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Peer-reviewed articles

2016

Moezzi,A. M., Varikooty,J., Schulze,M., Ngo,W., Lorenz,K. O., Boree,D., Jones,L. W. Corneal Swelling with Cosmetic etafilcon A Lenses versus No Lens Wear. Optometry and Vision Science 2016;93,6:619-628. [ Show Abstract ]

Purpose: To determine if the use of pigments or adding polyvinyl pyrrolidone during the fabrication of 1-DAY ACUVUE DEFINE (AD) brand contact lenses impacts open-eye corneal swelling compared with no lens wear (NLW). Methods: A partial double-masked, randomized, bilateral crossover study was conducted in 24 Asian subjects using AD, 1-DAY ACUVUE DEFINE with Lacreon (ADL), NLW, and a control lens with no tint (1-DAY ACUVUE MOIST [AM]). Central corneal thickness was measured before insertion and immediately after removal after 8 ± 1 h of open-eye wear using an optical pachymeter in one eye. Corneal thickness along a 10-mm cord was measured in the contralateral eye using the Visante optical coherence tomographer (OCT). Corneal swelling was tested for noninferiority using a 5% margin. The endothelial bleb response was measured at baseline and 20 min after lens insertion using specular microscopy. Subjective grading of corneal staining and limbal/bulbar hyperemia were also monitored. Results: After 8 ± 1 h of open-eye wear, central corneal swelling across the study lenses with either optical pachymeter or OCT methods was negligible. Peripheral corneal swelling least-square mean differences with OCT were -0.03% (95% confidence interval [95% CI], -0.65 to 0.58%) and -0.26% (95% CI, -0.87 to 0.36%) between AD and ADL and the control lens (AM), respectively, and 1.67% (95% CI, 1.06 to 2.29%) and 1.45% (95% CI, 0.84 to 2.06%) between AD and ADL and NLW, respectively. No endothelial blebs were observed. No clinically significant differences were distinguished between the lenses and NLW for corneal staining and limbal/bulbar hyperemia. Conclusions: After 8 ± 1 h of open-eye wear, central and peripheral corneal swelling along the horizontal meridian with AD, ADL, AM, and NLW were equivalent. These results confirm that the addition of polyvinyl pyrrolidone or pigments to etafilcon A to obtain a limbal ring design have no impact on corneal swelling or limbal/bulbar hyperemia during normal open-eye wear.

Dantam,J., McCanna,D. J., Subbaraman,L. N., Papinski,D., Lakkis,C., Mirza,A., Berntsen,D. A., Morgan,P., Nichols,J. J., Jones,L. W., Mathew,J. H., Cox,S. M., Bickle,K. M., Powell,D. R., Cox,J., Miller,W. L., Wallace-Tucker,A., Charrier,S., Chen,Y. -J, Cardenas,L., Huerta,S., Dionne,K., Maldonado-Codina,C., Plowright,A. J., Howarth,G. F., Chatterjee,N., Smith,S., Dumbleton,K., Schulze,M., Moezzi,A., Luensmann,D., Ngo,W., Paquette,L., Srinivasan,S., Varikooty,J., Johnson,J., Simpson,M., Voss,L., R Microbial contamination of contact lens storage cases during daily wear use. Optometry and Vision Science 2016;93,8:925-932. [ Show Abstract ]

Purpose. To evaluate contact lens (CL) storage case contamination when used with four different CL care solutions during daily wear of three different CL materials. Methods. A parallel, prospective, bilateral, randomized clinical trial (n = 38) was conducted. Subjects were randomly assigned to use one of three CL materials (etafilcon A, senofilcon A, or galyfilcon A) on a daily wear basis. Subsequently, each subject randomly used one of four different CL care solutions (Biotrue, OPTI-FREE PureMoist, RevitaLens OcuTec, and CLEAR CARE) for 2 weeks, along with their respective storage cases. After every 2-week period, their storage cases were collected and the right and left wells of each storage case were randomized for two procedures: (1) microbial enumeration by swabbing the storage case surface and (2) evaluation of biofilm formation (multipurpose solution cases only) using a crystal violet staining assay. Results. More than 80% of storage cases were contaminated when used in conjunction with the four CL care solutions, irrespective of the CL material worn. Storage cases maintained with CLEAR CARE (mean Log colony forming units (CFU)/ well ± SD, 2.0 ± 1.0) revealed significantly (p < 0.001) greater levels of contamination, compared to those maintained with Biotrue (1.3 ± 0.8) and RevitaLens OcuTec (1.2 ± 0.8). Predominantly, storage cases were contaminated with Gram-positive bacteria (= 80%). There were significant differences (p = 0.013) for the levels of Gram-negative bacteria recovered from the storage cases maintained with different CL care solutions. Storage cases maintained withOPTI-FREE PureMoist (0.526 ± 0.629) showed significantly higher biofilm formation (p = 0.028) compared to those maintained with Biotrue (0.263 ± 0.197). Conclusions. Levels of contamination ranged from 0 to 6.4 Log CFU/storage case well, which varied significantly (p < 0.001) between different CL care solutions, and storage case contamination was not modulated by CL materials. © Copyright 2016 American Academy of Optometry.

