse events, changes in corrected distance visual acuity (CDVA), intraocular pressure (IOP) and slit-lamp biomicroscopy.ResultsThe study group showed a statistically significant decrease in collarette grade compared to the control group beginning at Day 14 (p = 0.003) in the upper eyelid and at Day 28 (p = 0.003) in the lower eyelid. Decreases in both lids were maintained through Day 90 (p < 0.001). At Day 28, mite eradication was achieved in 66.7% and 25.9% of eyes in the study and control group (p = 0.005); at Day 90, these proportions were 68.2% and 18.5% (p = 0.001), respectively. No serious adverse events or clinically significant changes in CDVA and IOP were observed.ConclusionFor Demodex blepharitis, treatment with lotilaner ophthalmic solution, 0.25% for 4 weeks is safe and effective. The improvement in collarette grade and mite density observed during the treatment period persisted for at least two months following treatment cessation.     

Diurnal variation on tear stability and correlation with tear cytokine concentration

PurposeTo investigate the effect of time of day on tear evaporation rate (TER) and tear break-up time, and its possible relationship with the concentration of inflammatory tear molecules (cytokines) in healthy subjects.MethodsParticipants with healthy ocular surfaces attended 3 visits, including the screening visit (V0), the 2nd visit (V1) and the 3rd visit (V2). There were 7-day intervals between visits. Participants with Dry Eye Disease (DED) were excluded by using appropriate clinical tests during V0. Clinical evaluation (TER and Non-Invasive Tear Break-Up Time (NITBUT)) and tear collection were performed during V1 and V2, between 9 and 10AM and 3-4PM. The relative humidity and temperature of the examination room were also measured. The tear fluid concentrations of 15 cytokines were measured by multiplex bead analysis.ResultsSeven men and 10 women (mean age ± S.D; 25.1 ± 6.63 years old) participated in the study. There were no differences in neither the TER and NITBUT outcomes, nor humidity and temperature among times or visits. Eleven out of the 15 cytokines measured were detectable in tear fluids in > 50% of the participants. In the tear levels, no significant (p > 0.05) inter- and/or intra-day differences were detected for EGF, fractalkine, IL-1RA, IL-1β and IP-10. However, significant inter-day differences were found in the tear levels of IL-10 (p = 0.027), IFN-γ (p = 0.035) and TNF-α(p = 0.04) and intra-day differences in the tear levels of IL-8/CXCL8 (p = 0.034) and MCP-1 (p = 0.002). A significant correlation between TER and IL1-β, IL-2, and Fractalkine (p = 0.03, p = 0.03 and p = 0.046, respectively) was found at V1.ConclusionsNITBUT and TER values had no significant variability over the course of a day (AM versus PM), or on different days in healthy participants when humidity and temperature were constant. However, some tear molecule levels did show inter- and intra-day variability, having an inconsistent and moderate correlation with TER diurnal variation.     

The effect of thermo-mechanical device (Tixel) treatment on evaporative dry eye disease – A pilot prospective clinical trial

PurposeTo examine the effects of treatment with a thermomechanical skin device to the eyelid area on the clinical signs and symptoms of patients who suffer from dry eye disease (DED) secondary to meibomian gland dysfunction (MGD).MethodsForty patients aged 45 years or older with DED due to MGD were recruited. Both eyes (n = 80) of each patient received three treatments with the Tixel device (Novoxel®, Israel), with each treatment separated by a 2-week period. Treatment was applied across the upper and lower eyelids, with the same intensity, tip protrusion distance, and contact duration. Two additional follow-up visits were performed at 2-week intervals after treatment cessation. DED status was evaluated during each visit via SPEED II questionnaire, tear break-up time (TBUT), corneal staining score (CSS), MGD score, and frequency of lubricant use. Visual acuity (VA) was recorded during first and last visits.ResultsMean age was 64.3 ± 12.4 years and 72.5 % (n = 29) were female. 45 % (n = 18) had a history of blepharitis, 12.5 % (n = 5) had chalazia, and 17.5 % (n = 7) suffered from allergic conjunctivitis. Mean follow-up time was 2.1 ± 0.6 months. Comparing the first and last visits, all parameters showed significant improvement after Tixel treatment: mean SPEED II scores (16.5 ± 5.9 to 11.8 ± 6.7, p < 0.001), CSS (2.0 ± 1.3 to 0.5 ± 0.9, p < 0.001), TBUT (2.7 ± 0.8 s to 6.5 ± 2.2 s, p < 0.001), MGD score (2.7 ± 0.5 to 1.2 ± 0.4, p < 0.001), and rate of lubricant use (3.4 ± 2.4 per day to 1.9 ± 2.0, p < 0.001). VA also improved (0.10 ± 0.11 logMAR to 0.08 ± 0.10 logMAR, p < 0.05). No major side effects were observed.ConclusionsIn this pilot study Tixel treatment induced significant improvement of signs and symptoms among patients with DED due to MGD. Benefits persisted for at least one month. Further randomized controlled double-blinded studies are needed.     

