Purpose: Rigid gas permeable (GP) contact lenses may provide the safest option for lens wear, but prescribing rates are in decline. This study investigated the effect of practitioner attitudes on GP lens prescribing. Methods: A questionnaire was developed using a focus group and a pilot study. Questions addressed clinical time spent fitting GP lenses, specialist equipment requirements and perceived safety and comfort. With ethical approval, the questionnaire was sent to 1000 randomly selected UK registered eye care practitioners (ECPs). Results: In general, ECPs enjoy the challenge of fitting GPs, although fitting takes longer than soft lens fitting. There is a difference in attitude between longer qualified and more recently qualified ECPs. Longer qualified ECPs more frequently reported enjoyment of the fitting challenges, recommended GP lenses to patients and were less likely to believe that GP lenses were becoming obsolete. ECPs are in strong agreement on the ocular health advantages of fitting GPs. They do not feel specialist equipment is generally needed, although some reported a topographer to be advantageous. The large majority of ECPs do not have access to the specialist equipment they perceive to be normally associated with GP fitting (radiuscope, V-gauge). They believe that initial fitting discomfort of GP fitting is a major drawback to their fitting, and while they feel this greatly improves with adaptation, they do not feel it reaches soft lens wear comfort. A total of 30.3% of ECPs feel it is clinically acceptable to use topical anaesthetic during GP fitting, but only 1.4% of ECPs regularly do so. Conclusions: ECPs are aware of the benefits that GP lenses provide in terms of ocular health. They find GPs take longer to fit, but they enjoyed the challenge of fitting, which suggests that they are not lacking in clinical skill, nor any specialist equipment. However, they are unhappy with initial patient comfort, and are not yet prepared to use topical anaesthetics during initial fitting. As a consequence, ECPs believe that GP lenses are becoming obsolete. Negative practitioner attitudes toward various aspects of GP fitting may mean fewer recommendations to patients and reduced GP prescribing.
TA use during GP CL fitting has potential patient benefits: improved first-time GP CL wear comfort, reduced anxiety during adaptation, reduced anxiety prior to subsequent GP CL wear.
Purpose: Using atomic force microscopy (AFM) to investigate anterior surface topography (AST) in worn and unworn, plasma surface-treated (PST) and untreated (UT) gas permeable (GP) lenses, and influence of surface topography on in vivo comfort.Methods: GP lens AST evaluated with AFM in tapping mode, using an uncoated, 40nm symmetric tip (sampling frequency: 300kHz), at five randomised locations, over a 100µm 2 area, to produce mean average roughness (Ra) and root mean square (RMS) values for each sample. Four unworn lenses (two PST, two UT) were examined (Quasar/Boston EO material). Twenty worn lenses (ten PST, ten UT) of same design and material as unworn lenses collected after 3 months lens wear. General wearing comfort reported by visual analogue scale (VAS) at 3 months visit. For sample preparation, two worn UT GP lenses were divided into four segments; each segment underwent a different lens rinse and drying method.Results: Unworn: UT lenses had significantly higher mean RMS and Ra values compared to PST (Mann-Whitney, p<0.05). Worn: UT Median RMS values were significantly higher than PST (Mann-Whitney, p<0.05). Comfort: no correlation found between general comfort and RMS or Ra scores.Sample preparation: Method 4 (purified, distilled water rinse/nitrogen gas dry) produced optimum median RMS and Ra values.Conclusions: Unworn PST GP lenses had lower Ra and RMS values compared with unworn UT GP lenses. After 3 months wear, PST lenses had smoother surface topographies than UT lenses. No relationship was found between surface topography and lens wear comfort. Sample preparation protocol directly impacts AFM results.
Highlights:• Plasma-surface treatment reduces roughness of unworn gas permeable contact lenses.• Benefit of plasma treatment continues for at least 3 months of daily wear.• No relationship was found between surface roughness and wear comfort.• A sample preparation protocol was developed to produce repeatable results.
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