Publications by authors named "Craig A Woods"

51 Publications

Response to Re: are eye-care practitioners fitting scleral contact lenses?

Clin Exp Optom 2021 05 15;104(4):553. Epub 2021 Mar 15.

Eurolens Research, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK.

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http://dx.doi.org/10.1080/08164622.2021.1896338DOI Listing
May 2021

Demographics and distribution of new entrants to the optometry profession in Australia.

Clin Exp Optom 2021 Mar;104(2):222-228

Deakin Optometry, School of Medicine, Deakin University, Waurn Ponds, Australia.

Clinical Relevance: An assessment of the total number, demographics and geographic distribution of new entrants to the optometry profession in Australia can assist planning for workforce requirements.

Background: Over the past decade, the number of registered optometrists in Australia has increased by 30.1 per cent, a rate that is greater than the population growth of the country (12.1 per cent). Concerns have been expressed about the size of the optometry workforce in a context of increasing numbers of graduating optometrists. This paper analyses data obtained from the Australian Health Practitioner Regulation Agency (AHPRA) about new entrants to the profession and their initial practice location during the period 1 July 2010 to 30 June 2018.

Methods: A de-identified dataset was obtained from AHPRA that revealed the following characteristics of new entrants: qualification, gender, year of birth (in five-year bands), registration type, registration endorsement and principal place of practice including its Remoteness Area classification.

Results: Data for 1,680 entrants were eligible for analysis; 80 per cent graduated from an Australian university, 12 per cent graduated from the optometry program in New Zealand, and seven per cent were graduates of an overseas university. The remaining two per cent registered via the Trans-Tasman Mutual Recognition Agreement, although the dataset did not include the qualification. The United Kingdom and Republic of Ireland provided the majority of overseas entrants (60 per cent). Most (75 per cent) entrants commenced practice in a major Australian city. Graduates of Australian universities tended to commence practice in the state in which they trained or an adjacent state or territory. Juxtaposed on the data outlined above is the high proportion (42 per cent) of overseas-trained optometrists commencing practice in Western Australia.

Conclusion: Coincident with the newer optometry programs producing graduates is the increased number of optometrists entering the Australian workforce over the past decade, with the majority commencing practice in major cities. Australia-trained optometrists tend to commence practice in the state where their training was undertaken. New entrants to the optometry profession can be generalised as graduates of an Australian optometry program, female, aged in their early-mid 20s and qualified for therapeutic practice.
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http://dx.doi.org/10.1111/cxo.13122DOI Listing
March 2021

Are eye-care practitioners fitting scleral contact lenses?

Clin Exp Optom 2020 07 9;103(4):449-453. Epub 2020 Jun 9.

Eurolens Research, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK.

Background: To determine the extent of scleral lens fitting worldwide and to characterise the associated patient demographics.

Methods: Survey forms were sent to contact lens fitters around the world, every year for 20 consecutive years (2000 to 2019). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey. Data were analysed for those countries reporting ≥ 1,000 contact lens fits during this period.

Results: A total of 369,209 contact lens fits were recorded from 40 eligible countries, comprising 2,309 scleral lens fits and 366,900 other (non-scleral) lens fits. Overall scleral lenses represented 0.76 per cent of all contact lens fits with significant differences between countries (p < 0.0001), ranging from no fits in six countries: Hungary, Indonesia, Iran, Korea, Malaysia and Singapore, to 5.9 per cent in Switzerland. There has been an increase in scleral lens fitting over the survey period (p < 0.0001), with the rate of fits increasing from negligible (< 0.50 per cent) before 2006 and then increasing from 2011 onward (p < 0.0001). Scleral lenses were fit to older patients (38.5 ± 15.0 years) compared to other lenses (31.4 ± 13.7 years) (p < 0.0001), this age disparity increasing over the survey period (p < 0.0001) and were more likely to be males (scleral lens fits 53 per cent, non-scleral lenses 33 per cent, p < 0.0001). The increase in scleral lens fits is commensurate with the increase in related publications in the peer-reviewed literature over the same period (p < 0.05, r = 0.82).

Conclusion: Scleral lens use has increased since 2011 with these specialised lenses more likely to be fitted to males and older patients than non-scleral lenses.
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http://dx.doi.org/10.1111/cxo.13105DOI Listing
July 2020

Reflection of contact lens practice.

Cont Lens Anterior Eye 2019 12 15;42(6):587-589. Epub 2019 Oct 15.

School of Medicine (Optometry), Deakin University, Australia. Electronic address:

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http://dx.doi.org/10.1016/j.clae.2019.10.003DOI Listing
December 2019

International survey of contact lens fitting for myopia control in children.

Cont Lens Anterior Eye 2020 02 3;43(1):4-8. Epub 2019 Jul 3.

The University of Alabama at Birmingham, School of Optometry, Birmingham, Alabama, USA.

Purpose: To determine the extent of contact lens fitting for myopia control (MC) in children (defined as ≤ 17 years of age) worldwide and to characterize the associated demographics and fitting patterns.

Methods: Survey forms were sent to contact lens fitters in 66 countries between January and March every year for eight consecutive years (2011-2018, inclusive). Practitioners were asked to record data relating to the first 10 contact lens fits performed after receiving the survey form. Data were analysed for those countries reporting ≥ 100 contact lens fits to children.

Results: Data were analysed for 535 MC fits and 23,295 other (non-MC) lens fits undertaken in 31 countries reporting ≥ 100 contact lens fits to children, with 52.1% of MC fits and 12.0% of non-MC fits being with rigid lenses (p < 0.0001). Overall, MC lenses represented 2.3% of all contact lens fits to children, with significant differences between nations (p < 0.0001), ranging from no MC fits recorded in the Czech Republic, Greece, Japan, South Korea and Puerto Rico, to 24.9% in Austria. There has been an increase in contact lens fitting for MC over the survey period (p < 0.0001). MC contact lenses were fitted to younger children compared to non-MC lenses (MC, median 13 years vs. non-MC, median 15 years) (p < 0.0001). There was no sex bias in the fitting of MC lenses (p = 0.89).