Berntsen,D. A., Hickson-Curran,S. B., Jones,L. W., Mathew,J. H., Maldonado-Codina,C., Morgan,P. B., Schulze,M. M., Nichols,J. J., Cox,S. M., Bickle,K. M., Powell,D. R., Cox,J., Miller,W. L., Wallace-Tucker,A., Charrier,S., Chen,Y. -J, Cardenas,L., Huerta,S., Dionne,K., Plowright,A. J., Howarth,G. F., Chatterjee,N., Mirza,A., Smith,S., Dumbleton,K., Moezzi,A. M., Luensmann,D., Ngo,W., Paquette,L., Srinivasan,S., Varikooty,J., Johnson,J., Simpson,M., Voss,L., Ryan,L., Careless,N., Smith,A., Subbar Subjective comfort and physiology with modern contact lens care products. Optometry and Vision Science 2016;93,8:809-819. [ Show Abstract ]

Purpose. To compare subjective comfort and ocular physiology with three multipurpose solutions (MPSs) to that of a peroxide-based system with three different soft contact lens materials. Methods. Habitual soft contact lens wearers (n = 236) were enrolled at three sites and completed a washout period with no contact lens solution for =4 days. Subjects were randomly assigned to one of three lens types: etafilcon A, galyfilcon A, or senofilcon A. A new lens of the assigned type was worn for 10 to 14 days each while using one of four care solutions, in random order (A - polyaminopropyl biguanide + polyquaternium, B - POLYQUAD + Aldox, C - alexidine + polyquaternium-1, and D - hydrogen peroxide) with a washout period (=4 days) between each solution. After each care solution, biomicroscopy was performed and subjective comfort was assessed using the Contact Lens User Experience (CLUE) questionnaire and other instruments including comfortable wear time (CWT). Linear mixed models were used for analysis. Comfort and biomicroscopy signs with each MPS were compared to that of the peroxide solution. Results. Subjective CLUE Comfort score across all lens types with each MPS was not significantly different than with the peroxide solution (p = 0.98). There were no differences in CWT between each MPS and the peroxide solution for any lens type (range of differences: -0.8 to 0.8 h; all p = 0.13). Six MPS/material combinations had no clinically meaningful change in corneal staining versus peroxide (<0.5 units); three combinations could increase staining by up to 0.57 units. Staining was

Schulze,M. -M, Srinivasan,S., Hickson-Curran,S. B., Berntsen,D. A., Howarth,G. F., Toubouti,Y., Morgan,P., Nichols,J. J., Jones,L. W., Mathew,J. H., Cox,S. M., Bickle,K. M., Powell,D. R., Cox,J., Miller,W. L., Wallace-Tucker,A., Charrier,S., Chen,Y. -J, Cardenas,L., Huerta,S., Dionne,K., Maldonado-Codina,C., Plowright,A. J., Chatterjee,N., Mirza,A., Smith,S., Dumbleton,K., Moezzi,A. M., Luensmann,D., Ngo,W., Paquette,L., Varikooty,J., Johnson,J., Simpson,M., Voss,L., Ryan,L., Careless,N., Smith, Lid wiper epitheliopathy in soft contact lens wearers. Optometry and Vision Science 2016;93,8:943-954. [ Show Abstract ]

Purpose. To evaluate lid wiper epitheliopathy (LWE) in soft contact lens (SCL) wearers on initial presentation and after using various SCL and solution combinations. Methods. LWE was assessed in 253 habitual SCL wearers who attended a screening visit at one of three study sites. LWE was assessed using lissamine green and sodium fluorescein dyes (Korb scale); a final LWE grade was calculated as the averaged LWE grade of the two dyes. Eligible habitual wearers continued into the four study periods, during which they wore one of three SCL types (etafilcon A, galyfilcon A, or senofilcon A) while using each of four care solutions for 10 to 14 days in randomized order. Statistical analyses were performed using linear mixed models, testing for differences in LWE for subject characteristics and between three multipurpose (MPS) test solutions (BioTrue, OPTI-FREE PureMoist, RevitaLens OcuTec) compared to a hydrogen peroxide (Clear Care) control solution. Results. LWE was present in 85% of habitual SCL wearers. LWE was not different for age (p = 0.28), sex (p = 0.99), race (p = 0.34), and comfort (p = 0.38) and not correlated with refractive error (r = 0.07). LWE was lower in habitual senofilcon A wearers (least-squares (LS) mean ± SE = 0.82 ± 0.19) compared to wearers of lotrafilcon B (1.34 ± 0.20; p < 0.02), comfilcon A (1.41 ± 0.21; p < 0.01), and other (1.18 ± 0.16; p < 0.03). Two hundred three participants completed all four study solutions with their assigned lens type; LWE was not different between the MPSs compared to the peroxide control solution across lens materials, except for less LWE for BioTrue (0.88 ± 0.17) versus Clear Care for participants wearing galyfilcon A (1.11 ± 0.18; p < 0.01). Conclusions. On initial presentation, LWE was present in 85% of habitual wearers and found to be independent of age, sex, race, comfort, and refractive error but dependent on habitual SCL type. There were no clinically meaningful differences in LWE between the MPSs and hydrogen peroxide solution for the three lens types studied. © Copyright 2016 American Academy of Optometry.

