Dual-Polymer Drops, Contact Lens Comfort, and Lid Wiper Epitheliopathy

Abstract

PurposeThis study compared a new contact lens rewetting drop containing both carboxymethylcellulose and hyaluronic acid (CMC-HA) with a standard drop containing carboxymethylcellulose only (CMC). Symptoms of discomfort typical in lens wear and lid wiper epitheliopathy (LWE) were assessed over a 3-month period in a diverse sample of contact lens wearers.MethodsAdapted daily-wear contact lens subjects using hydrogel, silicone hydrogel, or rigid gas permeable lenses were enrolled in this prospective, randomized, double-masked, parallel-group, 90-day study conducted at 15 clinical sites. Subjects were randomized 2:1 to CMC-HA (n = 244) or CMC alone (n = 121) with dosage at least four times per day, along with their habitual lens care system. At baseline and at days 7, 30, 60, and 90, subject-completed questionnaires, bulbar conjunctival staining, LWE, contact lens distance visual acuity (CLDVA), and standard safety measures were assessed.ResultsAt day 90, CMC-HA performed significantly better than CMC in ocular symptoms including dryness throughout the day (p = 0.006), and burning/stinging throughout the day (p = 0.02) and at the end of the day (p < 0.001). CMC-HA also performed numerically better for dryness at the end of day (p = 0.06). LWE staining was improved in the CMC-HA group at day 90 whereas it increased slightly in the CMC alone group, with a significant between-group difference (p = 0.009). CMC-HA also demonstrated greater reduction in conjunctival staining compared with CMC alone at day 90 (p = 0.08). No differences in CLDVA, contact lens wear time, acceptability, and product use were observed, and safety outcomes were similar between groups.ConclusionsThe addition of HA to a standard CMC rewetting drop improves clinical performance. In this comparison of rewetting drop efficacy in contact lens wearers, LWE was a useful clinical sign for differentiating clinical performance.

Contact lens wear and dry eyes: challenges and solutions

“…Nichols et al assessed lid wiper epitheliopathy as well as CLD in a group of adapted contact lens wearers after randomizing them to rewetting drops containing either carboxymethylcellulose and hyaluronic acid (CMC-HA) or just CMC. 41 The group taking CMC-HA had improved comfort as well as improved lid wiper epitheliopathy staining, supporting its use as a marker of CLD. 41 In support of this, Deng et al analyzed the microvascular network of the lid wiper relative to CLD.…”

“… 41 The group taking CMC-HA had improved comfort as well as improved lid wiper epitheliopathy staining, supporting its use as a marker of CLD. 41 In support of this, Deng et al analyzed the microvascular network of the lid wiper relative to CLD. 42 The microvascular responses of the lid wiper were significantly correlated with CLD, suggesting that friction may be related to both this hyperemic response and lid wiper staining.…”

<p>Safety and Efficacy of a Preservative-Free Artificial Tear Containing Carboxymethylcellulose and Hyaluronic Acid for Dry Eye Disease: A Randomized, Controlled, Multicenter 3-Month Study</p>

“… 18 The same preserved formulation was also reported to be non-inferior to a non-preserved HA-based formula, with some advantages observed in symptom relief and subject acceptance. 37 Formulations (with and without preservatives) combining CMC and HA have also demonstrated symptom reduction and improved clinical outcomes in contact lens wearers 38 and following cataract 39 or refractive surgery, 40 which are both known to exacerbate dry eye symptoms. This post-surgical benefit with CMC and HA combined probably also relates to the additional mechanism of action involving activation of the CD-44 receptor by HA, 20 which helps promote corneal epithelial cell adhesion 41 and migration, 42 and improve ocular surface health.…”

Laser‐Induced Surface Modification of Contact Lenses

“…Lack of comfort is the most common cause of contact lens discontinuation . Hydrophobic contact lenses lead to hazy vision, a sensation of dryness, and discomfort . Consequently, increase in surface wettability and hydrophilicity has been known to enhance the wear comfort of contact lenses .…”

“…Consequently, increase in surface wettability and hydrophilicity has been known to enhance the wear comfort of contact lenses . Typically, two approaches are undertaken to improve the wettability of contact lenses temporarily; one is the regular application of lens solution (rewetting drops) that replenish the naturally diminishing tear film between the contact lens and ocular surface, while the other is to modify the lens material itself (plasma treatment) . However, introducing hydroxyl groups through chemical modifications have been utilized to increase the water affinity of the lens's surface…”