Is There a Role for Inflammation in Contact Lens Discomfort?

Willcox, Mark

doi:10.1097/icl.0000000000000343

Cited by 29 publications

(14 citation statements)

References 187 publications

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“…45–47 Inflammatory mediators released in tears have been recognized as one of the key components in ocular surface inflammation that have prominent roles in the pathophysiology of DED. 48 Of the multiple inflammatory biomarkers under investigation, cytokines and chemokines are the most frequently reported and studied in DED.…”

Section: Biomarkers Of Inflammationmentioning

confidence: 99%

“…48 Of the multiple inflammatory biomarkers under investigation, cytokines and chemokines are the most frequently reported and studied in DED. 45–47 Components of lipid metabolism also have been reported to be correlated with clinical measures of DED, and include secretory phospholipase A2 (sPLA2), 49 prostaglandin E2 (PGE2), 50 arachidonic acid (AA), docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and leukotriene B4 (LTB4). 51,52 Using a relatively new technology, isobaric tag for relative and absolute quantitation technology (iTRAQ) proteomics, tear proteins like α-enolase, α-1 acid glycoprotein 1, S100 A8/calgranulin A, S100 A9/calgranulin B, S100 A9/calgranulin B; S100 A4, and S100 A11 have been shown to be upregulated in DED tears.…”

Section: Biomarkers Of Inflammationmentioning

confidence: 99%

“…Though a number of different cytokines/chemokines have been analyzed in tears of DED patients, 45–47 this review will focus on 4 cytokines that have shown to be consistently elevated in DED tears compared to non-DED controls, and thought to have a mechanistic role in DED: (1) TNF-α for general inflammatory status of the ocular surface 61 (Table 3), (2) IL-6, which has pro- and anti-inflammatory roles, may provide important information on ocular immune status and on treatment effect 62 (Table 4), (3) IL-17a, which is secreted by specialized T helper 17 (Th17) subpopulation 63 (Table 5), and (4) IL-8, which is important in chemotaxis to mediate macrophage and epithelial innate immunity 64 (Table 6). As can be observed in the Tables , a wide range of concentrations has been observed for these cytokines.…”

Section: Biomarkers Of Inflammationmentioning

confidence: 99%

See 2 more Smart Citations

The Growing Need for Validated Biomarkers and Endpoints for Dry Eye Clinical Research

Roy

Wei

Kuklinski

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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PurposeBiomarkers with minimally invasive and reproducible objective metrics provide the key to future paradigm shifts in understanding of the underlying causes of dry eye disease (DED) and approaches to treatment of DED. We review biomarkers and their validity in providing objective metrics for DED clinical research and patient care.MethodsThe English-language literature in PubMed primarily over the last decade was surveyed for studies related to identification of biomarkers of DED: (1) inflammation, (2) point-of-care, (3) ocular imaging, and (4) genetics. Relevant studies in each group were individually evaluated for (1) methodological and analytical details, (2) data and concordance with other similar studies, and (3) potential to serve as validated biomarkers with objective metrics.ResultsSignificant work has been done to identify biomarkers for DED clinical trials and for patient care. Interstudy variation among studies dealing with the same biomarker type was high. This could be attributed to biologic variations and/or differences in processing, and data analysis. Correlation with other signs and symptoms of DED was not always clear or present.ConclusionsMany of the biomarkers reviewed show the potential to serve as validated and objective metrics for clinical research and patient care in DED. Interstudy variation for a given biomarker emphasizes the need for detailed reporting of study methodology, including information on subject characteristics, quality control, processing, and analysis methods to optimize development of nonsubjective metrics. Biomarker development offers a rich opportunity to significantly move forward clinical research and patient care in DED.OverviewDED is an unmet medical need — a chronic pain syndrome associated with variable vision that affects quality of life, is common with advancing age, interferes with the comfortable use of contact lenses, and can diminish results of eye surgeries, such as cataract extraction, LASIK, and glaucoma procedures. It is a worldwide medical challenge with a prevalence rate ranging from 8% to 50%. Many clinicians and researchers across the globe are searching for better answers to understand the mechanisms related to the development and chronicity of DED. Though there have been many clinical trials for DED, few new treatments have emerged over the last decade. Biomarkers may provide the needed breakthrough to propel our understanding of DED to the next level and the potential to realize our goal of truly personalized medicine based on scientific evidence. Clinical trials and research on DED have suffered from the lack of validated biomarkers and less than objective and reproducible endpoints. Current work on biomarkers has provided the groundwork to move forward. This review highlights primarily ocular biomarkers that have been investigated for use in DED, discusses the methodologic outcomes in providing objective metrics for clinical research, and suggests recommendations for further work.

