Cont Lens Anterior Eye [JOURNAL]
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200 papers
Agreement in the classification of keratoconus severity: a comparative study based on anterior corneal surface topographic parameters.
Villa-Collar C, Santodomingo-Rubido J, Bodas-Romero J … +3 more , Carracedo G, Serramito M, Suzaki A
Cont Lens Anterior Eye · 2026 Jul · PMID 42400963 · Publisher ↗
OBJECTIVE: This study aimed to analyse the agreement in the clinical classification of keratoconus using four grading systems based exclusively on anterior corneal surface topographic parameters. MATERIALS AND METHODS: A...
OBJECTIVE: This study aimed to analyse the agreement in the clinical classification of keratoconus using four grading systems based exclusively on anterior corneal surface topographic parameters. MATERIALS AND METHODS: A retrospective, descriptive, analytical, cross-sectional study was conducted to evaluate agreement and differences among the keratometric scale, Amsler-Krumeich (A-K), Alió-Shabayek (A-S), and Keratoconus Severity Score (KSS) classifications. Retrospective, anonymised data were obtained from anterior corneal surface tomography, including keratometry, pachymetry, corneal aberrations, and the location of the thinnest corneal point, measured with a corneal tomographer (Pentacam®, Oculus Optikgeräte GmbH, Wetzlar, Germany). Agreement between each pair of ordinal scales was assessed using weighted Cohen's kappa coefficient with quadratic weights. RESULTS: A total of 455 eyes with keratoconus were analysed. The mean age was 39.3 ± 12.2 years, with no significant sex differences (p > 0.05). Mean keratometry was 46.5 ± 5.9 D and mean pachymetry was 474.8 ± 70.2 μm. Only 111 eyes could be simultaneously classified across all four systems. Pairwise agreement analysis using weighted kappa revealed generally low concordance between classification systems. The highest agreement was observed between the keratometric and Amsler-Krumeich classifications (moderate agreement), whereas comparisons involving aberration-based systems showed weak to slight agreement. When classifications were based solely on each system's differential parameter, a similar pattern was observed, with moderate agreement between keratometric and pachymetry-based classifications and fair agreement in the remaining comparisons. CONCLUSION: Keratoconus classification systems based on anterior corneal surface parameters show significant discrepancies and cannot be used interchangeably. Even when reduced to their primary defining parameters, agreement remains limited, indicating that these systems capture different dimensions of keratoconus severity.
The answer is 23 years - what is the question? Understanding the time lag between ophthalmic research and clinical adoption.
Wolffsohn JS, Morgan P
Cont Lens Anterior Eye · 2026 Jul · PMID 42385648 · Publisher ↗
Abstract loading — click title to view on PubMed.
Orthokeratology versus extended depth-of-focus soft contact lenses for myopia control: a 12-month comparative study of axial elongation and corneal changes.
Corpus G, Molina-Martin A, Piñero DP
Cont Lens Anterior Eye · 2026 Jul · PMID 42385647 · Publisher ↗
PURPOSE: To compare the efficacy of orthokeratology (OK) and extended depth-of-focus (EDOF) soft contact lenses in controlling myopia progression over a 12-month period. METHODS: Ambispective comparative study including...
PURPOSE: To compare the efficacy of orthokeratology (OK) and extended depth-of-focus (EDOF) soft contact lenses in controlling myopia progression over a 12-month period. METHODS: Ambispective comparative study including 56 eyes from 28 myopic patients aged 6 to 16 years. Thirty eyes were fitted with EDOF soft contact lenses (prospective cohort), and 26 eyes with OK lenses (retrospective cohort). Axial length (AXL), spherical equivalent (SE), and binocular visual acuity (VA) were assessed at baseline, 6 months, and 12 months. Corneal parameters, including keratometry (K1,K2) and anterior chamber volume (ACV), were also evaluated. RESULTS: AXL increased significantly over time in both groups (p < 0.001), with no significant differences between groups at any follow-up visit (all p > 0.05). Mean axial elongation at 12 months was 0.05 ± 0.09 mm in the EDOF group and 0.11 ± 0.10 mm in the OK group. These values are lower than those reported in untreated myopic children. A small but statistically significant myopic shift in SE was observed in the EDOF group over time (p < 0.001), whereas no significant refractive changes were detected in the OK group. Visual acuity remained stable in both groups throughout follow-up. Significant corneal changes were observed exclusively in the OK group, including reductions in K1 and K2 (p < 0.001) and a decrease in ACV (p < 0.05). Correlation analysis revealed that, in the OK group, baseline AXL and SE were significantly associated with axial elongation (p < 0.05), indicating a baseline-dependent treatment response. CONCLUSION: Both OK and EDOF soft contact lenses were associated with reduced axial elongation over a 12-month period, with no significant differences in efficacy between treatments. OK demonstrated a distinct profile characterized by corneal remodelling and a response influenced by baseline ocular parameters, whereas EDOF lenses showed a structurally neutral and more consistent effect across patients.
Development of a model for the clinical prediction of contact lens discomfort.
