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Ispizua Mendivil E, Durán de la Colina JA. Infectious keratitis associated with contact lens wear: REGINFECOR multicenter study. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:237-247. [PMID: 38588998 DOI: 10.1016/j.oftale.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/27/2024] [Indexed: 04/10/2024]
Abstract
This 32-centre multicentre study addresses the lack of knowledge about the prevalence and significance of microbial keratitis (MK) associated with contact lens (CL) wear in Spain. A total of 304 cases recruited from 32 hospitals were studied and showed that infectious keratitis associated with contact lens wear mainly affects young women during the summer months. In this study, soft lenses with monthly replacement and single solution cleaning were most commonly used, purchased and fitted in opticians' shops. Common risk factors were identified among users, such as topping off solutions, prolonging the life of lenses, and frequently sleeping, swimming and showering with lenses. Overnight lens wear was significantly associated with a higher incidence of corneal opacities, and the presence of Pseudomonas aeruginosa in bacterial cultures was associated with more severe sequelae and a greater need for corneal transplantation. Although most cases were benign, the time taken to heal was long, which poses a problem for working patients. This study provides valuable epidemiological, microbiological and risk factor information and estimates the incidence of CL related MK in Spain to be approximately 1 case per 30,000 inhabitants per year.
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Affiliation(s)
- E Ispizua Mendivil
- Departamento de Oftalmología, Hospital de Urduliz, Urduliz, Bizkaia, Spain.
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Jasim H, Grzeda M, Foot B, Tole D, Hoffman JJ. Incidence of Acanthamoeba Keratitis in the United Kingdom in 2015: A Prospective National Survey. Cornea 2024; 43:269-276. [PMID: 38097200 DOI: 10.1097/ico.0000000000003445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/01/2023] [Indexed: 02/06/2024]
Abstract
PURPOSE The aims of this study were to quantify the incidence of Acanthamoeba keratitis (AK) in the United Kingdom and investigate risk factors and management parameters. METHODS This was a prospective population-based study from January to December 2015 through the British Ophthalmic Surveillance Unit. Data were collected on demographics, clinical features, and management. Incidence rates were calculated from estimates of population and contact lens (CL) user numbers. Statistical analysis compared annualized incidences per million and altered risk ratios for AK with the England and Wales 24 months 1997/1998 to 1998/1999 study. RESULTS The study identified 124 AK cases, an overall incidence of 2.35 per million. CL wearers accounted for 108 of 124 cases (87%), in whom the AK incidence was 26.94 per million. Herpes keratitis was initially misdiagnosed in 25 of 124 cases (20.2%). The highest incidence of AK was among planned replacement soft CL (PRSCL) wearers (50.65 per million), 7-fold greater than for daily disposable CL (DDSCL) users (7.24 per million). There was a significant increase in AK incidence ( P < 0.001) compared with both 1997/1998 [risk ratio 1.92, 95% confidence interval (CI) 1.38-2.66] and 1998/1999 (risk ratio 2.13, 95% CI 1.52-2.98) together with a higher incidence per million CL users of 26.94 versus 21.14 (1997/1998) and 17.53 (1998/1999). CONCLUSIONS This study provides the first published data on the nationwide incidence of AK in the United Kingdom. The findings confirm an increasing incidence of AK, particularly among contact lens wearers since 1997/1998 to 1998/1999. PRSCLs were identified as a significant risk factor compared with DDSCLs. Misdiagnosis and treatment delays remain an ongoing problem for patients with AK.
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Affiliation(s)
- Haneen Jasim
- Corneal and External Eye Service, Bristol Eye Hospital, Bristol, United Kingdom
| | - Mariusz Grzeda
- Corneal and External Eye Service, Bristol Eye Hospital, Bristol, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Barny Foot
- Royal College of Ophthalmologists, London, United Kingdom
| | - Derek Tole
- Corneal and External Eye Service, Bristol Eye Hospital, Bristol, United Kingdom
| | - Jeremy J Hoffman
- Corneal and External Disease Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; and
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Logan NS, Bullimore MA. Optical interventions for myopia control. Eye (Lond) 2024; 38:455-463. [PMID: 37740053 PMCID: PMC10858277 DOI: 10.1038/s41433-023-02723-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 07/26/2023] [Accepted: 08/25/2023] [Indexed: 09/24/2023] Open
Abstract
A range of optical interventions have been developed to slow the progression of myopia. This review summarizes key studies and their outcomes. Peer-reviewed, randomized controlled clinical trials of at least 18 months duration were identified. Randomized clinical trials were identified and summarised: 13 for spectacles, 5 for overnight orthokeratology, 5 for soft contact lenses, and 3 for orthokeratology combined with low concentration atropine. Overnight orthokeratology trials were the most consistent with 2-year slowing of axial elongation between 0.24 and 0.32 mm. Other modalities were more variable due to the wide range of optical designs. Among spectacle interventions, progressive addition lenses were the least effective, slowing axial elongation and myopia progression by no more than 0.11 mm and 0.31 D, respectively. In contrast, novel designs with peripheral lenslets slow 2-year elongation and progression by up to 0.35 mm and 0.80 D. Among soft contact lens interventions, medium add concentric bifocals slow 3-year elongation and progression by only 0.07 mm and 0.16 D, while a dual-focus design slows 3-year elongation and progression by 0.28 mm and 0.67 D. In summary, all three optical interventions have the potential to significantly slow myopia progression. Quality of vision is largely unaffected, and safety is satisfactory. Areas of uncertainty include the potential for post-treatment acceleration of progression and the benefit of adding atropine to optical interventions.
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Moon CW, Cho CH, Lee SB. Clinical comparative analysis of bacterial keratitis according to contact lens use: a retrospective study in a tertiary referral center of South Korea. Int Ophthalmol 2023; 43:3509-3521. [PMID: 37493928 DOI: 10.1007/s10792-023-02756-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/21/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE To compare the clinical aspects and treatment outcomes of contact lens-related bacterial keratitis (CLBK) and non-CLBK patients. METHODS Altogether 217 patients of bacterial keratitis (CLBK; 62, non-CLBK; 155) hospitalized between January 2012 and December 2020 were retrospectively analyzed for epidemiology, microbiological profiles, predisposing factors, clinical characteristics, and treatment outcomes. Poor treatment outcomes (PTO) were defined as a final BCVA < 0.3 (Snellen), a decreased visual acuity after treatment, complications, or surgical intervention. Relative importance of the initial clinical features leading to PTO was assessed using the random forest model and two-proportion Z-test. RESULTS The most common predisposing factors were sleeping with wearing CL (51.6%) in the CLBK group and trauma (55.5%) in the non-CLBK group. There were significant differences between the two groups in mean age (35.1:55.1 years, p < 0.001), female sex (56.5:34.8%, p = 0.003), symptom duration (6.2:6.9 days, p = 0.019), gram-negative organisms (83.3:48.3%, p = 0.008), epithelial healing time (8.5:14.1 days, p = 0.004), final BCVA (0.15:0.46 logMAR, p = 0.015), and PTO (9.7:21.9%, p = 0.035). For the entire group, the initial BCVA < 0.1 (27.9%), symptom duration ≥ 5 days (19.4%), age ≥ 60 years (16.4%), and hypopyon (14.0%) were important initial clinical features leading to PTO in the random forest model. In CLBK group, the type of CL or CL-related history was not significantly related to PTO. CONCLUSION CLBK patients had a higher proportion of females, younger age, gram-negative bacteria, and better treatment outcomes than those of non-CLBK patients. There were no significant risk factors leading to PTO in either the type of CL or CL-related history.
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Affiliation(s)
- Cheol-Won Moon
- Department of Ophthalmology, School of Medicine, Kyungpook National University, 680, Gukchaebosang-ro, Jung-gu, Daegu, 41944, South Korea
| | - Chan-Ho Cho
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, 48108, South Korea
| | - Sang-Bumm Lee
- Department of Ophthalmology, Yeungnam University College of Medicine, 170, Hyunchung-ro, Nam-gu, Daegu, 42415, South Korea.
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Astley RA, Mursalin MH, Coburn PS, Livingston ET, Nightengale JW, Bagaruka E, Hunt JJ, Callegan MC. Ocular Bacterial Infections: A Ten-Year Survey and Review of Causative Organisms Based on the Oklahoma Experience. Microorganisms 2023; 11:1802. [PMID: 37512974 PMCID: PMC10386592 DOI: 10.3390/microorganisms11071802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/29/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Ocular infections can be medical emergencies that result in permanent visual impairment or blindness and loss of quality of life. Bacteria are a major cause of ocular infections. Effective treatment of ocular infections requires knowledge of which bacteria are the likely cause of the infection. This survey of ocular bacterial isolates and review of ocular pathogens is based on a survey of a collection of isolates banked over a ten-year span at the Dean McGee Eye Institute in Oklahoma. These findings illustrate the diversity of bacteria isolated from the eye, ranging from common species to rare and unique species. At all sampled sites, staphylococci were the predominant bacteria isolated. Pseudomonads were the most common Gram-negative bacterial isolate, except in vitreous, where Serratia was the most common Gram-negative bacterial isolate. Here, we discuss the range of ocular infections that these species have been documented to cause and treatment options for these infections. Although a highly diverse spectrum of species has been isolated from the eye, the majority of infections are caused by Gram-positive species, and in most infections, empiric treatments are effective.
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Affiliation(s)
- Roger A Astley
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Md Huzzatul Mursalin
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Phillip S Coburn
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Erin T Livingston
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - James W Nightengale
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Eddy Bagaruka
- Department of Biology, Oklahoma Christian University, Edmond, OK 73013, USA
| | - Jonathan J Hunt
- Department of Biology, Oklahoma Christian University, Edmond, OK 73013, USA
| | - Michelle C Callegan
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- Dean McGee Eye Institute, Oklahoma City, OK 73104, USA
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Bullimore MA, Richdale K. Incidence of Corneal Adverse Events in Children Wearing Soft Contact Lenses. Eye Contact Lens 2023; 49:204-211. [PMID: 36877990 PMCID: PMC10503544 DOI: 10.1097/icl.0000000000000976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVES There is increasing interest in fitting children with soft contact lenses, in part due to the increase in prescribing of designs to slow the progression of myopia. This literature review summarizes large prospective and retrospective studies that include data on the incidence of microbial keratitis and corneal infiltrative events (CIEs) in children wearing soft contact lenses. METHODS Peer-reviewed prospective and retrospective studies that report contact lens-related complications in children with at least one year of wear and at least 100 patient years of wear were identified. RESULTS Seven prospective studies published between 2004 and 2022 were identified representing 3,752 patient years of wear in 1,756 children, nearly all of whom were fitted at age 12 years or younger. Collectively, they report one case of microbial keratitis and 53 CIEs, of which 16 were classified as symptomatic. The overall incidence of microbial keratitis was 2.7 per 10,000 patient years (95% CI: 0.5-15), and the incidence of symptomatic CIEs was 42 per 10,000 patient years (95% CI: 26-69). Two retrospective studies were identified representing 2,545 patient years of wear in 1,025 children, fitted at age 12 years or younger. One study reports two cases of microbial keratitis giving an incidence of 9.4 per 10,000 patient years (95% CI: 0.5-15). CONCLUSIONS Accurate classification of CIEs is challenging, particularly in retrospective studies. The incidence of microbial keratitis in children wearing soft lenses is no higher than in adults, and the incidence of CIEs seems to be markedly lower.