Systemic,environmental and lifestyle risk factors for dry eye disease in a mediterranean caucasian population

ObjectivesTo assess systemic, environmental and lifestyle risk factors for dry eye disease (DED) in a Mediterranean Caucasian population.MethodsA cross-sectional study was performed on 120 Caucasian participants aged between 18 and 89 years (47.0 ± 22.8 years). Medical history, information regarding environmental conditions and lifestyle, Ocular Surface Disease Index, Dry Eye Questionnaire-5, non-Invasive (Oculus Keratograph 5 M) breakup time, tear film osmolarity and ocular surface staining parameters were assessed in a single clinical session to allow DED diagnosis based on the guidelines of the Tear Film and Ocular Surface Society Dry Eye Workshop II Diagnostic Methodology Report. A multivariate logistic regression model was constructed including those variables with a p-value less than 0.15 in the univariate analysis.ResultsA prevalence of 57.7 % for DED was found. No age differences were found between those with and without DED (U = 1886.5, p = 0.243). Nevertheless, the DED group had more females (X² = 7.033, p = 0.008). The univariate logistic regression identified as potential risk factors for DED the following: female sex, sleep hours per day, menopause, anxiety, systemic rheumatologic disease, use of anxiolytics, daily medication, ocular surgery, poor diet quality, more ultra-processed food in diet, not drinking caffeine and hours of exposure to air conditioning per day. Multivariate logistic regression revealed that hours of sleep per day, menopause and use of anxiolytics were independently associated with DED (p ≤ 0.026 for all).ConclusionsDED is associated with systemic, environmental and lifestyle risk factors. These findings are useful to identify potentially modifiable risk factors, in addition to conventional treatments for DED.     

Blinking and upper eyelid morphology

PurposeTo explore blinking patterns and sagittal eyelid misalignment in the East Asian eye.MethodsForty-four participants (22 females; age 26 ± 5 years; 52% of East Asian ethnicity) were enrolled in this pilot study and subdivided, based on upper eyelid crease presence and extent, into single (n = 10), partial (n = 11) or double (n = 23) eyelid crease groups. Blinking was filmed surreptitiously with high-speed video simultaneously from an inferior temporal and frontal view. Spontaneous blink rate and type (incomplete, almost complete, or complete) were assessed over a 30 s period. Sagittal misalignment of the lids on closure was graded during complete spontaneous blinks, voluntary lid closure and voluntary maximal lid contraction (squeezing). A 0.15 µL drop of lissamine green was placed on the central lower lid margin and the number and type of blinks required to eliminate the drop informed complete palpebral apposition during blinking.ResultsMean ± SD blink rates averaged 16.9 ± 10.5 blinks/minute. The proportion of incomplete blinks was 83 ± 22% in single, 58 ± 35% in partial and 59 ± 30% in double eyelid crease groups. The sagittal misalignment of the lid margins during blinking was limited to approximately one-third of the lid margin width; this was similar for all lid morphologies and blink types. The lissamine green drop was eliminated only by voluntary maximal lid contraction, and was similar in all groups (p = 0.97).ConclusionsIncomplete blinking and sagittal lid misalignment of the central eyelid margin predominate in habitual blinking, irrespective of lid morphology.     

