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PURPOSE To compare two preservative-free hydrating agents, in multidose (ABAK) bottles, in contact lens wearers experiencing symptoms of ocular dryness. METHODS The endpoint of this 4-week multicenter, randomized, double-blind, parallel-group study comparing a 2% polyvinylpyrrolidone (PVP) solution with a 0.9% NaCl solution was to assess ocular discomfort using a visual analog scale. A biomicroscopic examination and a test of tolerability on instillation were also performed, and adverse events were recorded. RESULTS Thirty-nine subjects were enrolled (23 PVP; 16 NaCl). The average age was 30; subjects were predominantly female, and mostly wore frequent-replacement contact lenses. They were all exposed to environmental factors such as routine use of video monitors or air conditioning. The two groups were similar at baseline (D0). Both PVP and NaCl improved the comfort of contact lens wear (P = 0.0003), with no difference between them (P = 0.25). The mean daily duration of lens wear and the daily number of instillations to relieve discomfort (4.2 +/- 2.0 for PVP ABAK; 4.6 +/- 1.9 for NaCl ABAK) were comparable. However, PVP use led to more favorable evolution of fluorescein-staining corneal punctuations (P = 0.028). Safety was good, with minimal adverse events considered unrelated to the products. Lens wettability was excellent, and there were no clinically relevant deposits. Most subjects also found the ABAK bottles convenient. CONCLUSIONS Ocular hydration improves comfort in contact lens wearers. NaCl is an appropriate first-line treatment, but for subjects with fluorescein-staining punctuations, lubrication with PVP is preferable.

Purpose. This article reports clinical results comparing a high-oxygen permeable (HDk) silicone hydrogel soft contact lens with a low-oxygen permeable (LDk) soft hydroxyethyl methacrylate contact lens when worn on an extended-wear basis. Methods. Six practitioners in France enrolled 134 subjects in this 4-month, open-label, multicenter, prospective, randomized, cross-over study. Subjects were randomized to receive either an HDk lotrafilcon A or an LDk etafilcon A soft contact lens. Subjects crossed over to the alternative lens after either 3 months' experience with the HDk lens or 1 month's experience with the LDk lens. Clinical and subjective data were collected at scheduled follow-up visits. Results. The subjective data has been reported in a separate article. Both types of lenses gave similar performance for visual acuity. Biomicroscopic examination findings averaged below grade 1 (trace) for both lenses throughout the study. A statistically significant difference for limbal redness was found at 1 week (HDk = 0.11; LDk = 0.33; paired-t test, P

Purpose This article reports the subjective results of a study comparing extended-wear high-oxygen permeable (HDk) silicone hydrogel soft contact lenses with low-oxygen permeable (LDk) hydroxyethyl methacrylate lenses. Methods Six practitioners in France enrolled 134 subjects in this 4-month, open-label, multicenter, prospective, randomized, cross-over study. Subjects were randomized to receive prescriptions of either an HDk lotrafilcon A or an LDk etafilcon A soft contact lens. Subjects then crossed over to the alternative lens after either 3 months' experience with the HDk lens or 1 month's experience with the LDk lens. Clinical and subjective data were collected at scheduled follow-up visits. Results The clinical data has been reported in a separate article. After 1 month of wear. HDk lenses were rated better than LDk lenses for all aspects of comfort and overall average symptoms. Subjects were satisfied with both lenses, and lens features were comparable through 1 month. The preference was higher for HDk lenses after crossing over, either from or to LDk lenses. Eighty-six percent of HDk and 85% of LDk subjects reported wearing their lenses while sleeping for 7 nights per week during the study. Seventy-seven percent of HDk and 21% of LDk subjects reported wearing their lenses while sleeping for 22 to 31 nights during the study. Conclusions Based on subjective results, therefore, the HDk lens offers another option to patients and practitioners for extended-wear or continuous-wear soft contact lenses.

Purpose. To evaluate subclinical inflammation and mucus production of the conjunctiva in asymptomatic contact lens (CL) wearers, and to obtain an estimation of the chronologic variations in each group. Methods. Eighteen eyes fitted with rigid CL (RCL) and 28 eyes with soft CL (SCL) worn daily were compared with 10 eyes from five healthy non-CL wearers. Impression cytology (IC) specimens were collected after clinical examination and were analyzed by flow cytometry using antibodies directed to HLA DR and intercellular adhesion molecule type 1 (ICAM-1) (CD 54), as inflammatory markers, and to the peptidic core of the conjunctival mucin (M1/MUC5AC) for mucus and goblet cell detection. The percentage of positive cells was calculated, and levels of fluorescence expression were quantified and compared between each group. Results. A significant increase of HLA DR and ICAM-1 was observed in the SCL group in comparison with the control group. The two inflammatory markers were highly positively correlated with each other. Mucin detection with M1/MUC5AC did not find a significant difference between each group in terms of percentage of positive cells, but analyses of mean levels of fluorescence showed a significant decrease in the two CL groups. Evolution in time was different for each group, with a regular low level of inflammation in the RCL group in the first 10 years in comparison with the SCL group. In the SCL group, inflammation seemed to be higher before 2 years and after 10 years of wear. Mucin expression was variable in time, but without significant difference at any time. Conclusion. This study confirms difference in expression of subclinical conjunctival inflammation in asymptomatic CL wearers, with lower levels for RCL than SCL wearers with daily or extended wear. The mucin system is also modified by this low but chronic aggression of the ocular surface, with a tendency to decrease with time in the RCL and SCL groups.