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Sakr SI, Nayel AA, Habeel CS, Elkhabiry HK, Ibrahim GM, Tolba MM, Ghaith AA. Epidemiological profile of microbial keratitis in Alexandria-Egypt a 5 years retrospective study. J Ophthalmic Inflamm Infect 2023; 13:18. [PMID: 37055636 PMCID: PMC10102273 DOI: 10.1186/s12348-023-00332-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/26/2023] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVE To evaluate the epidemiologic profile of microbial keratitis in Alexandria- Egypt, with special emphasis on risk factors, visual outcome and microbiological results. METHODS This retrospective study reviewed files of patients treated for microbial keratitis during a period of 5 years at Alexandria Ophthalmology Hospital Cornea Clinic, Alexandria- Egypt, between February 2017 and June 2022. The patients were evaluated for the risk factors e.g., trauma, eyelid disorders, co-morbidities, and contact lens use. They were also evaluated for their clinical picture, the identified microorganisms, visual outcomes, and complications. Non-microbial keratitis and incomplete files were excluded from the study. RESULTS A total of 284 patients were diagnosed as microbial keratitis in our study. Viral keratitis was the most common cause of microbial keratitis (n = 118 (41.55%)), followed by bacterial keratitis (n = 77 (27.11%)), mixed keratitis (n = 51 (17.96%)), acanthamoeba keratitis (n = 22 (7.75%)) and the least cause was fungal keratitis (n = 16 (5.63%)). Trauma was the most common risk factor for microbial keratitis (29.2%). Fungal keratitis had a statistically significant association with trauma (p < 0.001), while the use of contact lenses had a statistically significant association with Acanthamoeba keratitis (p < 0.001). The percentage of culture-positive results in our study was 76.8%. Gram-positive bacteria were the most frequently isolated bacterial isolate (n = 25 (36.2%)), while filamentous fungi were the most frequently isolated fungi (n = 13(18.8%)). After treatment, there was a significant increase in the mean visual acuity among all groups; it was significantly higher in Acanthamoeba keratitis group with a mean difference of 0.262 ± 0.161 (p = 0.003). CONCLUSION Viral keratitis followed by bacterial keratitis were the most frequent etiologic agents causing microbial keratitis found in our study. Although trauma was the most frequent risk factor for microbial keratitis, contact lens wear was found an important preventable risk factor for microbial keratitis in young patients. Performing culture properly whenever indicated before starting antimicrobial treatment increased the cultures' positive results.
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Affiliation(s)
- Suzan Ibrahim Sakr
- Cornea Clinic, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt.
| | - Amira Ahmed Nayel
- Clinical Pharmacy Department, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt
| | - Christeena Saeed Habeel
- Cornea Clinic, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt
| | - Hala Kamal Elkhabiry
- Microbiology Department, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt
| | - Ghada Mahmoud Ibrahim
- Microbiology Department, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt
| | | | - Alaa Atef Ghaith
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Ung L, Chodosh J. Urgent unmet needs in the care of bacterial keratitis: An evidence-based synthesis. Ocul Surf 2023; 28:378-400. [PMID: 34461290 PMCID: PMC10721114 DOI: 10.1016/j.jtos.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/21/2022]
Abstract
Bacterial corneal infections, or bacterial keratitis (BK), are ophthalmic emergencies that frequently lead to irreversible visual impairment. Though increasingly recognized as a major cause of global blindness, modern paradigms of evidence-based care in BK have remained at a diagnostic and therapeutic impasse for over half a century. Current standards of management - based on the collection of corneal cultures and the application of broad-spectrum topical antibiotics - are beset by important yet widely underrecognized limitations, including approximately 30% of all patients who will develop moderate to severe vision loss in the affected eye. Though recent advances have involved a more clearly defined role for adjunctive topical corticosteroids, and novel therapies such as corneal crosslinking, overall progress to improve patient and population-based outcomes remains incommensurate to the chronic morbidity caused by this disease. Recognizing that the care of BK is guided by the clinical axiom, "time equals vision", this chapter offers an evidence-based synthesis for the clinical management of these infections, underscoring critical unmet needs in disease prevention, diagnosis, and treatment.
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Affiliation(s)
- Lawson Ung
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
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Abstract
Infectious keratitis is a rare but potentially severe sight-threatening disease, associated with considerable societal burden, cost and morbidity. This review summarises the most recent evidence for the incidence, risk factors and impact of disease, all of which vary widely according to region, access to health care, socioeconomic and environmental factors, predisposing conditions and causative organisms. The frequency and societal impact of infectious keratitis are significantly higher in low-income countries. In non-viral infectious keratitis, bacterial causes predominate in most regions. Fungi, particularly linked with agricultural trauma, are more frequently associated with infectious keratitis in low-income regions, particularly in India and certain African countries. The disease impact is compounded by poverty and limited access to services and treatment. Early diagnosis, access to appropriate treatment, prophylaxis in ocular trauma, availability of eye protection, awareness of risk factors may be associated with reduced disease severity and vision loss. Evidence for the incidence and burden of disease is lacking in certain regions and well-designed epidemiological studies to identify independent risk factors for the disease and those associated with more severe outcomes may better identify causation and guide resource allocation and preventative strategies.
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Affiliation(s)
- Fiona Stapleton
- School of Optometry and Vision Science, UNSW, Level 3, North Wing, RMB, Gate 14, Barker St, Sydney, NSW, 2052, Australia.
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Zhang Y, Xu X, Wei Z, Cao K, Zhang Z, Liang Q. The global epidemiology and clinical diagnosis of Acanthamoeba keratitis. J Infect Public Health 2023; 16:841-852. [PMID: 37030037 DOI: 10.1016/j.jiph.2023.03.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/05/2023] [Accepted: 03/20/2023] [Indexed: 04/10/2023] Open
Abstract
Acanthamoeba keratitis is a rare parasitic infection of the cornea that can lead to permanent blindness if not diagnosed and treated promptly. We collected data on the incidences of Acanthamoeba keratitis from 20 countries and calculated an annual incidence of 23,561 cases, with the lowest rates in Tunisia and Belgium, and the highest in India. We analyzed 3755 Acanthamoeba sequences from the GenBank database across Asia, Europe, North America, South America, and Oceania and genotyped them into T1, T2, T3, T4, T5, T10, T11, T12, and T15. Many genotypes possess different characteristics, yet T4 is the most prevalent genotype. As efficient treatment against Acanthamoeba remains lacking, prevention from early diagnosis via staining, PCR, or in vivo confocal microscopy (IVCM) becomes significant for the condition's prognosis. IVCM is the most recommended approach for the early detection of Acanthamoeba. If IVCM is unavailable, PCR should be used as an alternative.
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Affiliation(s)
- Yuheng Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100005, China
| | - Xizhan Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100005, China
| | - Zhenyu Wei
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100005, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100005, China
| | - Zijun Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100005, China
| | - Qingfeng Liang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100005, China.
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Lakkis C, Lorenz KO, Mayers M. Topical Review: Contact Lens Eye Health and Safety Considerations in Government Policy Development. Optom Vis Sci 2022; 99:737-742. [PMID: 36067391 PMCID: PMC9553256 DOI: 10.1097/opx.0000000000001937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE As new federal or state policies are introduced in the United States to shape the evolving contact lens market, it has never been more important to amplify the importance of patient health and safety during contact lens wear and promote the value of the eye care professional-patient relationship.Within the United States, contact lenses are regulated by the Food and Drug Administration as class II or III medical devices that require additional regulatory and professional oversight to keep consumers safe. The contact lens market and broader eye health landscape are rapidly changing. Recently, the U.S. Federal Trade Commission finalized its 10-year review of the Contact Lens Rule, implementing new policies that will shape the contact lens market in the United States for years to come. The purpose of this clinical perspective was to compile and review key data regarding contact lens-related adverse events, including their economic impact on the health care system, to inform government policy development. Although contact lenses provide many benefits to the wearer, a variety of complications can occur ranging from asymptomatic events or mild discomfort to severe sight-threatening adverse events such as microbial keratitis. Patients who do not routinely visit their eye care professional or do not receive the lenses prescribed to them are at a greater risk of contact lens-related adverse events. Nearly 1 million people in the United States experience ocular infections or inflammation annually, resulting in significant health care costs. The economic burden of contact lens-related microbial keratitis in the United States has been estimated to be approximately $175 million annually. The importance of eye care professional oversight of contact lens wear cannot be emphasized enough to key stakeholders, including lawmakers, government regulators, contact lens manufacturers and distributors, and the broader eye health community.
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Affiliation(s)
- Carol Lakkis
- iBiomedical Consulting, Neptune Beach, Florida
- University of Houston College of Optometry, Houston, Texas
| | | | - Michael Mayers
- Johnson and Johnson Vision Care, Inc., Jacksonville, Florida
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Maier P, Kammrath Betancor P, Reinhard T. Contact Lens-Associated Keratitis-an Often Underestimated Risk. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:669-674. [PMID: 35912449 PMCID: PMC9830382 DOI: 10.3238/arztebl.m2022.0281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 04/19/2022] [Accepted: 07/07/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Millions of people in Germany wear contact lenses every day. Deficient contact lens hygiene can lead to corneal infection. Contact lens-associated keratitis usually has a highly acute presentation and can cause long-term visual loss. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed, as well as on relevant metaanalyses, Cochrane reviews, and reports by national and international health care authorities. RESULTS 23-94% of contact lens wearers report associated discomfort and eye problems. The annual incidence of contact lens-associated keratitis is 2-4/10 000. It is due to bacteria in 90% of cases, and much less commonly to acanthamoebae and fungi. The pathogens generally arrive with the contact lens on the surface of the eye and can penetrate into the corneal tissue because the tear film under the lens is not swept away from the ocular surface by the eyelids, and corneal epithelial changes are often present as well. Corneal infiltration that is diagnosed early is often self-limited, but advanced bacterial infection usually requires intense topical antibiotic treatment. Some severe infections can only be eradicated by emergency corneal transplantation; this is the case in 20-30 % of fungal and acanthamoebic infections. CONCLUSION The wearing of contact lenses, particularly soft ones, is associated with a risk of microbial keratitis if proper contact lens hygiene is not exercised. Contact lens-associated keratitis very rarely causes permanent damage to eyesight (0.6 cases per 10 000 contact lens wearers per year). The use of contact lenses always calls for meticulous care.
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Affiliation(s)
- Philip Maier
- Eye Center, Medical Center, University of Freiburg,*Klinik für Augenheilkunde Universitätsklinikum Freiburg Killianstr. 5 79106 Freiburg, Germany
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Kawulok ER, Nau CB, Schornack MM. Microbial Keratitis Associated With Penetrating Keratoplasty and Scleral Lens Wear: A Case Series. Eye Contact Lens 2022; 48:217-221. [PMID: 35333807 DOI: 10.1097/icl.0000000000000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To report on microbial keratitis (MK) in three scleral lens (SL) wearers who had undergone penetrating keratoplasty (PKP). METHODS This retrospective case series describes 3 cases of MK in patients who wore SLs after PKP. RESULTS All three patients wore SLs for visual rehabilitation for corneal irregularity induced by PKP; all three also had concurrent ocular surface disease (keratoconjunctivitis sicca and corneal exposure). Cultures identified the causative organism in two patients, and septated hyphae suggestive of fungal infection were identified in tissue removed during therapeutic PKP in the third patient. All three patients were receiving either topical or systemic immunosuppressive therapy before the infection developed. CONCLUSIONS Scleral lenses are often used to manage complex ocular disease, which can make it difficult to determine the precise cause of complications that arise after wearing the lenses. Multiple factors, including SL wear, may have contributed to the initial development of MK in the three patients in this case series. Patients who wear SLs after PKP should be monitored closely.
