Longitudinal changes in Langerhans cell density of the cornea and conjunctiva in contact lens‐induced dry eye

Alzahrani, Yahya; Colorado, Luisa H.; Pritchard, Nicola; Efron, Nathan

doi:10.1111/cxo.12399

Cited by 54 publications

(48 citation statements)

References 34 publications

(71 reference statements)

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“…11 To be considered eligible for this study, participants were required to pass the DEQ-5 and at least one of the objective DE tests, according to the pass/fail scores shown in Table 1. The methods used during this study to assess DE and ocular surface staining have been reported in detail elsewhere 14 and are briefly described in Table 1.…”

Section: Dry Eye and Ocular Surface Assessmentmentioning

confidence: 99%

Time Course of Changes in Goblet Cell Density in Symptomatic and Asymptomatic Contact Lens Wearers

Colorado

Alzahrani

Pritchard

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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Citation: Colorado LH, Alzahrani Y, Pritchard N, Efron N. Time course of changes in goblet cell density in symptomatic and asymptomatic contact lens wearers. Invest Ophthalmol Vis Sci. 2016;57:288857: -289457: . DOI:10.1167 PURPOSE. To investigate longitudinal changes in goblet cell density (GCD) in contact lens (CL) wearers who do and do not develop symptoms of dry eye (DE). METHODS.Sixty healthy individuals fitted with daily disposable hydrogel CLs and 23 agebalanced non-CL-wearing controls underwent assessment using the 5-item dry eye questionnaire, noninvasive tear film break-up time measurement, ocular surface assessment, and phenol red thread test evaluation. Laser scanning confocal microscopy (LSCM) and conjunctival impression cytology (CIC) were used to assess GCD at baseline and follow-up visits at 1 week and 1 and 6 months. After 1 week, all CL wearers were categorized as those who were and were not symptomatic based on responses to the CL dry eye questionnaire-8 (CLDEQ-8). A linear mixed-model was used to examine changes in GCD over time. RESULTS.The global mean GCD of the 83 participants at baseline (before CL wear) was 476 6 41 and 467 6 52 cells/mm 2 using LSCM and CIC, respectively. After 6 months of CL wear, GCD was reduced by approximately 13% and 29% in asymptomatic (N ¼ 29) and symptomatic (N ¼ 17) CL wearers (all P < 0.001), respectively, observed with both LSCM and CIC.CONCLUSIONS. Contact lens wear induces a reduction of GCD over 6 months, which is exacerbated in those with DE symptoms. Either LSCM or CIC can be used to assess GCD in the conjunctiva.Keywords: contact lens wear, symptoms, dry eye, conjunctival goblet cells C onjunctival goblet cells (GCs) are secretory epithelial cells responsible for the production of the mucinous component of the tear film to support the integrity of the ocular surface. A decreased number of GCs is common in conditions of dry eye (DE), 1,2 which is described as a multifactorial disorder causing damage to the ocular surface. 3 Goblet cells may also contribute to the ocular immune response, as they have been shown to secrete cytokines and modulate dendritic cell phenotype. 4 The presence of mucin during contact lens wear (CLW) promotes surface wettability and tolerance to CLW. However, a lack of mucin discharge onto the ocular surface can cause the patient to experience symptoms such as itching, burning, reduction of visual acuity, and dryness. 5Contact lens (CL) wearers frequently report symptoms of dryness but the reason for this is not completely understood. The resulting discomfort may cause CL wearers to reduce wearing time, or cease lens wear altogether. Indeed, up to 50% of wearers will discontinue CLW permanently due to DE symptoms. 6 It is therefore important to understand whether CLW causes a reduction in GCD in those who are introduced to CLW and to determine the link between GCD and DE symptoms related to CLW.Reports of the impact of CLW on conjunctival GCD are equivocal, perhaps as a result of methodologic differences in using conjunctival impr...

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Section: Dry Eye and Ocular Surface Assessmentmentioning

confidence: 99%

Time Course of Changes in Goblet Cell Density in Symptomatic and Asymptomatic Contact Lens Wearers

Colorado

Alzahrani

Pritchard

et al. 2016

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. The association between lens‐induced discomfort and the upregulation of inflammatory mediators in ocular tissues during lens wear is less clear …”

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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Longitudinal changes in Langerhans cell density of the cornea and conjunctiva in contact lens‐induced dry eye

Cited by 54 publications

References 34 publications

Time Course of Changes in Goblet Cell Density in Symptomatic and Asymptomatic Contact Lens Wearers

Time Course of Changes in Goblet Cell Density in Symptomatic and Asymptomatic Contact Lens Wearers

Rethinking contact lens aftercare

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

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