S12 Abstracts of the 2011 BCLA Annual Clinical Conference / Contact Lens & Anterior Eye 34, Supplement 1 (2011) S1–S43

lens use “unsafe”.While many contact lens complications aremanaged in thecommunity, contact lens complications comprise a small but significant pro-portion of acute ophthalmic hospital care. Better understanding of the risksin contact lens wear may serve to reduce these complications. Preventativemanagement in the community, may also reduce the rate of complications incontact lens wear and hence the burden on hospital resources. Regular after-care and careful management of contact lens wearers, primarily thoughtfuluse of contact lens products, care systems or the way lenses are worn arevaluable tools for the prevention of adverse effects.

Contact lenses in mind and the mind

Fiona Fylan, Helen Fawkner

Body image is a multi-dimensional construct and can be affected by an arrayof psychosocial factors, including physical attributes and interpersonal expe-riences. Thus “noticeable” visual problems and their correction can presentchallenges to body image. Furthermore, high ametropia has an adverse effecton a patient’s quality of life, and can impact on both daily activities and onpsychologicalwell being. Such patients tend to have lower self-esteem, lowerconfidence in their appearance, and perceive their glasses as being less con-venient than equivalent patients with lower prescriptions. Contact lenses canincrease their quality of life. Certain life stages present particular problems,and any additional pressures arising from having to start wearing glasses –signalling differences from their previous selves and from their peers – canbe particularly difficult. During this presentation we will explore recent re-search in body image and visual quality of life with different forms of opticalcorrection, and will highlight the expectations, anxieties and concerns thatpatients have, how to address them, and how to communicate effectivelywith patients about their eyecare options.

Contact lenses and the diabetic patient

Nathan Efron*, Clare O’Donnell

*E-mail address: n.efron@qut.edu.au

This lecture will provide an overview of the anterior ocular manifestationsof diabetes, with emphasis on the changes influencing corneal structure andfunction. An important decision for the practitioner is whether or not pa-tients with diabetes should be fitted with contact lenses. The results of stud-ies in this area will be presented and the findings used to propose strategiesfor patient management. Contact lenses have been suggested as a novel vehi-cle for monitoring tear glucose levels, on the assumption that this parameteris correlated to blood glucose concentrations. This is potentially a significantadvantage over current finger prick technology, which is uncomfortable andmessy for the diabetic patient. Developments in this area, and prospects forthe future, will be discussed.

CONFERENCE SESSION 18 – Hot Topics Session

Not learning frommistakes of the past: should today’s lens careproducts induce corneal staining?

Arthur B Epstein

Ophthalmic Consultants, Phoenix, AZ, USA

E-mail address: artepstein@artepstein.com

Topic outline: Contact lens related corneal staining has remained among thehottest and most controversial topics in the modern history of contact lensesand lens care. Although revisionist perspective suggests that contact lens as-sociated superficial corneal staining is benign and may not represent barriercompromise, other evidence suggests that staining may actually be a sen-tinel sign of far greater ominous clinical import. Recent studies have demon-strated unexpectedly high levels of contact lens care related staining with anewly introduced lens care product. The relation of corneal staining to up-take and release of disinfectant during storage and lens wear is of grow-ing concern. Recent data correlating contact lens care related corneal stain-ing and barrier compromise quantified by fluorophotometric assessment ofsodium fluorescein uptake has helped underscore the potentially serious na-ture of this finding.

What do you really know about fluorescein?

Mohinder M Merchea

Bausch + Lomb Vision Care, Rochester, New York, USA

E-mail address:MMerchea@bausch.com

Topic outline: For decades, ECPs have been using fluorescein as an inexpen-sive diagnostic test to detect damage to the cornea, among other things. Buthow much do we actually know about this molecule and do we really knowwhat we are seeing when it “stains”? Few ECPs are aware that fluoresceinis a synthetic organic compound widely used as a fluorescent tracer and isnot a molecular probe of any kind. In fact, fluorescein was first used to deter-mine if the Rhine and Dandy Rivers were connected. Further, fluorescein isnot an optimal diagnostic test as at high concentrations it is self-quenchingleading to a diminution of fluorescence, its fluorescent intensity is highly pH-dependent, and how it interacts with the cornea is largely unknown. Thereare alsomany facts about the fluorescence seen in the presence of fluoresceindye in contact lens wearing patients that ECPs are unaware of – 1) fluoresceinhas a strong binding affinity for the preservatives found in MPS, such as PQ-1and PHMB, and it binds to them when they are in the same environment;2) fluorescein’s affinity for PHMB is 50× stronger than that for PQ-1, thus inthe presence of these two molecules a differential amount of fluorescencemaybe seen until the molecules dissipate with normal tear flow exchange;and 3) the “staining” seen from fluorescein and MPS preservatives bindingis not indicative of corneal cell damage, injury or cell death and is simply abenign, transient phenomenon.

Underlying mechanisms of sodium fluorescein staining using an in vitromodel of solution-induced corneal staining (SICS)

May Bakkar*, Carole Maldonado-Codina, Philip B Morgan, Curtis Dobson

University of Manchester, Manchester, UK

*E-mail address:may.bakkar@postgrad.manchester.ac.uk

Topic outline: The assessment of corneal integrity using sodium fluoresceinis a routine clinical tool. Despite its widespread use, the cell biology and cel-lular mechanisms underlying the staining of corneal epithelial cells are notwell understood. It has been reported that there is increased corneal fluores-cein staining in response to exposure to certain lens care solution and contactlens combinations. We have developed an in vitromodel of solution-inducedcorneal staining (SICS) to give further information regarding the mechanismof this phenomenon, and to determine whether the staining is correlatedwith cell toxicity or other cell physiological changes. Themodel comprised ofL929 mouse fibroblast cells exposed to ReNuMultiPlus contact lens solutionand treated with fluorescein.The extent of cell toxicity was assessed withpropidium iodideusing automated fluorescence microscopy. Similar to clini-cally observed SICS, exposure to ReNuMultiPlus caused a significant increasein the proportion of L929 cells stained brightly with fluorescein. However, in-tense fluorescein staining did not occur extensively in cells that were delib-erately lysed, suggesting such staining did not reflect simple chemical bind-ing of fluorescein within cells with incomplete plasma membranes. We alsonoted that the uptake and efflux of fluorescein from cells are temperaturedependent, suggesting these are active cellular processes.

Non-contact Meibography: keep it simple but effective

Heiko Pult1,2,*, Britta Riede-Pult1,2

1Optometry and Vision Research, Weinheim, Germany; 2Contact Lens &Anterior Eye Research Unit (CLEAR), School of Optometry and Vision Sciences,Cardiff University, UK

*E-mail address: ovr@heiko-pult.de

Purpose:Meibography is reported to be important in Meibomian Gland Dys-function (MGD) evaluation. Our purpose was to investigate the usefulness ofa standard infrared video security camera in meibography.

Methods: Meibographs were taken of the right lower lid of 17 subjects(female10; age = 44.3 years ±13.3 SD), randomly selected from the patientpool of Horst Riede GmbH, Weinheim, Germany. Meibomian glands (MG)were photographed by an infra-red video security camera and extend ofMG loss (MGL) was measured by digital image analyzes. Lidparallel con-