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Affiliation(s)
- Eric R Kawulok
- Department of Ophthalmology (E.R.K.), Mayo Clinic, Scottsdale, AZ; and Department of Ophthalmology (C.B.N., M.M.S.), Mayo Clinic, Rochester, MN
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Stapleton F, Shrestha GS, Vijay AK, Carnt N. Epidemiology, Microbiology, and Genetics of Contact Lens-Related and Non-Contact Lens-Related Infectious Keratitis. Eye Contact Lens 2022; 48:127-133. [PMID: 35192567 DOI: 10.1097/icl.0000000000000884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 01/14/2023]
Abstract
ABSTRACT Infectious keratitis is a rare but severe condition associated with a range of ocular and systemic predisposing conditions, including ocular trauma, prior surgery, surface disease, and contact lens (CL) wear. This review explores the epidemiology of infectious keratitis, specifically the differences in disease incidence and risk factors, causative organism profile and virulence characteristics and host microbiome, genetics, gene expression, proteomics, and metabolomic characteristics in CL-related and non-CL-related diseases. Differences exist in the epidemiology, demographics, causative organisms, and their virulence characteristics in CL-related and non-CL-related diseases, and there is less evidence to support differences between these groups of individuals in the ocular surface microbiome, genetics, and pathways of disease. Genetic variations, however, in the host immune profile are implicated in both the onset and severity of infectious keratitis in CL and non-CL wearers. As technologies in metabolomics, proteomics, and genomics improved to be better able to process small-volume samples from the ocular surface, there will be improved understanding of the interplay between the CL, ocular surface, host immune profile, and the microbial environment. This may result in a more personalized approach in the management of disease to reduce disease severity.
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Affiliation(s)
- Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Australia
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Shigeyasu C, Yamada M, Fukuda M, Koh S, Suzuki T, Toshida H, Oie Y, Nejima R, Eguchi H, Kawasaki R, Nishida K. Severe Ocular Complications Associated With Wearing of Contact Lens in Japan. Eye Contact Lens 2022; 48:63-68. [PMID: 34860721 DOI: 10.1097/icl.0000000000000870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the severe ocular complications associated with contact lens wearing in Japan. METHOD A questionnaire was sent to 964 ophthalmologist training facilities inquiring for cases of contact lens-associated complications from April 2016 to March 2018. The inclusion criteria were as follows: (1) corrected distance visual acuity ≤0.1 decimal after treatment for 3 months, (2) corneal perforation observed during follow-up, and (3) requiring surgery. A secondary analysis was conducted, inquiring for further information on the type of contact lens, clinical manifestations, and course of treatment. RESULTS Forty-two patients with infectious keratitis met the inclusion criteria. Eight patients were users of rigid gas-permeable contact lens, and 34 were users of soft contact lens. Microbiological tests were positive in 73.0%. The organisms isolated in microbiological culture were bacteria in 11 patients (Pseudomonas aeruginosa in 9 patients), fungi in 2 patients, and Acanthamoeba in 14 patients. Ten patients were treated with local antibiotics, 11 with a combination of systemic antibiotics, and 21 with a combination of surgical approaches, including 13 with corneal transplantation. CONCLUSIONS The major cause of serious contact lens-associated ocular complications was microbial keratitis, and P. aeruginosa and Acanthamoeba were the major pathogens in Japan.
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Affiliation(s)
- Chika Shigeyasu
- Department of Ophthalmology (C.S., M.Y.), Kyorin University School of Medicine, Tokyo, Japan ; Department of Ophthalmology (M.F.), Kindai University Faculty of Medicine, Nara Hospital, Nara, Japan ; Department of Ophthalmology (S.K., Y.O., R.K., K.N.), Osaka University Graduate School of Medicine, Osaka, Japan ; Department of Ophthalmology (T.S.), Toho University School of Medicine, Omori Medical Center, Tokyo, Japan ; Department of Ophthalmology (H.T.), Juntendo University School of Medicine, Shizuoka Hospital, Shizuoka, Japan ; Miyata Eye Hospital (R.N.), Miyazaki, Japan; and Department of Ophthalmology (H.E.), Kindai University Faculty of Medicine, Osakasayama, Japan
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Dong PN, Hang DTT, Duong NTN, Lien MT, Chen AC, Aldave AJ. Infectious keratitis in Vietnam: etiology, organisms, and management at Vietnam National Eye Hospital. Int J Ophthalmol 2022; 15:128-134. [PMID: 35047367 DOI: 10.18240/ijo.2022.01.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/06/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To report the etiologies, risk factors, treatments, and outcomes of infectious keratitis (IK) at a major Vietnamese eye hospital. METHODS This is a retrospective review of all cases of IK at Vietnam National Eye Hospital (VNEH) in Hanoi, Vietnam. Medical histories, demographics, clinical features, microbiological results, and treatment outcomes were reviewed. RESULTS IK was diagnosed in 1974 eyes of 1952 patients, with ocular trauma being the greatest risk factor for IK (34.2%), frequently resulting from an agriculture-related injury (53.3%). The mean duration between symptom onset and presentation to VNEH was 19.3±14.4d, and 98.7% of patients had been treated with topical antibiotic and/or antifungal agents prior to evaluation at VNEH. Based on smear results of 1706 samples, the most common organisms identified were bacteria (n=1107, 64.9%) and fungi (n=1092, 64.0%), with identification of both bacteria and fungi in 614 (36.0%) eyes. Fifty-five of 374 bacterial cultures (14.7%) and 426 of 838 fungal cultures (50.8%) were positive, with the most commonly cultured pathogens being Pseudomonas aeruginosa, Streptococcus pneumonia, Fusarium spp., and Aspergillus spp. Corneal perforation and descemetocele developed in 391 (19.8%) and 93 (4.7%) eyes, respectively. Medical treatment was successful in resolving IK in 50.4% eyes, while 337 (17.1%) eyes underwent penetrating or anterior lamellar keratoplasty. Evisceration was performed in 7.1% of eyes, most commonly in the setting of fungal keratitis. CONCLUSION Ocular trauma is a major risk factor for IK in Vietnam, which is diagnosed in almost 400 patients each year at VNEH. Given this, and as approximately one quarter of the eyes that develop IK require corneal transplantation or evisceration, greater emphasis should be placed on the development of prevention and treatment programs for IK in Vietnam.
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Affiliation(s)
| | | | | | | | - Angela C Chen
- Stein Eye Institute, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Anthony J Aldave
- Stein Eye Institute, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
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de Paiva ADCM, Ferreira MDC, da Fonseca ADS. Photodynamic therapy for treatment of bacterial keratitis. Photodiagnosis Photodyn Ther 2022; 37:102717. [PMID: 35021106 DOI: 10.1016/j.pdpdt.2022.102717] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/23/2021] [Accepted: 01/07/2022] [Indexed: 12/22/2022]
Abstract
Microbial keratitis is the main cause of corneal opacification and the fourth leading cause of blindness worldwide, with bacteria the major infectious agent. Recently, bacterial keratitis has become a serious threat due to routine use of antibiotics leading to selection of resistant and multidrug-resistant bacteria strains. New approaches for treatment of bacterial keratitis are necessary to outcome the increasing antibiotic resistance. Antimicrobial photodynamic therapy is based on three agents: photosensitizer, oxygen, and light radiation. This therapy has been successful for treatment of infections in different tissues and organs as well as against different type of infectious agents and no resistance development. Also, new photosensitizers are being developed that has increased the spectrum of therapeutic protocols for treatment of a number of infectious diseases. Thus, antimicrobial photodynamic therapy has an extraordinary potential for treatment of those bacterial keratitis cases that actually are not solved by traditional antibiotic therapy.
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Affiliation(s)
- Alexandre de Carvalho Mendes de Paiva
- Hospital Universitário Gaffrée e Guinle, Universidade Federal do Estado do Rio de Janeiro, Rua Mariz e Barros, 775, Maracanã, Rio de Janeiro 20270002, Brazil
| | - Michelle da Costa Ferreira
- Faculdade de Odontologia, Universidade do Estado do Rio de Janeiro, Boulevard Vinte e Oito de Setembro, 157, Vila Isabel, Rio de Janeiro 20551030, Brazil
| | - Adenilson de Souza da Fonseca
- Departamento de Ciências Fisiológicas, Instituto Biomédico, Universidade Federal do Estado do Rio de Janeiro, Rua Frei Caneca, 94, Rio de Janeiro 20211040, Brazil; Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Boulevard Vinte e Oito de Setembro, 87 fundos, 4º andar, Vila Isabel, Rio de Janeiro 20551030, Brazil; Centro de Ciências da Saúde, Centro Universitário Serra dos Órgãos, Avenida Alberto Torres, 111, Teresópolis, Rio de Janeiro 25964004, Brazil.
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Lim Wen Siang J, Wu Zhuan O, Yi Chen N, Sok Lin N. Profile of Microbial Keratitis. Cureus 2021; 13:e20663. [PMID: 35103213 PMCID: PMC8784021 DOI: 10.7759/cureus.20663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose: To study the demographic characteristics, predisposing factors, and latest trends of causative organisms and to analyze the prognostic factors of visual outcome in microbial keratitis. Methods: A retrospective study of patients diagnosed with microbial keratitis who required hospital admission in the period between January 2018 and December 2020 in Taiping Hospital, Perak, Malaysia. Results: A total of 75 eyes of 74 patients who were admitted to the hospital were studied. The male to female ratio was 13.8:1. Seventy percent of patients in this study were within the productive age group between 20 and 59 years old, with a mean age of 48 years old, and 51.4% of them were labourers. Cornea foreign bodies (42, 56%) were the most common predisposing factors and were associated with good visual outcomes (P<0.005). Other significant predictors for the final visual outcome were: presenting visual acuity, size of ulcer, duration of hospitalization, and duration of resolution. The mean duration of hospitalization was seven days. Corneal scrapings were done in all cases where 44 eyes (58.7%) were found to be positive for growth. Ten eyes (13.3%) that ended up with evisceration yielded a positive result. Gram-negative bacteria was the most prevalent causative organism of infective keratitis in the local/this region. Pseudomonas sp (20, 26.7%) being the most common bacterial isolate, was seen in all four contact lens-related cases and was associated with poor visual outcome and a high rate of evisceration. Patients who developed complications such as cornea melting (9, 12%), cornea perforation (11, 14.7%) and endophthalmitis (7, 9.3%) were associated with poor visual outcomes. Likewise, patients who required therapeutic interventions such as corneal gluing, tarsorrhaphy, and penetrating keratoplasty generally had poor visual outcomes (P<0.005; P=0.000008). Conclusion: Microbial keratitis is a major cause of ocular morbidity globally. Understanding the demographic and epidemiological characteristics of microbial keratitis of the region is important in the initial prompt treatment of the patients and may eventually improve the visual outcome.
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Green M, Zhang S, Nadivulath T, Apel A, Stapleton F. Clinical factors associated with positive corneal culture in suspected microbial keratitis. Cont Lens Anterior Eye 2021; 45:101543. [PMID: 34949563 DOI: 10.1016/j.clae.2021.101543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/03/2022]
Abstract
AIMS Determine demographic and clinical characteristics associated with positive culture in suspected microbial keratitis. METHODS Retrospective 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). RESULTS Univariate 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%). CONCLUSIONS In 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.
