青少年配戴角膜塑形镜的需求和配戴后的心理调查

目的对青少年配戴角膜塑形镜的需求和配戴后心理影响等方面进行调查并作初步分析。方法调查研究。对2011年1—8月在温州医科大学附属眼视光医院就诊的配戴角膜塑形镜矫正近视的青少年进行间卷调查,分别在配戴镜片前、配戴1周、1个月和3个月进行调查问卷,调查内容主要包括：青少年对角膜塑形镜的认识和需求;配戴角膜塑形镜对青少年的心理、视觉等的影响。共分发和调查100例青少年配戴者,并对完整完成的84份调查报告进行整理和统计分析。采用卡方检验对数据进行分析。结果在配戴角膜塑形镜的青少年群体中,有78％愿意主动选择配戴角膜塑形镜;83％的青少年配戴者认为夜间配戴镜片对入睡没有影响;青少年对于角膜塑形镜的需求主要是控制近视度数加深（占60％）;约50％的青少年配戴者自觉在美观、自信心、方便性等方面都有不同程度的提高,配戴1个月后,这种心理优势更加明显,其中戴镜后1个月自信心与1周差异有统计学意义（x^2=7．871,P〈O．05）。结论配戴角膜塑形镜对青少年的日常生活需求、视觉需求以及心理感觉等多方面都有着不同程度的影响。     

各种软性角膜接触镜破损调查

目的 探讨影响软性角膜接触镜破损的因素。方法 １９９５年１月至１９９８年１２月对配戴软性角膜接触镜９５３５人（１９０６８眼）,进行镜片破损调查。结果 不同含水量镜片中,低含水量镜片破损率较高,超过８．０％;不同制造工艺中,离心浇铸型破损率较高为９．５％;不同中心厚度（－３．００Ｄ为基准）镜片中,０．０３５ｍｍ镜片破损率较高为８．３５％。仅具有一年戴镜经验的患者,破损率较高,占破损人数的５７％;北方春秋季节破损率高,约３０％镜片破损发生在这两季节。结论 软性角膜接触镜破损与镜片的含水量、加工方式、中心厚度及配戴者使用经验,所处环境有关。     

新型长戴型角膜接触镜的临床观察

目的 :观察新型长戴型角膜接触镜———PureVi sion(PV)的临床效果及其安全性。方法 :33例 (6 6眼 )隐形眼镜配戴者平均屈光度为 (- 4 .36± 1.5 4 )D ,配戴PureVision连续配戴型隐形眼镜 (简称PV) ,共连续配戴 1个月后更换镜片 ,观察时间为 2个月。配戴前检查视力、屈光度 ,裂隙灯检查眼前段 ,做镜片配适评估并行问卷调查做主观评价。结果 :眼前段检查显示 ,第 1个月连续配戴后 ,角膜缘充血、角膜新生血管、球结膜充血、巨乳头结膜炎、角膜荧光素染色等程度与配戴前相同的患者所占的比例 ,分别是 88.9%、96 .3%、6 4 .8%、5 0 %及 5 7.4 %。第 2个月连续配戴后 ,以上指标观察显示 ,与配戴前相同的患者比例分别是 95 .8%、87.5 %、85 .4、70 .8%及 5 6 .3%。配戴前患者均无角膜水肿 ,而连续配戴 1个月后角膜轻度水肿者占 14 .8% ,第二个月连续配戴则无角膜水肿发生。配戴者的主观评价显示 ,PV镜片的舒适度、清晰度以及镜片的整体满意度方面均高于以往配戴的镜片。结论 :新型长戴型角膜接触镜———PureVision的配戴者对该镜片的主观评价满意度较高 ,连续配戴后未见严重并发症的出现     

配戴角膜接触镜的并发症及其预防

现将我院接触镜的配戴情况及接触镜的主要并发症和预防方法介绍如下，以引起人们的重视。我院配戴博士伦接触镜共505例987眼，其中长戴型201例388眼，短戴型304例599眼。随机观察戴镜者350例680眼，发现结膜充血对眼占3．38％，角膜炎2眼占0．29％，角膜上皮脱落15眼占2．21%，其中6眼因镜片破裂未及时更换所致。角膜新生血管2眼占0．29％，巨乳头样结膜炎4眼占0．59％。因配戴对象90％以上为本校学生，加之我院眼科掌握适应证严格，对接触镜的并发症及预防措施宣传教育及时，引起配戴者的重视，故发病率低。配戴者能定期随访观察，出现问题…     

