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Background: A new commercially available device (IOLMaster, Zeiss Instruments) provides high resolution non-contact measurements of axial length (using partial coherent interferometry), anterior chamber depth, and corneal radius (using image analysis). [...]

Whereas there are numerous reported ocular side effects from systemic sulpha medication, most are rare and reversible, with myopia being the most common reaction observed. A case report is presented of sudden bilateral onset of −1.0 DS of myopia (from −3.0 to −4.0 DS) in a young adult female following the addition of a sulphonamide (sulphasalazine) to oral non-steroidal anti-inflammatory treatment (meloxicam) for rheumatoid arthritis. The myopia regressed to −3.50 DS after 2 weeks when all medication was withdrawn and stabilised at this level when subsequent treatment was resumed after 8 weeks with the non-steroidal anti-inflammatory drug celecoxib. The case indicates that account needs to be taken of the possibility that relatively modest myopic shifts encountered in young adult contact lens wearers may be associated with concomitant systemic medication. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety of orthokeratology contact lens wear in slowing the axial elongation of the eye in myopic children., Methods: Safety data from three prospective studies, which evaluated the use of orthokeratology for slowing myopia progression in children in comparison to a parallel control group of single-vision spectacle lens wearers over a 2-year period, were pooled together for analysis. The primary and secondary safety endpoints are the comparisons of adverse events and slit-lamp findings grades ≥ 2 between orthokeratology and control groups, respectively., Results: Collectively, data from 125 orthokeratology and 118 control subjects were analyzed in this study. Of these, 101 (81 %) and 88 (75 %) orthokeratology and control subjects completed the 2-year follow-up period, respectively. Nineteen orthokeratology subjects experienced 28 adverse events, of which 6 were significant, whereas just one adverse event was found in the control group; this difference was statistically significant (p < 0.001). Most adverse events found in the orthokeratology group were corneal in nature, primarily corneal abrasion/staining, accounting for around 40 % of all adverse events. Of the 28 adverse events, only 18 (3 significant) are likely to be contact lens-related, leading to incidence rates of total and device-related adverse events per 100 patient years of lens wear (95 % confidence intervals) of 13.1 (9.2-18.2) and 8.4 (5.4-10.7), respectively. No significant differences were found between groups in the total number of silt-lamps findings with grades ≥ 2 (p > 0.05)., Conclusion: Around 13% of eyes wearing overnight orthokeratology contact lenses are likely to experience an adverse event over one year of lens wear, with this figure being lower when considering device-related adverse events alone. No serious adverse events were found, with most being non-significant. These results inform eye care practitioners on the safety of orthokeratology lenses when prescribed for slowing myopia progression to myopic children., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jacinto Santodomingo-Rubido is a full-time employee of Menicon Co., Ltd. The authors alone are responsible for the content and writing of the paper. Menicon Co., Ltd funded the publication costs of this study., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objetive: To assess differences in corneal higher-order aberrations (i.e., HOAs) between six different types of irregular corneas (i.e, keratoconus (KC), keratoglobus (KG), pellucid marginal degeneration (PMD), laser-assisted in situ keratomileusis (LASIK), penetrating keratoplasty (PK), and intrastromal corneal ring segments (ICRS))., Methods: Corneal aberration data from the 3 rd and 4 th order together with secondary vertical and horizontal coma, and secondary spherical aberration were retrospectively retrieved from a corneal tomographer and compared between irregular cornea types and for 3-, 5-, and 7-mm pupil diameters., Results: Significant differences were observed in vertical coma, oblique trefoil, secondary oblique astigmatism, primary spherical, and secondary spherical between irregular cornea types across all three pupil sizes (all p≤0.025). Vertical coma consistently exhibited the greatest magnitude of HOA across all irregular cornea types and pupil diameters. For the larger pupil diameters (5 and 7 mm), the 3rd order aberrations (mainly coma-like), the 4th order aberrations (mainly spherical-like), and total HOA RMS were significantly lower in the LASIK group compared to all other irregular cornea types (all p≤0.003). Additionally, at pupil sizes of 5 and 7 mm, the 3rd, 4th, coma-like, spherical-like, and total HOA RMS were significantly lower in KC compared to the ICRS and PK groups (all p≤0.01). Furthermore, the 4th, spherical-like, and total HOA RMS were significantly lower in KC compared to KG at pupil diameters of 3 and 7 mm, 5 and 7 mm, and 7 mm, respectively (all p≤0.03)., Conclusions: Vertical coma was the most elevated HOA across all irregular cornea types and pupil diameters. Corneal aberrations were lower in LASIK and KC, and higher in KG and PK., Competing Interests: Conflicts of interest Clara Martínez-Pérez, María Serramito, Julia Bodas, Gonzalo Carracedo and César Villa-Collar report no declarations of interest. Jacinto Santodomingo-Rubido and Asaki Susaki are full-time employees of Menicon Co., Ltd., (Copyright © 2024 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: To evaluate the efficacy of orthokeratology contact lens wear in slowing the axial elongation of the eye in myopic children., Methods: Data from three prospective studies, which evaluated the use of orthokeratology for slowing myopia progression in children in comparison to a parallel control group of distance, single-vision spectacle lens wearers over a 2-year period, were pooled together for analysis., Results: Collectively, data from 125 orthokeratology and 118 control subjects were analyzed in this study. Of these, 101 (81 %) and 88 (75 %) orthokeratology and control subjects completed the 2-year follow-up period, respectively. Statistically significant differences in the change in axial length from baseline were found over time, between groups and for the time*group interaction (all p < 0.001), indicating that the rate of increase in axial length over time was significantly lower in the orthokeratology versus the control group. The lower axial elongation of the orthokeratology versus the control group was statistically significant at all time points (all p < 0.001), with significant differences being also present between each of the different pairs of time points (all p < 0.001). The interactions of group with age, gender, mean spherical refractive error and ethnicity at baseline were not significant (p > 0.05). The change in axial length at the 2-year visit in comparison to baseline for the orthokeratology and control groups were 0.41 ± 0.25 and 0.65 ± 0.30 mm, respectively, thus providing a treatment effect following 2-years of lens wear of 0.24 mm (95 % confidence intervals: 0.15 to 0.34 mm). About 40 % and 25 % of the orthokeratology subjects experienced remarkably low and high levels of myopia progression, respectively (2-years axial elongation: ≤0.30 mm and >0.59 mm, respectively)., Conclusions: Orthokeratology lens wear slows the axial elongation of the eye in comparison to spectacle lens wear in myopic children. The use of these lenses for slowing myopia progression appears to be very effective and not effective at all in 40% and 25% of orthokeratology lens wearers, respectively., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jacinto Santodomingo-Rubido is a full-time employee of Menicon Co., Ltd. The authors alone are responsible for the content and writing of the paper. Menicon Co., Ltd funded the publication costs of this study., (Copyright © 2024. Published by Elsevier Ltd.)