Conclusions: MC lenses are currently being prescribed for younger children in equal measure in terms of soft vs. rigid lenses and males vs. females. The extent of MC fitting is low and varies between nations. The gradual increase in MC fitting throughout the survey period perhaps reflects growing concerns among practitioners over the myopia epidemic.
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http://dx.doi.org/10.1016/j.clae.2019.06.008DOI Listing
February 2020

Could adoption of the rural pipeline concept redress Australian optometry workforce issues?

Clin Exp Optom 2019 11 23;102(6):566-570. Epub 2019 Feb 23.

Deakin Optometry, School of Medicine, Deakin University, Geelong, Victoria, Australia.

People living in rural and remote areas have poorer ocular health outcomes compared with those living in metropolitan areas. Reasons for this are multiple and complex but access to care is consistently reported as a defining factor. The geographic maldistribution of eye-care professionals is a major obstacle for regional, rural and remote Australians seeking care. Research from the medical profession suggests adopting the 'rural pipeline' concept to address the issue of maldistribution. This approach appears to have had some success in medicine, and involves recruiting students from a rural background, exposing students to rural practice through placements and offering graduates incentives and support to practice rurally. Lessons could be learnt from the medical field as there is a dearth of literature describing the utilisation of the rural pipeline in allied health. However, given the differences between professions it cannot be assumed factors and results will be the same. A greater understanding is required to determine whether optometry is a profession which may benefit from the rural pipeline concept.
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http://dx.doi.org/10.1111/cxo.12873DOI Listing
November 2019

International survey of orthokeratology contact lens fitting.

Cont Lens Anterior Eye 2019 08 16;42(4):450-454. Epub 2018 Nov 16.

Menicon Co., Ltd., Nagoya, Japan.

Purpose: . To determine the extent of orthokeratology (OK) contact lens fitting worldwide and to characterize associated demographics and fitting patterns.

Methods: . Survey forms were sent to contact lens fitters in 45 countries between January and March every year for 14 consecutive years (2004 - 2017, inclusive). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey form.

Results: . Data were obtained for 295,044 contact lens fits, of which 2,702 were with OK lenses and 292,342 were with other lens types (non-OK). Overall, OK lenses represented 1.2% of all contact lens fits, with significant differences between nations (p < 0.0001), ranging from no fits recorded in Brazil, Egypt, Indonesia, Iran, Lithuania, Nepal and the United Arab Emirates, to 6.0% in The Netherlands. There has been a slight overall increase in OK lens fitting over the survey period (p < 0.0001). OK lenses were fitted to younger persons (OK, 25.0 ± 12.8 years vs. non-OK, 39.8 ± 14.9 years) (p < 0.0001). A higher proportion of males (55%) were fitted with OK lenses versus non-OK lenses (30%) (p < 0.0009). There was a skewed distribution towards OK lenses being fit with higher oxygen permeable materials (p < 0.0001) and on a planned replacement basis (p < 0.0001).

Conclusions: . OK contact lens prescribing is a niche activity, with this lens type typically being fitted in high oxygen permeable materials on a planned replacement basis to younger males. The slightly increasing rate of OK fitting, albeit at a very low level, may be attributed to practitioner interest in the reported myopia control properties of this lens type.
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http://dx.doi.org/10.1016/j.clae.2018.11.005DOI Listing
August 2019

Impact of supervised student optometry consultations on the patient experience.

Clin Exp Optom 2018 03 13;101(2):288-296. Epub 2017 Nov 13.

School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia.

Background: Understanding patient perceptions of having students involved in their clinical care is important as we strive to develop optimal models of care that integrate teaching with the best possible experience for the patient. The aim was to ascertain the impact of supervised optometry student consultations on the patient experience.

Methods: A survey comprising 45 questions was mailed to consecutive adult patients who had undergone a comprehensive eye examination at the Australian College of Optometry over a four-week period.

Results: Responses were received from 193 patients who had a student involved in their care (44 per cent response rate; 156 completed correctly) and 177 who did not have a student involved (32 per cent response rate; 105 completed correctly). There was no significant difference in overall patient satisfaction between the teaching and non-teaching clinics (p = 0.18). Over 87 per cent of patients in the teaching clinic felt completely comfortable with a student examining them, 44 per cent felt their care was better because a student was involved and 97 per cent rated the overall performance of the student as very good or good. Although 12 per cent would rather have seen only the optometrist and three per cent would not be happy to have a student involved in their eye care again, 100 per cent believed it is important for students to work with patients. The most common reason for student acceptance was the importance of students needing opportunities to learn. The main reasons for unwillingness to have a student involved in future were the additional time taken and prolonged testing.

Conclusions: The findings of this study suggest that most patients view supervised student involvement in their optometric care as an important and highly positive experience. However, efforts should be made to avoid excessively long consultations and prolonged testing. Concerns about patient satisfaction and acceptance are largely unwarranted and should not prevent optometry students being involved in patient care.
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http://dx.doi.org/10.1111/cxo.12633DOI Listing
March 2018

Temporal changes in contact lens comfort over a day of wear.

Ophthalmic Physiol Opt 2016 11;36(6):643-648

School of Optometry, University of Waterloo, Waterloo, Canada.

Purpose: Contact lens discomfort continues to be reported as the primary reason for soft lens discontinuation, regardless of new modalities and materials. The purpose of this analysis of comfort related data from a series of clinical studies was to review whether there was a difference between symptomatic and asymptomatic habitual lens wearers' comfort responses over the course of the day.

Methods: Data from five independent non-dispensing clinical studies were pooled and analysed. Participants in these studies were assigned to one of two groups depending on whether they were classified as symptomatic or asymptomatic contact lens wearers according to a modified Subjective Evaluation of Symptoms of Dryness (SESOD) questionnaire. Masked participants were randomised to wear either a hydrogel or a silicone hydrogel contact lens and their ocular comfort was rated using a visual analogue scale on insertion and 2-hourly during an 8-hour period of a single lens wearing day.