日本角膜接触镜的历史、现状和展望

日本的角膜接触镜历史可以追溯到1951年，美尼康公司的创始人，现任主席田中恭一先生成功地研制出日本第一枚角膜接触镜，那是一种不透氧的硬性角膜接触镜。1960年，配戴舒适、具有亲水性和更好透氧性的软镜在捷克斯洛伐克出现了。而美尼康公司则继续致力于研究硬性高透氧角膜接触镜(RGP)，他们开发出含水量为72％的非离子软性角膜接触镜材料，同时他们研制了可以连续30d配戴的RGP镜片：美尼康Z，并最先获得获得美国FDA认证。目前，在日本配戴角膜接触镜的人群大约有一千五百万，其中硬镜配戴者与软镜配戴者的比例为4：6。在日本RGP的高配戴率是因为日本的眼科医生让配戴者充分相信RGP镜片的安全保证。1990年日本开始生产抛弃型角膜接触镜。角膜接触镜的抛弃和频繁更换概念改变了人们对角膜接触镜传统的认识，很快就被大众所接受。但是，原本被人们认为是一种医疗器具的角膜接触镜变成了人们熟知的日用品。这导致了配戴者的依从性下降，超时配戴，甚至角膜缺氧的现象日益增加。于是，研究人员开始开发高透氧的硅水凝胶(SH)材料。在欧洲和美国，硅水凝胶材料的角膜接触镜已被批准可以连续配戴30d。现在角膜接触镜的新功能体现在双焦点角膜接触镜和角膜屈光治疗镜(CRT)上，它们分别可以用于矫正老视和提高裸眼视力。中国的角膜接触镜配戴人群在很短的时间内就迅速增长到一千万人。     

角膜塑形镜片的配戴依从性及影响因素

目的 探讨角膜塑形镜片配戴的依从性及其影响因素.设计回顾性病例调查研究.研究对象1999年2月至2005年4月门诊角膜塑形镜片配戴者470例（911眼）.方法 相关内容用问卷和电话的方式调查,内容包括配戴者的一般资料、配戴开始时间、选择配戴的动机、停止配戴的时间、停止配戴的原因、停止配戴后矫正方式的选择.主要指标配戴原因、配戴时间、停戴时间、停戴原因、停戴后矫正方式.结果 角膜塑形镜片配戴者选择该种近视矫正方式的原因,为提高裸眼视力者占23%,为控制近视者占14%,为体检目的者占48%,为降低近视度数者占15%.共283例配戴者停止配戴角膜塑形镜片,其中配戴3个月内停戴者99例（35.0%）,半年内者28例（9.9%）,1年内者42例（14.8%）,2年内者98例（34.6%）,2年以上者16例（5.7%）.停戴角膜塑形镜片后选择视力矫正方式,框架眼镜181例（64.0%）,RGP镜片46例（16.3%）.结论 角膜塑形镜片配戴者的动机、配戴的效果及媒体报道影响着镜片配戴的依从性.     

配戴角膜接触镜后的角膜地形图分析

配戴角膜接触镜可引起角膜形态的改变,停戴接触镜后,角膜形态会逐渐恢复,其恢复时间还与配戴镜片的种类、配戴方式、配戴时间的长短、个体差异等均有相对的关系;配戴接触镜后还可以引起角膜厚度的改变.角膜地形图可以全面客观地评估接触镜配戴者的角膜形态改变,尤其是对接触镜配戴者进行屈光治疗时,可以适当掌握手术时机,同时,可用于鉴别早期圆锥角膜及指导接触镜的更佳验配.     