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Affiliation(s)
- Matthew Green
- Ophthalmology Department, Gold Coast University Hospital, Gold Coast, Australia
| | - Susan Zhang
- Ophthalmology Department, Sunshine Coast Hospital and Health Service, Sunshine Coast, Australia.
| | - Thomas Nadivulath
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Andrew Apel
- Princess Alexandra Hospital, Brisbane, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Lasagni Vitar RM, Bonelli F, Rama P, Ferrari G. Immunity and pain in the eye: focus on the ocular surface. Clin Exp Immunol 2021; 207:149-163. [PMID: 35020868 PMCID: PMC8982975 DOI: 10.1093/cei/uxab032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/21/2021] [Accepted: 12/10/2021] [Indexed: 02/03/2023] Open
Abstract
Most ocular diseases are associated with pain. While pain has been generally considered a mere (deleterious) additional symptom, it is now emerging that it is a key modulator of innate/adaptive immunity. Because the cornea receives the highest nerve density of the entire body, it is an ideal site to demonstrate interactions between pain and the immune response. Indeed, most neuropeptides involved in pain generation are also potent regulators of innate and adaptive leukocyte physiology. On the other hand, most inflammatory cells can modulate the generation of ocular pain through release of specific mediators (cytokines, chemokines, growth factors, and lipid mediators). This review will discuss the reciprocal role(s) of ocular surface (and specifically: corneal) pain on the immune response of the eye. Finally, we will discuss the clinical implications of such reciprocal interactions in the context of highly prevalent corneal diseases.
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Affiliation(s)
- Romina Mayra Lasagni Vitar
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Filippo Bonelli
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Rama
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Ferrari
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy,Correspondence: Giulio Ferrari, Cornea and Ocular Surface Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy. E-mail:
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Lasagni Vitar RM, Triolo G, Fonteyne P, Acuti Martellucci C, Manzoli L, Rama P, Ferrari G. Epidemiology of Corneal Neovascularization and Its Impact on Visual Acuity and Sensitivity: A 14-Year Retrospective Study. Front Med (Lausanne) 2021; 8:733538. [PMID: 34722575 PMCID: PMC8551447 DOI: 10.3389/fmed.2021.733538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To quantify the severity and location of corneal neovascularization (cNV) and its impact on the visual acuity and corneal sensitivity in a cohort of the patients referred to a specialist cornea clinic and also to describe the etiology of cNV in the cohort. Methods: We retrospectively evaluated the charts of 13,493 subjects referred to the San Raffaele Cornea Unit between January 2004 and December 2018 to search for cNV diagnosis. The corneal neovascularization severity was measured in the quadrants (range: 1–4) and location was defined as superficial, deep, or both. Best spectacle corrected visual acuity (BSCVA) was measured in logMar. We used the multiple regression analysis to identify the independent predictors of logMAR, after adjusting for age, gender, keratoconus, herpes keratitis, penetrating keratoplasty, trauma, and cataract surgery. Results: Corneal neovascularization was diagnosed in 10.4% of the patients analyzed. The most prevalent etiology of cNV in our population was non-infectious corneal dystrophies/degenerations followed by herpes simplex virus infection. cNV affected OD, OS, or both eyes in 35.6, 40.2, and 24.2 of cases, respectively. Mean BSCVA (SD) was 0.59 (0.76), 0.74 (0.94), and 1.24 (1.08) in cNV one, two, and three or four of the quadrant groups. Superficial, deep, or mixed cNV occurred in 1,029, 348, and 205 eyes. Severe cNV (three or four of the quadrants) was a significant predictor of low visual acuity (p < 0.001) and reduced corneal sensitivity (p < 0.05). cNV location and its severity were associated (p < 0.05). In addition, corneal anesthesia was associated with lower BSCVA (p < 0.001). Conclusion: Severe and deep cNV are associated with the reduced visual acuity and corneal sensitivity. Our data strongly support the relevance of appropriate follow-up as cNV is a major risk factor for graft rejection.
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Affiliation(s)
- Romina Mayra Lasagni Vitar
- Cornea and Ocular Surface Unit, Eye Repair Lab, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Giacinto Triolo
- Ophthalmic Institute, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Philippe Fonteyne
- Cornea and Ocular Surface Unit, Eye Repair Lab, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | | | - Lamberto Manzoli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Paolo Rama
- Cornea and Ocular Surface Unit, Eye Repair Lab, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Ferrari
- Cornea and Ocular Surface Unit, Eye Repair Lab, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
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22
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Loo J, Woodward MA, Prajna V, Kriegel MF, Pawar M, Khan M, Niziol LM, Farsiu S. Open-Source Automatic Biomarker Measurement on Slit-Lamp Photography to Estimate Visual Acuity in Microbial Keratitis. Transl Vis Sci Technol 2021; 10:2. [PMID: 34605877 PMCID: PMC8496413 DOI: 10.1167/tvst.10.12.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose To assess clinical applicability of automatic image analysis in microbial keratitis (MK) by evaluating the relationship between biomarker measurements on slit-lamp photography (SLP) and best-corrected visual acuity (BCVA). Methods Seventy-six patients with MK with SLP images and same-day logarithm of the minimum angle of resolution (logMAR) BCVA were evaluated. MK biomarkers (stromal infiltrate, white blood cell infiltration, corneal edema, hypopyon, epithelial defect) were segmented manually by ophthalmologists and automatically by a novel, open-source, deep learning–based segmentation algorithm. Five measurements (presence, maximum width, total area, proportion of the corneal limbus area affected, centrality) were calculated. Correlations between the measurements and BCVA were calculated. An automatic regression model estimated BCVA from the measurements. Differences in performance between using manual and automatic measurements were evaluated using William's test (for correlation) and the paired-sample t-test (for absolute error). Results Measurements had high correlations of 0.86 (manual) and 0.84 (automatic) with true BCVA. Estimated BCVA had average (mean ± SD) absolute errors of 0.39 ± 0.27 logMAR (manual, median: 0.30) and 0.35 ± 0.28 logMAR (automatic, median: 0.30) and high correlations of 0.76 (manual) and 0.80 (automatic) with true BCVA. Differences between using manual and automatic measurements were not statistically significant for correlations of measurements with true BCVA (P = .66), absolute errors of estimated BCVA (P = .15), or correlations of estimated BCVA with true BCVA (P = .60). Conclusions The proposed algorithm measured MK biomarkers as accurately as ophthalmologists. Measurements were highly correlated with and estimative of visual acuity. Translational Relevance This study demonstrates the potential of developing fully automatic objective and standardized strategies to aid ophthalmologists in the clinical assessment of MK.
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Affiliation(s)
- Jessica Loo
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Venkatesh Prajna
- Department of Cornea and Refractive Services, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Matthias F Kriegel
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA.,Department of Ophthalmology, Augenzentrum am St. Franziskus Hospital Münster, Münster, Germany
| | - Mercy Pawar
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Mariam Khan
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Sina Farsiu
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.,Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
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Wu YTY, Ho A, Naduvilath T, Lim C, Carnt N, Keay LJ, Edwards KP, Stapleton F. Author's reply. Ophthalmic Physiol Opt 2021; 41:1387-1388. [PMID: 34496077 DOI: 10.1111/opo.12883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yvonne Tzu-Ying Wu
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Arthur Ho
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,Vision Cooperative Research Centre, Sydney, New South Wales, Australia.,Brien Holden Vision Institute, Sydney, New South Wales, Australia
| | - Thomas Naduvilath
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,Brien Holden Vision Institute, Sydney, New South Wales, Australia
| | - Chris Lim
- Department of Ophthalmology, National University Health System, Singapore, Singapore
| | - Nicole Carnt
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,Brien Holden Vision Institute, Sydney, New South Wales, Australia
| | - Lisa J Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,Vision Cooperative Research Centre, Sydney, New South Wales, Australia
| | - Katie P Edwards
- Vision Cooperative Research Centre, Sydney, New South Wales, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,Vision Cooperative Research Centre, Sydney, New South Wales, Australia
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Bradley CS, Sicks LA, Pucker AD. Common Ophthalmic Preservatives in Soft Contact Lens Care Products: Benefits, Complications, and a Comparison to Non-Preserved Solutions. CLINICAL OPTOMETRY 2021; 13:271-285. [PMID: 34522149 PMCID: PMC8434857 DOI: 10.2147/opto.s235679] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/24/2021] [Indexed: 05/23/2023]
Abstract
PURPOSE Preservatives are essential for preventing contact lens (CL)-related microbial keratitis (MK). The purpose of this review is to summarize the current knowledge related to the use of common ophthalmic preservatives in CL care products with respect to both safety and efficacy. METHODS Manuscripts written in English were obtained by searching PubMed.gov with the term contact lens plus antimicrobial, benzalkonium chloride, biguanide, Aldox, polyquaternium, preservative, thimerosal, EDTA (ethylenediaminetetraacetic acid), chlorhexidine, or blister pack. RESULTS This review found that first-generation preservatives are no longer used in CL multipurpose solutions (MPS) due to their high levels of ocular toxicity. Modern, high-molecular-weight preservatives, including polyquaternium-1 (PQ-1) and biguanides (PHMB), are generally effective against bacteria, minimally effective against fungi, and not effective against Acanthamoeba. PQ-1 and PHMB are likely safe when used with CLs, but they may cause ocular adverse events, with roughly equal risk between the two preservatives. Some CL MPS contain both PQ-1 and PHMB, but no increased risk of adverse events has been reported when combining the two. Hydrogen-peroxide (H2O2) solutions are effective against all common ocular microbes, including Acanthamoeba, and they have been proven safe with proper compliance. Povidone-iodine (P-I) solutions are not currently commercially available in North America, but they have been shown in other countries to be safe and effective. CONCLUSION Patients should be monitored when using PQ-1 or PHMB-containing solutions since they have been associated with ocular adverse events. If events are detected, patients should be switched to an alternative solution. H2O2 or P-I solutions are preferred for any patient who may expose their CLs to water because they are the only solution categories effective against Acanthamoeba.
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Affiliation(s)
| | | | - Andrew D Pucker
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
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25
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Stapleton F, Lim CHL, Kweon S, Tan D, Mehta JS. Cosmetic Contact Lens-Related Corneal Infections in Asia. Am J Ophthalmol 2021; 229:176-183. [PMID: 33727002 DOI: 10.1016/j.ajo.2021.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To explore demographics, disease characteristics, and wear habits in cosmetic contact lens (CL)-related corneal infections in Asia. DESIGN Prospective multicenter cross-sectional study. METHODS Cases of CL-related corneal infection presenting over a 12-month period were prospectively identified from 11 centers in 8 countries in Asia. Case demographics, clinical features, microbiology, and compliance characteristics were compared between wearers using CLs for cosmetic purposes and those using CLs for the correction of refractive errors. RESULTS Six hundred and ninety-four CL wearers with corneal infection presented: 204 cosmetic CL (29.4%) and 490 (70.6%) refractive CL wearers. Cosmetic CL infections comprised 7%-54% of cases across the region. Compared with noncosmetic CL wearers, cosmetic CLs wearers were significantly more likely to be female (90% vs 59%), young (aged <25, 68% vs 44%), and to have a shorter period of wear experience. Lenses worn by cosmetic CL wearers were more likely to be hydrogel materials and manufactured with the pigment located on the back surface of the CL. Presenting disease characteristics and visual outcomes were similar in both groups. Causative organisms were similar between the 2 groups; however, there was a higher rate of Acanthamoeba disease (9%) in cosmetic wearers, compared with refractive wearers (1%; P < .005). CONCLUSIONS Cosmetic CL infections represent a significant proportion of CL-related infections in Asia. Cosmetic CL users with corneal infections are generally young, female, and wearing hydrogel CLs. Internet supply, quality control, and regulation of the sale of these products provide significant challenges in managing this population of vulnerable wearers.