Results: Data from 103 participants were used, 58 in the symptomatic group and 45 in the asymptomatic group as determined by the SESOD questionnaire. There was no effect of lens material on comfort (p = 0.43). However, there was a significant interaction between symptoms and time. The difference in mean comfort between the symptomatic and asymptomatic group was significant at each time point (p < 0.05). However, comfort did not vary significantly over the day for the asymptomatic group (p = 0.87), whereas, there was a significant decline in mean comfort ratings for the symptomatic group from 84.6 ± 13.2 (S.D.) at insertion to 73.0 ± 18.5 at 8 hours (p < 0.001).

Conclusions: In our study, changes in contact lens comfort over a day were independent of lens material but not symptoms. Symptomatic lens wearers reported a progressive decrease in comfort, whereas asymptomatic wearers did not. Therefore, asymptomatic wearers should not be used when measuring contact lens comfort in clinical studies. The exclusion of asymptomatic lens wearers would likely increase the sensitivity of comfort ratings as a measure in contact lens research.
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http://dx.doi.org/10.1111/opo.12318DOI Listing
November 2016

Effect of Masking on Subjective Responses to Daily Disposable Contact Lenses.

Optom Vis Sci 2016 08;93(8):828-35

*OD, PhD, FAAO †Dipl Ing. (AO), PhD, FAAO ‡PhD MCOptom, FAAO §OD, FAAO ∥MOptom, FAAO Centre for Contact Lens Research, School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada (NK, DL, CAW, DF); and Alcon Laboratories, Inc., Ft. Worth, Texas (PB, MF).

Purpose: To explore the effect of masking on subjective responses when wearing daily disposable (DD) contact lenses.

Methods: In an adaptation phase, habitual wearers of Manufacturer-A (MFA) (n = 43) and Manufacturer-B (MFB) (n = 53) wore MFA-brand 1 or MFB-brand 1 DDs, respectively, for 30 days, open-label. Subjects were then randomly assigned to one of two experiments. Each experiment included two, 3-day crossover phases. An enhanced version of MFA and MFB lenses (MFA-brand 2 and MFB-brand 2) were worn contralaterally to evaluate potential differences in masking result between manufacturers. Experiment 1: subjects were fully masked to lens and packaging (FM) then unmasked (UM). Experiment 2: subjects were FM then partially masked using an over-label (PM). Comfort ratings (0-100) were recorded for each lens daily and preference between lenses was recorded on day 3 for each crossover phase. The mean difference between 0-100 ratings or preference when FM or PM versus UM for the same lens was considered a measurement of the effect associated with masking. The purpose of the study was withheld from subjects to minimize bias.

Results: The effect associated with masking for habitual wearers of MFA and MFB lenses was less than 1 out of 100 (0 ± 2.5) in both experiments. Fifty-eight subjects (60%) expressed no preference when FM. This decreased to 29 (30%) when UM or PM (proportion test, p < 0.001). Approximately half the subjects had a change in lens preference when they were UM or PM, primarily in favor of their habitual lens manufacturer.

Conclusions: Masking did not have a measurable impact on 0-100 ratings with the DD lenses used in this study but did have an impact on lens preference. Subjects were more likely to express a preference when they handled the lenses and were exposed to the lens packaging and, in some cases, able to read the lens brand and lens manufacturer.
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http://dx.doi.org/10.1097/OPX.0000000000000883DOI Listing
August 2016

Practitioner perspectives on extended clinical placement programs in optometry.

Clin Exp Optom 2016 May 18;99(3):248-57. Epub 2016 Feb 18.

Deakin Optometry, School of Medicine, Deakin University, Waurn Ponds, Australia.

Background: Some universities are looking to provide a more diverse range of clinical learning experiences through extended clinical placement programs. This approach will potentially have a significant impact on practitioners. The aim of this study was to conduct a national survey of optometrists to ascertain their perspectives on participating in extended clinical placement programs.

Methods: Members of Optometry Australia were invited to participate in a survey conducted during June and July 2014.

Results: A total of 268 practitioners participated (six per cent of registered Australian optometrists): 159 were predominantly employees or locums and 109 were owners or managers who identified as the key representative of a practice or organisation for the purpose of this survey. Almost two-thirds (65 per cent) of participants, who were employees or locums were supportive of extended clinical placement programs. Among this group, females were more likely to be supportive than males (p = 0.033). In comparison, just over one-third (34 per cent) of participants who were key decision-makers were supportive, with 30 per cent possibly supportive and 36 per cent not supportive. Among key decision-makers, males were more likely to be supportive (p = 0.009). The top three perceived advantages of supervising a student were: opportunity to mentor early career development, opportunity to give back to the profession and future recruitment. The top three perceived disadvantages were: burden on time, decrease in number of patients examined and burden on support staff. Suggested incentives for supervising students were credit for continuing professional development and financial remuneration.

Conclusion: There appears to be moderate support for extended clinical placement programs; however, there are incentives that might engage a larger proportion of the profession in the future. These findings can inform the development of effective and sustainable clinical training programs for optometry students. Additionally, the findings might be used as evidence to seek Government support for clinical placement training in optometry.
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http://dx.doi.org/10.1111/cxo.12337DOI Listing
May 2016

Trends in US Contact Lens Prescribing 2002 to 2014.

Optom Vis Sci 2015 Jul;92(7):758-67

*BScOptom, PhD, DSc, FAAO †OD, MPH, PhD, FAAO ‡BSc(Hons), PhD, FAAO Institute of Health and Biomedical Innovation, and School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Australia (NE); Office of the Vice President for Research and Economic Development, The University of Alabama at Birmingham, Birmingham, Alabama (JJN); School of Medicine (Optometry), Deakin University, Waurn Ponds, Victoria, Australia (CAW); and Eurolens Research, The University of Manchester, Manchester, UK (PBM).

Purpose: To document contact lens prescribing patterns in the United States between 2002 and 2014.