软性角膜接触镜与角膜新生血管

复查长戴型软接触镜配戴者203人（406）眼。对其因戴镜所致的角膜新生血管的发生与配戴者的性别、职业、屈光度、戴镜方式、镜片使用时间及服部炎症等因素之间的关系进行分析。     

软接触镜引起的巨乳头性结膜炎相关因素分析

目的分析软接触镜引起的巨乳头性结膜炎（ＧＰＣ）的相关因素。方法对软接触镜引起的巨乳头性结膜炎的患者１００例及无并发症软性隐形眼镜配戴者１００例进行调查分析。结果经计算机多因素逐步回归分析，相关因素为镜片类型、戴镜过夜、戴镜时间及每天清洗镜片４方面。相关症状为痒感，分泌物多，视物模糊及镜片耐受性下降４方面。结论软接触镜引起的ＧＰＣ可能是眼对作为抗原因素及机械因素的镜片沉淀物的变态反应。每日清洗镜片，避免戴镜过夜及定期更换镜片有利于预防本病     

软性抛弃型角膜接触镜基弧的选择及评价

本文用Ｓｕｒｅｖｕｅ抛弃型镜片对１５３例软性角膜接触镜配戴者做镜片基弧选择和配戴临床评价的研究。分为三组：①基弧为８．８ｍｍ配戴组；②先戴基弧为８．８ｍｍ，后换戴８．４ｍｍ对照组；③一眼戴基弧８．８ｍｍ，另眼戴基弧８．４ｍｍ同时对照组。所有镜片的直径为１４ｍｍ。评价项目：角膜曲率、镜片中心位置、镜片活动度、配戴者的主观感觉评价。结果表明：角膜曲率计读数在镜片基弧选择中仅起参考作用，基弧的选择应根据临床配戴评价而定。对于Ｓｕｒｅｖｕｅ抛弃型镜片（直径１４ｍｍ），８．８ｍｍ基弧镜片为首选镜片。     

Clinical evaluation of three bifocal contact lenses

The ACC, Alges, and Tangent Streak bifocal contact lenses were fit in separate populations of presbyopic patients, some of whom had not previously worn contact lenses. Complete eye examinations were performed on fitting and at 6 and 12 months after fitting to determine how effectively the lenses corrected presbyopic symptoms. Patients were examined for subjective comfort, visual acuity, contrast sensitivity, and by slit lamp. Sixteen of the 24 ACC lens wearers (67%), 23 of 31 Alges lens wearers (74%), and 25 of 27 Tangent Streak lens wearers (93%) wore their lenses comfortably after 12 months. Nine of 18 failures (50%) were successfully refit in one of the other bifocal lenses. Most patients read 20/25 and J1 with contrast sensitivity in the normal range at distance and near. Twelve of 16 patients (75%) with no prior contact lens experience continued to wear the lenses at 12 months. We believe that bifocal contact lenses provide an acceptable alternative for the correction of presbyopia. Lens fitting requirements and patient selection are discussed.     

A market survey of contact lens practice in Hong Kong

Purpose : The aim of this survey was to evaluate the use of contact lenses, current prescribing habits of practitioners and the development of the contact lens market in Hong Kong. Methods : Questionnaires were sent to all registered contact lens practitioners in Hong Kong. This questionnaire sought information about their choices on prescribing contact lenses and lens care products and their opinions on continuing education and future trends of contact lens development. Results : A total of 286 responses (22 per cent) were returned. On average, the respondents reported that 36 per cent of their patients were contact lens wearers and most were myopes. The ratio of new fittings to refittings was 1:3. Of the contact lens wearers, 66 per cent were fitted with planned replacement lenses, mostly daily disposable lenses. Multipurpose solution was the most popular lens care regimen prescribed. Only 48 per cent of astigmatic patients were fitted with toric lenses and the use of overnight orthokeratology and silicone hydrogel lenses was limited. Single vision contact lenses with over‐spectacles and monovision contact lenses were the most popular management for presbyopes. Dryness was the major problem reported by contact lens wearers. Practitioners look forward to further development of custom‐made toric, multifocal and silicone hydrogel lenses. The major source of new contact lens information was communication with contact lens suppliers. Conclusion : Compared to previous reports, there was no significant change in the prescribing habits of practitioners. The major complaint of contact lens wearers is still ocular dryness. The contact lens market is driven by younger contact lens wearers, and planned replacement soft contact lenses together with multipurpose solutions dominate. The use of bifocal/multifocal lenses remained low and practitioners want low cost bifocal/multifocal contact lenses with better visual performance and toric lenses with a wider range in parameters. The use of overnight wear lenses such as silicone hydrogel and ortho‐k lenses is limited and 30 days continuous wear silicone hydrogel lenses are prescribed mainly for daily wear.     