Valencia-Nieto L, Fernández I, González-García MJ … +1 more , López-Miguel A
Cont Lens Anterior Eye · 2026 Jun · PMID 42364421 · Publisher ↗
PURPOSE: To evaluate which ocular and contact lens (CL)-related dimensions, and their interactions, contribute most to CL discomfort (CLD), and to determine a set of clinical parameters for CLD assessment. METHODS: Cross...
PURPOSE: To evaluate which ocular and contact lens (CL)-related dimensions, and their interactions, contribute most to CL discomfort (CLD), and to determine a set of clinical parameters for CLD assessment. METHODS: Cross-sectional study of consecutive CL wearers was performed. Variables were grouped into six dimensions (personal factors, CL characteristics, symptoms, cornea and conjunctiva, tear film, and lid margin and Meibomian glands). Within each dimension composite indices (0-100) were generated with a principal component analysis (mixed data). A structural equation model (SEM) was used to define the latent construct "CLD", followed by unsupervised hierarchical agglomerative clustering. Cluster membership was subsequently predicted using a Least Absolute Shrinkage and Selection Operator (LASSO)-regularized logistic regression model with an 80/20 train-validation split. A simplified model intended for clinical use was developed. RESULTS: One hundred and fifty CL wearers (97 female; 34.4 ± 12.6 years) were included. SEM indicated a multidimensional structure in which the CL and symptom dimensions contributed most to latent CLD. Clustering yielded two distinct phenotypes that differed (p ≤ 0.043) in age, CL type and replacement schedule, daily wearing time, symptom severity, and several ocular surface parameters. A simplified predictor model (daily wearing time, CL replacement, Contact Lens Dry Eye Questionnaire-8, NIBUT, and tarsal hyperemia) predicted membership in the CLD phenotype with 85% accuracy and area under the curve of 0.956 in the validation set. CONCLUSIONS: Modeling CLD as a latent, multidimensional construct integrating subjective and objective measures allows identification of clinically meaningful phenotypes and supports the development of an easy-to-use classifier with excellent discrimination.
Effect of a head strap on the function of an eyelid warming compress.
Saha M, Mustashin A, Wolffsohn JS … +1 more , Travé-Huarte S
Cont Lens Anterior Eye · 2026 Jun · PMID 42361717 · Publisher ↗
PURPOSE: Warming eye masks, provide relief from symptoms of dry eye associated with meibomian gland disease along with other related eye conditions such as blepharitis, hordeolum and meibomian cysts. Certain eye mask des...
PURPOSE: Warming eye masks, provide relief from symptoms of dry eye associated with meibomian gland disease along with other related eye conditions such as blepharitis, hordeolum and meibomian cysts. Certain eye mask designs use head straps to potentially improve mask retention on the face and heat transfer to the eyelids. Straps may increase pressure on the eye, the chance of tissue damage from direct heating, or pose a vision hazard for the user if they move around with the mask in place. This study investigated whether the presence of a strap clinically influences the performance of such eye masks. METHODS: The surface temperature decline of a Blepha EyeBag® eye mask (Théa Pharmaceuticals Limited,UK) placed on the facial area of a composite manikin head was measured with a thermographer following heating in a domestic microwave for 30, 45 and 60 s at a 800mw settings. Thermographic images were analyzed based on scale intensity using ImageJ software, and variations in facial temperature were plotted. RESULTS: Using a strap significantly (F = 40.451, p < 0.001) decreased the temperature of the manikin upper eyelid by on average 1.4 ± 1.9 °C and lower eyelid by 2.5 ± 2.2 °C. The upper and lower eyelids heated to a similar temperature (on average 31.1 ± 5.1 °C vs 31.2 ± 5.4 °C, respectively; F = 0.064, p = 0.805), with temperate systematically increasing with Blepha EyeBag® heating time (F = 74.027, p < 0.001). The temperature dropped with time following heating (F = 56.483, p < 0.001) in a similar manner with and without the strap in place F = 1.949, p = 0.221). CONCLUSION: The temperature transference to the eyelid surfaces was higher without the strap (on average by 1.9 ± 2.2 °C) possibly because the mask could conform to the contours of the face better when it wasn't pulled tight.
Corneal nerve alterations in migraine: a systematic review of in vivo confocal microscopy and esthesiometry findings.
Mejía-Salgado G, Tello A, Galvis V … +4 more , Vergara-Arenas D, Forero-Vargas C, de-la-Torre A, Galor A
Cont Lens Anterior Eye · 2026 Jun · PMID 42361716 · Publisher ↗
OBJECTIVE: To systematically evaluate structural and functional alterations of the subbasal corneal nerve plexus (SBCNP) in adults with migraine using in vivo confocal microscopy (IVCM) and corneal sensitivity testing, a...