Cox,S. M., Berntsen,D. A., Chatterjee,N., Hickson-Curran,S. B., Jones,L. W., Moezzi,A. M., Morgan,P. B., Nichols,J. J., Mathew,J. H., Bickle,K. M., Powell,D. R., Cox,J., Miller,W. L., Wallace-Tucker,A., Charrier,S., Chen,Y. -J, Cardenas,L., Huerta,S., Dionne,K., Maldonado-Codina,C., Plowright,A. J., Howarth,G. F., Mirza,A., Smith,S., Dumbleton,K., Schulze,M., Luensmann,D., Ngo,W., Paquette,L., Srinivasan,S., Varikooty,J., Johnson,J., Simpson,M., Voss,L., Ryan,L., Careless,N., Smith,A., Subbarama Eyelid margin and meibomian gland characteristics and symptoms in lens wearers. Optometry and Vision Science 2016;93,8:901-908. [ Show Abstract ]

Purpose. To describe the lid margin characteristics of contact lens wearers and relate them to comfort during lens wear. Methods. Three study sites enrolled habitual contact lens wearers. Subjects completed the Comfort domain of the Contact Lens User Experience (CLUE) questionnaire, and each eye was graded for the presence of mucocutaneous junction (MCJ) displacement, lid margin irregularity, and lid margin vascularity. Examiners counted the number of meibomian gland (MG) orifices in the central centimeter of the lower eyelid and the number of those that showed pouting/plugging and vascular invasion. MG expressibility was graded according to the Shimazaki schema. Subjects were grouped based on presence/ absence of each characteristic, total number of orifices (=5 vs. 0). Descriptive statistics are reported. A linear model was used to assess the fixed effect of each characteristic on combined CLUE score and each CLUE statement, if the effect on combined CLUE score showed p < 0.10. Results. The study included 203 subjects (67.5% female) with mean age (±SD) of 30.3 ± 9.6 years. The most commonly observed characteristics were orifice pouting/plugging, compromised MG expressibility, and lid margin vascularity (35.0, 30.3, and 20.4%, respectively). MCJ displacement and MG expressibility had an effect on the combined CLUE score such that individual CLUE statements were analyzed (p = 0.01 and p = 0.06, respectively). MCJ displacement had an effect on comfort upon insertion (p = 0.01), comfort after 5 minutes (p = 0.03), end-of-day comfort (p = 0.01), and ability to maintain ocular moisture (p = 0.030). MG expressibility had a significant effect on general comfort (p = 0.01), comfort throughout the day (p = 0.02), and the ability to maintain ocular moisture (p = 0.02). Conclusions. MCJ displacement and MG expressibility have an effect on contact lens comfort. © Copyright 2016 American Academy of Optometry.

Omali,N. B., Heynen,M., Subbaraman,L. N., Papinski,D., Lakkis,C., Smith,S. L., Morgan,P. B., Berntsen,D. A., Nichols,J. J., Jones,L. W., Mathew,J. H., Cox,S. M., Bickle,K. M., Powell,D. R., Cox,J., Miller,W. L., Wallace-Tucker,A., Charrier,S., Chen,Y. -J, Cardenas,L., Huerta,S., Dionne,K., Maldonado-Codina,C., Plowright,A. J., Howarth,G. F., Chatterjee,N., Mirza,A., Dumbleton,K., Schulze,M., Moezzi,A. M., Luensmann,D., Ngo,W., Paquette,L., Srinivasan,S., Varikooty,J., Johnson,J., Simpson,M., Vos Impact of lens care solutions on protein deposition on soft contact lenses. Optometry and Vision Science 2016;93,8:963-972. [ Show Abstract ]

