Daily disposable contact lens prescribing around the world

Daily disposable contact lenses were introduced into the market 16 years ago. Data that we have gathered from annual contact lens fitting surveys conducted in Australia, Canada, Japan, The Netherlands, Norway, the UK and the USA between 2000 and 2008 indicates an overall increase in daily disposable lens fitting during this period. Daily disposable lenses are especially popular in Japan, Norway and the UK. There is a trend for these lenses to be fitted on a part-time basis. Males are over-represented in daily disposable lens fitting—a trend that is especially evident in Canada. Daily disposable lens wearers are about two years younger than wearers of reusable lenses in Japan and The Netherlands. The convenience and health benefits of daily disposable lenses are expected to fuel continued growth in this sector.

Demographics of international contact lens prescribing

Knowledge of differences in the demographics of contact lens prescribing between nations, and changes over time, can assist (a) the contact lens industry in developing and promoting various product types in different world regions, and (b) practitioners in understanding their prescribing habits in an international context. Data that we have gathered from annual contact lens fitting surveys conducted in Australia, Canada, Japan, the Netherlands, Norway, the UK and the USA between 2000 and 2008 reveal an ageing demographic, with Japan being the most youthful. The majority of fits are to females, with statistically significant differences between nations, ranging from 62 per cent of fits in Norway to 68 per cent in Japan. The small overall decline in the proportion of new fits, and commensurate increase in refits, over the survey periodmay indicate a growing rate of conversion of lens wearers to more advanced lens types, such as silicone hydrogels. � 2009 British Contact Lens Association.

Developing speaking assessment tasks to reflect the 'social turn' in language testing

Interactional competence has emerged as a focal point for language testing researchers in recent years. In spoken communication involving two or more interlocutors, the co-construction of discourse is central to successful interaction. The acknowledgement of co-construction has led to concern over the impact of the interlocutor and the separability of performances in speaking tests involving interaction. The purpose of this article is to review recent studies of direct relevance to the construct of interactional competence and its operationalisation by raters in the context of second language speaking tests. The review begins by tracing the emergence of interaction as a criterion in speaking tests from a theoretical perspective, and then focuses on research salient to interactional effectiveness that has been carried out in the context of language testing interviews and group and paired speaking tests.

Regional changes in corneal thickness and shape with soft contact lenses

Purpose: To investigate the influence of soft contact lenses on regional variations in corneal thickness and shape while taking account of natural diurnal variations in these corneal parameters. Methods: Twelve young, healthy subjects wore 4 different types of soft contact lenses on 4 different days. The lenses were of two different materials (silicone hydrogel, hydrogel), designs (spherical, toric) and powers (–3.00, –7.00 D). Corneal thickness and topography measurements were taken before and after 8 hours of lens wear and on two days without lens wear, using the Pentacam HR system. Results: The hydrogel toric contact lens caused the greatest level of corneal thickening in the central (20.3 ± 10.0 microns) as well as peripheral cornea (24.1 ± 9.1 microns) (p < 0.001) with an obvious regional swelling of the cornea beneath the stabilizing zones. The anterior corneal surface generally showed slight flattening. All contact lenses resulted in central posterior corneal steepening and this was weakly correlated with central corneal swelling (p = 0.03) and peripheral corneal swelling (p = 0.01). Conclusions: There was an obvious regional corneal swelling apparent after wear of the hydrogel soft toric lenses, due to the location of the thicker stabilization zones of the toric lenses. However with the exception of the hydrogel toric lens, the magnitude of corneal swelling induced by the contact lenses over the 8 hours of wear was less than the natural diurnal thinning of the cornea over this same period.

Contact Lens Practice, 2nd Edition

Thoroughly revised and updated, this popular book provides a comprehensive yet easy to read guide to modern contact lens practice. Beautifully re-designed in a clean, contemporary layout, this second edition presents relevant and up-to-date information in a systematic manner, with a logical flow of subject matter from front to back. This book wonderfully captures the ‘middle ground’ in the contact lens field … somewhere between a dense research-based tome and a basic fitting guide. As such, it is ideally suited for both students and general eye care practitioners who require a practical, accessible and uncluttered account of the contact lens field. Contents Part 1 Introduction Historical perspective. The anterior eye Visual optics Clinical instruments Part 2 Soft contact lenses Soft lens materials Soft lens manufacture Soft lens optics Soft lens measurement Soft lens design and fitting Soft toric lens design and fitting Soft lens care systems Part 3 Rigid contact lenses Rigid lens materials Rigid lens manufacture Rigid lens optics Rigid lens measurement Rigid lens design and fitting Rigid toric lens design and fitting Rigid lens care systems Part 4 Lens replacement modalities Unplanned lens replacement Daily soft lens replacement Planned soft lens replacement Planned rigid lens replacement Part 5 Special lenses and fitting considerations Scleral lenses Tinted lenses Presbyopia Continuous wear Sport Keratoconus High ametropia Paediatric fitting Therapeutic applications Post-refractive Surgery Post-keratoplasty Orthokeratology Diabetes Part 6 Patient examination and management History taking Preliminary examination Patient education Aftercare Complications Digital imaging Compliance Practice management Appendices Index