Profile of contact lens failures in Saudi Arabia

Background : Interest in contact lenses is increasing in Saudi Arabia, as in many parts of the world, but unfortunately many patients do not remain contact lens wearers. This paper presents the findings of the first survey on failures in contact lens wear in the Kingdom of Saudi Arabia. The purpose of the survey was to identify the reasons for failure in lens wear in the kingdom. Method : Two hundred previous contact lens wearers, mostly from the university population, were given questionnaires which included, among other items, demographics, length of post-fitting lens wear experience, type of lens worn and reasons for discontinuing lens wear. Data from questionnaires were analysed and presented. Results : Data from questionnaires revealed that 61 per cent of the subjects discontinued contact lens wear due to discomfort, followed by inconvenience of lens care regimen (30.5 per cent), poor vision (5.5 per cent), economy (two per cent) and refractive surgery (one per cent). The length of post-fitting lens wear experience before discontinuation ranged from two to 36 months. The majority had been soft contact lens wearers. Conclusion : The majority failed in contact lens wear due to lens discomfort and the inconvenience of lens care systems. Identification of the reason for failure in contact lens wearers is crucial if refitting is to be considered. This will aid in the selection of the appropriate lens or lens care regimen suitable to the patient and serve as a guide in the prevention of failures in prospective contact lens wearers.)Clin Exp Optom 1996; 79: 6: 255–259)     

Frequency of and factors associated with contact lens dissatisfaction and discontinuation

PURPOSE: To determine the frequency of and factors associated with contact lens dissatisfaction and discontinuation. METHODS: A cross-sectional survey of 730 subjects was conducted using a self-administered survey instrument. The survey collected information about present age and sex, history of contact lens wear, types of lenses worn, age at starting wear, current wearing schedule (hours per day, days per week), self-perceived contact lens satisfaction, and contact lens-related problems. A variety of statistical analyses including analysis of variance, logistic regression, and repeated-measures logistic regression were used to model the data. RESULTS: Current or previous experience with contact lenses was reported by 453 (62%) of the subjects. Of these subjects, 119 (26.3%) reported that contact lenses were not the ideal form of visual correction for them (contact lens dissatisfaction) and another 109 (24.1%) had permanently discontinued contact lens wear. Dissatisfied contact lens wearers had reduced self-reported wearing times compared with satisfied contact lens wearers. Previous lens wearers were more likely than current lens wearers to be men, older (by approximately 9.5 years), have started contact lens wear at a later age (approximately 4-5 years later), and have tried either rigid or both soft and rigid lenses. The primary self-reported reason for both contact lens dissatisfaction and discontinuation was ocular symptoms (dryness and discomfort), followed by preference for another corrective modality. CONCLUSION: A significant number of contact lens wearers are not satisfied with contact lenses and are at risk for discontinuation.     

Current perspectives in the management of keratoconus with contact lenses

Our aim is to review current and significant articles on contact lens wear in keratoconus patients. A comprehensive literature search of PubMed was performed for the following topics on contact lens wear in keratoconus patients: (1) characteristics of contact lens wearers, (2) safety and efficacy, (3) complications, (4) fitting techniques, (5) contact lens wear after procedures/surgeries, (6) patient satisfaction. A total of 104 studies were finally selected and reviewed. Gas permeable (GP) lens wear provided significantly better vision than glasses. Special cone design lenses had better patient comfort levels though there was no difference in best corrected visual acuity among the GP lenses. Soft lenses showed good efficacy for the treatment of mild-to-moderate keratoconus with newer designs improving visual performance such as customised hydrogel and novel pinhole lenses. Scleral and hybrid lenses provide good visual acuity and comfort for keratoconic patients previously intolerant to RGP lenses. RGP lens wear post-cross linking (CXL) is relatively well-tolerated. Contact lenses may still be required post intrastromal corneal ring procedures and post keratoplasty. Scheimpflug imaging and anterior segment optical coherent tomography (ASOCT) are useful in contact lens fitting. Computerized contact lens fitting techniques could reduce the chair time of lens fitting as well as improve comfort and visual performance. Contact lenses play an important role in the visual rehabilitation of keratoconus patients. New contact lens designs and materials have significantly expanded the available fitting options for keratoconus patients. Imaging technology can be utilized to guide contact lens fitting.Subject terms: Rehabilitation, Rehabilitation, Implants     

