A novel method to predict the dry eye symptoms in new contact lens wearers.
OBJECTIVE
Lid wiper epitheliopathy (LWE) and lid parallel conjunctival folds (LIPCOF) give moderate prediction levels for dryness symptoms in experienced contact lens (CL) wearers. This study investigated whether a combination of LWE and LIPCOF plus other tear film tests and subjective evaluation before contact lens fitting was better able to predict CL-induced dry eye (CLIDE) symptoms.


METHODS
Tear meniscus height, non-invasive break-up time (NIBUT), ocular hyperaemia, LIPCOF, phenol red thread test, corneal and conjunctival staining, and LWE of the right eye of 33 new soft CL wearers (12 males, 21 females, median age = 30.5 years; range = 19 to 44) were assessed in a prospective 2-mo longitudinal study. Symptoms were evaluated by the Ocular Surface Disease Index (OSDI) and subjects were grouped according to their response in the Contact Lens Dry Eye Questionnaire (CLDEQ) during the study (20 symptomatic and 13 asymptomatic). The subjects were fitted with vifilcon A and senofilcon A lenses for a 2-week period, consecutively.


RESULTS
Limbal hyperaemia (repeated measures analysis of variance; p < 0.05) and LWE (Friedman; p < 0.004) increased significantly during the study but not LIPCOF (p > or = 0.318; temporal, nasal, and Sum), bulbar hyperaemia (p = 0.432), staining (p > or = 0.060), OSDI (p = 0.126), or CLDEQ (p = 0.317, kappa = 0.279). Limbal hyperaemia significantly decreased in senofilcon A lenses. Wearing comfort among symptomatics was significantly better with senofilcon A (p = 0.005). At the enrolment visit, the subjects who became symptomatic exhibited significantly decreased NIBUT and increased LIPCOF and OSDI (range, p < 0.027). The best test combination to predict CLIDE (logistic regression analyses) was LIPCOF Sum plus NIBUT and OSDI, (positive predictive value = 87% and accuracy = 91%).


CONCLUSIONS
LIPCOF, NIBUT, and OSDI are significant discriminators for CLIDE in new CL wearers compared with hyperaemia, tear meniscus height, phenol red thread test, staining, and LWE. The best test combination is NIBUT plus LIPCOF Sum and OSDI (named the Contact-Lens-Predicting-Test).
Pult
Heiko
H
School of Optometry and Vision Sciences, Contact Lens and Anterior Eye Research (CLAER) Unit, Cardiff University, Wales, United Kingdom. ovr@heiko-pult.de
Murphy
Paul J
PJ
Purslow
Christine
C
D000328:Adult; D003228:Conjunctiva / Q000473:pathology; D003263:Contact Lenses, Hydrophilic / Q000009:adverse effects*; D003315:Cornea / Q000473:pathology; D003941:Diagnostic Techniques, Ophthalmological; D005123:Eye / Q000098:blood supply; D005260:Female; D006801:Humans; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D006940:Hyperemia / Q000175:diagnosis; D007202:Indicators and Reagents; D008137:Longitudinal Studies; D008297:Male; D010637:Phenolsulfonphthalein; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012044:Regression Analysis; D013194:Staining and Labeling; D011795:Surveys and Questionnaires; D013666:Tears / Q000378:metabolism; D014985:Xerophthalmia / Q000175:diagnosis* / Q000209:etiology*; D055815:Young Adult
D007202:Indicators and Reagents; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D010637:Phenolsulfonphthalein