Correlation between long-term use of rigid gas permeable contact lenses and endothelial morphometric changes in keratoconus patients

PurposeThis study was conducted to evaluate the effects of long-term use of rigid gas-permeable (RGP) contact lenses on corneal endothelium in keratoconus (KC) patients using non-contact specular microscopy. In addition, the correlation between wearing duration of RGP lenses (years & hours /d) and endothelial morphometric changes in KC patients was performed. This may provide more useful data for clinical application of RGP contact lens.Study designThis study was a prospective, observational, comparative, hospital based, nonrandomized, cross-sectional, and quantitative study.Subjects and methodsThe study included 40 eyes of non-wearer contact lens KC patients (group 1) and 38 KC eyes with a long history of Rose K2 RGP contact lens wearing (group 2). The corneal endothelial morphology such as endothelial cell density (ECD); coefficient of variation of cell area (CV); percentage of hexagonal cells (HEX); and central corneal thickness (CCT) were evaluated in all patients using SP3000P Specular Microscope.ResultsThe study included 40 eyes of non-wearer contact lens KC patients (20 mild KC eyes and 20 moderate KC eyes) and 38 KC eyes with a long history of RGP contact lens wearing (18 mild KC eyes and 20 moderate KC eyes). The mean duration of RGP lenses wearing was 5.67 ± 3.481 years & 12.11 ± 2.698 h/d in mild KC eyes and 7.15 ± 5.294 years &13.65 ± 2.889 h/d in moderate KC eyes. Wearing duration in hours in mild KC eyes showed a significant moderate negative correlation with ECD (r = ?0.529, p = 0.024) and a moderate positive correlation with CV (r = 0.565, p = 0.015). In addition, wearing duration in years in moderate KC eyes showed a significant moderate negative correlation with ECD (r = ?0.465, p = 0.039) and moderate positive correlation with CV (r = 0.627, p = 0.003). However, wearing duration in hours in moderate KC eyes showed a significant moderate negative correlation with HEX only (r = ?0.490, p = 0.028). This study reported significant corneal thinning in contact lens wearer KC eyes in contrast to non-wearer KC eyes.ConclusionThis study documented a significant correlation between a long-term use of Rose K2 RGP using the three-point touch and corneal endothelial morphometric changes in KC patients. In addition, the current study confirmed a significant corneal thinning in RGP contact lens wearer compared to non-contact lens wearer KC patients. Further studies are recommended to evaluate the association between different RGP lens materials with different oxygen permeability transmissibility; different lens design types; different fitting methods; the duration of contact lens wear and the endothelial morphometric changes in KC patients.     

Factors influencing treatment zone size in orthokeratology

PurposeThe aim of this study was to analyze the influence of corneal topography, contact lens parameters and degree of myopia on the treatment zone (TZ) and peripheral plus ring (PPR) size in orthokeratology.MethodsIn this retrospective study the topographic zones of the right eyes of 106 patients (73 female, 22.16 ± 8.96 years) were analyzed in the tangential difference map of the Oculus Keratograph 5M (Oculus, Wetzlar, Germany). Using the MB-Ruler Pro 5.4 software (MB-Softwaresolutions, Iffezheim, Germany) the horizontal, vertical, longest, shortest diameters and area of the TZ; horizontal, vertical, total diameters and width of the PPR were measured. Correlations were determined between these zones and the subjects’ baseline parameters (myopia; corneal diameter, radii, astigmatism, eccentricity, sagittal height; contact lens radii, toricity and total diameter) for three back optic zone diameter (BOZD) groups (5.5, 6.0 and 6.6 mm). A stepwise linear regression analysis was performed to test for TZ and PPR predictability.ResultsIn the group of BOZD 6.0 correlations were found between the amount of myopia and the short TZ diameter (r = −0.25, p = 0.025); the steep corneal radius and the vertical diameter (r = –0.244, p = 0.029), the longest diameter (r = −0.254, p = 0.023) and the area (r = −0.228, p = 0.042) of the TZ; the amount of astigmatism and PPR width (r = 0.266, p = 0.017); eccentricity of the steep corneal meridian and PPR width (r = –0.222, p = 0.047). BOZD correlated significantly positively with all zones (p < 0.05). The best prediction model (R² = 0.389) resulted with the TZ area as the outcome variable.ConclusionThe amount of myopia, topography and contact lens parameters influence TZ and PPR in orthokeratology. Describing the TZ by its area may provide the most accurate representation of its size.     