Purpose. To evaluate the effect of four contemporary lens care solutions on total protein, total lysozyme, and active lysozyme extracted from three contact lens materials. Methods. Adapted contact lens wearers were recruited at three sites, and all subjects were randomly assigned to daily wear of either etafilcon A, galyfilcon A, or senofilcon A for 2 weeks. Four lens care solutions (Biotrue, OPTI-FREE PureMoist, RevitaLens OcuTec, and ClearCare) were used by each subject in random order with a new pair of lenses after a washout period between solutions of at least 4 days. After 2 weeks of daily wear, contact lenses were collected for analysis. Proteins were extracted from a subset of contact lenses (n = 568) and total protein, total lysozyme, and lysozyme activity were quantified using a modified Bradford assay, an enzyme-linked immunosorbent assay, and a micrococcal assay, respectively. Results. Higher levels of total protein were extracted from etafilcon A when used with Biotrue compared to other solutions (p = 0.0001). There were higher levels of total lysozyme extracted from galyfilcon A lenses when used with PureMoist than with Biotrue or Clear Care (p < 0.006). Higher total lysozyme was extracted from senofilcon A when used with RevitaLens OcuTec compared to Biotrue (p = 0.002). Lower lysozyme activity was recovered from senofilcon A lenses with RevitaLens OcuTec when compared to all other care solutions (all p < 0.004). When Biotrue, PureMoist, or RevitaLens OcuTec were used, higher total lysozyme was extracted from galyfilcon A compared to senofilcon A(p < 0.01). When RevitaLens OcuTec was used, higher levels of active lysozyme were extracted from galyfilcon A compared to senofilcon A (p = 0.02). Conclusions. The ability of lens care solutions to remove protein from lenses varies depending upon the care solution composition and also the polymeric make-up of the contact lens material. © Copyright 2016 American Academy of Optometry.

2015

Varikooty,J., Schulze,M. M., Dumbleton,K., Keir,N., Woods,C. A., Fonn,D., Jones,L. W. Clinical performance of three silicone hydrogel daily disposable lenses. Optometry and Vision Science 2015;92,3:301-311. [ Show Abstract ]

Purpose. To determine the clinical performance of DAILIES TOTAL1 (DT1), Clariti 1Day (C1D), and 1-DAY ACUVUE TruEye (AVTE) silicone hydrogel daily disposable contact lenses (SiHy DDCLs). Methods. Eligible participants, subdivided into asymptomatic and symptomatic groups, wore each SiHy DDCLs for three consecutive days. Each participant attended three visits (on day 1 at 0 hours; on days 1 and 3 after 8 hours ofwear) per lens type. The order of lens wear was randomized, with at least 1 day washout between lenses. Lens-related performance was evaluated by assessing lens surface deposits, wettability, pre-lens noninvasive tear breakup time, lens movement, and centration; ocular response assessments included conjunctival redness, corneal staining, and conjunctival staining and indentation. Results. Fifty-one asymptomatic and 53 symptomatic participantscompleted the study. For all visits, themeannoninvasive tear breakup timewas about 1 second longer withDT1 than withC1DandAVTE (p < 0.01).Overall, thewettability of all three lenses was good; however, DT1 was graded marginally better than the other lenses (both p < 0.01). On day 3, eyes wearing AVTE had significantly more dehydration-induced corneal staining compared with DT1 (AVTE, 24%; DT1, 11%; p < 0.01). After 8 hours, conjunctival staining was different between lenses (greatest with C1D and least with DT1; all p < 0.01). Conjunctival indentation was more prevalent with the C1D lenses (n = 70) compared with DT1 (n = 1; p < 0.01) and AVTE (n = 11; p < 0.01). Therewere no differences between asymptomatic and symptomatic lenswearers for any of the clinical parameters (all p 9 0.05). Conclusions. Each of the three SiHy DDCLs performed well. Noninvasive tear breakup time was longest and wettability was greater with DT1. C1D had the most conjunctival staining conjunctival indentation. There was no difference between asymptomatic and symptomatic wearers with regard to ocular response and contact lensYrelated parameters. These results suggest that SiHy DDCLs may be an excellent contact lens modality for the symptomatic patient.