OBJECTIVE: To systematically evaluate structural and functional alterations of the subbasal corneal nerve plexus (SBCNP) in adults with migraine using in vivo confocal microscopy (IVCM) and corneal sensitivity testing, and to explore differences according to migraine subtype. METHODS: PubMed, Embase, Ovid, LILACS, VHL, and MedRxiv were searched through May 24, 2025, for studies assessing IVCM or corneal sensitivity in adults with migraine. Eligible designs included case-control and cross-sectional studies. Outcomes included corneal total branch density (CTBD), nerve fiber density (NFD), nerve fiber length (NFL), nerve branch density (NBD), tortuosity coefficient (TC), and corneal sensitivity. Risk of bias was assessed using tools designed for each study type, and Certainty of evidence was graded using the GRADE framework adapted to observational studies. Due to substantial methodological heterogeneity across studies, including differences in IVCM acquisition protocols, image analysis software, and mathematical definitions of nerve parameters, findings were synthesized narratively. The protocol was registered in PROSPERO (CRD420251105525). RESULTS: Eight studies, including 370 participants with migraine, met eligibility criteria. Most studies evaluating chronic migraine populations reported lower CTBD, NFD, and NFL compared with healthy controls, although findings remained heterogeneous across studies. Studies of episodic migraine showed contradictory findings, including preserved nerve parameters or isolated increases in TC. Two studies using different neurophysiological approaches to measure corneal sensitivity suggested altered peripheral and central trigeminal sensory processing in migraine individuals. CONCLUSION: Available evidence suggests that chronic migraine may be associated with structural alterations of the SBCNP, whereas episodic migraine demonstrates more variable findings, including possible increases in nerve tortuosity. Functional studies suggest altered peripheral and central trigeminal sensory processing in migraine.
What guides treatment decisions in dry eye disease: Signs or symptoms?
Abbott KS, Patnaik JL, Christopher KL … +2 more , Auer E, Ifantides C
Cont Lens Anterior Eye · 2026 Jun · PMID 42349061 · Publisher ↗
PURPOSE: To determine whether patient-reported symptoms or clinical signs more strongly influence dry eye disease (DED) treatment decisions and how decisions are made during sign-symptom discordance. METHODS: A cross-sec...
PURPOSE: To determine whether patient-reported symptoms or clinical signs more strongly influence dry eye disease (DED) treatment decisions and how decisions are made during sign-symptom discordance. METHODS: A cross-sectional survey was distributed via listservs to practicing optometrists (ODs) and ophthalmologists (OPH) who treat DED. Respondents reported demographic and practice characteristics and selected factors influencing treatment initiation, management of sign-symptom discordance, and definitions of treatment success. Group comparisons were analyzed using Chi-square/Fisher's exact tests and t-tests, focusing on OD vs. OPH differences. RESULTS: 208 clinicians participated (98 OPHs, 110 ODs). While most relied on a combination of signs and symptoms to initiate treatment, clinical severity heavily influenced decisions; clinicians were highly likely to initiate treatment for moderate-severe symptoms even when signs were minimal (OPH 79.8%, OD 70.5%) and to treat moderate-severe signs in asymptomatic patients (OPH 63.8%, OD 60.6%). However, symptoms were ultimately weighted more heavily for treatment initiation (OPH 61.7% vs. OD 49.0%). Only 1.1% of ophthalmologists and 5.2% of optometrists felt that signs and symptoms "frequently" correlate. When evaluating treatment success, both groups again prioritized symptom severity, selecting symptom improvement - either alone or over signs - as the primary indicator (OPH 78.7%, OD 66.6%). Ocular surface staining was rated the most influential clinical sign, followed by tear break-up time and eyelid abnormalities; tear osmolarity and MMP-9 were rated least influential. CONCLUSIONS: Clinicians routinely navigate sign-symptom discordance by treating high clinical severity in either domain, though subjective symptoms ultimately exert a heavier influence on initial therapy choices and determinations of success. Decision-making patterns were similar across clinician types, underscoring the central role of patient-reported symptoms in real-world DED management.
Effects of Geometrically Centered and Offset Soft Multifocal Optics on Vision Quality in Myopes.
Huang AY, Avisado M, Tai YC … +4 more , Kojima R, Lampa M, Hayes J, Caroline P
Cont Lens Anterior Eye · 2026 Jun · PMID 42335852 · Publisher ↗
PURPOSE: Center-distance multifocal soft contact lenses (CDMFSCLs) correct refractive error. However, their optical center is misaligned due to the temporal decentration of the soft contact lens on eye. This places the o...
PURPOSE: Center-distance multifocal soft contact lenses (CDMFSCLs) correct refractive error. However, their optical center is misaligned due to the temporal decentration of the soft contact lens on eye. This places the optics relatively inferonasal from the visual axis, potentially degrading vision. This study primarily investigated the effects of geometrically-centered optics (GCO) and offset optics (OFO, lens optics positioned over the visual axis) CDMFSCLs on wavefront aberrations in myopic adults. Secondary outcomes included visual performance and subjective ratings. METHODS: Thirty-four myopic adults with disease-free eyes participated in a randomized, crossover, double-masked, order-balanced study. All participants were fitted bilaterally with custom GCO and OFO CDMFSCL that shared identical designs, differing only in optic location. The amount and direction of lens decentration from the visual axis were measured using corneal topography maps over a plano GCO CDMFSCL. Wavefront aberrations, visual performance (acuity & contrast sensitivity), and subjective rating were compared between GCO and OFO designs. RESULTS: All subjects completed the study. On average, GCO lenses displaced temporally (0.56 mm in the right eye, 0.59 mm in the left eye) and superiorly (0.29 mm in the right eye, 0.23 mm in the left eye). After Holm-Bonferroni correction, differences in ocular aberrations and physical discomfort remained statistically significant. However, improvements in contrast sensitivity at the 20/40 line under glare did not reach the adjusted significance threshold. CONCLUSIONS: OFO CDMFSCLs improved optical alignment and reduced wavefront aberrations, but increased spherical aberration. Optimizing optical alignment may enhance visual quality, offering significant implications for lens customization.