A multi-centre study of lapsed contact lens wearers

PURPOSE: Discontinuation from contact lens wear has been identified as a contributing factor in the lack of growth of contact lens use in Europe. The purpose of this study was to determine the proportion of lapsed contact lens wearers that can be refitted successfully with contact lenses and to evaluate the reasons for discontinuation from contact lens wear. METHODS: This was a multi-site clinical study involving 15 UK investigators and 236 lapsed contact lens wearers who had previously tried contact lenses and discontinued. The reasons for discontinuation were assessed by subjects, who were then refitted with contact lenses. Investigators subsequently evaluated factors associated with their initial discontinuation. Short-term success was defined as the successful completion of 1 month of contact lens wear with absence of complications that would prevent further wear. Subjects were interviewed by telephone 6 months after being refitted to determine whether they were still wearing contact lenses. Those who were not wearing lenses were questioned about the reasons for discontinuation and their likelihood of resuming lens wear. RESULTS: A majority of subjects (51%) cited discomfort as the principal reason for having previously given up contact lens wear. Problems with vision were the second most common reason (13%), either with reading (6%) or general vision (7%). The most common type of discomfort was dryness (40%). In almost all cases (97%), the investigator's assessment of the reasons for discontinuation agreed with the subject's own assessment but investigators also cited product-related and practitioner-related factors as contributing to previous failure. The short-term success rate for refitting lapsed wearers was found to be 77% (Cl: 70-82%). The highest short-term success rates were for 2-weekly/monthly soft spherical lenses (91%) and daily disposable lenses (89%). Lower success rates were found for soft toric (69%) and soft bifocal (53%) lenses. At the 6-month stage, 73% of those who continued in lenses after the 1-month visit were still wearing contact lenses and a further 18% indicated that they were either 'very likely' or 'likely' to resume lens wear. CONCLUSIONS: A high proportion of lapsed contact lens wearers can be successfully refitted with contact lenses. The prime reason for previous discontinuation from contact lenses is discomfort and, in particular, dryness-related discomfort. In many cases, previous contact lens failure is product or practitioner-related rather than because of patient-specific problems. Once refitted with contact lenses, lapsed wearers cite vision problems rather than discomfort as the most common reason for discontinuing. This finding suggests that recent advances in contact lens material, design, replacement frequencies and care systems have improved the prospects for avoiding lens-related discomfort and for continuing contact lens wear.     

Contact lenses in the military service

This paper discusses contact lenses in a military environment and reports the results of a literature survey, an extensive questionnaire sent to 1400 spectacle and contact lens wearers, and a short questionnaire given to soldiers taking part in a large scale and long military maneuver. Only a small number of publications were found concerning the relation between adverse environmental conditions and contact lens wearing. In Vietnam dust and poor hygiene often led to eye irritations that precluded the wearing of contact lenses by soldiers. Nevertheless, persons in the army are often in favor of contact lenses. In the air force and navy, wearing contact lenses seems compatible with nearly all military duties. A questionnaire was sent to all known contact lens wearers in the Dutch army and air force and to about an equal number of spectacle wearers. The responses indicate that the proportion of contact lens wearers is 1.8%. The distribution of hard vs. soft lenses was 60 and 40%, respectively. Military personnel wore their lenses during nearly all daily activities. Most contact lens wearers were of the opinion that in military conditions contact lenses have advantages over spectacles. To obtain more information on field exercises, a second questionnaire was handed out immediately after a large-scale NATO field maneuver. Twenty percent of the contact lens wearers had decided in advance not to wear their lenses, but another 30% ceased wearing their lenses during the exercise. It was recommended that for nearly all functions and/or conditions, wearing of contact lenses should be allowed, but that during extended field exercises wearing of hard contact lenses should be discouraged.     