2014

Ngo,W., Srinivasan,S., Schulze,M., Jones,L. Repeatability of grading meibomian gland dropout using two infrared systems. Optometry and Vision Science 2014;91,6:658-667. [ Show Abstract ]

PURPOSE: To determine the interobserver and intraobserver repeatability in using the OCULUS Keratograph 4 (K4) and 5M (K5M) to grade meibomian gland (MG) dropout using meibography grading scales. METHODS: The inferior and superior eyelids of 40 participants (35 women, 5 men; mean age = 32 years) were imaged three times each on both instruments. The images were split into one training and two study sets; the latter were graded (four-point meibography scale) by two observers on two separate occasions (24 hours apart) to determine repeatability. Semiobjective quantification of percentage MG dropout was conducted using ImageJ on K4 and K5M images. A finer seven-point meibography scale was used to grade a separate set of K5M images. RESULTS: For the four-point scale, interobserver mean difference (MD) (±SD) was 0.08 (±0.55) on day 1 and 0.13 (±0.50) on day 2, and the concordance correlation coefficient (CCC) was 0.79 and 0.81 on days 1 and 2, respectively. Intraobserver MD (±SD) was 0.04 (±0.54), CCC = 0.79 for observer 1; intraobserver MD (±SD) was -0.09 (±0.60), CCC = 0.74 for observer 2. For the seven-point scale, interobserver MD (±SD) was 0.05 (±0.45), CCC = 0.89 on day 1, and interobserver MD (±SD) was 0.01 (±0.41), CCC = 0.91 on day 2. Intraobserver MD (±SD) was -0.10 (±0.35), CCC = 0.93 for observer 1, and intraobserver MD (±SD) was -0.06 (±0.30), CCC = 0.95 for observer 2. Percentage dropout measured between the K4 and K5M images showed lack of agreement, with 21.8% coefficient of repeatability. There was no significant correlation (r 0.05) between meibography score and clinical signs (corneal staining, gland expressibility, telangiectasia, vascularity, lash loss); however, there was a high correlation (r = 0.77; p < 0.05) between meibography score with percentage dropout. CONCLUSIONS: Observers graded from -1 to +1 grade units between and within themselves for a four-point scale, 95% of the time. Although the interobserver and intraobserver repeatability of the K4 and K5M were very similar, a high rate of disagreement in percentage dropout between K4 and K5M images suggests that the two instruments cannot be interchanged. Meibomian gland dropout scores did not correlate significantly with clinical signs. Using a finer scale may be beneficial for detecting change.

2011

Schulze,M. M., Hutchings,N., Simpson,T. L. Grading bulbar redness using cross-calibrated clinical grading scales. Investigative Ophthalmology and Visual Science 2011;52,8:5812-5817. [ Show Abstract ]

Purpose. To determine the between-scale agreement of grading estimates obtained with cross-calibrated McMonnies/Chapman- Davies (MC-D), Institute for Eye Research (IER), Efron, and Validated Bulbar Redness (VBR) grading scales. Methods. Modified reference images of each grading scale were positioned on a desk according to their perceived redness (within a 0 to 100 range) as determined in a previous psychophysical scaling experiment. Ten observers were asked to represent perceived bulbar redness of 16 sample images by placing them, one at a time, relative to the reference images of each scale. Only 0 and 100 were marked on the scale, but not the numerical position of the reference images. Perceived redness was taken as the measured position of the placed image from 0 and was averaged across observers. Results. Overall, perceived redness depended on the sample image and the reference scale used (repeated measures ANOVA; P = 0.0008); six sample images had a perceived redness that was significantly different between at least two of the scales. Between-scale correlation coefficients of concordance ranged from 0.93 (IER vs. Efron) to 0.98 (VBR vs. Efron). Between-scale coefficients of repeatability ranged from five units (IER vs. VBR) to eight units (IER vs. Efron) of the 0 to 100 range. Conclusions. The use of cross-calibrated reference grades for bulbar redness grading scales allows comparison of grading estimates obtained with different scales. Perceived redness is dependent on the dynamic range of the reference images of the scale, with redness estimates generally being found to be higher for scales with a shorter dynamic range. © 2011 The Association for Research in Vision and Ophthalmology, Inc.

2010

Schulze,M. M., Hutchings,N., Simpson,T. L. The conversion of bulbar redness grades using psychophysical scaling. Optometry and Vision Science 2010;87,3:159-167.

2009

Schulze,M. M., Hutchings,N., Simpson,T. L. The perceived bulbar redness of clinical grading scales. Optometry and Vision Science 2009;86,11:E1250-E1258. [ Show Abstract ]

Purpose. To use a psychophysical scaling method to estimate the perceived redness of reference images of the McMonnies and Chapman-Davies (six reference levels), Institute for Eye Research (four), Efron (five), and Validated Bulbar Redness (five) bulbar redness grading scales. Methods. Regions of interest were cropped out of the grading scale reference images; three separate image sets (color, grayscale, and binarized) were created for each scale, combining to a total of 20 images per image set. Ten naïve observers were asked to arrange printed copies of the 20 images per image set across a distance of 1.5 m on a flat surface, so that separation reflected their perception of bulbar redness; only start and end point of this range were indicated. The position of each image was averaged across observers to represent the perceived redness for this image, within the 0 to 100 range. Subjective data were compared with physical attributes (chromaticity and spatial metrics) of redness. Results. For each image set, perceived redness of the reference images within each scale was ordered as expected, but not all consecutive within-scale levels were rated as having different redness. Perceived redness of the reference images varied between scales, with different ranges of severity being covered by the images. Perception of redness severity depended on the image set (repeated-measures analysis of variance; all p ≤ 0.0002). The perceived redness was strongly associated with the physical attributes of the reference images. Conclusions. Subjective estimates of redness are based on a combination of chromaticity and vessel-based components. Psychophysical scaling of perceived redness lends itself to being used to cross-calibrate these four clinical scales. © 2009 American Academy of Optometry.