Axial changes and long-term myopia progression with orthokeratology: A risk-stratification study.
Ai X, Wang R, Li Y … +1 more , Zhang X
Cont Lens Anterior Eye · 2026 Jun · PMID 42335851 · Publisher ↗
PURPOSE: To analyze long-term changes in axial length and anterior segment parameters among children wearing orthokeratology lenses and screen indicators correlated with 5-year myopia progression risk. METHODS: A retrosp...
PURPOSE: To analyze long-term changes in axial length and anterior segment parameters among children wearing orthokeratology lenses and screen indicators correlated with 5-year myopia progression risk. METHODS: A retrospective study enrolled 61 children with 5-year follow-up after orthokeratology lens fitting. Participants were stratified into a slow progression group (n = 32, 5-year axial length elongation ΔAL₅ < 1 mm) and a rapid progression group (n = 29, ΔAL₅ ≥ 1 mm). The axial length, lens thickness, anterior chamber depth, and central corneal thickness were monitored from baseline to 5 years. Correlation analysis, ROC curve analysis, multivariate binary logistic regression, and repeated-measures ANCOVA were performed for statistical analysis. RESULTS: Baseline age was the only parameter that showed significant intergroup differences (P < 0.001). ΔAL₁ to ΔAL₄ were positively correlated with ΔAL₅ (all P < 0.001). ΔAL₁ yielded an AUC of 0.860 (95% CI: 0.761-0.960) with an optimal cutoff of 0.155 mm, and ΔAL₃ achieved an AUC of 0.907 (95% CI: 0.829-0.984) with an optimal cutoff of 0.480 mm. ΔLT₃ to ΔLT₄ were negatively correlated with ΔAL₅ (P < 0.05, AUC = 0.704). Significant time-group interactive effects were detected in axial length, anterior chamber depth, lens thickness, and central corneal thickness (all P < 0.05). CONCLUSIONS: Early and mid-term axial length variations are strongly associated with long-term myopia progression under orthokeratology intervention. Axial elongation exceeding 0.480 mm at year 3 indicates a high risk of rapid myopia progression, and 1-year axial growth exceeding 0.155 mm facilitates early risk stratification.
Microplastic contamination associated with contact lenses and related ophthalmic materials under real-world conditions.
Heinzelmann J, Vaghasiya H, Gadara MD … +4 more , Gramsall S, Viestenz A, Nguyen HT, Miclea PT
Cont Lens Anterior Eye · 2026 Jun · PMID 42320335 · Publisher ↗
PURPOSE: Commercial ophthalmic products including contact lenses are a source of microplastic pollution with increasing scientific interest due to prolonged and repeated contact with the ocular surface. But the polymer-b...
PURPOSE: Commercial ophthalmic products including contact lenses are a source of microplastic pollution with increasing scientific interest due to prolonged and repeated contact with the ocular surface. But the polymer-based materials of associated containers for storing and cleaning of contact lenses may represent an underestimated source of microplastic exposure. This preliminary study investigated microparticle presence and composition, with particular focus on microplastics. METHODS: Samples of new and long-term used contact lenses, packaging materials, storage containers, and cleaning and storage solutions associated with vision-correction and bandage contact lenses were examined under routine real-world and laboratory conditions using standardized filtration with silicon membranes (1 μm pore size), high-resolution optical microscopy, and micro-Raman spectroscopy supported by automated spectral classification. RESULTS: Organic and anorganic microparticles were detected in all analyzed sample types, including laboratory water sources, clinical storage solutions as well as contact lens-associated materials and solutions. Packaging materials, storage containers, and cleaning solutions contributed substantially to the observed microplastic burden, exceeding background levels. Microplastics were detected in all sample types, with higher counts in long-term used lenses and their storage solutions. Polymer profiles suggested that most detected microplastics particles originated from external sources rather than from degradation of the lens material itself. CONCLUSION: Contact lens associated materials represent relevant sources of microplastic exposure in ophthalmic practice. Repeated exposure during prolonged contact lens wear may facilitate cumulative microplastic accumulation at the ocular surface. Further systematic studies are required to clarify the biological relevance of this exposure and to inform future clinical and material design strategies.
Comparison of corneoscleral topographic consistency in eyes with low-to-moderate and high astigmatism.