Objective: This study analyses strategies and attitudes on myopia management reported by eye care practitioners (ECP) from Spain in 2022., Methods: A questionnaire was distributed to ECPs worldwide via the internet through professional associations. The questionnaire was distributed by email to all registered Spanish optician-optometrists. Questions examined awareness of increasing myopia prevalence; perceived efficacy; uptake of available approaches; and reasons preventing further uptake of specific approaches., Results: Of 3,107 practitioners who participated in the study, 380 were Spanish ECPs. Using a 10-point scale, Spanish practitioners reported less concern about increasing pediatric myopia (8.3 ± 1.6) compared to ECP's worldwide (8.5 ± 1.9) (p < 0.001), but similar level of clinical activity in myopia control (7.8 ± 2.3 vs. 7.5 ± 2.5, respectively) (p > 0.05); however, around half of all prescribed treatments were single-vision distance spectacles/contact lenses both in Spain and in most regions, with Spanish practitioners prescribing less single-vision spectacles than African and Asian (p < 0.001), but more than Australasian practitioners (p = 0.04). No significant differences were found between Spain and the other regions in the perceived efficacy of combined therapy, orthokeratology, and outdoor time (p > 0.05), with the former being perceived as the most effective myopia control method followed by orthokeratology. No significant differences were found between Spain and the world's average in factors preventing the prescription of myopia control approaches (p > 0.05). Spanish practitioners reported that embracing myopia management has a positive, but lower impact on customer loyalty, practice revenue and job satisfaction compared with the other regions (all p < 0.001)., Conclusions: Myopia control is increasing, although around half of practitioners still prescribe single-vision distance spectacles/contact lenses to young/progressive myopes. Combined therapy followed by orthokeratology were perceived as the most effective treatments. Embracing myopia management improved patient loyalty and job satisfaction., Competing Interests: Conflicts of Interest Jacinto Santodomingo-Rubido is a full-time employee of Menicon Co., Ltd. The authors alone are responsible for the content and writing of the paper. Menicon Co., Ltd funded the publication costs of this study., (Copyright © 2023 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.)

Myopia is a dynamic and rapidly moving field, with ongoing research providing a better understanding of the etiology leading to novel myopia control strategies. In 2019, the International Myopia Institute (IMI) assembled and published a series of white papers across relevant topics and updated the evidence with a digest in 2021. Here, we summarize findings across key topics from the previous 2 years. Studies in animal models have continued to explore how wavelength and intensity of light influence eye growth and have examined new pharmacologic agents and scleral cross-linking as potential strategies for slowing myopia. In children, the term premyopia is gaining interest with increased attention to early implementation of myopia control. Most studies use the IMI definitions of ≤-0.5 diopters (D) for myopia and ≤-6.0 D for high myopia, although categorization and definitions for structural consequences of high myopia remain an issue. Clinical trials have demonstrated that newer spectacle lens designs incorporating multiple segments, lenslets, or diffusion optics exhibit good efficacy. Clinical considerations and factors influencing efficacy for soft multifocal contact lenses and orthokeratology are discussed. Topical atropine remains the only widely accessible pharmacologic treatment. Rebound observed with higher concentration of atropine is not evident with lower concentrations or optical interventions. Overall, myopia control treatments show little adverse effect on visual function and appear generally safe, with longer wear times and combination therapies maximizing outcomes. An emerging category of light-based therapies for children requires comprehensive safety data to enable risk versus benefit analysis. Given the success of myopia control strategies, the ethics of including a control arm in clinical trials is heavily debated. IMI recommendations for clinical trial protocols are discussed.

Objective: An international survey evaluated the opportunities and threats related to contact lens practice reported by eye care professionals worldwide. This study reports on the results specifically found in Spain and how these compare with those from other regions of the world., Methods: A questionnaire was distributed to eye care practitioners around the world through professional associations. The questionnaire consisted of 9, 5 and 12 questions about opportunities, interventions, and potential threats related to contact lens practice, respectively., Results: A total of 2,408 responses were obtained from practitioners worldwide, of which 436 responses were obtained from Spanish practitioners. Spain was found among the regions with the highest perception of opportunities (median: 6.5/10) along with Australasia, North America, Europe, and South America. Spanish (median: 7.3/10), along with South American practitioners, also reported the highest perception of threats. Continuously updating of knowledge/skills, recommending contact lens wearing options to potential patients, creating an efficient recall system for follow-up examinations and being competent in managing contact lens-related complications were reported as important interventions for contact lens practice growth by Spanish eye care practitioners., Conclusions: Spain is one of the regions in the world with the highest perception of both opportunities and threats regarding future contact lens practice. As such, Spanish practitioners consider it important to continuously update knowledge/skills and to recommend and educate patients on the benefits of contact lens wear. Online sales were found to be one of the most important concerns reported by both Spanish and eye care practitioners worldwide., (Copyright © 2022 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: In 2019, an international survey was conducted to evaluate strategies and attitudes in the management of myopia in clinical practice worldwide. This study reports on the results found in Spain and how these results compare with those from other regions of the world., Methods: A self-administrated, internet-based questionnaire was distributed to eye care professionals around the world through professional associations. The questions examined were based on the available strategies and their use., Results: A total of 173 Spanish optometrists, of the 1,336 practitioners from the five different continents who participated in the study, responded to the online survey. Spain, Asia and South America were found among the regions with the highest concern regarding the increased incidence of myopia (p ≤ 0.001). However, in these regions, the prescription of single-vision spectacles and single-vision contact lenses continues to be the main methods of visual correction prescribed to young myopic patients (p ≤ 0.001). Spanish practitioners, like those from other regions, considered orthokeratology to be the most effective treatment to control myopia progression (p ≤ 0.001). The major reasons why Spanish practitioners were not prescribing myopia control strategies were increased cost, inadequate information and unpredictable outcomes (p < 0.05)., Conclusions: The uptake of myopia control methods by Spanish practitioners is relatively low, despite the increase in the prevalence of paediatric myopia as well as increased concern and perceived clinical activity in the area in recent years., Competing Interests: Declaration of Competing Interest Jacinto Santodomingo-Rubido is a full-time employee of Menicon Co., Ltd. The authors alone are responsible for the content and writing of the paper., (Copyright © 2022 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To investigate eye care practitioners' attitudes and perceptions toward potential interventions that can enhance contact lens (CL) practice across the world, and how this is influenced by their practice setting., Methods: A self-administered, anonymized survey was constructed in English and then forward and backward translated into six more languages. The survey was distributed online via social media platforms and mailing lists involving reputed international professional bodies., Results: In total, 2,222 responses from 27 countries with sufficient responses were analyzed (53% females, median age- 37 years). Most of the respondents were optometrists (81.9%) and 47.6% were from stand-alone/independent practices. Median working experience in CL prescribing was 11.0 years (IQR: 18.0, 4-22 years). Over two-third of them declared themselves to be very hopeful (22.9%) or hopeful (45.1%) about the future of their CL practice. Among the potential interventions proposed, continuous update of knowledge and skills and competently managing CL-related complications were rated the most important (median score: 9/10 for each). Practitioners working in national/regional retail chains expressed higher proactivity in recommending CLs (9/10) than those in local chains, hospitals, and universities (for all 8/10, P <0.05). National differences were also identified in eye care practitioner attitudes and perceptions ( P <0.05)., Conclusions: The study provided important information to delineate a variety of elements characterizing CL practice across the world. These insights can serve as a basis to design strategies at national and international levels., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2022 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)

