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Contact Lens Interactions with the Tear Film Subcommittee Report
Contact Lens Interactions with the Tear Film Subcommittee Report
Contact Lens Interactions with the Tear Film Subcommittee Report
Contact Lens Interactions with the Tear Film Subcommittee Report
Contact Lens Interactions with the Tear Film Subcommittee Report
Contact Lens Interactions with the Tear Film Subcommittee Report
The tear film is crucial to ocular surface health, and a contact lens,
The tear film is crucial to ocular surface health, and a contact lens,
The tear film is crucial to ocular surface health, and a contact lens,
The tear film is crucial to ocular surface health, and a contact lens,
The tear film is crucial to ocular surface health, and a contact lens,
The tear film is crucial to ocular surface health, and a contact lens,
The tear film is crucial to ocular surface health, and a contact lens,
The tear film is crucial to ocular surface health, and a contact lens,
Tear film dynamics Blink impact on tear film Lipid layer quantity and
Tear film dynamics Blink impact on tear film Lipid layer quantity and
Biochemistry Lipidome Proteome Mucins, glycocalyx and “mucin” balls
Biochemistry Lipidome Proteome Mucins, glycocalyx and “mucin” balls
Biochemistry Lipidome Proteome Mucins, glycocalyx and “mucin” balls
Biochemistry Lipidome Proteome Mucins, glycocalyx and “mucin” balls
Biochemistry Lipidome Proteome Mucins, glycocalyx and “mucin” balls
Biochemistry Lipidome Proteome Mucins, glycocalyx and “mucin” balls
Blink impact CL –
Blink impact CL –
Evaporation Non-CL: Evaporation
Evaporation Non-CL: Evaporation
Tear film stability Evaluated with TBUT / NIBUT tests or dynamic tests
Tear film stability Evaluated with TBUT / NIBUT tests or dynamic tests
Tear film stability Evaluated with TBUT / NIBUT tests or dynamic tests
Tear film stability Evaluated with TBUT / NIBUT tests or dynamic tests
Tear film thickness Normal thickness around 3µm In CL, PLTF around 2µm
Tear film thickness Normal thickness around 3µm In CL, PLTF around 2µm
Tear volume Total volume in non-CL eye around 2 to 4µl11 In CL,
Tear volume Total volume in non-CL eye around 2 to 4µl11 In CL,
Tear Exchange
Tear Exchange
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1Contact Lens Interactions with the 16inconclusive. Link to discomfort ? Link to
Tear Film Subcommittee Report Members: discomfort ? stability. lipid layer
Jennifer Craig (Chair & SC Liason) thickness. evaporation. surface tension.
Mark Willcox (Workshop Vice-Chair) Pablo tear turnover. osmolarity. volume. pH.
Argueso Cecile Maissa Ulrike Stahl Alan ferning. temperature. Interactions with
Tomlinson Jianhua Wang Norihiko Yokoi the Tear Film Subcommittee.
Fiona Stapleton (Harmonization 17Conclusions absence of a consistent
Subcommittee Member). definition has hindered the correlation of
2The tear film is crucial to ocular biophysical and biochemical tear film
surface health, and a contact lens, by its parameters with discomfort the close
very presence, affects the tear film, and relationship that exists between tear film
therefore has the potential to affect stability, ocular surface temperature, and
comfort. Interactions with the Tear Film tear evaporation suggests that
Subcommittee. interventions that modify one aspect will
3Effects on the tear film. Biophysical influence all consideration of tear type
- changes to dynamics and quality. important in relating tear film
Biochemical - compositional changes. biochemistry to discomfort. Interactions
Interactions with the Tear Film with the Tear Film Subcommittee.
Subcommittee. 18Future directions to define the
4Biophysical & biochemical tear biophysical and biochemical properties
film aspects. Comprehensive review of the inherent to the structural integrity of
literature on each topic with respect to: the normal non-CL tear film to develop
the pre-corneal (non-CL) tear film the lens materials, designs and surfaces that
tear film in the presence of a CL the promote biocompatibility … and refine the
impact of that aspect on discomfort in CL wetting agents within CL care solutions
wear Evaluation of deficiencies in the for long-term wettability of the CL
current literature, together with surface … … to a level that allows the
suggestions for future research. tear film to remain stable over the CL
Interactions with the Tear Film surface and support an adequate lipid
Subcommittee. layer. Interactions with the Tear Film
5Tear film dynamics Blink impact on Subcommittee.