Xiang Z, Han D, Gu D … +2 more , Qian Y, Chen Z
Cont Lens Anterior Eye · 2026 Jun · PMID 42308824 · Publisher ↗
PURPOSE: This study aimed to compare the corneoscleral topographic consistency between eyes with low-to-moderate and high refractive astigmatism (RA). METHODS: A total of 131 eyes of 69 participants with astigmatism (51...
PURPOSE: This study aimed to compare the corneoscleral topographic consistency between eyes with low-to-moderate and high refractive astigmatism (RA). METHODS: A total of 131 eyes of 69 participants with astigmatism (51 females and 18 males) and no ocular diseases or history of ocular surgery were included in this study. Participants were divided into a low-to-moderate astigmatism (LMA) group (|RA| ≤ 2.50 D; mean 1.57 ± 0.71 DC; n = 94 eyes) and a high astigmatism (HA) group (|RA| > 2.50 D; mean 3.72 ± 1.08 DC; n = 37 eyes). Corneoscleral topography was acquired via Anterior Segment Analyzer (Scansys TA517). The measurement repeatability at 8-mm and 14-mm chord lengths was examined using Bland-Altman approach. Intraclass correlation coefficient (ICC) between the corneal and scleral shapes was used to calculate corneoscleral topographic consistency. Inter-eye ICC of corneoscleral shape were compared in participants exhibiting a marked interocular astigmatic asymmetry (≥ 1.50 DC). RESULTS: The 8-mm chord lengths demonstrated superior repeatability, with narrower limits of agreement (LoA: 0.356 ± 0.029 mm; range 0.312 to 0.406 mm) compared to the 14-mm chord (LoA: 0.541 ± 0.058 mm; range 0.429 to 0.648 mm). The eyes with HA showed stronger corneoscleral topographic consistency (mean ICC = 0.54 ± 0.19) than those with LMA (mean ICC = 0.34 ± 0.37, t = -3.96, p < 0.001). In participants with interocular astigmatic asymmetry, the eye with greater astigmatic power exhibited a significantly higher corneoscleral topographic consistency (mean ICC = 0.67 ± 0.20) than the contralateral eye (mean ICC = 0.32 ± 0.24, t = 3.09, p = 0.01). CONCLUSION: Eyes with HA exhibited greater corneoscleral topographic consistency than those with LMA. This finding may help with scleral lens fitting in participants with corneal and refractive astigmatism in the absence of scleral shape data.
Morphological alterations of corneal nerve after short-term scleral lens therapy for severe dry eye: an in vivo confocal microscopic study.
Chen X, Lu C, Zhou X … +6 more , Tian L, Zeng L, Zhou X, Hong J, Chen Z, Le Q
Cont Lens Anterior Eye · 2026 Jun · PMID 42259092 · Publisher ↗
PURPOSE: To evaluate the morphological alterations of corneal subbasal nerve plexus after short-term scleral lens (SL) therapy in severe dry eye (DE) patients with the application of in vivo confocal microscopy (IVCM). M...
PURPOSE: To evaluate the morphological alterations of corneal subbasal nerve plexus after short-term scleral lens (SL) therapy in severe dry eye (DE) patients with the application of in vivo confocal microscopy (IVCM). METHODS: This single-center prospective cohort study enrolled 20 eyes of 20 severe DE patients. Apart from the collection of DE symptoms and clinical signs, IVCM was performed before and after one-month SL therapy, and the parameters of subbasal nerve plexus were analyzed including corneal nerve fibre length (CNFL), corneal nerve fibre density (CNFD), corneal nerve branch density (CNBD), and tortuosity coefficient (TC). Moreover, correlation analysis was performed to explore the relationship between the alterations of DE and nerve parameters. RESULTS: The symptoms and signs of DE were significantly improved after one-month SL therapy. The score of Ocular Surface Disease Index (OSDI) and corneal fluorescein staining (CFS) score decreased from 57.28 (2.780-100.0) and 13.1 ± 2.4 to 8.86 (0-50) and 8 (0-15), respectively, while fluorescein tear break-up time (FBUT) increased from (0.4 ± 0.5) s to (2.2 ± 2.0) s (all p < 0.001). Moreover, CNFL and CNFD were considerably increased after one-month SL therapy (all p < 0.05). The correlation analysis revealed that the first and average non-invasive breakup times (f-NIBUT, a-NIBUT) negatively correlated with CNBD (both p < 0.05). CONCLUSIONS: One-month SL therapy may not only alleviate the symptoms and signs of severe DE, but also improve the morphology of corneal subbasal nerve plexus. SL therapy has great potential in the management of ocular discomfort symptoms and refractory ocular pain associated with corneal nerve abnormalities in severe DE patients.
Diagnostic utility of inflammation-associated clinical signs in detecting MMP-9 expression in dry eye disease: A cross-sectional conjunctival impression cytology and droplet digital PCR study.
Jennings CJ, Muntz A, Wang MTM … +3 more , Ismail S, Wolffsohn JS, Craig JP
Cont Lens Anterior Eye · 2026 Jun · PMID 42250563 · Publisher ↗
PURPOSE: Clinical test utility for detecting inflammation in dry eye disease (DED) remains largely uninvestigated. This cross-sectional study explored relationships between clinical tests and molecular biomarkers of ocul...