2008

Schulze,M. M., Hutchings,N., Simpson,T. L. The use of fractal analysis and photometry to estimate the accuracy of bulbar redness grading scales. Investigative Ophthalmology and Visual Science 2008;49,4:1398-1406. [ Show Abstract ]

Purpose. To use physical attributes of redness to determine the accuracy of four bulbar redness grading scales, and to cross- calibrate the scales based on these physical measures. Methods. Two image-processing metrics, fractal dimension (D) and percentage of pixel coverage (% PC), as well as photometric chromaticity were selected as physical measures, to describe and compare grades of bulbar redness among the McMonnies/Chapman-Davies scale, the Efron Scale, the Institute for Eye Research scale, and a validated scale developed at the Centre for Contact Lens Research. Two sets of images were prepared by using image processing: The first included multiple segments covering the largest possible region of interest (ROI) within the bulbar conjunctiva in the original images; the second contained modified scale images that were matched in size and resolution across scales, and a single, equally-sized ROI. To measure photometric chromaticity, the original scale images were displayed on a computer monitor, and multiple conjunctival segments were analyzed. Pearson correlation coefficients between each set of image metrics and the reference image grades were calculated to determine the accuracy of the scales. Results. Correlations were high between reference image grades and all sets of objective metrics (all Pearson's r ≥ 0.88, P ≤ 0.05); each physical attribute pointed to a different scale as being most accurate. Independent of the physical attribute used, there were wide discrepancies between scale grades, with almost no overlap when cross-calibrating and comparing the scales. Conclusions. Despite the generally strong linear associations between the physical characteristics of reference images in each scale, the scales themselves are not inherently accurate and are too different to allow for cross-calibration. Copyright © Association for Research in Vision and Ophthalmology.

2007

Schulze,M. M., Jones,D. A., Simpson,T. L. The development of validated bulbar redness grading scales. Optometry and Vision Science 2007;84,10:976-983. [ Show Abstract ]

PURPOSE: To develop a perceptually and physically based bulbar redness grading scale. METHODS: Digital conjunctival hyperemia photographs were taken using a photo-slit lamp at controlled exposures. Nine participants arranged 25 images on a tabletop over a range of 1.5 m, using separation to represent changes in redness. The position of each image was recorded and normalized for a 0 to 100 scale, and compared to chromaticity of each image obtained using a spectrophotometer. The performance of two versions of the scale (5 and 10 images) and a continuous grading scale was evaluated based on repeatability data collected from nineteen observers who used each scale twice to grade 30 randomly presented images of bulbar redness. RESULTS: Psychophysical scaling was highly correlated between single observers (Pearson's r >or= 0.92, p < 0.05). The averaged subjective grades significantly correlated with chromaticity (r = 0.95 and r = 0.99, p < 0.001 for CIE u* and log u*, respectively). Across all observers, test and retest ratings were highly correlated with either scale (r >or= 0.98), and showed high levels of repeatability expressed by intraclass correlation coefficients (ICC >or= 0.98), correlation coefficients of concordance (CCC >or= 0.96), and coefficients of repeatability (COR <or= 5.64). Despite single unit increment options, the majority of grade values assigned using the discrete scales were distributed in multiples of 5. CONCLUSIONS: Combining psychophysical and physical attributes is a promising method for the development of novel anterior segment scales; the newly developed scales performed well in a clinical setting.

Sorbara,L., Simpson,T., Duench,S., Schulze,M., Fonn,D. Comparison of an objective method of measuring bulbar redness to the use of traditional grading scales. Contact Lens and Anterior Eye 2007;30,1:53-59. [ Show Abstract ]