Methods: A survey of contact lens prescribing trends was conducted each year between 2002 and 2014, inclusive. Randomly selected contact lens practitioners were asked to provide information relating to 10 consecutive contact lens fits between January and March each year.

Results: Over the 13-year survey period, 1650 survey forms were received from US practitioners representing details of 7702 contact lens fits. The mean (±SD) age of lens wearers was 33.6 (±15.2) years, of whom 65.2% were female. Rigid lens new fits decreased from 13.0% in 2002 to 9.4% in 2014. Across this period, silicone hydrogels have replaced mid water contact lens hydrogels as the soft lens material of choice. Toric lenses represented about 25 to 30% of all soft lens fits. Multifocal soft lenses are generally preferred to monovision. Daily disposable lens fits have recently increased, and in 2014, they represented 27.1% of all soft lens fits. Most lenses are prescribed on 1 to 2 weekly or monthly lens replacement regimen. Extended wear remains a minority lens wearing modality. The vast majority of those wearing reusable lenses use multipurpose lens care solutions. Lenses are mostly worn 7 d/wk.

Conclusions: This survey has revealed prescribing trends and preferences in the United States over the past 13 years.
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http://dx.doi.org/10.1097/OPX.0000000000000623DOI Listing
July 2015

Contact lens fitting and training in a child and youth population.

Cont Lens Anterior Eye 2015 Dec 9;38(6):419-23. Epub 2015 Jun 9.

School of Medicine (Optometry), Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC 3214, Australia. Electronic address:

Purpose: To determine the ease with which children and youths without previous soft contact lens (SCL) experience were able to handle, care for, adapt and be fitted with SCLs.

Methods: 179 children aged 8-16 were recruited. Study visits included: screening and training visits, 1-week and 3-month follow-ups. During the training visit, the time taken to demonstrate proficiency in lens insertion and removal and care was recorded. A second training visit was scheduled if necessary.

Results: Nine children did not complete the screening visit and eight discontinued during the study. Of those eight, seven discontinued during the first week and one before the 3-month visit. Of those recruited, 90.5% (162/179) were successfully fitted and completed the study. A majority of children were dispensed with lenses at the first training visit (94.6%, 162/171). The mean training time for all children was 30 min. There were no statistically significant differences in the number of lenses required to fit or instruction time by age group (p > 0.05) or gender (p > 0.05). Nine participants (5.3%, 9/171) required a second training visit with four still unable to handle lenses (2.3%, 4/171). By the 1-week visit 13.2% (22/167) of participants either lost or tore lenses, no subsequent lost or torn lenses occurred. No serious adverse events occurred during the study.

Conclusion: Children and youths with no previous contact lens experience were easily fitted, able to successfully wear and care for lenses. The results of this study should encourage practitioners to recommend SCLs as a vision correction option.
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http://dx.doi.org/10.1016/j.clae.2015.05.002DOI Listing
December 2015

Variations in observable lid wiper epitheliopathy (LWE) staining patterns in wearers of silicone hydrogel lenses.

Cont Lens Anterior Eye 2015 Dec 6;38(6):471-6. Epub 2015 Jun 6.

Centre for Contact Lens Research, School of Optometry and Vision Science, University of Waterloo, Canada; School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada.

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http://dx.doi.org/10.1016/j.clae.2015.05.004DOI Listing
December 2015

Clinical performance of three silicone hydrogel daily disposable lenses.

Optom Vis Sci 2015 Mar;92(3):301-11

*MSc †PhD, FAAO ‡MOptom, FAAO Centre for Contact Lens Research, School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada.

Purpose: To determine the clinical performance of DAILIES TOTAL1 (DT1), Clariti 1Day (C1D), and 1-DAY ACUVUE TruEye (AVTE) silicone hydrogel daily disposable contact lenses (SiHy DDCLs).

Methods: Eligible participants, subdivided into asymptomatic and symptomatic groups, wore each SiHy DDCLs for three consecutive days. Each participant attended three visits (on day 1 at 0 hours; on days 1 and 3 after 8 hours of wear) per lens type. The order of lens wear was randomized, with at least 1 day washout between lenses. Lens-related performance was evaluated by assessing lens surface deposits, wettability, pre-lens noninvasive tear breakup time, lens movement, and centration; ocular response assessments included conjunctival redness, corneal staining, and conjunctival staining and indentation.

Results: Fifty-one asymptomatic and 53 symptomatic participants completed the study. For all visits, the mean noninvasive tear breakup time was about 1 second longer with DT1 than with C1D and AVTE (p < 0.01). Overall, the wettability of all three lenses was good; however, DT1 was graded marginally better than the other lenses (both p < 0.01). On day 3, eyes wearing AVTE had significantly more dehydration-induced corneal staining compared with DT1 (AVTE, 24%; DT1, 11%; p < 0.01). After 8 hours, conjunctival staining was different between lenses (greatest with C1D and least with DT1; all p < 0.01). Conjunctival indentation was more prevalent with the C1D lenses (n = 70) compared with DT1 (n = 1; p < 0.01) and AVTE (n = 11; p < 0.01). There were no differences between asymptomatic and symptomatic lens wearers for any of the clinical parameters (all p > 0.05).

Conclusions: Each of the three SiHy DDCLs performed well. Noninvasive tear breakup time was longest and wettability was greater with DT1. C1D had the most conjunctival staining conjunctival indentation. There was no difference between asymptomatic and symptomatic wearers with regard to ocular response and contact lens-related parameters. These results suggest that SiHy DDCLs may be an excellent contact lens modality for the symptomatic patient.
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http://dx.doi.org/10.1097/OPX.0000000000000514DOI Listing
March 2015

The TFOS International Workshop on Contact Lens Discomfort: report of the subcommittee on clinical trial design and outcomes.

Invest Ophthalmol Vis Sci 2013 Oct 18;54(11):TFOS157-83. Epub 2013 Oct 18.

Department of Ophthalmology and Vision Science, University of Louisville, Wilmington, North Carolina.