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Perez-Gutierrez L, Martin R. Regular soft contact lens wearers' comprehension of graphical symbols labelled on multipurpose solutions. Clin Exp Optom 2021; 105:514-519. [PMID: 34236287 DOI: 10.1080/08164622.2021.1945408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
CLINICAL RELEVANCE Symbols are commonly used to represent information of health care products included multipurpose solutions (MPSs) for contact lens (CL) care. BACKGROUND Little knowledge is available about recognition and comprehension by regular soft CL wearers of commonly used symbols in the instructions of CL MPSs marketed worldwide. METHODS CL wearers from the UK and Spain were invited to answer an anonymous on-line questionnaire (distributed though Facebook and Twitter) concerning the recognition and comprehension of seven common symbols (ISO 15223:2017 and EN 980:2008) included in MPS package instructions. RESULTS Answers of one hundred-ten soft CL wearers who use MPS (27 in the UK and 83 in Spain) were analysed showing low recognition and comprehension of the surveyed symbols even in wearers with > 5 years of CL wear (71.8%). The CE marked was the most recognised (96% in the UK and 88% in Spain, P = 0.29) and understood (78% in the UK and 85% in Spain, P = 0.25) symbol, but other important symbols, such as 'Caution' and 'Do not reuse', were under recognised (22% in the UK and 19% in Spain, P = 0.78 and 11% in the UK and 6% in Spain, P = 0.40 respectively) and understood (close to 30% in both countries P > 0.15). Participants with > 5 years of experience, showed slightly higher comprehension (P < 0.05) in some symbols ('Sterilised'; 'Do not reuse'; 'Use by date' and 'CE marked'). CONCLUSION These results suggest an insufficient comprehension of seven common symbols included in MPS instructions among regular CL wearers in the UK and Spain without high impact of CL wear experience. Improving the education and symbol comprehension of regular CL wearers could help to get better patients' behaviour and safe use of MPS in soft CLs care.
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Affiliation(s)
- Lidia Perez-Gutierrez
- Faculty of Sciences, School of Optometry, University of Valladolid, Valladolid, Spain
| | - Raul Martin
- IOBA Eye Institute, University of Valladolid, Valladolid, Spain
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Enzor R, Bowers EM, Perzia B, Perera C, Palazzolo L, Mammen A, Dhaliwal DK, Kowalski RP, Jhanji V. Comparison of Clinical Features and Treatment Outcomes of Pseudomonas aeruginosa Keratitis in Contact Lens and Non-Contact Lens Wearers. Am J Ophthalmol 2021; 227:1-11. [PMID: 33657419 DOI: 10.1016/j.ajo.2021.02.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the outcomes of Pseudomonas aeruginosa keratitis (PAK) in contact lens wearers (CLWs) and non-contact lens wearers (non-CLWs) and identify risk factors for poor visual acuity (VA) outcomes in each group. DESIGN Retrospective cohort study METHODS: Two hundred fourteen consecutive cases of PAK were included between January 2006 and December 2019. Clinical features, microbiologic results, and treatment course were compared between CLW and non-CLW groups. Analyses of clinical features predicting poor final VA were performed. RESULTS This study identified 214 infected eyes in 207 patients with PAK, including 163 eyes (76.2%) in CLWs and 51 eyes (23.8%) in non-CLWs. The average age was 39.2 years in CLWs and 71.9 years in non-CLWs (P < .0001). The average logMAR visual acuity (VA) at presentation was 1.39 in CLWs and 2.17 in non-CLWs (P < .0001); average final VA was 0.76 in CLWs and 1.82 in non-CLWs (P < .0001). Stromal necrosis required a procedural or surgical intervention in 13.5% of CLWs and 49.0% of non-CLWs (P < .0001). A machine learning-based analysis yielded a list of clinical features that most strongly predict a poor VA outcome (worse than 20/40), including worse initial VA, older age, larger size of infiltrate or epithelial defect at presentation, and greater maximal depth of stromal necrosis. CONCLUSIONS Non-CLWs have significantly worse VA outcomes and required a higher rate of surgical intervention, compared with CLWs. Our study elucidates risk factors for poor visual outcomes in non-CLWs with PAK.
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Russello G, Moramarco A, Vizzini L, Farina C, Fontana L, Carretto E. Diagnostic approach and epidemiology of Microbial Keratitis: findings from an Italian Tertiary Care center. Diagn Microbiol Infect Dis 2021; 101:115470. [PMID: 34352436 DOI: 10.1016/j.diagmicrobio.2021.115470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 06/17/2021] [Accepted: 06/19/2021] [Indexed: 11/30/2022]
Abstract
Rapid identification of causative microorganisms of microbial keratitis (MK) and knowledge of the most common local pathogens are prerequisites for rational antimicrobial therapy. We retrospectively reviewed the characteristics of MK diagnosed at the IRCCS Arcispedale Santa Maria Nuova of Reggio Emilia (Italy) in a 5-years period, where the Ophthalmologist Unit is a reference center for corneal infections. During the study period, 183 MK were evaluated through corneal scrapings cultures. The positivity rate was 54,1%. A total of 107 microorganisms have been isolated: Acanthamoeba species was the etiologic agent in 19 cases. Pseudomonas aeruginosa and Staphylococcus aureus were more frequently isolated in bacterial keratitis, while Fusarium spp., Candida albicans, and Alternaria alternata were predominant among the fungal isolates. Strict cooperation between ophthalmologists and clinical microbiologists is advisable to allow the best diagnostic approach for MK.
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Affiliation(s)
- Giuseppe Russello
- Clinical Microbiology Laboratory, IRCCS Arcispedale S. Maria Nuova, AUSL Reggio Emilia, Italy
| | - Antonio Moramarco
- Ophthalmology Unit, IRCCS Arcispedale S. Maria Nuova, AUSL Reggio Emilia, Italy
| | - Loredana Vizzini
- Clinical Microbiology Laboratory, IRCCS Arcispedale S. Maria Nuova, AUSL Reggio Emilia, Italy
| | - Claudio Farina
- Clinical Microbiology and Virology Laboratory, ASST "Papa Giovanni XXIII", Bergamo, Italy
| | - Luigi Fontana
- Ophthalmology Unit, IRCCS Arcispedale S. Maria Nuova, AUSL Reggio Emilia, Italy
| | - Edoardo Carretto
- Clinical Microbiology Laboratory, IRCCS Arcispedale S. Maria Nuova, AUSL Reggio Emilia, Italy.
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Mordmuang A, Udomwech L, Karnjana K. Influence of Contact Lens Materials and Cleaning Procedures on Bacterial Adhesion and Biofilm Formation. Clin Ophthalmol 2021; 15:2391-2402. [PMID: 34135567 PMCID: PMC8197623 DOI: 10.2147/opth.s310862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/10/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose The present study aimed to compare the existing soft contact lens (CL) materials regarding their influence on bacterial biofilm formation and adhesion susceptibility. Then, the study was designed to investigate the effectiveness of various disinfecting solutions and evaluate the ability of cleaning regimens in terms of anti-bacterial adhesion and biofilm removal on different soft CL materials. Methods Bacterial biofilm formation on CLs was evaluated by biomass assay. Adhesion assay and standard plate count were carried out at time-interval periods within 24 h. Various CL disinfecting procedures were assessed for their efficacy to remove biofilm and reduce bacterial adhesion. Scanning electron microscopy (SEM) was performed for the morphological assessment of bacterial biofilm. Results Printed hydroxyethyl methacrylate (HEMA) CLs significantly demonstrated more biofilm staining and bacterial attachment when compared with non-printed HEMA CLs, while the Filcon II 3 and Nesofilcon A CLs possessed less biofilm biomass and adherent cells. Staphylococcus aureus and Pseudomonas aeruginosa represented the highest biofilm producing bacteria on HEMA-based materials in this study. The disinfecting regimen with the highest efficacy was the two-step system, first using multipurpose disinfecting solution containing edetate disodium and sorbic acid (MPDS+EDSA), followed by soaking in multipurpose solution (MPS). The regimen demonstrated the greatest effect against the pre-formed biofilm and the adhesion activity of S. aureus and P. aeruginosa on the soft CLs. The SEM micrographs confirmed the morphological changes of bacterial biofilm after disinfecting and revealed that the two-step system treated CLs displayed less adherent bacteria. Conclusion HEMA-based soft CLs may facilitate bacterial biofilm formation and adhesion capability. The two-step system was the most effective regimen for biofilm removal, where the soaking period in the disinfecting solution of the no-rub regimen should last more than 6 h to remove pre-formed biofilm.
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Affiliation(s)
| | - Lunla Udomwech
- School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand.,Walailak University Hospital, Walailak University, Nakhon Si Thammarat, Thailand
| | - Kulwadee Karnjana
- School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand
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Chen DZ, Chai C, Tan A, Ray M. Microbial patterns of Acanthamoeba keratitis at a Singapore ophthalmic referral hospital: A 5-year retrospective observational study. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:494-496. [PMID: 34195759 DOI: 10.47102/annals-acadmedsg.2020507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- David Z Chen
- Department of Ophthalmology, National University Hospital, Singapore
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Bullimore MA, Ritchey ER, Shah S, Leveziel N, Bourne RRA, Flitcroft DI. The Risks and Benefits of Myopia Control. Ophthalmology 2021; 128:1561-1579. [PMID: 33961969 DOI: 10.1016/j.ophtha.2021.04.032] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 02/09/2023] Open
Abstract
PURPOSE The prevalence of myopia is increasing around the world, stimulating interest in methods to slow its progression. The primary justification for slowing myopia progression is to reduce the risk of vision loss through sight-threatening ocular pathologic features in later life. The article analyzes whether the potential benefits of slowing myopia progression by 1 diopter (D) justify the potential risks associated with treatments. METHODS First, the known risks associated with various methods of myopia control are summarized, with emphasis on contact lens wear. Based on available data, the risk of visual impairment and predicted years of visual impairment are estimated for a range of incidence levels. Next, the increased risk of potentially sight-threatening conditions associated with different levels of myopia are reviewed. Finally, a model of the risk of visual impairment as a function of myopia level is developed, and the years of visual impairment associated with various levels of myopia and the years of visual impairment that could be prevented with achievable levels of myopia control are estimated. RESULTS Assuming an incidence of microbial keratitis between 1 and 25 per 10 000 patient-years and that 15% of cases result in vision loss leads to the conclusion that between 38 and 945 patients need to be exposed to 5 years of wear to produce 5 years of vision loss. Each additional 1 D of myopia is associated with a 58%, 20%, 21%, and 30% increase in the risk of myopic maculopathy, open-angle glaucoma, posterior subcapsular cataract, and retinal detachment, respectively. The predicted mean years of visual impairment ranges from 4.42 in a person with myopia of -3 D to 9.56 in a person with myopia of -8 D, and a 1-D reduction would lower these by 0.74 and 1.21 years, respectively. CONCLUSIONS The potential benefits of myopia control outweigh the risks: the number needed to treat to prevent 5 years of visual impairment is between 4.1 and 6.8, whereas fewer than 1 in 38 will experience a loss of vision as a result of myopia control.