Purpose: The primary objective was to compare measures of bulbar redness objectively using a photometric method with standard grading methods. Measures of redness were made on 24 participants wearing a silicone hydrogel contact lens in one eye for overnight wear. This report compares hyperaemia after 1 week of daily wear (baseline) with redness measured after 6 months of overnight wear. Method: A new method of objectively measuring bulbar conjunctival redness was performed using the Spectrascan650® Photometer by Photo Research® under fixed illumination. Photometric measures in CIEu* chromaticity values involve the measurement of chromaticity, a physical analogue of redness, greenness and blueness in the image. This method was validated in Part 1 of the study using repeated measurements on the photographic CCLRU scale. In Part 2 of the study, the photographic grading scale (CCLRU) from 0 (none) to 100 (extreme) was used to make the comparison. Results: Part 1 indicated that the photometer provides a repeatable and reliable measure of bulbar redness (CCC = 0.989). A moderately strong and significant correlation was found between the CIEu* chromaticity values and the analogue data (R = 0.795, p = 0.000) at each measurement session (from baseline to 1 day, 1 week, and 1, 3 and 6 months of overnight wear). Conclusions: This new standardized and objective method of measuring bulbar redness has great potential to replace subjective grading scales, especially with multi-centre studies, where variability between investigators occurs. This method may also detect smaller changes between visits or between eyes. Crown Copyright © 2007.

Abstracts

2016

Schulze M, Wong A, Haider S, Ebare K, Fadli Z, Coles-Brennan C, Jones L. Blink rate in silicone hydrogel contact lens wearers during digital device use. Optom Vis Sci 2016;93: E-abstract 165122. [ PDF ]

Moezzi A, Varikooty J, Luensmann D, Ng A, Schulze M, Karkkainen T, Xu J, Jones L. Open-eye clinical performance of etafilcon a multifocal daily disposable hydrogel contact lenses compared to habitual silicone hydrogel lens wear. Optom Vis Sci 2016;93: E-abstract 165259. [ PDF ]

Jones L, Varikooty J, Schulze M, Keir N. Assessment of contact lens comfort: Single report scores vs cumulative comfort. Asian Cornea and Contact Lens Conference, Hong Kong, 2016.

2015

Schulze M, Srinivasan S, Hickson-Curran S, Toubouti Y, Cox S, Mirza A, Nichols J, Morgan P, Jones L. Comparisons between Age, Gender, Lens Type and Lid Wiper Epitheliopathy with Soft Contact Lens Comfort. Invest Ophthalmol Vis Sci 2015;56: E-abstract 6069. [ PDF ]

Schulze M, Luensmann D, Ng AY, Panjwani F, Srinivasan S, Jones L. The relationship between the positioning of multifocal contact lens optics and satisfaction with vision. Optom Vis Sci 2015;92: E-abstract 155256. [ PDF ]

2014

Berntsen D, Hickson-Curran S, Jones L, Mathew J, Mirza A, Morgan P, Schulze M, Nichols J. Comparison of soft contact lens comfort using three contact lens materials and four contact lens solutions. Invest Ophthalmol Vis Sci 2014;55: E-abstract 863.

Srinivasan S, Schulze M, Hickson-Curran S, Berntsen D, Howarth G, Nichols J, Morgan P, Jones L. Comparison of upper lid margin staining with different soft contact lens materials and care product combinations. Invest Ophthalmol Vis Sci 2014;55: E-abstract 4673. [ PDF ]

Moezzi A, Varikooty J, Schulze M, Ngo W, Lorenz K, Jones L. Open Eye Corneal Swelling with 1-DAY ACUVUE® DEFINE™ and 1-DAY ACUVUE® DEFINE™ with Lacreon® compared to 1-DAY ACUVUE® MOIST®. Invest Ophthalmol Vis Sci 2014;55: E-abstract 4672. [ PDF ]

Moezzi A, Varikooty J, Schulze M, Ngo W, Lorenz K, Boree M. Open-eye corneal swelling with etafilcon A daily disposable hydrogel contact lenses compared to no lens wear. BCLA Clinical Conference and Exhibition, 2014. [ PDF ]

Schulze M, Subbaraman L, Babaei Omali N, Stahl U, Canavan K, Jones L. Is there a difference between clinical signs and symptoms in asymptomatic adapted contact lens and spectacle wearers?. BCLA Clinical Conference and Exhibition, 2014. [ PDF ]

Schulze M, Srinivasan S, Hickson-Curran S, Bemsten D, Howarth G, Nichols J, Morgan P, Jones L. Upper lid margin staining with different soft contact lenses and lens care solution combinations. BCLA Clinical Conference and Exhibition, 2014. [ PDF ]

Stahl U, Luensmann D, Lemp J, Moezzi A, Schulze M, Varikooty, Dumbleton K, Jones L. Determination of higher order aberrations with two silicone hydrogel toric lenses. Optom Vis Sci 2014;91: E-abstract 145188. [ PDF ]

Babaei Omali N, Subbaraman L, Schulze M, Heynen M, Canavan K, Fadli Z, Jones L. Clinical Signs, Symptoms, Tear Film and Meibum Composition in Asymptomatic Senofilcon A Contact Lens and Spectacle Wearers. Optom Vis Sci 2014;91: E-abstract 145185. [ PDF ]

Schulze M, Luensmann D, Hickson-Curran S, Toubouti Y, Cox S, Plowright A, Nichols J, Morgan P, Jones L. Analysis of lid wiper epitheliopathy in habitual soft lens wearers. Optom Vis Sci 2014;91: E-abstract 140104.