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http://dx.doi.org/10.1167/iovs.13-13189DOI Listing
October 2013

A multi-country assessment of compliance with daily disposable contact lens wear.

Cont Lens Anterior Eye 2013 Dec 8;36(6):304-12. Epub 2013 Jul 8.

Centre for Contact Lens Research, University of Waterloo, Waterloo, Ontario, Canada. Electronic address:

Purpose: To investigate compliance with daily disposable contact lens (DDCL) wear and investigate re-use of lenses according to country and DDCL material worn.

Methods: Optometrists invited eligible DDCL patients from their practices to participate in a survey on DDCL wear in Australia, Norway, the United Kingdom (UK) and the United States (US). Eligible participants completed an online or paper version of the survey.

Results: 805 participants completed the survey (96% online): Australia 13%, Norway 32%, UK 17%, US 38%. The median age was 38 years; 66% were female. Silicone hydrogel (SiHy) DDCLs were worn by 14%. Overall, 9% were non-compliant with DDCL replacement; Australia 18%, US 12%, UK 7% and Norway 4%. There were no differences with respect to sex, years of contact lens wear experience or DDCL material (SiHy versus hydrogels). The primary reason for re-use was "to save money" (60%). Re-use of DDCLs resulted in inferior comfort at insertion and prior to lens removal (p=0.001). 75% reported occasional napping and 28% reported sleeping overnight for at least one night in the preceding month, while wearing their DDCLs.

Conclusion: Non-compliance with replacement of DDCLs occurred in all countries investigated; the rate was highest in Australia and lowest in Norway. Re-use of DDCLs was associated with reduced comfort. DDCL wearers often reported wearing lenses overnight. It is important for optometrists to counsel their patients on the importance of appropriate lens wear and replacement for DDCLs.
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http://dx.doi.org/10.1016/j.clae.2013.05.004DOI Listing
December 2013

Prevalence of visual impairment and uncorrected refractive error - report from a Canadian urban population-based study.

Ophthalmic Epidemiol 2013 Jun;20(3):123-30

School of Optometry, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada.

Purpose: The prevalence of visual impairment due to uncorrected refractive error has not been previously studied in Canada. A population-based study was conducted in Brantford, Ontario.

Methods: The target population included all people 40 years of age and older. Study participants were selected using a randomized sampling strategy based on postal codes. Presenting distance and near visual acuities were measured with habitual spectacle correction, if any, in place. Best corrected visual acuities were determined for all participants who had a presenting distance visual acuity of less than 20/25.

Results: Population weighted prevalence of distance visual impairment (visual acuity <20/40 in the better eye) was 2.7% (n = 768, 95% confidence interval (CI) 1.8-4.0%) with 71.8% correctable by refraction. Population weighted prevalence of near visual impairment (visual acuity <20/40 with both eyes) was 2.2% (95% CI 1.4-3.6) with 69.1% correctable by refraction. Multivariable adjusted analysis showed that the odds of having distance visual impairment was independently associated with increased age (odds ratio, OR, 3.56, 95% CI 1.22-10.35; ≥65 years compared to those 39-64 years), and time since last eye examination (OR 4.93, 95% CI 1.19-20.32; ≥5 years compared to ≤2 years). The same factors appear to be associated with increased prevalence of near visual impairment but were not statistically significant.

Conclusions: The majority of visual impairment found in Brantford was due to uncorrected refractive error. Factors that increased the prevalence of visual impairment were the same for distance and near visual acuity measurements.
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http://dx.doi.org/10.3109/09286586.2013.789915DOI Listing
June 2013

Determinants of the frequency of contact lens wear.

Eye Contact Lens 2013 May;39(3):200-4

Eurolens Research, Faculty of Life Sciences, The University of Manchester, Manchester, United Kingdom.

Objectives: To characterize and discover the determinants of the frequency of wear (FOW) of contact lenses.

Methods: Survey forms were sent to contact lens fitters in up to 40 countries between January and March every year for 5 consecutive years (2007-2011). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey form. Only data for daily wear lens fits were analyzed.

Results: Data were collected in relation to 74,510 and 9,014 soft and rigid lens fits, respectively. Overall, FOW was 5.9±1.7 days per week (DPW). When considering the proportion of lenses worn between one to seven DPW, the distribution for rigid lenses is skewed toward full-time wear (7 DPW), whereas the distribution for soft daily disposable lenses is perhaps bimodal, with large and small peaks at seven and two DPW, respectively. There is a significant variation in FOW among nations (P<0.0001), ranging from 6.8±1.0 DPW in Greece to 5.1±2.5 DPW in Kuwait. For soft lenses, FOW increases with decreasing age. Females (6.0±1.6 DPW) wear lenses more frequently than males (5.8±1.7 DPW) (P=0.0002). FOW is greater among those wearing presbyopic corrections (6.1±1.4 DPW) compared with spherical (5.9±1.7 DPW) and toric (5.9±1.6 DPW) designs (P<0.0001). FOW with hydrogel peroxide systems (6.4±1.1 DPW) was greater than that with multipurpose systems (6.2±1.3 DPW) (P<0.0001).

Conclusions: Numerous demographic and contact lens-related factors impact FOW. There may be a future trend toward a lower FOW associated with the increasing popularity of daily disposable lenses.
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http://dx.doi.org/10.1097/ICL.0b013e31827a7ad3DOI Listing
May 2013

An international survey of toric contact lens prescribing.

Eye Contact Lens 2013 Mar;39(2):132-7

Eurolens Research, Faculty of Life Sciences, The University of Manchester, Manchester, United Kingdom.

Objectives: To characterize toric contact lens prescribing worldwide.

Methods: Up to 1,000 survey forms were sent to contact lens fitters in up to 39 countries between January and March every year for 5 consecutive years (2007-2011). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey form. Only data for toric and spherical soft lens fits were analyzed. Survey data collected since 1996 were also analyzed for 7 nations to assess toric lens fitting trends since that time.