Patient and parent perceptions of myopia modalities

PurposeThis study compared quality of life (QoL) of myopic adults and children who were established spectacle, soft contact lens (SCL), or orthokeratology (OK) wearers as well as parent/child responses using Pediatric Refractive Error Profile 2 (PREP2).MethodsForty-eight adults (aged 18–26 years), 49 children (aged 9–17 years), and the children’s parent, completed PREP2, with 7 subscales (symptoms, vision, activities, appearance, peer perception, handling, and overall). Adults and children must have worn their correction for at least three years. Parents were asked to answer how they thought their child would answer. Scores were compared between age groups, among correction groups, and between children and their parents using non-parametric ANOVA, Mann-Whitney U and Wilcoxon Signed-Rank tests, as appropriate. Post-hoc pairwise comparisons among correction groups were conducted with Bonferroni adjustment.ResultsAverage age of adults was 22 ± 2 and children was 14 ± 2 years, and duration of correction use was 8 ± 3 for adults and 5 ± 2 years for children (both p < 0.01). Adult OK wearers were more satisfied with vision (p = 0.04), activities (p < 0.001) and overall (p = 0.03) compared to spectacle wearers. Children OK wearers reported higher scores for activities than SCL (p = 0.048) and spectacle wearers (p < 0.001). Parents of contact lens wearers reported higher perceived QoL for activities (OK p < 0.001; SCL p = 0.02), handling (OK p = 0.02; SCL p < 0.001), appearance (SCL p = 0.001), and overall (OK p = 0.001; SCL p < 0.001) subscales than parents of child spectacle wearers.ConclusionActivity-driven children and adults perceive significant benefits from OK over spectacles. Parents’ perceptions did not align with their children’s perceptions of their correction.     

A machine learning-based algorithm for estimating the original corneal curvature based on corneal topography after orthokeratology

ObjectiveTo estimate the original corneal curvature after orthokeratology by applying a machine learning-based algorithm.MethodsA total of 497 right eyes of 497 patients undergoing overnight orthokeratology for myopia for more than 1 year were enrolled in this retrospective study. All patients were fitted with lenses from Paragon CRT. Corneal topography was obtained by a Sirius corneal topography system (CSO, Italy). Original flat K (K1) and original steep K (K2) were set as the targets of calculation. The importance of each variable was explored by Fisher’s criterion. Two machine learning models were established to allow adaptation to more situations. Bagging Tree, Gaussian process, support vector machine (SVM), and decision tree were used for prediction.ResultsK2 after one year of orthokeratology (K2_after) was most important in the prediction of K1 and K2. Bagging Tree performed best in both models 1 and 2 for K1 prediction (R = 0.812, RMSE = 0.855 in model 1 and R = 0.812, RMSE = 0.858 in model 2) and K2 prediction (R = 0.831, RMSE = 0.898 in model 1 and R = 0.837, RMSE = 0.888 in model 2). In model 1, the difference was 0.006 ± 1.34 D (p = 0.93) between the predictive value of K1 and the true value of K1 (K1_before) and was 0.005 ± 1.51 D(p = 0.94) between the predictive value of K2 and the true value of K2 (K2_before). In model 2, the difference was −0.056 ± 1.75 D (p = 0.59) between the predictive value of K1 and K1_before and was 0.017 ± 2.01 D(p = 0.88) between the predictive value of K2 and K2_before.ConclusionBagging Tree performed best in predicting K1 and K2. Machine learning can be applied to predict the corneal curvature for those who cannot provide the initial corneal parameters in the outpatient clinic, providing a relatively certain degree of reference for the refitting of the Ortho-k lenses.     