Use of silicone hydrogel contact lenses by Australian optometrists

Background: Prior to the launch of silcone hydrogel (Si‐H) materials in Australia in 1999, only 1.6 per cent of lenses were prescribed on a continuous wear basis. Methods: One thousand surveys were distributed randomly to practitioners in Australia during January 2000, 2001 and 2002 (total surveys 3,000). Each anonymous survey requested data about the next 10 patients fitted with contact lenses, including date, age, gender, new fitting or refitting, lens material type, lens design, frequency of replacement, modality of wear, uses per week and care regimen. Results: Twenty per cent (599) were returned, reporting data on 5,976 fittings. A total of 710 fittings used Si‐H contact lenses (11.9 per cent), which represented 18.6 per cent of all soft lens fittings. During the three years, the proportion of practitioners prescribing Si‐H lenses increased from 42.2 to 52.5 per cent. In 2000, 43.8 per cent were daily wear, which decreased to 32.2 per cent by 2002. The solution system of choice for daily wear lenses was multipurpose solutions (98.4 per cent); the only alternative was hydrogen peroxide systems. Continuous wear represented 11.7 per cent of all fittings, ofwhich 85.7 per cent were Si‐H, 3.0 per cent RGP lenses and 11.3 per cent conventional hydrogels. For continuous wear, 79.0 per cent of fittings were to existing wearers, whereas for daily wear, 59.4 per cent were existing wearers. More males were prescribed Si‐H continuous wear contact lenses, while females were more likely to be prescribed Si‐H on a daily wear basis. Discussion: Si‐H contact lenses were introduced to the Australian market as a continuous wear contact lens, yet many practitioners use this product for daily wear with multipurpose solutions. By 2002, more practitioners were prescribing Si‐H contact lenses for continuous wear than in 2000, suggesting a growing confidence in that product for that mode of wear. A comparison with an earlier survey shows there is an increase in continuous wear from 1.6 per cent to 11.7 per cent over a five‐year period.     

Rules and regulations concerning contact lens-related infection

Contact lens-related infectious keratitis is a potentially sight-threatening complication. Bacterial keratitis, mostly due to Gram-negative bacteria, is associated with poor lens hygiene, overnight wear, and contaminated lens care solutions. Contamination of the lens storage case may cause fungal keratitis. Acanthamoeba infection is related to the use of tap water or swimming while wearing soft lenses. Viruses are of less concern among contact lens wearers. Possible transmission of Creutzfeldt-Jakob disease by multi-patient trial lenses must be taken in account. To minimize these risk factors, regulations are applied at various levels: CE marking of contact lenses and care products as they are medical devices; contact lens fitting only by health care professionals; distribution of contact lenses by opticians and lens care solutions by opticians and pharmacists; hygienic management of trial lenses following official recommendations. Contact lens-related keratitis must be reported to health care Authorities.     

Treatment, material, care, and patient-related factors in contact lens-related dry eye

PURPOSE: To examine the effect of general contact lens and material characteristics, care solutions, treatment, and patient-related factors on contact lens-related dry eye. METHODS: The data were derived from the Contact Lens and Dry Eye Study, designed as a cross-sectional and nested case-control study including 360 subjects. In separate statistical models, logistic regression was used to examine general contact lens characteristics, specific hydrogel lens materials, care solutions, and patient-related factors associated with dry eye status (controlled for age, gender, and current treatments). RESULTS: Several factors were significantly associated with dry eye, including treatment factors such as a recent contact lens refitting (odds ratios [OR] = 5.75, 95% confidence intervals [CI] = 2.14 to 15.46) and use of artificial tears/rewetting drops (OR = 1.09, 95% CI = 1.02 to 1.16), in addition, currently worn materials including Food and Drug Administration (FDA) group II (OR = 2.98, 95% CI = 1.14 to 6.19) and IV (OR = 1.87, 95% CI = 1.08 to 3.24). Significant patient-related factors included decreased overall satisfaction (OR = 3.57, 95% CI = 2.08 to 5.88,), dry eye in the absence of contact lens wear (OR = 6.54, 95% CI = 2.57 to 16.62), reduced daily lens wear duration (OR = 1.16, 95% CI = 1.06 to 1.26), and reduced ability to wear lenses as long as desired (OR = 2.44, 95% CI = 1.30 to 4.54). Care solutions were not associated with contact lens-related dry eye. CONCLUSIONS: The strong association of common treatment factors with dry eye status in contact lens wearers suggests that these treatments are not entirely effective. The use of high water content materials was strongly related to dry eye in lens wearers, whereas care solutions were not. Contact lens-related dry eye was also associated with several patient-related factors such as greater ocular discomfort (without lenses), dissatisfaction, and inability to wear lenses for desired durations.