PURPOSE: Clinical test utility for detecting inflammation in dry eye disease (DED) remains largely uninvestigated. This cross-sectional study explored relationships between clinical tests and molecular biomarkers of ocular surface inflammation to determine their diagnostic utility. METHODS: Inflammation indicators including bulbar conjunctival hyperaemia (subjective and objective grading), InflammaDry® MMP-9 test, Ocular Surface Inflammation Evaluation® score (Tearcheck®) and ocular surface staining were assessed in individuals with and without DED. Conjunctival impression cytology samples underwent droplet digital PCR to quantify MMP-9, IL-8 and IL-1β gene expression. Receiver operating characteristic curves established clinical test utility for detecting elevated biomarker levels and optimal cut-off values. RESULTS: Of 47 participants (55 ± 18 years; 21% male), 79% met the TFOS DEWS II diagnostic criteria for DED, with 84% classified as lipid-deficient. Biological MMP-9 presence was associated with NIBUT <5.8 s, hyperaemia score (JENVIS >1.0 or Efron grading >1.5), positive InflammaDry results, positive symptom scores (DEQ-5 >9 or OSDI >33.3), and thinner tear film lipid layer grade (LLG ≤ 2; all p < 0.05). No significant clinical associations with IL-8 or IL-1β levels were found. Two or more positive assessments from hyperaemia (JENVIS), NIBUT and LLG offered within-sample diagnostic accuracy of 78.6% sensitivity and 78.8% specificity. CONCLUSIONS: A test battery comprising bulbar conjunctival redness (JENVIS >1.0), tear film instability (NIBUT <5.8 s) and lipid insufficiency (LLG ≤2) optimally identified individuals with detectable MMP-9 expression. Two or more clinical signs identified high-risk individuals and, while further validation is warranted, it suggests inflammatory marker detection is limited to those with higher DED symptom and clinical sign scores.
Outcomes of rigid gas permeable contact lens correction in paediatric aphakia.
Leeson L, Webber A, Barkley M … +3 more , Sharma R, Nguyen V, Dai S
Cont Lens Anterior Eye · 2026 Jun · PMID 42241868 · Publisher ↗
BACKGROUND: This study aimed to assess visual outcomes, tolerance, and adverse events in paediatric aphakia following lensectomy when managed with rigid gas-permeable contact lenses worn on a 7-day extended-wear schedule...
BACKGROUND: This study aimed to assess visual outcomes, tolerance, and adverse events in paediatric aphakia following lensectomy when managed with rigid gas-permeable contact lenses worn on a 7-day extended-wear schedule. METHODS: A retrospective chart review was conducted of children undergoing lensectomy at the [redacted for review] Hospital from 1 January 2014 to 1 January 2021. Children whose aphakia was corrected with rigid gas-permeable contact lenses following lensectomy were included. Children corrected with a primary intraocular lens were excluded. Ophthalmic follow-up data were analysed up to 1 September 2024. RESULTS: A total of 113 aphakic eyes (73 children) were included. Forty children had bilateral lensectomies and 33 had unilateral lensectomies. Median age at lensectomy was 19 weeks (range 4.5 weeks-11.0 years; IQR 3.3 years). Median ophthalmic follow-up was 5.5 years (range 0.4-9 years; IQR 3.2 years). Median post-operative visual acuity was better in the bilateral lensectomy group (logMAR 0.3) compared to the unilateral group (logMAR 1.1) (Mann-Whitney U = 1370.5, p < 0.001). Corneal infiltrative events occurred in 5.3% of eyes (n = 6; 0.97 cases per 100 eye-years) and all resolved with topical treatment, with no visually significant sequelae documented. At final review, 63% of children were still wearing rigid gas-permeable contact lenses as their primary aphakic correction. Secondary intraocular lens implantation occurred at a median age of 4.7 years. CONCLUSION: Rigid gas-permeable contact lenses worn on a 7-day extended-wear schedule remained a viable optical correction for many children over long-term follow-up; however, the observed rate of corneal infiltrative events underscores the need for vigilant follow-up and caution with overnight wear. Children with bilateral aphakia demonstrated better visual outcomes than those with unilateral aphakia, which is consistent with the known amblyogenicity of unilateral visual deprivation in childhood.
Corneal epithelial morphological changes in orthokeratology lens wearers.
Qasim MSA, Kang P, Evans B … +2 more , Madigan MC, Carnt NA
Cont Lens Anterior Eye · 2026 Jun · PMID 42241867 · Publisher ↗
PURPOSE: To investigate the utility of in vivo confocal microscopy (IVCM) combined with standardized image grading for identifying early morphological changes in the central corneal and superior limbal basal epithelial c...