tear film Lipid layer quantity and quality 19Thank you. TFOS Contact Lens
Evaporation Stability Temperature Interactions with the Tear Film
Thickness Turn over Volume / CL edge Subcommittee Sponsors. Interactions with
profile Exchange (post-lens). Tear film the Tear Film Subcommittee.
quality Osmolality Ferning. pH Viscosity. 20References Collins M, J , Stahmer D,
Interactions with the Tear Film Pearson G. Clinical findings associated
Subcommittee. with incomplete blinking in soft lens
6Biochemistry Lipidome Proteome Mucins, wearers. Clin Exp Optom 1989;72:55-56.
glycocalyx and “mucin” balls Other Yokoi N, Yamada H, Mizukusa Y, et al.
components. Cellular content (PMNs) Rheology of tear film lipid layer spread
Contaminants. Interactions with the Tear in normal and aqueous tear-deficient dry
Film Subcommittee. eyes. Invest Ophthalmol Vis Sci
7Blink impact CL – ? blink frequency to 2008;49:5319-5324. Kojima T, Matsumoto Y,
compensate for ? TBUT Incomplete blinks in Ibrahim OM, et al. Effect of controlled
hydrogel CL wear linked to: increased adverse chamber environment exposure on
fluorescein staining discomfort and tear functions in silicon hydrogel and
increased lens deposition1. Lipid layer hydrogel soft contact lens wearers. Invest
(LL) Lipid layer ? ? surface tension and ? Ophthalmol Vis Sci 2011;52: 8811-8817.
evaporation In CL wear, LL thickness and Guillon JP, Guillon M. Tear film
uniformity are ? due to ? aqueous layer examination of the contact lens patient.
thickness2 No clear relationship with Contax 1988;14-20. Chui WS, Cho P, Brown
comfort. Interactions with the Tear Film B. Soft contact lens wear in Hong
Subcommittee. Kong-Chinese: predicting success.
8Evaporation Non-CL: Evaporation ? with Ophthalmic Physiol Opt 2000;20:480-486.
incomplete lipid layer CL ? ? evaporation Fonn D, Dumbleton K. Dryness and
(x 1.2 – x 2.6) associated with ? discomfort with silicone hydrogel contact
stability, independent of lens material lenses. Eye Contact Lens 2003;29:S101-104
Under adverse conditions, ? evaporation Glasson MJ, Hseuh S, Willcox MD.
related to discomfort in hydrogel, but not Preliminary tear film measurements of
SiHy, CL wearers3. Temperature Surrogate tolerant and non-tolerant contact lens
measure for tear film evaporation and/or wearers. Clin Exp Optom 1999;82:177-181.
stability No clear relation with comfort. Hom MM, Bruce AS. Prelens tear stability:
Interactions with the Tear Film relationship to symptoms of dryness.
Subcommittee. Optometry 2009;80:181-184. Interactions
9Tear film stability Evaluated with with the Tear Film Subcommittee.
TBUT / NIBUT tests or dynamic tests Lipid 21References Maruyama K, Yokoi N,
thickness closely associated with TBUT, Takamata A, Kinoshita S. Effect of
thus, in CL: ? Aqueous ? ? lipid layer environmental conditions on tear dynamics
spread ? ? TBUT. 4. Pre-corneal TBUT ? in soft contact lens wearers. Invest
initially but longer term changes in Ophthalmol Vis Sci 2004;45:2563-2568.
post-removal TBUT* not observed5. Non-CL Glasson MJ, Stapleton F, Keay L, Sweeney
> 10s. Rigid CL 2 – 3 s. Hydrogel CL* 5 D, Willcox MD. Differences in clinical
– 6 s. Interactions with the Tear Film parameters and tear film of tolerant and
Subcommittee. *non-material specific. intolerant contact lens wearers. Invest
10Relation of stability to comfort With Ophthalmol Vis Sci 2003;44:5116-5124. Chen
soft CL, discomfort is observed with ? Q, Wang J, Tao A, Shen M, Jiao S, Lu F.