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Affiliation(s)
| | - Eric R Ritchey
- College of Optometry, University of Houston, Houston, Texas
| | - Sunil Shah
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom; Ophthalmic and Vision Sciences Research Group, Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Nicolas Leveziel
- Service d'ophtalmologie, Centre Hospitalier Universitaire (CHU) Poitiers, Poitiers, France; University of Poitiers, Poitiers, France; Centre d'Investigation Clinique (CIC 1402), Poitiers, France; Institut National de la Santé et de la Recherche Médicale (INSERM 1084), Poitiers, France; Vision & Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
| | - Rupert R A Bourne
- Vision & Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom; Department of Ophthalmology, Cambridge University Hospital, Cambridge, United Kingdom
| | - D Ian Flitcroft
- Department of Ophthalmology, Children's University Hospital, Dublin, Ireland; Centre for Eye Research Ireland, School of Physics, Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
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Tichenor AA, Cofield SS, Gann D, Elder M, Ng A, Walsh K, Jones LW, Nichols JJ. Frequency of Contact Lens Complications Between Contact Lens Wearers Using Multipurpose Solutions Versus Hydrogen Peroxide in the United States and Canada. Eye Contact Lens 2021; 47:277-282. [PMID: 33290295 DOI: 10.1097/icl.0000000000000761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To retrospectively compare frequency of contact lens (CL) complications in soft CL users of hydrogen peroxide (H2O2) and multipurpose solutions (MPS). METHODS This was a multicenter, retrospective chart review of CL records from each patient's three most recent eye examinations at academic and private practices. Patients must have used the same solution type for at least 3 years. Univariate analyses were conducted using t tests, and chi-square or Fisher's exact test for categorical measures. RESULTS There were 1,137 patients included, with 670 (59%) using MPS and 467 (41%) H2O2. In total, 706 (62%) experienced at least one complication; 409 used MPS and 297 used H2O2. There was no difference in the proportion of patients experiencing at least one complication between MPS (61%) and H2O2 (64%) (P=0.38). Multipurpose solutions users were more likely to report discomfort compared with H2O2 users (P=0.04). Presumed microbial keratitis was experienced by 16 MPS and nine H2O2 users (P=0.60). CONCLUSIONS No significant differences were found in the frequency of CL complications between MPS and H2O2. H2O2 users were less likely to report discomfort and thus switching to a H2O2 system may be an alternative in CL users with discomfort.
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Affiliation(s)
- Anna A Tichenor
- Indiana University (A.A.T.), School of Optometry, Bloomington, IN; University of Alabama at Birmingham School of Optometry (S.S.C., J.J.N.), Birmingham, AL; EyeCare Associates (D.G.), Hueytown, Alabama; Centre for Ocular Research and Education (CORE) (M.E., A.N., K.W., L.W.J.), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada ; and Centre for Eye and Vision Research (LWJ), Hong Kong
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Mohammadinia M, Amiri MA, Delavari F, Yousefzadeh B, Maymeh MH. Antifungal efficacy of soft contact lens disinfecting solutions against Fusarium solani and Candida albicans. Clin Exp Optom 2021; 95:207-11. [DOI: 10.1111/j.1444-0938.2011.00694.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Mohadeseh Mohammadinia
- College of Rehabilitation, Department of Optometry, Shahid Beheshti University Medical Science, Teheran, Iran. E‐mail:
| | - Mohammad Aghazadeh Amiri
- College of Rehabilitation, Department of Optometry, Shahid Beheshti University Medical Science, Teheran, Iran. E‐mail:
| | - Fatemeh Delavari
- College of Rehabilitation, Department of Optometry, Shahid Beheshti University Medical Science, Teheran, Iran. E‐mail:
| | - Bahman Yousefzadeh
- College of Rehabilitation, Department of Optometry, Shahid Beheshti University Medical Science, Teheran, Iran. E‐mail:
| | - Maryam Heydarpour Maymeh
- College of Rehabilitation, Department of Optometry, Shahid Beheshti University Medical Science, Teheran, Iran. E‐mail:
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Sadik N, Elzeiny SM, Ali YE, Sobeih D. Fungal Keratitis in the Egyptian Delta: Epidemiology, Risk Factors, and Microbiological Diagnosis. Ophthalmic Epidemiol 2021; 29:198-205. [PMID: 33853473 DOI: 10.1080/09286586.2021.1914667] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: The current study evaluates the epidemiological characteristics, risk factors, and microbiological diagnosis of fungal keratitis among patients living in the Egyptian Delta.Methods: This is a prospective hospital-based study that included patients who were clinically diagnosed and confirmed by culture test to have fungal keratitis. Patients were examined at baseline and risk factors were identified and collected. Patients were followed over 6 months and the outcomes were documented.Results: A total of 171 (67%) of 252 microbial keratitis patients was proved fungal by microbial culture test. Rural residence and agricultural activity were reported in 139 (81.3%) and 85 (49.7%) patients, respectively. Patients presented within 1 week from the start of symptoms were 120 (70.2%). A total of 54 (31.6%) patients reported ocular trauma. Forty patients (23.4%) had prior ocular surgery and 43 (25.1%) patients had a history of previous ocular disorders. Aspergillus species was the most common organism found in 120 (70.17%) patients, followed by Dematiceous fungi that were found in 25 (14.6%) patients. The main outcome was corneal opacity in 132 (77.2%) patients following medical treatment.Conclusion: Filamentary fungal predominance in Mansoura is influenced by the rural residence of its population. Therefore, more efforts in spreading awareness about microbial keratitis among villagers are important to reduce blindness caused by corneal opacity in rural areas.
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Affiliation(s)
- Nashwa Sadik
- Mansoura Ophthalmic Hospital, Ministry of Health, Mansoura, Egypt
| | | | | | - Doaa Sobeih
- Mansoura Ophthalmic Hospital, Ministry of Health, Mansoura, Egypt
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35
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Stapleton F. Contact lens‐related corneal infection in Australia. Clin Exp Optom 2021; 103:408-417. [DOI: 10.1111/cxo.13082] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Fiona Stapleton
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia,
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Sweeney D, Holden B, Evans K, Ng V, Cho P. Best practice contact lens care: A review of the Asia Pacific Contact Lens Care Summit. Clin Exp Optom 2021; 92:78-89. [DOI: 10.1111/j.1444-0938.2009.00353.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Deborah Sweeney
- Vision CRC, University of New South Wales, Sydney, Australia
- Institute for Eye Research, University of New South Wales, Sydney, Australia
| | - Brien Holden
- Vision CRC, University of New South Wales, Sydney, Australia
- Institute for Eye Research, University of New South Wales, Sydney, Australia
| | - Kylie Evans
- Vision CRC, University of New South Wales, Sydney, Australia
- Institute for Eye Research, University of New South Wales, Sydney, Australia
| | | | - Pauline Cho
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, China
E‐mail:
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Schubert TL, Hume EB, Willcox MD. Staphylococcus aureus ocular isolates from symptomatic adverse events: antibiotic resistance and similarity of bacteria causing adverse events. Clin Exp Optom 2021; 91:148-55. [DOI: 10.1111/j.1444-0938.2007.00219.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Tracey L Schubert
- The School of Optometry and Vision Science, University of New South Wales, NSW, Australia
- The Institute for Eye Research, Kensington, New South Wales, Australia
- Vision CRC, Kensington, New South Wales, Australia
E‐mail:
| | - Emma Bh Hume
- The Institute for Eye Research, Kensington, New South Wales, Australia
- Vision CRC, Kensington, New South Wales, Australia
E‐mail:
| | - Mark Dp Willcox
- The School of Optometry and Vision Science, University of New South Wales, NSW, Australia
- The Institute for Eye Research, Kensington, New South Wales, Australia
- Vision CRC, Kensington, New South Wales, Australia
E‐mail:
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Wolffsohn JS, Dumbleton K, Huntjens B, Kandel H, Koh S, Kunnen CME, Nagra M, Pult H, Sulley AL, Vianya-Estopa M, Walsh K, Wong S, Stapleton F. CLEAR - Evidence-based contact lens practice. Cont Lens Anterior Eye 2021; 44:368-397. [PMID: 33775383 DOI: 10.1016/j.clae.2021.02.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 12/15/2022]
Abstract
Evidence-based contact lens -->practice involves finding, appraising and applying research findings as the basis for patient management decisions. These decisions should be informed by the strength of the research study designs that address the question, as well as by the experience of the practitioner and the preferences and environment of the patient. This reports reviews and summarises the published research evidence that is available to inform soft and rigid contact lens history and symptoms taking, anterior eye health examination (including the optimised use of ophthalmic dyes, grading scales, imaging techniques and lid eversion), considerations for contact lens selection (including the ocular surface measurements required to select the most appropriate lens parameter, lens modality and material selection), evaluation of lens fit, prescribing (teaching self-application and removal, adaptation, care regimen and cleaning instructions, as well as -->minimising risks of lens wear through encouraging compliance) and an aftercare routine.
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Affiliation(s)
| | - Kathy Dumbleton
- School of Optometry, University of California, Berkeley, CA, USA
| | - Byki Huntjens
- Division of Optometry and Visual Sciences at City, University of London, London, UK
| | - Himal Kandel
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Shizuka Koh
- Department of Innovative Visual Science, Osaka University Graduate School of Medicine, Japan
| | | | - Manbir Nagra
- Vision and Eye Research Institute, ARU, Cambridge, UK
| | - Heiko Pult
- Optometry and Vision Research, Weinheim, Germany
| | | | - Marta Vianya-Estopa
- Department of Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Karen Walsh
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Stephanie Wong
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Australia
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Jones L, Hui A, Phan CM, Read ML, Azar D, Buch J, Ciolino JB, Naroo SA, Pall B, Romond K, Sankaridurg P, Schnider CM, Terry L, Willcox M. CLEAR - Contact lens technologies of the future. Cont Lens Anterior Eye 2021; 44:398-430. [PMID: 33775384 DOI: 10.1016/j.clae.2021.02.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
Abstract
Contact lenses in the future will likely have functions other than correction of refractive error. Lenses designed to control the development of myopia are already commercially available. Contact lenses as drug delivery devices and powered through advancements in nanotechnology will open up further opportunities for unique uses of contact lenses. This review examines the use, or potential use, of contact lenses aside from their role to correct refractive error. Contact lenses can be used to detect systemic and ocular surface diseases, treat and manage various ocular conditions and as devices that can correct presbyopia, control the development of myopia or be used for augmented vision. There is also discussion of new developments in contact lens packaging and storage cases. The use of contact lenses as devices to detect systemic disease has mostly focussed on detecting changes to glucose levels in tears for monitoring diabetic control. Glucose can be detected using changes in colour, fluorescence or generation of electric signals by embedded sensors such as boronic acid, concanavalin A or glucose oxidase. Contact lenses that have gained regulatory approval can measure changes in intraocular pressure to monitor glaucoma by measuring small changes in corneal shape. Challenges include integrating sensors into contact lenses and detecting the signals generated. Various techniques are used to optimise uptake and release of the drugs to the ocular surface to treat diseases such as dry eye, glaucoma, infection and allergy. Contact lenses that either mechanically or electronically change their shape are being investigated for the management of presbyopia. Contact lenses that slow the development of myopia are based upon incorporating concentric rings of plus power, peripheral optical zone(s) with add power or non-monotonic variations in power. Various forms of these lenses have shown a reduction in myopia in clinical trials and are available in various markets.
