title: Predicting success with silicone-hydrogel contact lenses in new wearers.
abstract: OBJECTIVE
  to evaluate changes in tear metrics and ocular signs induced by six months of silicone-hydrogel contact lens wear and the difference in baseline characteristics between those who successfully continued in contact lens wear compared to those that did not.
  
  
  METHODS
  Non-invasive Keratograph, Tearscope and fluorescein tear break-up times (TBUTs), tear meniscus height, bulbar and limbal hyperaemia, lid-parallel conjunctival folds (LIPCOF), phenol red thread, fluorescein and lissamine-green staining, and lid wiper epitheliopathy were measured on 60 new contact lens wearers fitted with monthly silicone-hydrogels (average age 36±14 years, 40 females). Symptoms were evaluated by the Ocular Surface Disease Index (OSDI). After six months full time contact lens wear the above metrics were re-measured on those patients still in contact lens wear (n=33). The initial measurements were also compared between the group still wearing lenses after six months and those who had ceased lens wear (n=27).
  
  
  RESULTS
  There were significant changes in tear meniscus height (p=0.031), bulbar hyperaemia (p=0.011), fluorescein TBUT (p=0.027), corneal (p=0.007) and conjunctival (p=0.009) staining, LIPCOF (p=0.011) and lid wiper epitheliopathy (p=0.002) after six months of silicone-hydrogel wear. Successful wearers had a higher non-invasive (17.0±8.2s vs 12.0±5.6s; p=0.001) and fluorescein (10.7±6.4s vs 7.5±4.7s; p=0.001) TBUT than drop-outs, although OSDI (cut-off 4.2) was also a strong predictor of success.
  
  
  CONCLUSIONS
  Silicone-hydrogel lenses induced significant changes in the tear film and ocular surface as well as lid margin staining. Wettability of the ocular surface is the main factor affecting contact lens drop-out.
authors.affiliation: Specsavers, 41 High Row, Darlington, Co Durham DL3 7QW, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Best
authors.forename: Laura
authors.initials: L
authors.lastname: Drury
authors.forename: James S
authors.initials: JS
authors.lastname: Wolffsohn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003229:Conjunctival Diseases / Q000175:diagnosis / Q000209:etiology*; D003263:Contact Lenses, Hydrophilic / Q000009:adverse effects* / Q000145:classification*; D005260:Female; D006801:Humans; D020100:Hydrogels / Q000009:adverse effects; D006940:Hyperemia / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011379:Prognosis; D012030:Refractive Errors / Q000150:complications* / Q000175:diagnosis / Q000534:rehabilitation*; D012825:Silicon / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D020100:Hydrogels; D012825:Silicon
keywords: Comfort; Contact lens induced dry-eye; Drop-out; Neophytes; Silicone-hydrogel contact lenses; Tear-film