Variability of pressure drops in grain generated by kernel shape and bedding method

Experiments were performed to evaluate the influence of seed shape and the packing orientation of seeds on the pressure drop. Relationships between the pressure drop and airflow velocity of five seeds were determined as a function of filling method and its influence on kernel orientation. The sample container was a cube with a length of 0.35 m on each side that held approximately 35 kg of clean wheat. Eleven airflow rates were supplied in a range from 0.03 to 0.35 m s⁻¹. Seeds that were nearly spherical (rapeseed and pea) as well as oblong seeds (wheat, rye and oats) were used for the tests. Three filling methods of the cube were used, including one that produced asymmetric particle orientation (bedding) within the grain sample. Pressure drop was measured in all three directions: the vertical (Z) and both horizontal directions (X and Y). Results obtained from the experiments showed that seed shape and the filling method strongly influenced pressure drop. At an air velocity of 0.3 m s⁻¹, when the cube was filled along the vertical axis the uncompacted samples had a pressure drop in the vertical direction that was 1.1 (peas) to 2.1 (oats) times higher than the pressure drops along the X and Y axes. The pressure drops along the X and Y axes were approximately equal. Compaction of the sample filled vertically resulted in the pressure drop in the vertical direction increasing between 1.7 (wheat, rye and peas) and 2.4 (oats) times the pressure drop in the uncompacted sample. In asymmetrically filled samples the pressure drops along the horizontal directions increased by a factor of 2.2 relative to the centrally filled samples.     

Exploring the factors which impact overall satisfaction with single vision contact lenses

PurposeTo explore the impact of subjective factors (lens handling, comfort and vision) on overall single vision contact lens satisfaction.MethodsCorrelation analysis of a prospective, randomised, double-masked, bilateral crossover study involving 55 adapted lens wearers fitted with somofilcon A (SiHy) (clariti® 1 day, CooperVision) and etafilcon A (Hy) (1 DAY ACUVUE® MOIST, Johnson & Johnson Vision) was conducted. Subjective ratings of lens handling, comfort and vision collected after 1 week of lens wear for each lens type were correlated with overall satisfaction. Data were analysed by combining data for both lens types and also for each lens separately.ResultsFor the combined analysis, significant correlations (p < 0.01) were found between subjective ratings of overall satisfaction and ratings of handing for application (r = 0.64), handling for removal (r = 0.50), comfort upon application (r = 0.59), comfort at end of day (r = 0.61), overall satisfaction with comfort (r = 0.88) and overall satisfaction with vision (r = 0.64).Correlation analysis of the per lens data showed that lens specific correlations of overall satisfaction with handling for lens application varied greatly with lens material (SiHy: r = 0.26, p = 0.05 vs Hy: r = 0.72, p < 0.01). Correlation strength of comfort upon application/at end of day with overall satisfaction also varied with lens material (Application: SiHy: r = 0.40 vs Hy: r = 0.61; End of day: SiHy: r = 0.76 vs Hy: r = 0.58; all p ≤ 0.01).ConclusionOverall satisfaction was significantly correlated with the specific subjective evaluations of handling, vision and comfort. Correlations of overall satisfaction and ease of handling for each lens type suggest that, for habitual contact lens wearers, dissatisfaction with handling at the time of lens application can play a major role in overall dissatisfaction with a lens. Handling for application had a similar correlation (r) value as vision, suggesting that handling for application should not be underestimated when considering overall patient satisfaction.     