Keratoconus is a bilateral and asymmetric disease which results in progressive thinning and steeping of the cornea leading to irregular astigmatism and decreased visual acuity. Traditionally, the condition has been described as a noninflammatory disease; however, more recently it has been associated with ocular inflammation. Keratoconus normally develops in the second and third decades of life and progresses until the fourth decade. The condition affects all ethnicities and both sexes. The prevalence and incidence rates of keratoconus have been estimated to be between 0.2 and 4,790 per 100,000 persons and 1.5 and 25 cases per 100,000 persons/year, respectively, with highest rates typically occurring in 20- to 30-year-olds and Middle Eastern and Asian ethnicities. Progressive stromal thinning, rupture of the anterior limiting membrane, and subsequent ectasia of the central/paracentral cornea are the most commonly observed histopathological findings. A family history of keratoconus, eye rubbing, eczema, asthma, and allergy are risk factors for developing keratoconus. Detecting keratoconus in its earliest stages remains a challenge. Corneal topography is the primary diagnostic tool for keratoconus detection. In incipient cases, however, the use of a single parameter to diagnose keratoconus is insufficient, and in addition to corneal topography, corneal pachymetry and higher order aberration data are now commonly used. Keratoconus severity and progression may be classified based on morphological features and disease evolution, ocular signs, and index-based systems. Keratoconus treatment varies depending on disease severity and progression. Mild cases are typically treated with spectacles, moderate cases with contact lenses, while severe cases that cannot be managed with scleral contact lenses may require corneal surgery. Mild to moderate cases of progressive keratoconus may also be treated surgically, most commonly with corneal cross-linking. This article provides an updated review on the definition, epidemiology, histopathology, aetiology and pathogenesis, clinical features, detection, classification, and management and treatment strategies for keratoconus., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: To understand the views of contact lens (CL) practitioners across the globe regarding what they perceive as opportunities and threats in CL practice., Methods: A self-administered anonymised questionnaire, constructed in English and translated in six more languages, was distributed through reputed international professional bodies and academic institutions worldwide. The questionnaire included items on demographic characteristics, type of practice, and questions designed to explore practitioners' perspective on the future of their CL practice over the next five years., Results: A total of 2408 valid responses were analysed. Multifocal CLs for presbyopia, CLs for myopia control, use of daily disposable (DD) CLs for occasional wear, and biocompatible materials to improve comfort were identified as promising areas of opportunities by practitioners (all 8/10). Respondents from North America, and Europe valued DDCLs for occasional wear moderately more favourable (Median: 9/10 for all) as compared to colleagues in Asia (Median: 8/10, p < 0.001), South America (Median: 8/10, p < 0.01), and Africa (Median: 8/10p < 0.01). Multifocal CLs for presbyopia was perceived as a better opportunity by practitioners in North America and Europe (Median: 9/10 for both), as well as in Australasia (Median: 8/10), in comparison to Asia, Africa, and Middle East (for all Median: 6/10, p < 0.001). Practitioners expressed concerns about the availability of CLs and CL prescriptions online without direct professional involvement (both 9/10)., Conclusions: Overall, the most appealing opportunities for CL practice growth were identified in occasional use of DD CLs, biocompatible materials to reduce CL discomfort, multifocal CLs for presbyopia correction and management of myopia control with CLs. Lack of regulation in CL sales, especially online, seemed to be a constant threat. The insights from this study can be used to design targeted strategies to enhance CL practice across the globe and in specific geographical areas., (Copyright © 2021 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: Total deposition and deposition along the reverse curve of heavily deposited worn orthokeratology (OK) lenses were quantitatively evaluated using two novel imaging methods. In addition, the cleaning efficacies of a contact lens cleaning solution for daily use and an intensive cleaner and protein remover solution were evaluated using the same two methods., Study Design: Experimental study., Methods: Twenty-six worn reverse-geometry OK lenses (MY Emerald, Technopia) were photographed for use in three experiments: (1) total deposition was assessed before and after cleaning with two cleaning solutions; (2) in addition to assessing total lens deposition, the feasibility of measuring the thickness of lens deposits along the reverse curve was assessed; and (3) after confirming it was possible to assess the thickness of lens deposits, the thickness of deposits was assessed before and after cleaning with a daily contact lens cleaning solution (O 2 Care ® , Menicon Co., Ltd.) and an intensive cleaner and protein remover (Progent ® , Menicon Co., Ltd.). Total lens deposition was assessed as the total volume of cloudiness over the lens surface in terms of volume per unit pixel. Cross-sectional images were taken from worn OK lenses to assess the thickness of lens deposits on the reverse curve as the area of deposits/horizontal length., Results: Significant differences in total deposition were found between the three cleaning conditions for the twenty worn OK lenses (mean total deposition ± SD for pre-cleaning = 0.209 ± 0.076; post-daily cleaning = 0.124 ± 0.078; and post-intensive cleaning = 0.045 ± 0.046) (p < 0.001). Mean total deposition and thickness of the deposits along the reverse curve for the three lenses from the second experiment were 0.310 and 6.0 mm, respectively. The mean thicknesses of lens deposits found in the third experiment under the 3 conditions were as follows: pre-cleaning = 3.4 µm; post-daily cleaning = 2.3 µm; and post-intensive cleaning = 0.0 µm., Conclusion: The two novel imaging methods used in this study detected significant amounts of deposits attached to worn OK lenses and were sensitive enough to detect a reduction in deposition following the use of the two cleaning solutions tested. Furthermore, these methods could visualize and quantify the thickness of lens deposits along the reverse curve., (© 2021. Japanese Ophthalmological Society.)