PURPOSE: To investigate the utility of in vivo confocal microscopy (IVCM) combined with standardized image grading for identifying early morphological changes in the central corneal and superior limbal basal epithelial cells during short-term orthokeratology (Ortho-K) lens wear, and its potential for identifying subclinical limbal stem cell stress. METHODS: In this prospective study, 12 healthy participants (aged 18-29 years) with no prior Ortho-K experience wore 10.5 mm total diameter Ortho-K lenses for 14 days. IVCM was performed at baseline, Day 7, and Day 14 to assess central corneal and superior limbal basal epithelial cells regularity, and palisades of Vogt (POV) prominence. Clinical assessments included subjective refraction, visual acuity, and corneal topography. IVCM images were graded 0 to 3 (grade 0 = no irregularity, grade 1 = slight irregularity, grade 2 = moderate irregularity, grade 3 = marked irregularity) by three masked examiners. Inter-grader reliability was assessed using intraclass correlation coefficients (ICC), and changes were analysed with the Friedman test. RESULTS: No significant changes were observed in central corneal basal epithelial cells regularity (p = 0.05), superior limbal basal epithelial cells regularity (p = 0.20), or POV prominence (p = 0.61). Inter-grader reliability was moderate for central epithelium (ICC = 0.66) and POV prominence (ICC = 0.62), and low for superior limbus (ICC = 0.46). Clinically, a significant hyperopic shift in spherical refraction (p < 0.001) and central corneal flattening (p < 0.001) occurred, with stable visual acuity (p = 0.86). CONCLUSION: IVCM revealed subtle, non-significant changes in corneal and limbal basal epithelial morphology and POV prominence over 14 days Ortho-K wear. The technique provides a practical, non-invasive approach for monitoring ocular surface health in Ortho-K users. Larger studies are needed to validate these findings and refine diagnostic criteria.
Associations of soft contact lens wear duration and stromal neuromediator profiles with recovery after SMILE: A prospective cohort study.
Shao Y, Wang W, Shi Y … +5 more , Sun L, Qian Y, Ma X, Li M, Zou J
Cont Lens Anterior Eye · 2026 Jun · PMID 42235422 · Publisher ↗
BACKGROUND: To investigate the associations of soft contact lens (SCL) wear duration and stromal neuromediator profiles measured in small incision lenticule extraction (SMILE)-derived lenticules with postoperative recove...
BACKGROUND: To investigate the associations of soft contact lens (SCL) wear duration and stromal neuromediator profiles measured in small incision lenticule extraction (SMILE)-derived lenticules with postoperative recovery after SMILE. METHODS: This prospective observational cohort study enrolled 90 patients undergoing SMILE, stratified by SCL wear duration: long-term (> 10 years, n = 25), short-term (≤ 10 years, n = 35), and non-wearers (n = 30). Corneal stromal lenticules obtained during SMILE were analyzed for nerve growth factor (NGF), calcitonin gene-related peptide (CGRP), substance P (SP), mesencephalic astrocyte-derived neurotrophic factor (MANF), and insulin-like growth factor binding protein-1 (IGFBP-1) via ELISA, with concentrations normalized to tissue weight. Corneal higher-order aberrations (HOA), corneal nerve fiber parameters, tear film breakup time (BUT), corneal fluorescein staining (CFS), ocular surface disease index (OSDI), quality of vision (QoV) scores, and contrast sensitivity (CS) were detected preoperatively and at 1/3/6 months postoperatively. Multiple linear regression was used to assess the associations of SCL wear duration and stromal neuromediator levels with changes in postoperative clinical parameters following SMILE. RESULTS: Long-term SCL wearers had higher NGF, CGRP, SP, and MANF levels than non-wearers. Compared with non-wearers, long-term SCL wearers showed higher preoperative corneal HOAs and OSDI/QoV scores, shorter BUT, lower CS, and poorer corneal nerve fiber parameters. After SMILE, all groups had increased HOA, reduced nerve fiber parameters, higher OSDI/QoV, and shorter BUT. Non-wearers achieved better recovery in spherical aberration, nerve fiber density, OSDI/QoV, and BUT. SCL wear duration was significantly associated with postoperative changes in HOA, OSDI, and CS, whereas stromal neuromediator levels were associated with changes in HOA, corneal nerve fiber density, OSDI, and CS. CONCLUSIONS: Preoperative SCL wear duration and stromal neuromediator profiles measured in SMILE-derived lenticules were associated with postoperative recovery after SMILE. Compared with non-wearers, long-term SCL wearers showed less favorable postoperative recovery.
Effect of blinking on the measurement of tear evaporation rate.
Martínez-Plaza E, Sánchez-Miguel L, Arroyo-Del Arroyo C … +2 more , González-García MJ, López-de la Rosa A
Cont Lens Anterior Eye · 2026 May · PMID 42218885 · Publisher ↗
PURPOSE: To evaluate the reliability and agreement of tear film evaporation measurements under different blinking conditions. METHODS: Ninety-six healthy volunteers (96 eyes) were recruited. Tear evaporation was measured...