Invited review: Antibiotic treatment of metritis in dairy cows: A systematic approach

Acute puerperal metritis (APM) is an acute systemic illness with fever ≥39.5°C and signs of toxemia due to an infection of the uterus occurring within 21 d after parturition. Because of the infectious nature of APM, antibiotics are considered beneficial for its treatment. Each use of an antimicrobial drug, however, is associated with selective pressure for the emergence of resistant bacteria. Hence, there is a significant need to encourage prudent use of antibiotics and alternative therapies to antibiotics. Therefore, the objective of this study was to systematically review the current literature on treatment of APM. A comprehensive and systematic literature search was conducted utilizing the PubMed and CAB Abstracts databases to identify literature focusing on the antibiotic therapy of puerperal metritis in the cow. After application of specific exclusion criteria, 21 publications comprising 23 trials remained for final evaluation. Data extraction revealed that the majority of the studies (n = 19) were attributable to the highest evidence level. Of 21 studies controlled, 11 had an untreated group and 3 a positive control group. The majority of the studies (n = 17) applied ceftiofur for the treatment of APM. Concerning the efficacy of ceftiofur, 7 studies observed clinical improvement, whereas none found improved reproductive performance. Fewer than half of the studies (n = 10) performed a bacteriological examination and only 4 implemented an antibiotic susceptibility test. Also, 3 studies (13.0%) described a self-cure rate per se. Little attention was given to the issue of bacterial resistance (n = 3), the need for reducing the application of antibiotics (n = 2), or guidelines for prudent use of antibiotics (n = 1). Our findings demonstrate that implementation of bacteriological examinations, sensitivity testing, and determination of minimum inhibitory concentrations, as well as reporting and discussion of critical issues (e.g., self-cure rates, resistance, prudent drug use), were suboptimal. On the other hand, the quality of studies on the treatment of APM was good, as indicated by evidence level 1. Nevertheless, more high-quality research considering self-cure rates is necessary to address critical issues related to APM and crucial to the dairy industry, such as resistance, prudent use of antibiotics, animal welfare, and cost-benefit ratios.     

Determining initial ocular comfort differences between 0.7% olopatadine and 0.035% ketotifen fumarate

PurposeTo compare the ocular comfort at application of topical, over-the-counter, 0.7% olopatadine and 0.035% ketotifen fumarate anti-allergy eye drops.MethodsThis study recruited participants who were minimally symptomatic based upon Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire scores (≤3 units) and who had minimal between-eye inter-ocular comfort differences as judged by visual analog scale scores (VAS; ≤7 units). Baseline comfort was evaluated by eye with a VAS. One drop of 0.7% olopatadine or 0.035% ketotifen fumarate was then applied to the right eye with the alternative drop being immediately applied to the left eye. Participants were next evaluated with the same comfort VAS by eye at drop application, and then at 30 s, 1 min, and 2 min post-application. LogMAR visual acuities and bulbar conjunctival redness were evaluated pre- and post-drop application to judge initial changes.ResultsThis study enrolled 159 participants who had a mean ± SD age of 26.3 ± 7.7 years, and 78.6% of the participants were female. The VAS found that the 0.7% olopatadine drop was more comfortable than the 0.035% ketotifen fumarate drop at all time-points. There were no between-eye differences in LogMAR visual acuities, yet bulbar redness was significantly less in 0.7% olopatadine treated eyes compared 0.035% ketotifen fumarate treated eyes.ConclusionThis study found that topically applied 0.7% olopatadine drops were initially more comfortable than 0.035% ketotifen fumarate drops.     