Results: Data were collected in relation to 21,150 toric fits (25%) and 62,150 spherical fits (75%). Toric prescribing ranged from 6% of lenses in Russia to 48% in Portugal. Compared with spherical fittings, toric fittings can be characterized as follows: older age (29.8 ± 11.4 years vs. 27.6 ± 10.8 years for spherical lenses); men are overrepresented (38% vs. 34%); greater proportion of new fits (39% vs. 32%); use of silicone hydrogel lenses (49% vs. 39%); and lower proportion of daily disposable lenses (14% vs. 28%). There has been a continuous increase in toric lens prescribing between 1996 and 2011. The proportion of toric lens fits was positively related to the gross domestic product at purchasing power parity per capita for year 2011 (r = 0.21; P=0.004).

Conclusions: At the present time, in the majority of countries surveyed, toric soft contact lens prescribing falls short of that required to correct clinically significant astigmatism (≥ 0.75 diopters) in all lens wearers.
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http://dx.doi.org/10.1097/ICL.0b013e318268612cDOI Listing
March 2013

The impact of contemporary contact lenses on contact lens discontinuation.

Eye Contact Lens 2013 Jan;39(1):93-9

Centre for Contact Lens Research, University of Waterloo, Waterloo, Canada.

Objectives: Discontinuation or "dropout" from contact lens (CL) wear continues to afflict the CL industry. This study was conducted to determine whether the advent of new CL materials and designs has impacted the dropout rate and the reasons for discontinuation.

Methods: Current and lapsed CL wearers residing in Canada were recruited using Facebook to take part in an on line survey investigating CL wearing experiences during 2008 to 2010 and to establish the percentage of participants who temporarily and permanently discontinued CL wear during the period surveyed.

Results: Four thousand two hundred seven eligible surveys were received (64% female; median age 27 years). Forty percent had lapsed from lens wear for at least 4 months; however, 62% of the lapsed wearers (LWs) resumed wear. There were no differences between LWs and nonlapsed wearers (NLWs) with respect to gender; however, LWs were older, started lens wear when older, and had not worn lenses for as long as NLWs (all P<0.001). More NLWs than LWs wore silicone hydrogel CLs (49% vs. 38%, P<0.001) and more LWs than NLWs wore daily disposable lenses and hydrogel CLs (24% vs. 19% and 22% vs. 18%, respectively, P≤0.001). Primary reasons for discontinuation were discomfort (24%), dryness (20%), red eyes (7%), and expense (7%). Compliance with lens replacement was no different between LWs and NLWs (48% vs. 45%).

Conclusions: About 23% of those surveyed had discontinued CL wear permanently. The primary reasons for dropping out continue to be discomfort and dryness. Dropout rates were lower in silicone hydrogel wearers.
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http://dx.doi.org/10.1097/ICL.0b013e318271caf4DOI Listing
January 2013

International survey of rigid contact lens fitting.

Optom Vis Sci 2013 Feb;90(2):113-8

Institute of Health and Biomedical Innovation and School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Queensland, Australia.

Purpose: To determine the extent of rigid contact lens fitting worldwide and to characterize the associated demographics and fitting patterns.

Methods: Survey forms were sent to contact lens fitters in up to 40 countries between January and March every year for five consecutive years (2007 to 2011). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey form. Survey data collected between 1996 and 2011 were also analyzed to assess rigid lens fitting trends in seven nations during this period.

Results: Data were obtained for 12,230 rigid and 100,670 soft lens fits between 2007 and 2011. Overall, rigid lenses represented 10.8% of all contact lens fits, ranging from 0.2% in Lithuania to 37% in Malaysia. Compared with soft lens fits, rigid lens fits can be characterized as follows: older age (rigid, 37.3 ± 15.0 years; soft, 29.8 ± 12.4 years); fewer spherical and toric fits; more bifocal/multifocal fits; less frequent replacement (rigid, 7%; soft, 85%); and less part-time wear (rigid, 4%; soft, 10%). High-Dk (contact lens oxygen permeability) (36%) and mid-Dk (42%) materials are predominantly used for rigid lens fitting. Orthokeratology represents 11.5% of rigid contact lens fits. There has been a steady decline in rigid lens fitting between 1996 and 2011.

Conclusions: Rigid contact lens prescribing is in decline but still represents approximately 10% of all contact lenses fitted worldwide. It is likely that rigid lenses will remain as a viable, albeit increasingly specialized, form of vision correction.
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http://dx.doi.org/10.1097/OPX.0b013e31827cd8beDOI Listing
February 2013

An international survey of daily disposable contact lens prescribing.

Clin Exp Optom 2013 Jan 31;96(1):58-64. Epub 2012 Jul 31.

Institute of Health and Biomedical Innovation and School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia.

Purpose: The aim was to determine the extent of daily disposable contact lens prescribing worldwide and to characterise the associated demographics and fitting patterns.

Methods: Up to 1,000 survey forms were sent to contact lens fitters in up to 40 countries between January and March every year for five consecutive years (2007 to 2011). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey form. Survey data collected since 1996 were also analysed for seven nations to assess daily disposable lens fitting trends since that time.

Results: Data were collected in relation to 97,289 soft lens fits, of which 23,445 (24.1 per cent) were with daily disposable lenses and 73,170 (75.9 per cent) were with reusable lenses. Daily disposable lens prescribing ranged from 0.6 per cent of all soft lenses in Nepal to 66.2 per cent in Qatar. Compared with reusable lens fittings, daily disposable lens fittings can be characterised as follows: older age (30.0 ± 12.5 versus 29.3 ± 12.3 years for reusable lenses); males are over-represented; a greater proportion of new fits versus refits; 85.9 per cent hydrogel; lower proportion of toric and presbyopia designs and a higher proportion of part-time wear. There has been a continuous increase in daily disposable lens prescribing between 1996 and 2011. The proportion of daily disposable lens fits (as a function of all soft lens fits) is positively related to the gross domestic product at purchasing power parity per capita (r(2) = 0.55, F = 46.8, p < 0.0001).