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Affiliation(s)
- Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada; Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong.
| | - Alex Hui
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia
| | - Chau-Minh Phan
- Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada; Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong
| | - Michael L Read
- Eurolens Research, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Dimitri Azar
- Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, Chicago, IL, USA; Verily Life Sciences, San Francisco, CA, USA
| | - John Buch
- Johnson & Johnson Vision Care, Jacksonville, FL, USA
| | - Joseph B Ciolino
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Shehzad A Naroo
- College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
| | - Brian Pall
- Johnson & Johnson Vision Care, Jacksonville, FL, USA
| | - Kathleen Romond
- Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, Chicago, IL, USA
| | - Padmaja Sankaridurg
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia; Brien Holden Vision Institute, Sydney, Australia
| | | | - Louise Terry
- School of Optometry and Vision Sciences, Cardiff University, UK
| | - Mark Willcox
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia
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Konda N, Garg P, Sharma S, Willcox MDP. Risk Factors for Contact Lens-Related Microbial Keratitis and Associated Vision Loss in a South Indian Population. Eye Contact Lens 2021; 47:118-126. [PMID: 33009258 DOI: 10.1097/icl.0000000000000737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To identify risk factors associated with contact lens-related microbial keratitis (CL-MK) and subsequent vision loss in a south Indian population. METHODS A retrospective study of medical records at the LV Prasad Eye Institute in Hyderabad, India, of patients diagnosed with CL-MK and of controls who had no history of corneal inflammation during contact lens wear was undertaken. Variables such as demographic data, contact lens wear details, duration of the event, visual acuity, epithelial defect and infiltrate size, and microbiology of the cornea during the event were collected. Differences between cases and controls were analyzed using parametric and nonparametric tests. Logistic regression was used to calculate the odds ratio (OR) and associated 95% confidence intervals in univariate and multivariate analyses for cases vs. controls and for factors associated with vision loss. RESULTS One hundred sixty-seven cases of CL-MK and 153 controls were included in the analyses. Risk factors associated with the greatest increased OR for CL-related MK were: being in professional employment vs. a student (OR=3.9), disposing lenses yearly versus monthly or biweekly (OR=2.2), and any overnight wear (OR=2.8). Risk factors associated with vision loss were: high myopia (OR=3.6), severe vs. mild severity (OR=16.0), and hypopyon (OR=4.3). CONCLUSIONS Identification of these risk factors may help inform safe contact lens wear habits and management strategies.
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Affiliation(s)
- Nagaraju Konda
- School of Optometry and Vision Science (N.K., M.D.P.W.), University of New South Wales, Australia; Brien Holden Vision Institute (N.K.), Sydney, Australia; Cornea Service (P.G.), L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India; and Jhaveri Microbiology Centre (S.S.), Prof. Brien Holden Eye Research Centre, Hyderabad Eye Research Foundation, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
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Tabbasum K, Reddy DS, Singh V, Subasri R, Garg P. Sol-Gel Nanocomposite Coatings for Preventing Biofilm Formation on Contact Lens Cases. Transl Vis Sci Technol 2021; 10:4. [PMID: 33505771 PMCID: PMC7794269 DOI: 10.1167/tvst.10.1.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/08/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose To evaluate the efficacy of a nanosilver-based sol–gel coating in preventing biofilm formation on contact lens cases. Methods An organic–inorganic hybrid silica–zirconia sol formulation with immobilized silver nanoparticles was deposited on contact lens case coupons. The coated and uncoated coupons were subjected to biofilm formation to Gram-negative and Gram-positive keratitis isolates and ATCC strains using a standard protocol. The biofilms were evaluated using crystal violet, MTT assay, and scanning electron microscope (SEM) examination. The duration of efficacy of the coating was evaluated by exposing the coated and uncoated coupons to a multipurpose lens cleaning solution for various durations up to 30 days and comparing their biofilm characteristics. The cytotoxicity of the coated surface was assessed using cell culture studies. Results Cross-hatch tests and SEM confirmed the presence of a uniform, well-adhered coating on the surface. The coating resulted in a nearly 95% reduction in biofilm formation of the tested bacteria and was effective despite exposures of up to 30 days to a multipurpose lens cleaning solution. The coating did not exhibit cytotoxicity to human corneal epithelial cells. Conclusions The silver nanoparticle-based coating exhibits a good antibiofilm property for both Gram-negative bacilli and Gram-positive cocci and is promising for commercial use in preventing contact lens-related infections. Translational Relevance Biofilm formation on lens cases continues to be an important concern. The proposed coating will help reduce such formations, thus reducing the risk of lens-associated microbial keratitis.
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Affiliation(s)
- Khatija Tabbasum
- L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - D S Reddy
- Centre for Sol-Gel Coatings, International Advanced Research Centre for Powder Metallurgy and New Materials, Balapur, Hyderabad, Telangana, India
| | - Vivek Singh
- L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - R Subasri
- Centre for Sol-Gel Coatings, International Advanced Research Centre for Powder Metallurgy and New Materials, Balapur, Hyderabad, Telangana, India
| | - Prashant Garg
- L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
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Loo J, Kriegel MF, Tuohy MM, Kim KH, Prajna V, Woodward MA, Farsiu S. Open-Source Automatic Segmentation of Ocular Structures and Biomarkers of Microbial Keratitis on Slit-Lamp Photography Images Using Deep Learning. IEEE J Biomed Health Inform 2021; 25:88-99. [PMID: 32248131 PMCID: PMC7781042 DOI: 10.1109/jbhi.2020.2983549] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We propose a fully-automatic deep learning-based algorithm for segmentation of ocular structures and microbial keratitis (MK) biomarkers on slit-lamp photography (SLP) images. The dataset consisted of SLP images from 133 eyes with manual annotations by a physician, P1. A modified region-based convolutional neural network, SLIT-Net, was developed and trained using P1's annotations to identify and segment four pathological regions of interest (ROIs) on diffuse white light images (stromal infiltrate (SI), hypopyon, white blood cell (WBC) border, corneal edema border), one pathological ROI on diffuse blue light images (epithelial defect (ED)), and two non-pathological ROIs on all images (corneal limbus, light reflexes). To assess inter-reader variability, 75 eyes were manually annotated for pathological ROIs by a second physician, P2. Performance was evaluated using the Dice similarity coefficient (DSC) and Hausdorff distance (HD). Using seven-fold cross-validation, the DSC of the algorithm (as compared to P1) for all ROIs was good (range: 0.62-0.95) on all 133 eyes. For the subset of 75 eyes with manual annotations by P2, the DSC for pathological ROIs ranged from 0.69-0.85 (SLIT-Net) vs. 0.37-0.92 (P2). DSCs for SLIT-Net were not significantly different than P2 for segmenting hypopyons (p > 0.05) and higher than P2 for WBCs (p < 0.001) and edema (p < 0.001). DSCs were higher for P2 for segmenting SIs (p < 0.001) and EDs (p < 0.001). HDs were lower for P2 for segmenting SIs (p = 0.005) and EDs (p < 0.001) and not significantly different for hypopyons (p > 0.05), WBCs (p > 0.05), and edema (p > 0.05). This prototype fully-automatic algorithm to segment MK biomarkers on SLP images performed to expectations on an exploratory dataset and holds promise for quantification of corneal physiology and pathology.
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Mukhtar S, Atta S, Durrani A, Perera C, Kowalski R, Jhanji V. Microbiological evaluation of corneal and contact lens cultures in contact lens-associated bacterial keratitis. Br J Ophthalmol 2020; 106:600-604. [PMID: 33361442 DOI: 10.1136/bjophthalmol-2020-317832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 11/04/2022]
Abstract
PURPOSE To determine the degree of microbiological agreement between corneal scrapings and contact lens cultures in cases of contact lens-associated keratitis. METHODS Electronic medical records of all cases of contact lens-associated keratitis at a single institution from April 2006 to May 2019 were reviewed. Cases where both corneal scrapings and contact lens cultures were obtained were included in the study. Group 1 demonstrated agreement between corneal scrapings and contact lens cultures. Group 2 demonstrated growth on both cultures, but disagreement in isolated organism. Group 3 demonstrated negative corneal cultures but growth on contact lens cultures and the diagnostic yield of contact lens microbiological cultures and agreement between corneal and contact lens cultures. RESULTS A total of 80 eyes of 72 patients were included in the study. 135 total incidences of microbiological results were included for data analysis. Group 1 contained nine incidences (6.7%), group 2 contained 60 incidences (44.4%) and group 3 contained 66 incidences (49%). In group 3, 50% of the cases were treated based on contact lens culture data. There was no statistically significant difference between all three groups in terms of baseline characteristics, presenting vision, vision at last follow-up, number of antibiotics used or complications from keratitis. Pseudomonas was the most common microorganism isolated, and in 89% of these cases, there was disagreement between corneal and contact lens cultures. CONCLUSIONS Although there was a disagreement in the microbiological yield between contact lens and corneal cultures, contact lens cultures were useful in management of patients while achieving similar outcomes.
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Affiliation(s)
- Sabrina Mukhtar
- Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sarah Atta
- Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Asad Durrani
- Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Regis Kowalski
- Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,The Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Vishal Jhanji
- Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA .,The Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Shrestha GS, Vijay AK, Stapleton F, Henriquez FL, Carnt N. Understanding clinical and immunological features associated with Pseudomonas and Staphylococcus keratitis. Cont Lens Anterior Eye 2020; 44:3-13. [PMID: 33303356 DOI: 10.1016/j.clae.2020.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 12/11/2022]
Abstract
Pseudomonas aeruginosa and Staphylococcus aureus are the two dominant Gram-negative and -positive species, respectively, isolated from patients with contact lens-related bacterial keratitis. The clinical features of bacterial keratitis vary, such that timely differential diagnosis can be challenging, which may cause a delay in diagnosis resulting in poorer outcome. This review aims to explore the current understanding of clinical and immunological features associated with contact lens-related P. aeruginosa and S. aureus keratitis based on currently available evidence. Firstly, the review characterises contact lens-related P. aeruginosa and S. aureus keratitis, based on clinical features and prognostic factors. Secondly, the review describes the primary immune response associated with a bacterial infection in in-vivo non-scratch contact lens-wearing animal models, colonised by bacteria on contact lens and topical administration of bacteria on the cornea. Finally, the review discusses the role of macrophage inflammatory protein-2 (MIP-2) and intercellular adhesion molecule (ICAM-1) in neutrophil recruitment based on both in-vivo scratch models of bacterial keratitis and bacterial challenged in cell culture models.
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Affiliation(s)
| | | | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Australia
| | - Fiona L Henriquez
- School of Health and Life Sciences, The University of the West of Scotland, United Kingdom
| | - Nicole Carnt
- School of Optometry and Vision Science, UNSW Sydney, Australia; Westmead Institute for Medical Research, University of Sydney, Australia; Institute of Ophthalmology, University College London, United Kingdom
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Mitchell GL, Richdale K, Lam D, Wagner H, Kinoshita BT, Zimmerman AB, Sorbara L, Rosner B. Development of a contact Lens risk survey. Cont Lens Anterior Eye 2020; 44:101383. [PMID: 33281075 DOI: 10.1016/j.clae.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/29/2020] [Accepted: 11/09/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To describe the development and report psychometric properties of the Contact Lens Risk Survey (CLRS) to identify patients at risk for soft contact lens-related complications. METHODS Psychometric properties of the CLRS, a web-based survey with branching logic, were determined using data from 5 multi-site fieldings (n = 1059), including re-fielding to sub groups. Responses from participants with and without an active red eye were used to identify risk factors of a red eye event and calculate an overall risk score. A 6th fielding of the CLRS (n = 171) was used to assess discriminate validity. RESULTS Participants needed 11-12 min to complete the survey with a negligible difference by age. Internal consistency was excellent (Cronbach's α ≥ 0.70) for 3 of the 5 constructs identified by factor analysis. Twelve of the 17 survey items exhibited excellent within-subject repeatability (Kappa ≥ 0.61). Between-subject agreement, assessed in 18-25 year olds, was high for the majority of items, suggesting good generalizability across different populations of SCL wearers. The ability of the model using individual items of the CLRS to discriminate Controls and participants with a red eye was good with an area under the curve of 0.779. CONCLUSION The CLRS tool is a repeatable and valid instrument to standardize documentation of demographic, behavior, and exposure factors which appear to drive the greatest risk of a contact lens related red eye event.