The short-term effect of contact lens wear on blink characteristics

PurposeThe aim of this pilot study was to investigate the initial effect of contact lens wear on spontaneous blink characteristics.MethodsThis was a randomised, crossover pilot study. Spontaneous blinking was recorded using a high-speed infrared camera in ten subjects with three different soft contact lenses (spherical hydrogel, spherical silicone hydrogel and toric hydrogel), one rigid contact lens and without contact lenses. Custom semi-automated software was used to determine palpebral aperture height, interblink interval (IBI), blink speed, blink completeness and blink duration.ResultsThe IBI was significantly greater for non-lens wear compared with the silicone hydrogel [ratio (95% CI): 1.34 (1.16, 1.55), p < 0.0001], toric hydrogel [1.28 (1.10, 1.48), p = 0.0001] and rigid corneal lenses [1.48 (1.27, 1.73), p < 0.0001]. The spherical silicone hydrogel lens showed greater closing-phase speed than non-lens wear [mean difference (95% CI): 27.4 (5.6, 49.1) mm/s, p = 0.006]. Shorter total blink duration was found for non-lens wear compared with any of the lens types [spherical hydrogel: ratio 0.89 (0.81, 0.98), p = 0.01; spherical silicone hydrogel: 0.87 (0.80, 0.95), p = 0.0001; toric hydrogel: 0.90 (0.83, 0.98), p = 0.004; and rigid corneal: 0.88 (0.82, 0.96), p = 0.0004]. Opening-phase speed (p = 0.12) and blink completeness metrics (all p > 0.5) were not influenced by wearing condition.ConclusionThis work showed that short-term contact lens wear influenced the palpebral aperture height, IBI, speed and duration of the blink, and the effect is dependent on the contact lens type. The completeness of the blink was not altered by contact lens wear. Future work should be conducted to assess the effect of long-term wear of different contact lens types on blink characteristics. The measurement of spontaneous blinking characteristics represents an immediate, sensitive and non-invasive evaluation of the impact of a contact lens on the ocular surface.     

Colour as a cue to eat: Effects of plate colour on snack intake in pre-school children

Environmental cues, such as the colour of food and dishware, have been shown to influence food and drink consumption in adult populations. This proof of concept study investigated whether plate colour could be utilised as a strategy to reduce intake of high energy density (HED) snacks and increase intake of low energy density (LED) snacks in pre-school children. In a between and within-subjects design, children were randomly assigned to either a control group (no colour message) or intervention group (received a colour message: red = stop, green = go) and were provided a snack at nursery on three occasions on differently coloured plates (red, green, white), for each snack type (HED, LED). Snack intake, colour preference, colour association, and anthropometrics were recorded for each child. The results showed that there was no effect of group (control vs intervention) on HED (p = 0.540) and LED intake (p = 0.575). No effect of plate colour on HED (p = 0.147) or LED snack intake (p = 0.505) was evident. Combining red and green plates for a chromatic versus achromatic comparison showed that there was no significant effect of chromatic plate on HED (p = 0.0503) and LED (p = 0.347) intakes. Despite receiving a brief learning intervention, the use of plate colour was found in the present study to be an ineffective strategy to control snack food intake in pre-school aged children. Rather, we suggest that food intake in young children may best be predicted by portion size, energy density and eating behaviour traits.     

Further validation of the engagement questionnaire (EQ): Do immersive technologies actually increase consumer engagement during wine evaluations?

The use of immersive technologies allows for the addition of contextually relevant information into the, otherwise, sterile laboratory experience. The addition of context has been hypothesized to yield improved sample discriminability, in part, due to enhanced involvement or engagement of the panelist. A questionnaire was recently developed to characterize consumer engagement during sensory and consumer testing. The main factors contributing to engagement were active involvement, purposeful intent and affective value. The objective of this study was to further validate the temporal reliability of the engagement questionnaire (EQ) and evaluate how subject engagement changes when assessing red wines in a traditional, immersive, and actual environment. After evaluating the wines in each environment, participants (N = 62) rated their level of agreement on a 10-item questionnaire (EQ) that measured overall levels of engagement with a task. Participants were less actively involved in the wine evaluation (F_2,122 = 14.672; p < 0.001) and found less affective value in the task as they progressed through the weeks regardless of which environment they were in (F_2,122 = 3.819; p = 0.025). Overall, there were significant correlations of the factor averages across the three weeks (p < 0.05), suggesting the way subjects interpreted and responded to each factor was temporally consistent. When evaluating subject engagement across the environments, subjects were more actively involved in the task when in the traditional environment (F_2,122 = 3.635; p = 0.029). However, subjects rated increased levels of affective value when in the actual environment (F_2,122 = 6.055; p = 0.003). Consistently, subjects reported a similar level of purpose and intent in the evaluation across all three weeks (F_2,122 = 0.424; p = 0.656) and all three environments (F_2,122 = 0.245; p = 0.783) suggesting they understood the importance of the test in all three conditions. More work needs to continue to ensure that we understand the panelists’ experience during testing and how context might influence their level of engagement.