Conclusions: The greater convenience and other benefits of daily disposable lenses have resulted in this modality capturing significant market share. The contact lens field appears to be heading toward a true single-use-only, disposable lens market.
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http://dx.doi.org/10.1111/j.1444-0938.2012.00773.xDOI Listing
January 2013

International survey of contact lens prescribing for extended wear.

Optom Vis Sci 2012 Feb;89(2):122-9

FAAO Institute of Health and Biomedical Innovation and School of Optometry, Queensland University of Technology, Kelvin Grove, Queensland, Australia.

Purpose: To determine the extent of extended wear (EW) contact lens prescribing worldwide and to characterize the associated demographics and fitting patterns.

Methods: Up to 1000 survey forms were sent to contact lens fitters in up to 39 countries between January and March every year for five consecutive years (2006-2010). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey form. Survey data collected since 1997 was also analyzed to assess EW fitting trends since that time.

Results: Details for lens modality were received for 107,094 rigid and soft lens fits of which 88,392 were for soft lens daily wear (DW) and 7470 were for soft lens EW. Overall, EW represents 7.8% of all soft lens fits, ranging from 0.6% in Malaysia to 27% Norway. Compared with DW fittings, EW fittings can be characterized as follows: older age (32.7 ± 13.6 vs. 29.4 ± 12.0 years for DW); males are over-represented; greater proportion of refits; 72% silicone hydrogel; higher proportion of presbyopia and spherical designs; and higher proportion of monthly lens replacement. Of those wearing EW lenses, 80% use multipurpose solutions, whereas 9% do not use any care system. Between 1997 and 1999, the rate of EW prescribing decreased from 5 to 1% of all soft lens fits; it increased to a peak of 12% in 2006, and settled back to 8% by 2010.

Conclusions: EW prescribing has failed to break through the "glass ceiling" of 15% and is unlikely to become a mainstream lens wearing modality until the already low risks of ocular complications can be reduced to be equivalent to that for DW.
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http://dx.doi.org/10.1097/OPX.0b013e31823ee077DOI Listing
February 2012

Non-invasive collection and examination of human corneal epithelial cells.

Optom Vis Sci 2011 Nov;88(11):1317-25

Centre for Contact Lens Research, School of Optometry, University of Waterloo, Waterloo, Ontario, Canada.

Purpose: To report the development of a new apparatus for non-invasive collection of human corneal epithelial cells.

Methods: Previous methods of non-invasive, irrigative corneal cell collection resulted in low cell yields limiting potential analysis. A new ocular surface cell collection apparatus (OSCCA) was designed to collect more epithelial cells from direct irrigation of the corneal surface to allow for clinical comparisons. Forty-five samples were obtained (unilateral or bilateral over seven visits) from five human participants. Cell yield, size, phenotype, and corneal staining (prior and post eye wash) were examined.

Results: On average 364 ± 230 epithelial cells were collected from the cornea per eye. Epithelial cell sizes ranged from 8.21 to 51.69 μm in diameter, and 67.30 to 2098.85 μm area. The proportion of corneal specific cells collected per sample was 75 ± 14% as determined by positive K3 expression with AE5. On average, 77 ± 0.2% of epithelial cells harvested were nucleated, the remainder were non-nucleated ghost cells. Corneal staining was reduced in the OSCCA-washed vs. contralateral non-washed eyes (p = 0.02).

Conclusions: The OSCCA allows collection of human corneal epithelial cells with significantly higher yields, and greater specificity than previously reported. Reduced corneal staining observed post eye-wash demonstrated the safety of the technique, and its ability to remove cells directly from the corneal surface. The OSCCA could provide an objective non-invasive method of investigating pathological changes, effects of topical therapeutics, and impact of contact lenses and care-solutions of the cells of the ocular surface.
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http://dx.doi.org/10.1097/OPX.0b013e31822c095dDOI Listing
November 2011

Ability of patients to recall habitual contact lens products and enhancement of recall using photographic aids.

Cont Lens Anterior Eye 2011 Oct 7;34(5):236-40. Epub 2011 Jul 7.

Centre for Contact Lens Research, University of Waterloo, Ontario, Canada.

Purpose: To determine the proportion of soft contact lens (CL) wearers who are able to recall their habitual products (lenses and care system) correctly from memory, and to evaluate the value of using photographic aids (PAs) to improve recall.

Methods: 103 soft lens wearers attended 2 visits to investigate their habitual CL product use. At the first visit they were asked to recall which products they were using and then to identify their products from PAs. They returned for a second visit with their products for confirmation.

Results: 51% correctly reported their lens brands from memory alone, which improved to 87% with the use of the PAs (p<0.001). 41% correctly reported their habitual care system from memory alone, which improved to 80% with the use of PAs (p<0.001). Females were better at recalling care system brand names than males (49% versus 27% correct, p=0.040) and wearers with more than 1 year experience with their habitual CLs had better recall than those with up to 1 year experience (63% versus 27%, p=0.014).

Conclusion: Less than 50% of contact lens wearers were able to recall the names of their habitual lens and lens care products correctly from memory. PAs improved this recall significantly for both contact lenses and contact lens care systems.
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http://dx.doi.org/10.1016/j.clae.2011.06.005DOI Listing
October 2011

The relationship between compliance with lens replacement and contact lens-related problems in silicone hydrogel wearers.

Cont Lens Anterior Eye 2011 Oct 13;34(5):216-22. Epub 2011 Apr 13.

Centre for Contact Lens Research, University of Waterloo, Ontario, Canada.

Purpose: To evaluate the relationship between compliance with replacement frequency (RF) and contact lens (CL)-related problems in silicone hydrogel (SiHy) wearers.

Methods: 501 SiHy wearers from seven optometry offices completed surveys regarding their lens wear and any CL related problems which they may have experienced in the preceding 12 months. File review was subsequently conducted at their optometry offices to confirm the information provided.