PURPOSE: To evaluate the reliability and agreement of tear film evaporation measurements under different blinking conditions. METHODS: Ninety-six healthy volunteers (96 eyes) were recruited. Tear evaporation was measured using the Eye Vapometer under four randomized conditions: no-blinking, natural blinking, controlled blinking (one blink every 3 s), and eyes-closed. Raw evaporation rates were recorded in three consecutive measurements for each condition. Tear evaporation rates (TER) were calculated by subtracting the raw evaporation rate with eyes-closed from the other three conditions. Reliability of raw measurements were assessed, and agreement between TER values was evaluated using the Bland-Altman method. RESULTS: Consecutive measurements taken under the no-blinking condition showed significant differences (p ≤ 0.04). The repeatability values for no-blinking, natural blinking, controlled blinking and eyes-closed were 56.12, 44.78, 42.46 and 22.32, respectively. The no-blinking condition provided significantly higher TER values than natural blinking (p < 0.001) and controlled blinking (p = 0.005). CONCLUSIONS: Blinking affects the reliability of evaporation measurement, with the least reliable condition being no-blinking. TER under the natural blinking condition shows good reliability and best represents physiological function during daily activities; therefore, it appears to be the most appropriate condition for TER evaluation.
Optimising slit-lamp biomicroscope fluorescein imaging filters.
Wolffsohn JS, Ting PWK, Hunt OA … +1 more , Craig JP
Cont Lens Anterior Eye · 2026 May · PMID 42208478 · Publisher ↗
AIM: Fluorescein dye plays a pivotal role in ophthalmic care as a diagnostic agent due to its fluorescent properties when exposed to blue light. This study examined the spectral profile of blue and yellow filters within...
AIM: Fluorescein dye plays a pivotal role in ophthalmic care as a diagnostic agent due to its fluorescent properties when exposed to blue light. This study examined the spectral profile of blue and yellow filters within commercial slit lamps with a view to determining whether these are optimal. METHODS: The spectral transmission of the white light, blue filtered light(s) and inbuilt yellow filters (where available) of 16 models of slit lamp biomicroscope from 11 different manufacturers were measured with a spectrophotometer. To confirm the peak wavelength required to excite sodium fluorescein dye, the intensity of fluorescence was measured in vitro on exposure to blue light of narrow wavelength bands between 400 and 490 nm. Finally, the effect of altering the blue light, from a Cobalt filter profile (broad ranged with a peak around 450 nm) to one centred at approximately 490 nm, was demonstrated on-eye at 1-min intervals post-fluorescein dye instillation. RESULTS: Most slit lamp blue lights had a similar spectral profile to Cobalt blue, with a peak wavelength of between 443 and 463 nm. The spectral width of the blue light band at 50% of its height was significantly greater with a tungsten (63 to 80 nm) than a LED source (20 to 40 nm; p < 0.001). Yellow filters had a 50% cut-off of 512.3 to 524.5 (with a 16.0 to 33.3 nm range), higher than the optimal ∼505 nm. Optimising blue and yellow filters improved fluorescein visibility by 1.8 ± 0.3× (p < 0.05). CONCLUSION: Despite the suboptimal transmission of Cobalt blue filters for exciting fluorescein molecules, their use prevails in the majority of slit lamps, and the yellow filters lack a sharp spectral cut-off. Adopting new "fluoro-" enhanced slit-lamp illumination filters would address shortcomings of existing filters.
Reply to "Effect of orthokeratology on ocular dominance in Chinese myopic children: a 1-year longitudinal study".
Yang Z
Cont Lens Anterior Eye · 2026 May · PMID 42203618 · Publisher ↗
Abstract loading — click title to view on PubMed.
Contact Lens usage in pediatric patients: Experiences from a tertiary eyecare center in Turkey.
Balci AS, Altindis B, Sen K … +2 more , Gumus Akgun G, Ozcelik F
Cont Lens Anterior Eye · 2026 May · PMID 42184571 · Publisher ↗
PURPOSE: To evaluate the indications, patterns of use, complications, and reasons for discontinuation of contact lenses in pediatric patients over a 10-year period in a tertiary eye care center. METHODS: This retrospecti...
PURPOSE: To evaluate the indications, patterns of use, complications, and reasons for discontinuation of contact lenses in pediatric patients over a 10-year period in a tertiary eye care center. METHODS: This retrospective, observational study included patients who use contact lenses before age of 18 years and followed more than 12 months, between 2014 and 2024. Demographic data, lens type, indication, technical parameters, complications, discontinuation reasons, and follow-up duration were recorded. Descriptive statistics were calculated. RESULTS: A total of 923 patients (63.7% female, 36.3% male) with a mean age of 14.6 ± 3.5 years and mean follow-up of 38.1 ± 26.6 months were included. The leading indications were ametropia (65.7%), anisometropia (14.1%), and keratoconus (13.2%). Most patients (94.1%) used soft contact lenses; 3.6% used rigid corneal lenses and 2.3% used silicone elastomer lenses. Contact lens-related complications occurred in 35.0% of soft lens users and 51.5% of rigid corneal lens users. Punctate epithelial keratitis (41.5%) and allergic conjunctivitis (26.9%) were the most common events. Ninety-six patients (10.4%) discontinued lens use, mainly due to poor adherence (53.1%) or discomfort (25.0%). CONCLUSION: Contact lenses are effective options for visual correction in children and adolescents. However, contact lens use in pediatric patients may be associated with complications and discontinuation. Appropriate follow-up and patient education remain important components of pediatric contact lens care.
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