Natural course of lid wiper epitheliopathy (LWE) in symptomatic contact lens wearers

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Abstract

Purpose

To establish the time course of lid wiper epitheliopathy (LWE) in established CL wearers after a single day (6–10 h) of daily disposable contact lens (CL) wear, the following day post-CL removal and 1-week after CL discontinuation.

Methods

Twenty-one symptomatic (CLDEQ-8 score ≥ 12) habitual wearers of MyDay® silicone hydrogel daily disposable were included. LWE staining was assessed prior to CL wear (Visit 1, V1) using semi-automated analysis after instillation of two drops of 1 % lissamine green (10 μL) that were applied to the superior bulbar conjunctiva. LWE measurements were repeated after 6–10 h of continuous CL wear (Visit 2, V2), post-CL removal the following day (Visit 3, V3) and after 1-week CL discontinuation (Visit 4, V4). At each visit, ocular symptoms were evaluated using the SPEED-8 questionnaire and set of 0–100 visual analogue scales (VAS).

Results

LWE showed no significant changes after 6–10 h of continuous CL wear (p = 0.536), post-CL removal the following day (p = 0.677) or following 1-week of CL discontinuation (p = 0.478). Analysis revealed a significant improvement in symptomatology between V1 and V2 (SPEED-8, p < 0.01) and also improvements in the 0–100 VAS scores between V2 and V4 for average daily dryness (p < 0.01), end-of-day dryness (p < 0.01) and frequency of end-of-day dryness (p < 0.05).

Conclusion

The present data suggest that the etiology of LWE is multifactorial and the sole intervention of temporarily discontinuing CL wear does not lead to resolution of these clinical signs.

Introduction

Lid wiper epitheliopathy (LWE) has been established as a diagnostic sign of dry eye disease and may contribute to contact lens (CL) dropout [[1], [2]]. LWE is thought to reflect micro-trauma caused by inadequate ocular lubrication and/or excessive friction between the eye and eyelids [[3], [4]]. Reported prevalence of LWE in symptomatic CL wearers is high (67–85 %), while a lower prevalence has been described in asymptomatic CL wearers (13–32 %) [[1], [5], [6], [7], [8], [9]]. Based on these data, Pult et al. [10] proposed a link between CL symptomatology and LWE but other studies have been unable to show a relation between LWE and subjective discomfort/dryness in CL wearers [[3], [9], [11], [12], [13], [14]].

A limited number of prospective longitudinal studies have evaluated the progression of LWE over time [[11], [13], [15], [16]]. One study was a four-week crossover study that examined neophyte CL wearers with two reusable lenses and found that LWE significantly increased with CL wear [15]. Similarly, another study with neophyte CL wearers, also found that lid wiper damage increased following six months of monthly reusable silicone hydrogel CL wear [11]. Stahl et al (2018) evaluated two reusable silicone hydrogel lenses in a cross-over study with existing wearers and also reported increased upper lid wiper staining following 10-days of wear [13]. Yet, there is no evidence of the effect of daily disposable lenses on LWE and/or a link between CL coefficient of friction and LWE.

The time course of LWE resolution is also currently unknown. Despite this, proposed management strategies include reducing CL wearing time or discontinuing CL wear altogether [3]. It has been speculated that a reduction in LWE might take place overnight (post-CL wear) [3]. A close observation over a period of days has been recommended to determine the diurnal course of LWE as well as the impact and effect of ceasing CL wear altogether [3]. For this reason, the aim of this study was to examine the natural course of LWE in symptomatic CL-wearing participants during CL wear and post CL-cessation using a semi-objective technique. Specifically, the intentions were to determine: (1) if LWE increases with daily disposable CL wear, (2) if LWE resolves overnight (after a short break in wear once lenses are removed in established CL wearers), and (3) the pattern of LWE changes after CL discontinuation (one week of no CL wear). Parallel to the monitoring of the LWE changes, participant symptomatology was measured using the 8-item Standard Patient Evaluation of Eye Dryness (SPEED-8) score [17] and visual analogue scale (VAS) questions exploring dryness symptoms as they have previously been associated between LWE length/width in symptomatic CL wearers.[7]

Section snippets

Participants and experimental protocol

Participants were recruited from the Southern College Optometry (SCO; Memphis, TN, USA) patient base. The study was approved by the Institutional Review Board of SCO and conformed to the tenets of the Declaration of Helsinki. Ethical approval was additionally obtained from Anglia Ruskin University (Cambridge, United Kingdom). Written informed consent was obtained after explanation of the study and possible consequences of participation.

Study inclusion criteria included age 18–50 years, and the

Results

Twenty-one (21) symptomatic CL wearers completed the study; 71 % were female (n = 15). Enrolled subjects had a spherical power range of + 0.25D to −8.00D. Table 2 shows that at the enrolment visit all participants presented with CL related dryness as measured using CLDEQ-8 and SPEED-8 (mean ± SD; 20.04 ± 4.06 and 12.54 ± 2.95 respectively). In addition, all participants showed a positive LWE ranging from 1.0 to 3.0 (mean ± SD, 1.96 ± 0.87) using Korb protocol B score [18].

Discussion

This study focused on diurnal LWE change following soft CL wear as well as overnight and the following day after CL discontinuation. The present results showed that semi-objective measurements of LWE did not significantly change after 6–10 h wear of a modern daily disposable soft CL, the following day (without CL) or after one-week cessation from habitual CL wear in symptomatic CL wearers. This contradicts the clinical wisdom that: i) friction is likely to increase cumulatively during the day

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

The authors acknowledge Scott M. Paluszkiewicz, PhD, for his editorial support. Funding disclosure: No specific grant from funding agencies in the public, commercial, or not-for-profit sectors was provided for this study.

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