2013

Schulze M, Simpson T, Situ P, Menzies K, Walther H, Jones L. Effects of magnification on tear meniscus parameters using optical coherence tomography (OCT) images. Canadian Optometry Schools Research Conference, Waterloo, Canada, 2013.

Ngo W, Srinivasan S, Schulze M, Jones L. Inter- and intra-observer agreement using infrared meibography systems. Canadian Optometry Schools Research Conference, Waterloo, Canada, 2013.

Ngo W, Srinivasan S, Schulze M, Jones L. Inter- and intra-observer agreement and repeatability of imaging the meibomian glands with the Oculus Keratograph 4 and Keratograph 5M. Tear Film & Ocular Surface International Conference, Sicily, Italy, 2013.

Ngo W, Srinivasan S, Schulze M, Jones L. Inter- and intra-observer agreement and repeatability of imaging the meibomian glands with the oculus Keratograph 4 and Keratograph 5M. Invest Ophthalmol Vis Sci 2013;54: E-Abstract 3569. [ PDF ]

2012

Schulze M, Varikooty J, Keir N, Jones L. The clinical performance of three contact lens solutions in symptomatic and asymptomatic contact lens wearers. Contact Lens & Anterior Eye 2012;35,S1:e8.

Jerchel N, Sickenberger W, Schulze M. Objective classification and documentation of bulbar redness using a corneal topographer. Contact Lens & Anterior Eye 2012;35,S1:e18.

2011

Schulze M, Simpson T, Stolee P. Rasch Analysis Of Bulbar Redness Scaling And The Relationship Between Physical Redness (u’) and “Rasch Redness”. Invest Ophthalmol Vis Sci 2011;52:E-abstract 1966.

Simpson T, Schulze M, Stolee P. Rasch Analysis of Clinical Grading of Corneal Staining. Invest Ophthalmol Vis Sci 2011;52:E-abstract 1967.

Schulze M, Simpson T, Situ P, Menzies K, Walther H, Jones L. Effects of magnification on tear meniscus parameters using optical coherence tomography (OCT) images. Optom Vis Sci 2011;88:E-abstract 115482.

2010

Schulze M, Simpson T, Feng Y, Lucchetti E, Chou R, Hutchings N. Statistical Approach for Differentiating Happy and Unhappy Progressive Addition Lens Wearers. Optom Vis Sci 2010;87:E-Abstract 105398.

2009

Schulze M, Hutchings N, Simpson T. Grading Bulbar Redness using Cross-calibrated Grading Scales. Optom Vis Sci 2009;86:E-Abstract 95543.

Schulze M, Hutchings N, Simpson T. Clinical Scale Constancy – The Relationship between Bulbar Redness Grading Scales. Contact Lens & Anterior Eye 2009;32210-254.

2008

Schulze M, Hutchings N, Simpson TL. Perceptual differences between reference images of bulbar redness grading scales. Optom Vis Sci 2008;85: E-abstract 80036.

2007

Schulze M, Simpson TL, Hutchings N. Cross-calibrating between grading scales of redness — is it possible?. Invest Ophthalmol Vis Sci 2007;48: E-abstract 5369.

Schulze M, Hutchings N, Simpson T. Cross-calibrating between grading scales of redness: is it possible?. Biomedical Imaging & Computer Vision (BICV) Conference, Waterloo, ON, CA., 2007.

Schulze M, Hutchings N, Simpson T. The use of fractal analysis to estimate the accuracy of bulbar redness grading scales. 6th Canadian Optometry Conference on Vision Science, Waterloo, Ontario, 2007.

2001

Jones D, Schulze M, Simpson T. The Application of Clinical Grading Scales by Trained and Non-trained Observers. Contact Lens & Anterior Eye 2001;2523-51.

Schulze M, Jones D, Simpson T. The Production of an Enhanced Grading Scale for Determination of Ocular Hyperaemia (BCLA 2001 Da Vinci Award). Contact Lens & Anterior Eye 2001;2523-51.

2000

Schulze M, Jones D, Simpson T. The production of an enhanced grading scale for determination of ocular hyperemia. Optom Vis Sci 2000;77,12s:184.

Professional Publications

2014

Schulze M. Summary: Report of the Clinical Trial Design and Outcomes Subcommittee. ContactLensUpdate.com 2014.

Schulze M. Review of "In vivo 3D meibography of the human eyelid using real time imaging Fourier-Domain OCT". ContactLensUpdate.com 2014.