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Affiliation(s)
- G Lynn Mitchell
- Ohio State University, College of Optometry, Columbus, OH, United States.
| | - Kathryn Richdale
- University of Houston, College of Optometry, Houston, TX, United States
| | - Dawn Lam
- Marshall B. Ketchum University, College of Optometry, Fullerton, CA, United States
| | - Heidi Wagner
- Ohio State University, College of Optometry, Columbus, OH, United States
| | - Beth T Kinoshita
- Pacific University, College of Optometry, Forest Grove, OR, United States
| | - Aaron B Zimmerman
- Ohio State University, College of Optometry, Columbus, OH, United States
| | - Luigina Sorbara
- University of Waterloo, School of Optometry, Waterloo, ON, Canada
| | - Bernard Rosner
- Harvard University, T. H Chan School of Public Health, Boston, MA, United States
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Enhancement of Contact Lens Disinfection by Combining Disinfectant with Visible Light Irradiation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176422. [PMID: 32899295 PMCID: PMC7504152 DOI: 10.3390/ijerph17176422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 01/05/2023]
Abstract
Multiple use contact lenses have to be disinfected overnight to reduce the risk of infections. However, several studies demonstrated that not only microorganisms are affected by the disinfectants, but also ocular epithelial cells, which come into contact via residuals at reinsertion of the lens. Visible light has been demonstrated to achieve an inactivation effect on several bacterial and fungal species. Combinations with other disinfection methods often showed better results compared to separately applied methods. We therefore investigated contact lens disinfection solutions combined with 405 nm irradiation, with the intention to reduce the disinfectant concentration of ReNu Multiplus, OptiFree Express or AOSept while maintaining adequate disinfection results due to combination benefits. Pseudomonads, staphylococci and E. coli were studied with disk diffusion assay, colony forming unit (cfu) determination and growth delay. A log reduction of 4.49 was achieved for P. fluorescens in 2 h for 40% ReNu Multiplus combined with an irradiation intensity of 20 mW/cm2 at 405 nm. For AOSept the combination effect was so strong that 5% of AOSept in combination with light exhibited the same result as 100% AOSept alone. Combination of disinfectants with visible violet light is therefore considered a promising approach, as a reduction of potentially toxic ingredients can be achieved.
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Abstract
PURPOSE To report the predisposing factors, microorganisms, antibiotic sensitivity associated with bacterial keratitis, and treatment outcomes in Miri, Borneo which has a tropical climate. METHODS This is a retrospective study on patients presenting with microbial keratitis in Miri, Sarawak, Borneo over a 7-year period from January 1, 2010 until December 31, 2016. Demographic data, predisposing factors, culture and sensitivity results together with treatment outcomes were studied. RESULTS There were a total of 221 cases treated as microbial keratitis with a peak age group of 21 to 30 years. The predisposing factors were trauma (49.3%), improper contact lens usage (29.1%), ocular surface diseases (5.9%), ocular surgeries (0.9%), drugs (1.8%), and other factors (19.0%). Occupational injuries among oil palm plantation workers was the leading cause within the trauma cohort (28.8%). Corneal scraping was performed in 189 cases, 61.4% of them yielded positive cultures. The cultures demonstrated that 49.1% were of bacterial origin, 46.6% were fungal, and 4.3% showed mixed growth. The most common bacteria isolated was Pseudomonas aeruginosa, which was sensitive toward ceftazidime and gentamicin antibiotics. One hundred ninety-two cases (86.9%) were treated with purely topical medication, whereas 29 cases (13.1%) required further interventions. CONCLUSION The commonest predisposing factor for microbial keratitis was trauma. With the nearby oil palm industries, we report a corresponding increase of incidence in fungal keratitis at our center. Culture and sensitivity reports from corneal scrapings are essential in treatment guidance; however, more than a third of the microbial keratitis cases studied were culture-negative. The organisms cultured reflect the profile expected in tropical climates. Fortunately, there was no increase in resistance rates observed for the commonly used antibiotics.
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Vianya-Estopa M, Wolffsohn JS, Beukes E, Trott M, Smith L, Allen PM. Soft contact lens wearers' compliance during the COVID-19 pandemic. Cont Lens Anterior Eye 2020; 44:101359. [PMID: 32839091 PMCID: PMC7427528 DOI: 10.1016/j.clae.2020.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 11/26/2022]
Abstract
Aim Contact lens wearers need to maintain optimal hygiene practices during the COVID-19 pandemic to minimise contact-lens complications including microbial keratitis and corneal infiltrative events. This online survey (UK and Ireland) explored contact lens wearers’ compliance behaviours, attitudes and concerns during the pandemic. Method The 60-item anonymous online survey was distributed during a 1-month period via Qualtrics (starting on 14/04/20). The survey captured: a) demographic information, b) type of lenses worn and compliance with lens wear and care procedures, c) adherence to recommendations and d) concerns associated with contact lens wear during the pandemic. Results Two hundred and forty seven responses were received (34.3 ± 11.7 years old, 79% female). Seventy nine percent of participants reported that they were self-isolating or rigorously following social distance advice. Fifty-six percent of participants reported using their lenses less during the pandemic. Eighty-seven percent of respondents reported following the recommended 20-second rule most times/every time and 96% used soap and water during handwashing. Eleven percent of respondents admitted not following recommendations regarding disposal of lenses and 18% would not consider ceasing lens wear if unwell (with flu/cold) during the pandemic. Conclusion Respondents reported wearing their contact lenses less than usual. Good compliance with handwashing was observed but soft reusable lens wearers showed a statistically significant lower compliance with lens wear and care compared to daily disposable lens wearers (p=<0.001).
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Affiliation(s)
- Marta Vianya-Estopa
- Anglia Ruskin University, Vision and Hearing Sciences Research Centre, Cambridge, CB1 1PT, United Kingdom.
| | - James S Wolffsohn
- Ophthalmic Research Group, Aston University, Aston Triangle, Birmingham, B4 7ET, United Kingdom.
| | - Eldre Beukes
- Anglia Ruskin University, Vision and Hearing Sciences Research Centre, Cambridge, CB1 1PT, United Kingdom.
| | - Mike Trott
- Anglia Ruskin University, The Cambridge Centre for Sport and Exercise Sciences, Cambridge, CB1 1PT, United Kingdom.
| | - Lee Smith
- Anglia Ruskin University, The Cambridge Centre for Sport and Exercise Sciences, Cambridge, CB1 1PT, United Kingdom.
| | - Peter M Allen
- Anglia Ruskin University, Vision and Hearing Sciences Research Centre, Cambridge, CB1 1PT, United Kingdom.
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Spernovasilis N, Maraki S, Kokorakis E, Kofteridis D, Tsilimbaris M, Siganos C, Samonis G. Antimicrobial susceptibility of isolated pathogens from patients with contact lens-related bacterial keratitis in Crete, Greece: A ten-year analysis. Cont Lens Anterior Eye 2020; 44:101355. [PMID: 32778366 DOI: 10.1016/j.clae.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/24/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the bacterial spectrum and antimicrobial susceptibilities of pathogens isolated from contact lens-related bacterial keratitis cases in a large academic Greek hospital. METHODS All adult patients with positive corneal scrapings or contact lens culture between 2007 and 2016 at the University Hospital of Heraklion, Greece, were retrospectively identified through a local microbiology database and their medical records were reviewed. RESULTS A total of 240 isolates were recovered from 131 patients with culture-proven contact lens-associated bacterial keratitis. The most common microorganism identified was Serratia marcescens (17.1% of total isolates), followed by Pseudomonas aeruginosa, Klebsiella spp. and coagulase-negative staphylococci (CoNS). Rates of aztreonam-resistant P. aeruginosa and erythromycin-resistant CoNS decreased in recent years, while the decrease in oxacillin-resistant CoNS was statistically significant (p=0.009). More than 90% of the isolated organisms (S. marcescens, P. aeruginosa, Klebsiella spp. and CoNS) were susceptible to ciprofloxacin or gentamicin. CONCLUSION Gram-negative microorganisms are the most common causative pathogens of contact lens-related keratitis in the region of Crete. Topical antibacterials containing quinolones or gentamicin represent an effective empirical treatment for the majority of the cases. This is quite encouraging, considering that the present study was conducted in a country characterised by high antimicrobial resistance rates. However, culture-driven antimicrobial treatment is mandatory for this sight-threatening infection.
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Affiliation(s)
- Nikolaos Spernovasilis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Sofia Maraki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Heraklion, Crete, Greece.
| | - Evangelos Kokorakis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Diamantis Kofteridis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Miltiadis Tsilimbaris
- Department of Ophthalmology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Charalampos Siganos
- Department of Ophthalmology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - George Samonis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece; Metropolitan Hospital, N. Faliro, Athens, Greece
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Jones L, Walsh K, Willcox M, Morgan P, Nichols J. The COVID-19 pandemic: Important considerations for contact lens practitioners. Cont Lens Anterior Eye 2020; 43:196-203. [PMID: 32273245 PMCID: PMC7129028 DOI: 10.1016/j.clae.2020.03.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 03/29/2020] [Accepted: 03/29/2020] [Indexed: 01/08/2023]
Abstract
A novel coronavirus (CoV), the Severe Acute Respiratory Syndrome Coronavirus - 2 (SARS-CoV-2), results in the coronavirus disease 2019 (COVID-19). As information concerning the COVID-19 disease continues to evolve, patients look to their eye care practitioners for accurate eye health guidance. There is currently no evidence to suggest an increased risk of contracting COVID-19 through contact lens (CL) wear compared to spectacle lens wear and no scientific evidence that wearing standard prescription spectacles provides protection against COVID-19 or other viral transmissions. During the pandemic there will potentially be significant changes in access to local eyecare. Thus, it is imperative CL wearers are reminded of the steps they should follow to minimise their risk of complications, to reduce their need to leave isolation and seek care. Management of adverse events should be retained within optometric systems if possible, to minimise the impact on the wider healthcare service, which will be stretched. Optimal CL care behaviours should be the same as those under normal circumstances, which include appropriate hand washing (thoroughly with soap and water) and drying (with paper towels) before both CL application and removal. Daily CL cleaning and correct case care for reusable CL should be followed according to appropriate guidelines, and CL exposure to water must be avoided. Where the availability of local clinical care is restricted, practitioners could consider advising patients to reduce or eliminate sleeping in their CL (where patients have the appropriate knowledge about correct daily care and access to suitable lens-care products) or consider the option of moving patients to daily disposable lenses (where patients have appropriate lens supplies available). Patients should also avoid touching their face, including their eyes, nose and mouth, with unwashed hands and avoid CL wear altogether if unwell (particularly with any cold or flu-like symptoms).
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Affiliation(s)
- Lyndon Jones
- School of Optometry & Vision Science, Centre for Ocular Research & Education (CORE), University of Waterloo, Waterloo, Ontario, Canada.
| | - Karen Walsh
- Centre for Ocular Research & Education (CORE), University of Waterloo, Waterloo, Ontario, Canada.
| | - Mark Willcox
- School of Optometry and Vision Science, UNSW, Sydney, Australia.
| | | | - Jason Nichols
- University of Alabama at Birmingham, Birmingham, AL, USA.
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