Purpose: To report on a second-generation prototype contact lens (modified lens) with enhanced optics to correct coma aberration and compare its performance with that of the prototype contact lens (conventional lens) used to optimise correction of coma aberration in keratoconus (KC)., Methods: Both lenses were designed as a set of standardised soft contact lenses (SCLs) with asymmetric powers along the posterior surface. The modified lens differs from the conventional lens in that the optical zone is decentred superiorly by 0.7 mm. The on-eye performance was compared between the SCLs and no-lens wearing in terms of manifest refraction, corrected distance visual acuity (CDVA), ocular aberrations, subjective quality of vision, and on-eye lens position relative to the pupil., Results: Thirty-four KC eyes were included. SCLs significantly decreased coma aberration compared to no-lens wear (none, 0.68 ± 0.27 μm; conventional lens, 0.37 ± 0.28 μm; modified lens, 0.19 ± 0.15 μm; P < 0.001), with the reduction in coma aberration being significantly greater with the modified lens than with the conventional lens (P = 0.018). No significant difference in manifest refraction or CDVA was found among the three conditions. Quality of vision was significantly better with the modified lens than with no SCL wear (P < 0.05) but no differences were found between the SCLs. The on-eye optical center position relative to the pupil was closer to the pupil centre using the modified lens than the conventional lens (P < 0.001)., Conclusion: Optimisation of the location of the optical zone in a standardised asymmetric SCL improves correction of coma aberrations and on-eye optical centration., (Copyright © 2021 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Contact lens materials have undergone significant changes over the past 20 years, particularly with respect to the introduction of silicone hydrogel materials. Whilst this development addressed hypoxic issues, other important areas relating to contact lens success, notably comfort, require further research. Contact lens wettability remains a crucially important part of biocompatibility. Contact lenses can be made more wettable by incorporation of surfactants into blister packs, internal wetting agents, surface treatments or care solutions. However, there remains no clear association between contact lens wettability and comfort, making it challenging to determine the potential for these approaches to be of significant clinical benefit. Most contact lenses are used on a daily wear, reusable basis, which requires them to be disinfected when not worn. The ideal disinfecting solution would also improve comfort during wear. However, balancing these requirements with other factors, including biocompatibility, remains a challenge. Soft lens materials invariably take up and subsequently release certain components of disinfecting solutions onto the ocular surface. This may affect tear film stability and the normal ocular microbiome, and further research is needed in this area to determine whether this has any affect on comfort. Finally, contact lens materials sorb components of the tear film, and these interactions are complex and may change the biochemistry of the tear film, which in turn may affect their comfort. In conclusion, the interaction between lens materials, tear film and disinfection solution plays an important role in the biocompatibility of lenses. However, the exact role and whether this can be altered to improve biocompatibility and comfort during wear remains debatable. This report summarises the best available evidence to examine this complex relationship and the opportunities for practitioners to enhance in-eye comfort of contemporary lenses, along with providing suggestions for areas of study that may provide further information on this topic., (Copyright © 2021 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: A survey in 2015 identified a high level of eye care practitioner concern about myopia with a reported moderately high level of activity, but the vast majority still prescribed single vision interventions to young myopes. This research aimed to update these findings 4 years later., Methods: A self-administrated, internet-based questionnaire was distributed in eight languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy of available strategies and adoption levels of such strategies, and reasons for not adopting specific strategies., Results: Of the 1336 respondents, concern was highest (9.0 ± 1.6; p < 0.001) in Asia and lowest (7.6 ± 2.2; p < 0.001) in Australasia. Practitioners from Asia also considered their clinical practice of myopia control to be the most active (7.7 ± 2.3; p < 0.001), the North American practitioners being the least active (6.3 ± 2.9; p < 0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by pharmaceutical approaches and approved myopia control soft contact lenses (p < 0.001). Although significant intra-regional differences existed, overall, most practitioners did not consider single-vision distance under-correction to be an effective strategy for attenuating myopia progression (79.6 %), but prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients (63.6 ± 21.8 %). The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (20.6 %) and inadequate information (17.6 %)., Conclusions: While practitioner concern about myopia and the reported level of activity have increased over the last 4 years, the vast majority of eye care clinicians still prescribe single vision interventions to young myopes. With recent global consensus evidence-based guidelines having been published, it is hoped that this will inform the practice of myopia management in future., (Copyright © 2019 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To determine the extent of contact lens fitting for myopia control (MC) in children (defined as ≤ 17 years of age) worldwide and to characterize the associated demographics and fitting patterns., Methods: Survey forms were sent to contact lens fitters in 66 countries between January and March every year for eight consecutive years (2011-2018, inclusive). Practitioners were asked to record data relating to the first 10 contact lens fits performed after receiving the survey form. Data were analysed for those countries reporting ≥ 100 contact lens fits to children., Results: Data were analysed for 535 MC fits and 23,295 other (non-MC) lens fits undertaken in 31 countries reporting ≥ 100 contact lens fits to children, with 52.1% of MC fits and 12.0% of non-MC fits being with rigid lenses (p < 0.0001). Overall, MC lenses represented 2.3% of all contact lens fits to children, with significant differences between nations (p < 0.0001), ranging from no MC fits recorded in the Czech Republic, Greece, Japan, South Korea and Puerto Rico, to 24.9% in Austria. There has been an increase in contact lens fitting for MC over the survey period (p < 0.0001). MC contact lenses were fitted to younger children compared to non-MC lenses (MC, median 13 years vs. non-MC, median 15 years) (p < 0.0001). There was no sex bias in the fitting of MC lenses (p = 0.89)., Conclusions: MC lenses are currently being prescribed for younger children in equal measure in terms of soft vs. rigid lenses and males vs. females. The extent of MC fitting is low and varies between nations. The gradual increase in MC fitting throughout the survey period perhaps reflects growing concerns among practitioners over the myopia epidemic., (Copyright © 2019 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: . To determine the extent of orthokeratology (OK) contact lens fitting worldwide and to characterize associated demographics and fitting patterns., Methods: . Survey forms were sent to contact lens fitters in 45 countries between January and March every year for 14 consecutive years (2004 - 2017, inclusive). Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the survey form., Results: . Data were obtained for 295,044 contact lens fits, of which 2,702 were with OK lenses and 292,342 were with other lens types (non-OK). Overall, OK lenses represented 1.2% of all contact lens fits, with significant differences between nations (p < 0.0001), ranging from no fits recorded in Brazil, Egypt, Indonesia, Iran, Lithuania, Nepal and the United Arab Emirates, to 6.0% in The Netherlands. There has been a slight overall increase in OK lens fitting over the survey period (p < 0.0001). OK lenses were fitted to younger persons (OK, 25.0 ± 12.8 years vs. non-OK, 39.8 ± 14.9 years) (p < 0.0001). A higher proportion of males (55%) were fitted with OK lenses versus non-OK lenses (30%) (p < 0.0009). There was a skewed distribution towards OK lenses being fit with higher oxygen permeable materials (p < 0.0001) and on a planned replacement basis (p < 0.0001)., Conclusions: . OK contact lens prescribing is a niche activity, with this lens type typically being fitted in high oxygen permeable materials on a planned replacement basis to younger males. The slightly increasing rate of OK fitting, albeit at a very low level, may be attributed to practitioner interest in the reported myopia control properties of this lens type., (Copyright © 2018 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To discuss guidelines and ethical considerations associated with the development and prescription of treatments intended for myopia control (MC)., Methods: Critical review of published papers and guidance documents was undertaken, with a view to carefully considering the ethical standards associated with the investigation, development, registration, marketing, prescription, and use of MC treatments., Results: The roles and responsibilities of regulatory bodies, manufacturers, academics, eye care practitioners, and patients in the use of MC treatments are explored. Particular attention is given to the ethical considerations for deciding whether to implement a MC strategy and how to implement this within a clinical trial or practice setting. Finally, the responsibilities in marketing, support, and education required to transfer required knowledge and skills to eye care practitioners and academics are discussed., Conclusions: Undertaking MC treatment in minors creates an ethical challenge for a wide variety of stakeholders. Regulatory bodies, manufacturers, academics, and clinicians all share an ethical responsibility to ensure that the products used for MC are safe and efficacious and that patients understand the benefits and potential risks of such products. This International Myopia Institute report highlights these ethical challenges and provides stakeholders with recommendations and guidelines in the development, financial support, prescribing, and advertising of such treatments.

Purpose: To assess the relationship between short-term and long-term changes in power at different corneal locations relative to the change in central corneal power and the 2-year change in axial elongation relative to baseline in children fitted with orthokeratology contact lenses (OK)., Methods: Thirty-one white European subjects 6 to 12 years of age and with myopia -0.75 to -4.00 DS and astigmatism ≤1.00 DC were fitted with OK. Differences in refractive power 3 and 24 months post-OK in comparison with baseline and relative to the change in central corneal power were determined from corneal topography data in eight different corneal regions (i.e., N[nasal]1, N2, T[temporal]1, T2, I[inferior]1, I2, S[superior]1, S2), and correlated with OK-induced axial length changes at two years relative to baseline., Results: After 2 years of OK lens wear, axial length increased by 0.48±0.18 mm (P<0.001), which corresponded to an increase of 1.94±0.74% ([2-years change in axial length/baseline axial length]×100). However, the change in axial elongation in comparison with baseline was not significantly correlated with changes in corneal power induced by OK relative to baseline for any of the corneal regions assessed (all P>0.05)., Conclusion: The reduction in central corneal power and relative increase in paracentral and pericentral power induced by OK over 2 years were not significantly correlated with concurrent changes in axial length of white European children.

Purpose: To assess the correlation between changes in corneal aberrations and the 2-year change in axial length in children fitted with orthokeratology (OK) contact lenses., Methods: Thirty-one subjects 6 to 12 years of age and with myopia -0.75 to -4.00DS and astigmatism ≤1.00DC were fitted with OK. Measurements of axial length and corneal topography were taken at regular intervals over a 2-year period. Corneal topography at baseline and after 3 and 24 months of OK lens wear was used to derive higher-order corneal aberrations (HOA) that were correlated with OK-induced axial length changes at 2 years., Results: Significant changes in (Equation is included in full-text article.)root mean square (RMS) secondary astigmatism and fourth and total HOA were found with both 3 and 24 months of OK lens wear in comparison with baseline (all P<0.05). Additionally, significant changes in (Equation is included in full-text article.)and RMS tetrafoil were found at 3 months and in second-order RMS at 24 months of OK lens wear in comparison with baseline (all P<0.05). However, none of the changes in corneal aberrations were significantly correlated with the 2-year change in axial elongation (all P>0.05). Coma angle of orientation changed significantly pre-OK in comparison with 3 and 24 months post-OK as well as secondary astigmatism angle of orientation pre-OK in comparison with 24 months post-OK (all P<0.05). However, coma, trefoil, secondary astigmatism, and tetrafoil angles of orientation pre-OK or post-OK were not significantly correlated with the 2-year change in axial elongation (all P>0.05)., Discussion: Short-term and long-term OK lens wear induces significant changes in corneal aberrations that are not significantly correlated with changes in axial elongation after 2-years.

