Lid Wiper Epitheliopathy in Soft Contact Lens Wearers

Schulze, Marc; Srinivasan, Sruthi; Hickson-Curran, Sheila; Berntsen, David A.; Howarth, Gillian; Toubouti, Youssef; Morgan, Philip B.; Nichols, Jason J.; Jones, Lyndon

doi:10.1097/opx.0000000000000919

Cited by 34 publications

(33 citation statements)

References 19 publications

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“…Previous studies have reported that lid wiper staining in soft contact lens wearers is independent of age, gender, or ethnicity. 43 Future work should investigate the relationship between the dimensions of the upper tarsal plate and CLD.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Upper Eyelid Tarsus and Lid Wiper Dimensions

Navascues‐Cornago

Maldonado‐Codina

Morgan

2016

Eye &Amp; Contact Lens: Science &Amp; Clinical Practice

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Section: Discussionmentioning

confidence: 99%

Characterization of Upper Eyelid Tarsus and Lid Wiper Dimensions

Navascues‐Cornago

Maldonado‐Codina

Morgan

2016

Eye &Amp; Contact Lens: Science &Amp; Clinical Practice

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“…A recent multi-center study conducted by Schulze et al failed to demonstrate a relationship between LWE and CLD in a larger sample of habitual lens wearers (Schulze MM, et al IOVS 2015;56:ARVO E-Abstract 6069). 57 …”

Section: Discussionmentioning

confidence: 99%

Lid Wiper Microvascular Responses as an Indicator of Contact Lens Discomfort

Deng

Wang

Jiang

et al. 2016

American Journal of Ophthalmology

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Purpose-To analyze quantitatively the alterations in the microvascular network of the upper tarsal conjunctiva, lid wiper, and bulbar conjunctiva relative to ocular discomfort after contact lens wear.Design-A prospective, cross-over clinical study.Methods-Functional slit-lamp biomicroscopy (FSLB) was used to image the microvascular network of the upper tarsal conjunctiva, lid wiper, and bulbar conjunctiva. The microvascular network was automatically segmented, and fractal analyses were performed to yield the fractal dimension (D box ) that represented vessel density. Sixteen healthy subjects (nine female and seven male) with an average age of 35.5 ± 6.7 years old (mean ± standard deviation) were recruited. The right eye was imaged at 9 AM and 3 PM at the first visit (Day 1) when the subject was not wearing contact lenses. During the second visit (Day 2), the right eye was fit with a contact lens for 6 h. Microvascular imaging was performed before (at 9 AM) and after lens wear (at 3 PM). Ocular comfort was rated using a 50-point visual analogue scale before and after 6 h of lens wear, and its relationships with microvascular parameters were analyzed.Results-There were no significant differences in D box among the upper tarsal conjunctiva, lid wiper, and bulbar conjunctiva among the measurements at 9 AM (Day 1 and Day 2) and 3 PM Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Financial Disclosures HHS Public AccessAuthor manuscript Am J Ophthalmol. Author manuscript; available in PMC 2017 October 01. Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscript (Day 1) when the subjects were not wearing the lenses (P > 0.05), whereas after 6 h of lens wear, the microvascular network densities were increased in all three of these locations. D box of the lid wiper increased from 1.411 ± 0.116 to 1.548 ± 0.079 after 6 h of contact lens wear (P < 0.01). D box of the tarsal conjunctiva was 1.731 ± 0.026 at baseline and increased to 1.740 ± 0.030 (P < 0.05). D box of the bulbar conjunctiva increased from 1.587 ± 0.059 to 1.632 ± 0.060 (P < 0.001). The decrease in ocular discomfort was strongly related to the D box change in the lid wiper (r = 0.61, P < 0.05). There were no correlations between the changes of ocular comfort and the microvascular network densities of either the tarsal or bulbar conjunctivas (P > 0.05).Conclusion-This study is the first to show that the microvascular network of the lid wiper can be quantitatively analyzed in contact lens wearers. The microvascular responses of the lid wiper were significantly correlated with contact lens discomfo...

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“…[3][4][5]13 Several groups [3][4][5]12,14,15 have found evidence to support these findings and have additionally argued that LWE may be the missing key in explaining the discrepancy often noted between signs and symptoms related to dry eye and contact lens discomfort. Interestingly, other groups [16][17][18] have failed to find corroborating evidence. These conflicting results have made it difficult to discern whether LWE is a true pathology or an acceptable physiological variation of the lid wiper.…”

mentioning

confidence: 88%

“…The use of the right and left eye in the statistical analysis was designed to account for the intereye variability in ocular surface parameters, and in symptoms of ocular discomfort and dryness for each subject. 18 Upon examining residual plots, FTBUT and NITBUT were naturallog transformed to better approximate normality to meet key assumptions for univariate and multivariate modeling. For multivariate analysis, a stepwise regression procedure with consideration of F test P values and examination of residual and other diagnostic plots was used to determine accurate models.…”

Section: Methodsmentioning

confidence: 99%

“…13 In addition, there have also been questions regarding whether certain demographic groups are more likely to present with LWE. 13,18 Therefore, the purpose of this study was to gain greater clarity about the clinical significance of LWE through a cross-sectional study on a large and diverse population, using a comprehensive set of ocular surface assessments. There were three aims in this study: (1) to compare LWE prevalence rates among demographic groups, (2) to determine if subject characteristics or ocular surface features were associated with severity of LWE, (3) and to assess if LWE was associated with patient symptomology.…”

mentioning

confidence: 99%

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The Relationship of Lid Wiper Epitheliopathy to Ocular Surface Signs and Symptoms

Yeh

Leung

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. There has been interest in determining whether lid wiper epitheliopathy (LWE) plays a key role in causing ocular discomfort. Conflicting reports have made it difficult to discern whether LWE is more prevalent in certain populations, what characteristics are associated with its severity, and what its role is in symptomology. This cross-sectional study on a large and diverse population attempts to answer these questions.METHODS. Subjects were asked to complete questionnaires related to dry eye and to ocular discomfort. A comprehensive set of ocular surface parameters were assessed, including LWE length and width, tear-film lipid layer thickness, fluorescein tear breakup time (FTBUT), lidparallel conjunctival folds (LIPCOF), and corneal staining. RESULTS.A total of 287 subjects participated in the study. LWE was observed in 45% of the study cohort and was twice as prevalent in Asians than non-Asians (P < 0.005). LWE was more likely to present in contact lens wearers than non-contact lens wearers (P ¼ 0.03). Decreased FTBUT was associated with increased LWE length and width (P < 0.005 and P ¼ 0.01, respectively), although only a small effect size was noted. Presence of LIPCOF was linked with a 0.25-grade increase in LWE width (P ¼ 0.01). Only LWE width was associated with greater symptoms in contact lens wearers.CONCLUSIONS. LWE was associated with decreased tear-film stability, contact lens wear, lid anatomy, and LIPCOF. LWE was not associated with symptoms in non-contact lens wearers. LWE width was associated with greater symptoms in contact lens wearers but was only clinically significant with moderate to severe LWE width.

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Lid Wiper Epitheliopathy in Soft Contact Lens Wearers

Cited by 34 publications

References 19 publications

Characterization of Upper Eyelid Tarsus and Lid Wiper Dimensions

Characterization of Upper Eyelid Tarsus and Lid Wiper Dimensions

Lid Wiper Microvascular Responses as an Indicator of Contact Lens Discomfort

The Relationship of Lid Wiper Epitheliopathy to Ocular Surface Signs and Symptoms

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