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Section: Biomarkers Of Inflammationmentioning

confidence: 99%

Section: Biomarkers Of Inflammationmentioning

confidence: 99%

Section: Biomarkers Of Inflammationmentioning

confidence: 99%

See 1 more Smart Citation

The Growing Need for Validated Biomarkers and Endpoints for Dry Eye Clinical Research

Roy

Wei

Kuklinski

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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“…More recently, it has been proposed that discomfort may arise as a result of the intrinsically sub‐clinical inflammatory response of the eye to contact lens wear . Preliminary studies have demonstrated a link between the mobilisation of inflammatory cells and contact lens‐induced discomfort.…”

Section: Preserving Ocular Healthmentioning

confidence: 99%

Rethinking contact lens aftercare

Efron

Morgan

2017

Clinical and Experimental Optometry

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The evolution of contact lens technology and clinical practice over the past three decades has been remarkable, with dramatic improvements in material biocompatibility, better lens designs and care systems, and more flexible and convenient modalities of wear. However, our approach to the aftercare examination has remained conservative, with the general modus operandi having not fully evolved from the difficult, early years of fitting non-regular replacement rigid and low water content hydrogel lenses. In this paper, we review current aftercare practice and in particular, the preferred frequency that lens wearers should return for routine visits and the appropriateness of regulations governing contact lens prescription expiry. Four key clinical reasons for conducting a routine aftercare visit are identified: preserving ocular health, maintaining good vision, optimising comfort and ensuring satisfactory lens fitting performance. Commercial reasons for conducting aftercare visits are also considered. A decision matrix is presented to help practitioners decide on an appropriate time interval between routine aftercare visits. The first aftercare visit should always take place within one to two weeks of lens dispensing. After this, the following time intervals between routine aftercare visits are advised as a general guideline: soft daily disposable, 24 months; soft daily reusable and rigid daily wear, 12 months; soft and rigid extended wear, six months. These aftercare visit frequencies may need to be adjusted when rapid rates of refractive change are anticipated, such as every six months during child/teenager myopic progression and every 12 months during the advancement of presbyopia. Numerous clinical caveats for varying these recommended aftercare frequencies are also discussed. Those new to lens wear should be seen within the first two months of lens dispensing. Regulatory authorities charged with the responsibility of stipulating the validity of a contact lens prescription should continue to allow optometrists to set an expiry date relevant to the circumstances of individual lens wearers.

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“…Currently, the role of inflammation in contact lens discomfort is controversial . A recent study that longitudinally evaluated Langerhans cells, being antigen‐presenting immune cells, in the cornea and conjunctiva demonstrated an initial transient increase in the density of these cells in people experiencing contact lens‐induced discomfort; the same effect was not observed in asymptomatic contact lens wearers, suggesting a potential inflammatory component to the aetiology of the condition …”

Section: The Process Of Assessing the Tear Film And Ocular Surface Inmentioning

confidence: 99%

Tear film evaluation and management in soft contact lens wear: a systematic approach

Downie

Craig

2017

Clinical and Experimental Optometry

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The human tear film is a highly ordered structure consisting of a thin layer of lipid on the surface and a thicker aqueous-mucin phase, which increases in mucin concentration toward the corneal epithelial cell layer. The health of the tear film and ocular surface influences the likelihood of being able to achieve successful contact lens wear. Contact lens discomfort and dryness are the most frequent reasons why contact lens wearers experience reduced wearing times, which can eventually lead to contact lens discontinuation. Comprehensive clinical assessment of tear film integrity and ocular surface health is therefore essential prior to commencing contact lens wear, to enable the ocular surface environment to be optimised to support lens wear. These parameters should also be evaluated over the course of contact lens wear, in order to identify any aspects requiring clinical management and ensure maintenance of optimal lens-wearing conditions. This review summarises current knowledge relating to the effects of soft contact lens wear on the tear film and ocular surface. It also provides a systematic approach to evaluating tear film and ocular surface integrity, in order to guide the clinical management of tear film anomalies with respect to contact lens wear.Key words: conjunctiva, contact lenses, cornea, dry eye, tearsThe tear film is a complex, precisely ordered fluid structure comprising a thin outer layer of lipid and a thicker underlying aqueous-mucin phase, with increasing mucin concentration toward the corneal epithelial cell layer. A thin layer of membrane-bound mucin, glycocalyx, imparts hydrophilicity to the hydrophobic corneal surface.1 In excess of 1,000 proteins or fractions of proteins have been identified within the human tear film.2,3 The tear fluid also contains a variety of regulated inflammatory mediators, including by-products of arachidonic acid metabolism, the complement cascade, cytokines and components derived from the ocular microbiome. 3,4The integrity of the tear film can strongly influence the likelihood of achieving successful contact lens wear. Contact lens discomfort and dryness are the most frequent reasons why contact lens wearers experience reduced wearing times, which can eventually lead to contact lens discontinuation. 5 Comprehensive clinical assessment of tear film quality and quantity, and ocular surface health are therefore essential both prior to commencing contact lens wear, to enable the ocular surface environment to be optimised to support lens wear, and over the course of lens wear, to identify any aspects requiring clinical attention to maintain optimal lens-wearing conditions. This review summarises current knowledge relating to the effects of soft contact lens wear on tear film composition, and outlines an approach to evaluating tear film and ocular surface integrity, to guide the clinical management of tear film anomalies with respect to contact lens wear. ASSESSING THE TEAR FILM AND OCULAR SURFACE IN CONTACT LENS WEAR: A SYSTEMATIC APPROACHUsing techniques such as in...

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Is There a Role for Inflammation in Contact Lens Discomfort?

Abstract: There have been only a few studies that have investigated a role for inflammation in contact lens-induced discomfort, and the strongest associations have been found with lipid degradation processes.

Cited by 29 publications

References 187 publications

The Growing Need for Validated Biomarkers and Endpoints for Dry Eye Clinical Research

The Growing Need for Validated Biomarkers and Endpoints for Dry Eye Clinical Research

Rethinking contact lens aftercare

Tear film evaluation and management in soft contact lens wear: a systematic approach

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