Purpose: The primary outcome of this study is to compare the axial length growth of white European myopic children wearing orthokeratology contact lenses (OK) to a control group (CT) over a 7-year period., Methods: Subjects 6-12 years of age with myopia -0.75 to -4.00DS and astigmatism ≤1.00DC were prospectively allocated OK or distance single-vision spectacles (SV) correction. Measurements of axial length (Zeiss IOLMaster), corneal topography, and cycloplegic refraction were taken at 6-month intervals over a 2-year period. Subjects were invited to return to the clinic approximately 5 years later (i.e., 7 years after the beginning of the study) for assessment of their ocular refractive and biometric components. The CT consisted of 4 SV and 12 subjects who switched from SV to soft contact lens wear after the initial 2 years of SV lens wear. Changes in axial length relative to baseline over a 7-year period were compared between groups., Results: Fourteen and 16 subjects from the OK and CT groups, respectively, were examined 6.7 ± 0.5 years after the beginning of the study. Statistically significant changes in the axial length were found over time and between groups (both p < 0.001), but not for the time*group interaction (p = 0.125). The change in the axial length for the OK group was 22% (p = 0.328), 42% (p = 0.007), 40% (p = 0.020), 41% (p = 0.013), and 33% (p = 0.062) lower than the CT group following 6, 12, 18, 24, and 84 months of lens wear, respectively., Conclusion: A trend toward a reduction in the rate of axial elongation of the order of 33% was found in the OK group in comparison to the CT group following 7 years of lens wear.

Purpose: Myopia is a global public health issue; however, no information exists as to how potential myopia retardation strategies are being adopted globally., Methods: A self-administrated, internet-based questionnaire was distributed in six languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy and adoption of available strategies, and reasons for not adopting specific strategies., Results: Of the 971 respondents, concern was higher (median 9/10) in Asia than in any other continent (7/10, p<0.001) and they considered themselves more active in implementing myopia control strategies (8/10) than Australasia and Europe (7/10), with North (4/10) and South America (5/10) being least proactive (p<0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by increased time outdoors and pharmaceutical approaches, with under-correction and single vision spectacles felt to be the least effective (p<0.05). Although significant intra-regional differences existed, overall most practitioners 67.5 (±37.8)% prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients. The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (35.6%), inadequate information (33.3%) and the unpredictability of outcomes (28.2%)., Conclusions: Regardless of practitioners' awareness of the efficacy of myopia control techniques, the vast majority still prescribe single vision interventions to young myopes. In view of the increasing prevalence of myopia and existing evidence for interventions to slow myopia progression, clear guidelines for myopia management need to be established., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: The aim was to assess the potential association between entrance pupil location relative to the coaxially sighted corneal light reflex (CSCLR) and the progression of myopia in children fitted with orthokeratology (OK) contact lenses. Additionally, whether coma aberration induced by decentration of the entrance pupil centre relative to the CSCLR, as well as following OK treatment, is correlated with the progression of myopia, was also investigated., Methods: Twenty-nine subjects aged six to 12 years and with myopia of -0.75 to -4.00 DS and astigmatism up to 1.00 DC were fitted with OK contact lenses. Measurements of axial length and corneal topography were taken at six-month intervals over a two-year period. Additionally, baseline and three-month topographic outputs were taken as representative of the pre- and post-orthokeratology treatment status. Pupil centration relative to the CSCLR and magnitude of associated corneal coma were derived from corneal topographic data at baseline and after three months of lens wear., Results: The centre of the entrance pupil was located superio-temporally to the CSCLR both pre- (0.09 ± 0.14 and -0.10 ± 0.15 mm, respectively) and post-orthokeratology (0.12 ± 0.18 and -0.09 ± 0.15 mm, respectively) (p > 0.05). Entrance pupil location pre- and post-orthokeratology lens wear was not significantly associated with the two-year change in axial length (p > 0.05). Significantly greater coma was found at the entrance pupil centre compared with CSCLR both pre- and post-orthokeratology lens wear (both p < 0.05). A significant increase in vertical coma was found with OK lens wear compared to baseline (p < 0.001) but total root mean square (RMS) coma was not associated with the change in axial length (all p > 0.05)., Conclusion: Entrance pupil location relative to the CSCLR was not significantly affected by either OK lens wear or an increase in axial length. Greater magnitude coma aberrations found at the entrance pupil centre in comparison to the CSCLR might be attributed to centration of orthokeratological treatments at the CSCLR., (© 2015 Optometry Australia.)

Purpose: To evaluate how soft lens power affects rigid gas-permeable (RGP) lens power and visual acuity (VA) in piggyback fittings for keratoconus., Methods: Sixteen keratoconus subjects (30 eyes) were included in the study. Piggyback contact lens fittings combining Senofilcon-A soft lenses of -6.00, -3.00, +3.00 and +6.00 D with Rose K2 RGP contact lenses were performed. Corneal topography was taken on the naked eye and over each soft contact lens before fitting RGP lenses. Mean central keratometry, over-refraction, RGP back optic zone radius (BOZR) and estimated final power as well as VA were recorded and analyzed., Results: In comparison to the naked eye, the mean central keratometry flattened with both negative lens powers (p<0.05 in all cases), did not change with the +3.00 soft lens power (p=1.0); and steepened with the +6.00 soft lens power (p=0.02). Rigid gas-permeable over-refraction did not change significantly between different soft lens powers (all p>0.05). RGP's BOZR decreased significantly with both positive in comparison with both negative soft lens powers (all p<0.001), but no significant differences were found among negative- or positive-powers separately (both p>0.05). Estimated RGP's final power increased significantly with positive in comparison with negative lens powers (all p<0.001), but no significant differences were found among negative or positive lens powers separately (both p>0.05). Visual acuity did not change significantly between the different soft lens powers assessed (all p>0.05)., Conclusion: The use of negative-powered soft lenses in piggyback fitting reduces RGP lens power without impacting VA in keratoconus subjects., (Copyright © 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To evaluate changes in anterior corneal topography and higher-order aberrations (HOA) after 14-days of rigid gas-permeable (RGP) contact lens (CL) wear in keratoconus subjects comparing two different fitting approaches., Methods: Thirty-one keratoconus subjects (50 eyes) without previous history of CL wear were recruited for the study. Subjects were randomly fitted to either an apical-touch or three-point-touch fitting approach. The lens' back optic zone radius (BOZR) was 0.4mm and 0.1mm flatter than the first definite apical clearance lens, respectively. Differences between the baseline and post-CL wear for steepest, flattest and average corneal power (ACP) readings, central corneal astigmatism (CCA), maximum tangential curvature (KTag), anterior corneal surface asphericity, anterior corneal surface HOA and thinnest corneal thickness measured with Pentacam were compared., Results: A statistically significant flattening was found over time on the flattest and steepest simulated keratometry and ACP in apical-touch group (all p<0.01). A statistically significant reduction in KTag was found in both groups after contact lens wear (all p<0.05). Significant reduction was found over time in CCA (p=0.001) and anterior corneal asphericity in both groups (p<0.001). Thickness at the thinnest corneal point increased significantly after CL wear (p<0.0001). Coma-like and total HOA root mean square (RMS) error were significantly reduced following CL wearing in both fitting approaches (all p<0.05)., Conclusion: Short-term rigid gas-permeable CL wear flattens the anterior cornea, increases the thinnest corneal thickness and reduces anterior surface HOA in keratoconus subjects. Apical-touch was associated with greater corneal flattening in comparison to three-point-touch lens wear., (Copyright © 2014 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.)