Results: 49% of respondents were wearing 2-week replacement (2WR) and 51% 1-month replacement (1MR) SiHy lenses. 67% wore their lenses for longer than the manufacturers' recommended RF (MRRF) and 60% for longer than their optometrist's recommended RF (ORRF). The mean RF was 2.6× the MRRF for 2WR and 1.5× for 1MR wearers (p<0.001) with median values of 31 and 37 days, respectively. Twenty-three percent reported signs or symptoms consistent with potential complications relating to CL wear. This rate was significantly higher for wearers who were non-compliant with the ORRF than compliant wearers (26% versus 18%, p=0.028). It was also higher for those multipurpose solution users who reported never/almost never rubbing and rinsing their lenses when compared with those who did this every night (29% versus 17%, p=0.007).

Conclusions: Two thirds of the SiHy wearers did not comply with the MRRF and 2WR wearers stretched the replacement interval of their lenses to a greater degree than 1MR wearers. Failing to replace lenses when recommended and failing to rub and rinse lenses were associated with a higher rate of patient-reported CL problems.
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http://dx.doi.org/10.1016/j.clae.2011.03.001DOI Listing
October 2011

Survey of contact lens prescribing to infants, children, and teenagers.

Optom Vis Sci 2011 Apr;88(4):461-8

Institute of Health and Biomedical Innovation,Queensland University of Technology, Kelvin Grove, Queensland, Australia.

Purpose: To determine the types of contact lenses prescribed for infants (aged 0 to 5 years), children (6 to 12 years), and teenagers (13 to 17 years) around the world.

Methods: Up to 1000 survey forms were sent to contact lens fitters in each of 38 countries between January and March every year for 5 consecutive years (2005 to 2009). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey form.

Results: Data were received relating to 105,734 fits [137 infants, 1,672 children, 12,117 teenagers, and 91,808 adults (age ≥ 18 years)]. The proportion of minors (<18 year old) fitted varied considerably between nations, ranging from 25% in Iceland to 1% in China. Compared with other age groups, infants tend to be prescribed a higher proportion of rigid, soft toric, and extended wear lenses, predominantly as refits for full-time wear, and fewer daily disposable lenses. Children are fitted with the highest proportion of daily disposable lenses and have the highest rate of fits for part-time wear. Teenagers have a similar lens fitting profile to adults, with the main distinguishing characteristic being a higher proportion of new fits. Orthokeratology fits represented 28% of all contact lenses prescribed to minors.

Conclusions: Patterns of contact lens prescribing to infants and children are distinctly different to those of teenagers and adults in a number of respects. Clinicians can use the data presented here to compare their own patterns of contact lens prescribing to minors.
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http://dx.doi.org/10.1097/OPX.0b013e31820efa0fDOI Listing
April 2011

Patient use of smartphones to communicate subjective data in clinical trials.

Optom Vis Sci 2011 Feb;88(2):290-4

Centre for Contact Lens Research, School of Optometry, University of Waterloo, Waterloo, Ontario, Canada.

Purpose: Various methods have been used in clinical trials to collect time-sensitive subjective responses, including study diaries, telephone interviews, and use of text messaging. However, all of these methods are limited by the uncertainty of when the participants enrolled in the study actually record their responses. This technical note reports on the utility of the BlackBerry smartphone to collect such data and why such a system provides advantages over other methods to report subjective ratings in clinical studies.

Methods: The Centre for Contact Lens Research developed an on-line web-enabled system that permits participants to record and immediately transmit subjective rating scores in numerical form directly into a web-enabled database. This, combined with the utility of BlackBerrys, enabled time-specific e-mail requests to be sent to the study participants and then for that data to be simultaneously transmitted to the web-enabled database. This system has been used in several clinical trials conducted at the Centre for Contact Lens Research, in which data were collected at various times and in several specific locations or environments.

Results: In the clinical trials conducted using this system, participants provided responses on 97.5% of occasions to the requests for data generated by the automated system. When the request was for data on a set date, this method resulted in responses of 84.1% of the time.

Conclusions: The series of clinical trials reported here show the benefits of the utilization of the BlackBerry to collect time- or environment-sensitive data via a web-enabled system.
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http://dx.doi.org/10.1097/OPX.0b013e3181ff9b80DOI Listing
February 2011

Impact of a rub and rinse on solution-induced corneal staining.

Optom Vis Sci 2010 Dec;87(12):1030-6

Centre for Contact Lens Research, School of Optometry, University of Waterloo, Canada ON N2L 3G1.

Purpose: To investigate whether the inclusion of a rub and rinse step before contact lens disinfection has an impact on solution-induced corneal staining.

Methods: This was a prospective, double-masked, single investigator study. Twenty participants were recruited for two visits, where balafilcon-A lenses were worn bilaterally for 2 h. Each pair of lenses was prepared using two different methodologies. The "control" lens was transferred from the blister pack directly into a storage case containing polyhexamethylene biguanide-based lens care solution. The contralateral "test" lens was rubbed and simultaneously rinsed using the same polyhexamethylene biguanide-based care solution, for either 60 s (visit 1) or 20 s (visit 2). Both lenses were then soaked in the solution overnight. After baseline corneal staining assessments, the lenses were inserted following a randomized contralateral model. After 2 h, lenses were removed, corneal staining was regraded, and comfort scores were obtained.

Results: Rubbed and rinsed test lenses induced significantly less corneal staining than control lenses for all participants during visit 1 (mean ± SD: 516 ± 843 vs. 2170 ± 902; p < 0.001) and visit 2 (522 ± 417 vs. 2091 ± 965; p < 0.001). There was no significant difference between the test lenses during visits 1 and 2 (p = 0.72) or controls (p = 0.50). Comfort scores did not differ between eyes (p > 0.05).

Conclusions: Corneal staining induced after 2 h of lens wear with the combination of balafilcon-A and polyhexamethylene biguanide-based lens care solution can be significantly reduced by including a rub and rinse step before overnight soaking. Further work is required to establish the longevity of this effect during the monthly wearing cycle.
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December 2010
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