TBUT6, 7 Pre-lens TBUT < 3 s predicts Ultrahigh-resolution measurement by
symptomatic CL wear8 With CL, under optical coherence tomography of dynamic
adverse environmental conditions: ? tear film changes on contact lenses.
relative humidity ? ? stability ? ? Invest Ophthalmol Vis Sci
symptoms9 Wearers unable to tolerate 6 hrs 2010;51:1988-1993. Tomlinson A, Fagehi R,
CL wear have lower NIBUT than tolerant Manahilov V. Why do some contact lens
wearers (13s vs 20s)10. Interactions with wearers avoid contact lens dry eye
the Tear Film Subcommittee. symptoms? , 90th Annual Meeting of the
11Tear film thickness Normal thickness American Academy of Optometry. Phoenix,
around 3µm In CL, PLTF around 2µm on AZ, USA; 2012:E-abstract 120286 Chen Q,
stabilisation11 PoLTF approximately 1 – Wang J, Shen M, et al. Tear menisci and
3µm11 No established association with ocular discomfort during daily contact
discomfort. Tear turnover rate No lens wear in symptomatic wearers. Invest
consistent change in TTR with CL wear Ophthalmol Vis Sci 2011;52:2175-2180.
However, immediately post lens removal, McNamara NA, Polse KA, Brand RJ, Graham
TTR in symptomatic individuals is less AD, Chan JS, McKenney CD. Tear mixing
than that in asymptomatic individuals12. under a soft contact lens: effects of lens
Interactions with the Tear Film diameter. Am J Ophthalmol
Subcommittee. 1999;127:659-665. Stahl U, Willcox M,
12Tear volume Total volume in non-CL eye Naduvilath T, Stapleton F. Influence of
around 2 to 4µl11 In CL, meniscus volume ? tearfilm and contact lens osmolality on
from around 1.5 to 1.0µl11 Limited but comfort in CL wear. Optom Vis Sci
significant effect of tear volume on 2009;86:857-867. Interactions with the
comfort10, 13. Meniscus profile Altered in Tear Film Subcommittee.
soft CL wear13 No association with CL 22References Stahl U, Willcox M,
discomfort established. Interactions with Naduvilath T, Stapleton F. Influence of
the Tear Film Subcommittee. tearfilm and contact lens osmolality on
13Tear Exchange ? with ? lens size,14 comfort in CL wear. Optom Vis Sci
but not linked with discomfort Osmolarity 2009;86:857-867. Evans KS, North RV,
No consistent effect of adapted CL wear on Purslow C. Tear ferning in contact lens
osmolarity15 Relation to discomfort wearers. Ophthalmic Physiol Opt
equivocal15, 16 Ferning Ferning grade 2009;29:199-204. Ravazzoni L, Ghini C,
increases with CL wear17 Can differentiate Macri A, Rolando M. Forecasting of
CL and non-CL wearers, but ability to hydrophilic contact lens tolerance by
predict intolerance not currently means of tear ferning test. Graefes Arch
confirmed17, 18. Interactions with the Clin Exp Ophthalmol 1998;236:354-358. Chen
Tear Film Subcommittee. FS, Maurice DM. The pH in the precorneal
14pH ? by 0.27 – 0.53 units in CL wear19 tear film and under a contact lens
but is not clearly related to comfort20 measured with a fluorescent probe. Exp Eye
Viscosity effects of CL unknown Surface Res 1990;50:251-259. McCarey BE, Wilson
tension no studies specific to CL wear LA. pH, osmolarity and temperature effects
some biochemistry changes (lipids, sPLA2, on the water content of hydrogel contact
lipocalin) may relate to changes to lenses. Contact Intraocul Lens Med J
surface tension21. Interactions with the 1982;8:158-167. Glasson MJ, Stapleton F,
Tear Film Subcommittee. Willcox MD. Lipid, lipase and lipocalin
15Changes in tear biochemistry Lipidome: differences between tolerant and
? phospholipid levels (due to ? sPLA2)21 intolerant contact lens wearers. Curr Eye
is conceivably a contributing factor in CL Res 2002;25:227-235. Berry M, Pult H,
discomfort Proteome: Most major proteins Purslow C, Murphy PJ. Mucins and ocular
unaffected by CL wear Possible increases signs in symptomatic and asymptomatic
in cytokines ? lipocalin-1 in CL contact lens wear. Optom Vis Sci
intolerance21 Mucins: Relation to 2008;85:E930-938. Pisella PJ, Malet F,
tolerance inconclusive22, 23 Possible Lejeune S, et al. Ocular surface changes
relation between pattern of mucin induced by contact lens wear. Cornea
degradation and CL discomfort24. 2001;20:820-825. Berry M, Purslow C,
Interactions with the Tear Film Murphy PJ, Pult H. Contact lens materials,
Subcommittee. mucin fragmentation and relation to
16Summary CLs induce: ? stability, lipid symptoms. Cornea 2012;31:770-776.
layer and volume ? evaporation rate To Interactions with the Tear Film
date, the effect on comfort of many of Subcommittee.
these biophysical properties is unknown or
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