Objective: To assess refractive and biometric changes 1 week after discontinuation of lens wear in subjects who had been wearing orthokeratology (OK) contact lenses for 2 years., Methods: Twenty-nine subjects aged 6 to 12 years and with myopia of -0.75 to -4.00 diopters (D) and astigmatism of ≤1.00 D participated in the study. Measurements of axial length and anterior chamber depth (Zeiss IOLMaster), corneal power and shape, and cycloplegic refraction were taken 1 week after discontinuation and compared with those at baseline and after 24 months of lens wear., Results: A hyperopic shift was found at 24 months relative to baseline in spherical equivalent refractive error (+1.86±1.01 D), followed by a myopic shift at 1 week relative to 24 months (-1.93±0.92 D) (both P<0.001). Longer axial lengths were found at 24 months and 1 week in comparison to baseline (0.47±0.18 and 0.51±0.18 mm, respectively) (both P<0.001). The increase in axial length at 1 week relative to 24 months was statistically significant (0.04±0.06 mm; P=0.006). Anterior chamber depth did not change significantly over time (P=0.31). Significant differences were found between 24 months and 1 week relative to baseline and between 1-week and 24-month visits in mean corneal power (-1.68±0.80, -0.44±0.32, and 1.23±0.70 D, respectively) (all P≤0.001). Refractive change at 1 week in comparison to 24 months strongly correlated with changes in corneal power (r=-0.88; P<0.001) but not with axial length changes (r=-0.09; P=0.66). Corneal shape changed significantly between the baseline and 1-week visits (0.15±0.10 D; P<0.001). Corneal shape changed from a prolate to a more oblate corneal shape at the 24-month and 1-week visits in comparison to baseline (both P≤0.02) but did not change significantly between 24 months and 1 week (P=0.06)., Conclusions: The effects of long-term OK on ocular biometry and refraction are still present after 1-week discontinuation of lens wear. Refractive change after discontinuation of long-term OK is primarily attributed to the recovery of corneal shape and not to an increase in the axial length.

Purpose: To examine which baseline measurements constitute predictive factors for axial length growth over 2 years in children wearing orthokeratology contact lenses (OK) and single-vision spectacles (SV)., Methods: Sixty-one children were prospectively assigned to wear either OK (n = 31) or SV (n = 30) for 2 years. The primary outcome measure (dependent variable) was axial length change at 2 years relative to baseline. Other measurements (independent variables) were age, age of myopia onset, gender, myopia progression 2 years before baseline and baseline myopia, anterior chamber depth, corneal power and shape (p value), and iris and pupil diameters as well as parental refraction. The contribution of all independent variables to the 2-year change in axial length was assessed using univariate and multivariate regression analyses., Results: After univariate analyses, smaller increases in axial length were found in the OK group compared to the SV group in children who were older, had earlier onset of myopia, were female, had lower rate of myopia progression before baseline, had less myopia at baseline, had longer anterior chamber depth, had greater corneal power, had more prolate corneal shape, had larger iris diameter, had larger pupil sizes, and had lower levels of parental myopia (all p < 0.05). In multivariate analyses, older age and greater corneal power were associated with smaller increases in axial length in the OK group (both p < 0.05), whereas in SV wearers, smaller iris diameter was associated with smaller increases in axial length (p = 0.021)., Conclusions: Orthokeratology is a successful treatment option in controlling axial elongation compared to SV in children of older age, had earlier onset of myopia, were female, had lower rate of myopia progression before baseline, had lower myopia at baseline, had longer anterior chamber depth, had greater corneal power, had more prolate corneal shape, had larger iris and pupil diameters, and had lower levels of parental myopia.

Objectives: To compare the number of ordered lenses required to achieve an optimal lens fit between three-point-touch and apical touch fittings in keratoconus subjects with nipple and oval cones using the first definite apical clearance lens (FDACL) as a starting point., Methods: First trial lens was selected following manufacturer's guidelines and the back optic zone radius (BOZR) was flattened or steepened in 0.10 mm steps until a FDACL was found. Subsequently, subjects were randomly allocated to three-point-touch (BOZR 0.10 mm flatter than FDACL) and apical touch fittings (BOZR 0.40 mm flatter than FDACL). Changes were made solely in total lens diameter, edge lift, and/or back vertex power until an optimal lens fit was achieved. Differences between fitting approaches were compared in terms of optimal lens fit rates defined as the percentage of subjects successfully fitted with the first lens ordered from the manufacturer., Results: Sixty-one subjects (109 eyes) were randomly allocated to three-point-touch and apical touch fitting approaches. An average of 2.3 trial lenses were necessary to achieve the FDACL. An optimal lens fit rate was achieved with the first lens in 84 of 109 eyes (77%). No statistically significant differences in optimal lens fit rates were found between three-point-touch and apical touch fitting approaches (83% and 71%, respectively; P = 0.12) and between nipple and oval cones (81% and 68%, respectively; P = 0.12)., Conclusions: The use of the FDACL provides a systematic, reliable, and repeatable starting point for Rose K2 contact lens fitting in keratoconus. Eye care practitioners should anticipate higher optimal lens fit rates when using three-point-touch (83%) in comparison with apical touch contact lens fittings (71%).

Purpose: To assess the relationship between the thinnest corneal location and the steepest and maximum elevation corneal locations in subjects with keratoconus and the effect of gas permeable contact lens wear on the location of these points., Methods: Sixty-one consecutive subjects (98 eyes) with keratoconus. Thirty-one (49 eyes) and 30 (49 eyes) subjects were gas permeable contact lens (CL-W) and non-contact lens wearers (N-CL), respectively. Thinnest, steepest, and maximum elevation corneal locations were evaluated from topographies collected with Pentacam Eye Scanner., Results: In the entire sample and in N-CL and CL-W, the thinnest location does not overlap with the steepest or maximum elevation corneal locations (all P > 0.05). The thinnest and maximum tangential curvature locations were found to be located further away from the geometric center of the cornea in CL-W versus N-CL (P < 0.05)., Conclusion: The thinnest corneal location does not overlap with maximum axial and tangential curvatures or with the front and back elevation locations in keratoconus subjects. Contact lens wear does not affect this lack of overlapping.

Purpose: To compare vision-related quality-of-life measures between children wearing orthokeratology (OK) contact lenses and distance single-vision (SV) spectacles., Methods: Subjects 6 to 12 years of age and with myopia of -0.75 to -4.00 diopters and astigmatism less than or equal to 1.00 diopters were prospectively assigned OK contact lens or SV spectacle correction. A pediatric refractive error profile questionnaire was administered at 12- and 24-month intervals to evaluate children's perceptions in terms of overall vision, near vision, far distance vision, symptoms, appearance, satisfaction, activities, academic performance, handling, and peer perceptions. The mean score of all items was calculated as the overall score. Additionally, parents/guardians were asked to rate their child's mode of visual correction and their intention to continue treatment after study completion., Results: Thirty-one children were fitted with OK contact lenses and 30 with SV spectacles. Children wearing OK contact lenses rated overall vision, far distance vision, symptoms, appearance, satisfaction, activities, academic performance, handling, peer perceptions, and the overall score significantly better than children wearing SV spectacles (all P<0.05). Near vision and handling were, respectively, rated better (P<0.001) and similar (P=0.44) for SV spectacles in comparison to OK contact lenses. No significant differences were found between 12 and 24 months for any of the subjective ratings assessed (all P>0.05). Parents/guardians of children wearing OK contact lenses rated visual correction method and intention to continue treatment higher than parents of children wearing SV spectacles (P≤0.01)., Conclusion: The results indicate that the significant improvement in vision-related quality of life and acceptability with OK contact lenses is an incentive to engage in its use for the control of myopia in children.

Purpose: To evaluate the impact of differente soft contact lens power in the anterior corneal curvature and regularity in subjects with keratoconus., Methods: Nineteen subjects (30 eyes) with keratoconus were included in the study. Six corneal topographies were taken with Pentacam Eye System over the naked eye and successively with soft lens (Senofilcon A) powers of -3.00, -1.50, 0.00, +1.50 and +3.00 D. Corneal measurements of mean central keratometry (MCK), maximum tangential curvature (TK), maximum front elevation (MFE) and eccentricity (Ecc) at 6 and 8 mm diameters as well as anterior corneal surface high order aberrations (i.e. total RMS, spherical- and coma-like and secondary astigmatism) were evaluated., Results: Negative- and plano-powered soft lenses flattened (p<0.05 in all cases), whereas positive-powered lenses did not induce any significant changes (p>0.05 in all cases) in MCK in comparison to the naked eye. The TK power decreased with negative lenses (p<0.05 in both cases) and increased with +3.00 D lenses (p=0.03) in comparison to the naked eye. No statistically significant differences were found in MFE with any soft lens power in comparison to the naked eye (p>0.05 in all cases). Corneal eccentricity increased at 8 mm diameter for all lens powers (p<0.05 in all cases). No statistically differences were found in HOA RMS and spherical-like aberration (both p>0.05). Statistically differences were found in coma-like and secondary astigmatism (both p<0.05)., Conclusion: Negative-powered soft contact lenses provide a flatter anterior surface in comparison to positive-powered lenses in subjects with keratoconus and thus they might be more suitable for piggyback contact lens fitting., (Copyright © 2012 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To compare axial length growth between white children with myopia wearing orthokeratology contact lenses (OK) and distance single-vision spectacles (SV) over a 2-year period., Methods: Subjects 6 to 12 years of age with myopia -0.75 to -4.00 diopters of sphere (DS) and astigmatism ≤1.00 diopters of cylinder (DC) were prospectively allocated OK or SV correction. Measurements of axial length (Zeiss IOLMaster), corneal topography, and cycloplegic refraction were taken at 6-month intervals., Results: Thirty-one children were fitted with OK and 30 with SV. Following 24 months, axial length increased significantly over time for both the OK group (0.47 mm) and SV group (0.69 mm; P < 0.001), with a significant interaction between time and group (P = 0.05) reflecting a greater increase in the SV group. Significant differences in refraction were found over time, between groups and for the interaction between time and group for spherical (all P < 0.001) but not cylindrical components of refraction (all P > 0.05). Significantly greater corneal flattening was evident in the OK group for the flatter and steeper corneal powers and for corneal shape factor (all P ≤ 0.05)., Conclusions: Orthokeratology contact lens wear reduces axial elongation in comparison to distance single-vision spectacles in children.

Keratoconus is the most common primary ectasia. It usually occurs in the second decade of life and affects both genders and all ethnicities. The estimated prevalence in the general population is 54 per 100,000. Ocular signs and symptoms vary depending on disease severity. Early forms normally go unnoticed unless corneal topography is performed. Disease progression is manifested with a loss of visual acuity which cannot be compensated for with spectacles. Corneal thinning frequently precedes ectasia. In moderate and advance cases, a hemosiderin arc or circle line, known as Fleischer's ring, is frequently seen around the cone base. Vogt's striaes, which are fine vertical lines produced by Descemet's membrane compression, is another characteristic sign. Most patients eventually develop corneal scarring. Munson's sign, a V-shape deformation of the lower eyelid in downward position; Rizzuti's sign, a bright reflection from the nasal area of the limbus when light is directed to the limbus temporal area; and breakages in Descemet's membrane causing acute stromal oedema, known as hydrops, are observed in advanced stages. Classifications based on morphology, disease evolution, ocular signs and index-based systems of keratoconus have been proposed. Theories into the genetic, biomechanical and biochemical causes of keratoconus have been suggested. Management varies depending on disease severity. Incipient cases are managed with spectacles, mild to moderate cases with contact lenses and severe cases can be treated with keratoplasty. This article provides a review on the definition, epidemiology, clinical features, classification, histopathology, aetiology and pathogenesis, and management and treatment strategies for keratoconus., (2010 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Objective: To compare instant reporting of comfort throughout the day in hydrogel, silicone-hydrogel, gas-permeable, and non-contact lens wearers., Methods: More than twenty subjects were recruited per group. Comfort scores were recorded using short message service (text message) in the morning (9:00-11:00 am), afternoon (2:00-4:00 pm), and night (7:00-9:00 pm) using a 0 (causes pain) to 100 (excellent) scale., Results: The pooled comfort scores across all groups and time periods revealed that data are skewed toward high values: 88% of the scores felt between >or=70 and 100, whereas the remaining 12% felt between >or=40 and <70. Comfort changed significantly over time (P=0.003), but no significant differences were found between groups (P=0.66) or in the interaction between time and group (P=0.79). Hydrogel and silicone-hydrogel contact lens-wearing groups showed similar reductions in afternoon (-4.5 +/- 11.8 and -4.5 +/- 8.6, respectively) and night comfort scores (-8.3 +/- 14.1 and -9.1 +/- 8.7, respectively), and these were greater than those found in gas-permeable and non-contact lens wearers both in the afternoon (-1.0 +/- 11.3 and -1.8 +/- 16.3, respectively) and night (-7.3 +/- 9.7 and -4.1 +/- 21.9, respectively)., Discussion: Hydrogel and silicone-hydrogel contact lens wearers' comfort scores are reduced at night compared with morning. The slight comfort reduction at night versus morning found in non-contact lens wearers might be related to ocular or general physical fatigue, which suggest the possibility that reduced end-of-day comfort reported by contact lens wearers might not be solely related to contact lens wear. The results of this study also suggest that interpretation of comfort scores should be carried out with caution.

Purpose: To assess the disinfection efficacy of MeniCare Soft contact lens multipurpose solution against Acanthamoeba and viruses in suspension and when inoculated on to contact lenses and subjected to rub-and-rinse or no-rub-and-rinse care regimes., Methods: MeniCare Soft was challenged with Acanthamoeba spp trophozoites or cysts, herpes simplex virus (type 1), adenovirus (type 8), and poliovirus (type 2) and the log reduction in Acanthamoeba viability and viral infectivity determined over time. In addition, contact lenses were incubated with Acanthamoeba and viruses and the number of viable organisms determined after the lenses were processed using rub-and-rinse or no-rub-and-rinse care regimes followed by a 4 hr soaking time., Results: MeniCare Soft showed >3 log reduction against Acanthamoeba spp trophozoites and cysts after 6 hr exposure. Approximately 1 log reduction was found against the 3 viruses after 4 hr exposure. No surviving Acanthamoeba trophozoites or cysts were recovered from any of the contact lens tested when MeniCare Soft was used in a rub-and-rinse or no-rub-and-rinse care regimes (>5.0 log reduction). Rub-and-rinse regimen resulted in a 4.5 to 5.0 log reduction in viruses compared with 3.7 to 5.2 log when no-rub-and-rinse was used., Conclusions: MeniCare Soft showed effective disinfection efficacy against Acanthamoeba trophozoites and cysts using solution and regimen assays. The viruses were more resistant to disinfection in solution but were removed effectively from contact lenses using a rub-and-rinse or no-rub-and-rinse care regimen.

Objectives: To assess the ability of commercial and experimental soft contact lens multipurpose solutions (MPS) to promote Acanthamoeba trophozoite encystment and their biocidal efficacy against Acanthamoeba trophozoites and cysts. The effects on encystment and disinfection efficacy by the incorporation of propylene glycol (PG) in the formulation of MPS were also investigated., Methods: Acanthamoeba trophozoites (Acanthamoeba castellanii ATCC 50730 and Acanthamoeba polyphaga CCAP 1501/3G) were inoculated into MeniCare Soft, MeniCare Soft (-PG), Epica Cold II, OptiFree Plus, and Rohto C cube Softone-Moist MPS, and the percentage of encystment induced by each solution was determined after 24 hr. In addition, Acanthamoeba trophozoites and cysts (A. castellanii ATCC 50730 and A. polyphaga CCAP 1501/3G and Ros) were also inoculated into each of the five MPS, and their log reduction determined after 0, 1, 4, 6, and 24 hr of incubation using stand-alone assays., Results: Significantly higher encystment rates were found with Epica Cold II for A. polyphaga CCAP 1501/3G and Rohto C cube Softone-Moist for A. polyphaga and A. castellanii compared with the other MPS assessed (P<0.05). MeniCare Soft, MeniCare Soft (-PG), and Opti-Free Plus produced little or no encystment, with mean encystment values ranging from 0.0% to 2.0%. A significantly higher disinfection efficacy was found with MeniCare Soft, MeniCare Soft (-PG), and Epica Cold II compared with Opti-Free Plus and Rohto C cube Softone-Moist (P<0.05)., Conclusions: Significant differences in encystment rate and disinfection efficacy between MPS were found. The presence of PG in the formulation of MeniCare Soft did not affect the disinfection efficacy or the encystment rate. The latter indicates that other factors play a role in the induction of Acanthamoeba encystment after inoculation into MPS.

Purpose: Different values of the lower tear meniscus height (TMH) can be obtained depending on the method and technique of measurement employed. This study aimed to assess (1) differences between the absolute (TMH-A), reflex (TMH-R) and fluorescein (TMH-F) lower tear meniscus heights, (2) differences between the central (TMH-R), nasal (TMH-RN) and temporal (TMH-RT) reflex lower tear meniscus heights and (3) the amount of fluorescein present in the lower tear meniscus, 5 min after fluorescein instillation (TMH-FV)., Methods: Thirty four young healthy subjects were included in the study. The lower tear meniscus height (TMH) was measured using an eye piece graticule inserted into a slit-lamp., Results: Mean +/- S.D. values of TMH-A, TMH-R, TMH-RN, TMH-RT, TMH-F and TMH-FV of 0.25 +/- 0.08, 0.13 +/- 0.05, 0.23 +/- 0.06, 0.21 +/- 0.05, 0.27 +/- 0.11 and 0.004 +/- 0.001 mm, respectively were found. The TMH-R was significantly lower than the TMH-A and the TMH-F (p < 0.0001). The TMH-RN and TMH-RT were significantly higher than the TMH-R (p < 0.0001). The TMH-F was significant higher than the TMH-FV (p < 0.0001). No significant differences were found between the TMH-A and TMH-F (p = 0.2), and between the TMH-RN and TMH-RT (p = 0.36)., Conclusion: Careful instillation of fluorescein does not affect normal TMH values. Fluorescein is washed out from the lower tear meniscus 5 min after instillation. Higher values of the TMH can be found at nasal and temporal locations compared to the center of the lower eye lid.

Whereas there are numerous reported ocular side-effects from isotretinoin medication, we present the first case report of corneal steepening after systemic treatment with isotretinoin for seven and a half weeks. The case was associated with a significant drop in visual acuity which could not be explained from the refractive error change. All signs and symptoms were absent seven and a half weeks after the medication was withdrawn. The case indicates that eye care professionals need to be vigilant about the possibility of adverse ocular manifestations associated with the use of systemic medications.

Purpose: The purpose of this study is to assess corneal staining and subjective symptom ratings with six different silicone hydrogel contact lens/multipurpose solution combinations, including the recently launched Menicon PremiO silicone hydrogel contact lens, after the first night of soaking the lenses in solution., Methods: This study is a prospective, single-centre, subject-masked, contralateral, crossover, daily wear clinical trial in which subjects were randomly fitted in the morning with a different lens/solution combination in each eye, asked to wear the lenses for the whole day (at least 12 h), soak each of the lenses overnight in one of the test solutions and insert the lenses on the following morning. Subjects were asked to come on that morning for assessment of corneal staining and subjective ratings. All subjects repeated this procedure on another two occasions in order to collect the results of the six different lens/solution combinations: Menicon PremiO/MeniCare Soft; Menicon PremiO/Complete 10; Menicon PremiO/OptiFree Express; Acuvue Oasys/MeniCare Soft; Acuvue Oasys/Complete 10; Acuvue Oasys/OptiFree Express., Results: Menicon PremiO lenses were associated with a lower level of corneal staining overall, and in the nasal and temporal locations, compared with Acuvue Oasys lenses (p < 0.05). No significant differences were found in corneal staining between solutions (p > 0.05). An overall rate of solution-induced corneal staining per eye of 12% was found. Symptoms were very similar among the six different lens/solution combinations (p > 0.05)., Discussion: The lower level of corneal staining found with Menicon PremiO lenses compared with Acuvue Oasys lenses might be attributed to material, surface and design differences between lens types. The overall rate of solution-induced corneal staining and symptomatology found between the different lens/solutions combinations is consistent with previous studies.

Purpose: To compare the lens fitting characteristics and comfort rates between the two base curves of a prototype silicone hydrogel contact lens and between the prototype and a senofilcon A contact lens., Methods: This study was a prospective, single-center, masked, controlled, randomized, contralateral-eye, short-term comparison clinical trial consisting of two different studies. In the first study, subjects were randomly fitted with the 8.3- and 8.6-mm base curves of a prototype contact lens in each eye. In the second study, subjects were randomly fitted with the more comfortable prototype lens found in the first study in one eye and a senolfilcon A lens in the other eye. In both studies, lens centration and movement, corneal coverage, and comfort were assessed in both eyes 15 minutes after insertion for each lens separately., Results: The overall fit of the 8.3 base curve (8.08 +/- 1.98) was similar to that of the 8.6 base curve (8.15 +/- 2.09) (P=0.38). The mean comfort scores for the 8.3 and 8.6 base curves were 80.13 +/- 16.08 and 77.33 +/- 18.00, respectively (P=0.47). The overall fit of the prototype lens (8.79 +/- 1.56) was similar to that of the senofilcon A lens (8.63 +/- 1.20 mm) (P=0.29). The mean comfort scores for the prototype and senofilcon A lenses were 84.67 +/- 13.92 and 86.35 +/- 12.20, respectively (P=0.52)., Conclusions: The slightly better lens fitting characteristics and comfort of the lens with the 8.3 base curve versus the 8.6 base curve are attributed to the lower movement of the lens with the 8.3 base curve. That the lens fitting characteristics and comfort rates of the prototype lens and the senofilcon A lens were similar is not surprising, because of their similarities in material and design.