Values, controversial issues and interfaith understanding

Values are fundamental to human activity. What makes us distinctive is our ability to understand the challenges we face in life, and to make choices about how to respond. Yet, as the Cheshire Cat from Lewis Carroll’s Alice’s Adventures in Wonderland observed, if we don’t care about how we make such choices, the outcome of our decision-making is diminished. Values education is a broad, complex and controversial area, and, while it has shifted in emphasis and focus, it continues to be an essential part of many education systems. For example, some international education systems are exploring the links between values education and student wellbeing. In Australia, the values basis for ethical behaviour is receiving emphasis as a general capability, or important component of education, that can be developed across the curriculum. Indeed, some syllabus and policy documents require that particular values are emphasised, while numerous schools aim to inculcate and foster a range of personal social, moral and spiritual values in their students, many of which are shared by members of the wider community. However, because values are also contested in the community, values education involves the exploration of controversial issues. Similarly, values education explores the underlying belief systems of different world views and how they influence value commitments, ways of behaving, and interfaith understanding in today’s globalised world. This chapter explores the significance and teaching possibilities of values, controversial issues and interfaith understanding.

Concept building

In this world of continuous change, there’s probably one certainty: more change lies ahead. Our students will encounter challenges and opportunities that we can’t even imagine. How do we prepare our students as future citizens for the challenges of the 21st century? One of the most influential public intellectuals of our time, Howard Gardner, suggests that in the future individuals will depend to a great extent on the capacity to synthesise large amounts of information. ‘They will need to be able to gather together information from disparate sources and put it together in ways that work for themselves and can be communicated to other persons’(Gardner 2008, p. xiii). One of the first steps in ‘putting things together’ so they ‘work’ in the mind is ‘to group objects and events together on the basis of some similarity between them’ (Lee & das Gupta 1995, p. 116). When we do this and give them a collective name, we are conceptualising. Apart from helping to save our sanity by simplifying the vast amounts of data we encounter every day, concepts help us to understand and gain meaning from what we experience. Concepts are essential for synthesising information and they also help us to communicate with others. Put simply, concepts serve as building blocks for knowledge, understanding and communication. This chapter addresses the importance of teaching and learning about concepts and conceptual development in studies of society and environment. It proceeds as follows: first, it considers how individuals use concepts, and, second, it explores the characteristics of concepts; the third section presents a discussion of approaches that might be adopted by teachers intending to help their students build concepts in the classroom.

Multicultural education, global studies and studies of Asia

Like other nations, Australia has experienced significant change in the past few decades as its society has become increasingly diverse. The new cultures and traditions that result from ethnic and religious diversity have both enriched Australian society and presented it with some challenges. Other challenges have resulted from increased globalisation. For example, the economic fallout from the recent global financial crisis indicates that global issues can impact across a range of levels, from multinational corporations and nation-states to local sites and individual livelihoods. Some suggest that Australia fared better than other nations during this economic crisis because of its export trade with China. Although this is disputed by economists, it highlights another facet of change that is impacting on Australian society and this relates to Australia’s growing engagement with the nations of Asia. There is increasing awareness in education systems that if young people are to achieve their potential as future citizens they need to be able to negotiate the cultural, social, political and economic ties that connect them to the global and regional community through work, leisure and citizenship. Multicultural education, global studies and studies of Asia play a particular part in helping young people to: • appreciate cultural diversity within and beyond their own nation • imagine with some accuracy how others view their world • participate in shaping a better future. This chapter explores the origins, distinctions and common features of each approach.

Nonlinear diffusion and exclusion processes with contact interactions

Exclusion processes on a regular lattice are used to model many biological and physical systems at a discrete level. The average properties of an exclusion process may be described by a continuum model given by a partial differential equation. We combine a general class of contact interactions with an exclusion process. We determine that many different types of contact interactions at the agent-level always give rise to a nonlinear diffusion equation, with a vast variety of diffusion functions D(C). We find that these functions may be dependent on the chosen lattice and the defined neighborhood of the contact interactions. Mild to moderate contact interaction strength generally results in good agreement between discrete and continuum models, while strong interactions often show discrepancies between the two, particularly when D(C) takes on negative values. We present a measure to predict the goodness of fit between the discrete and continuous model, and thus the validity of the continuum description of a motile, contact-interacting population of agents. This work has implications for modeling cell motility and interpreting cell motility assays, giving the ability to incorporate biologically realistic cell-cell interactions and develop global measures of discrete microscopic data.

Confocal microscopy of the bulbar conjunctiva in contact lens wear

Purpose: The aim of this study was to investigate the capabilities of laser scanning confocal microscopy (LSCM) for undertaking qualitative and quantitative investigations of the response of the bulbar conjunctiva to contact lens wear. Methods: LSCM was used to observe and measure morphological characteristics of the bulbar conjunctiva of 11 asymptomatic soft contact lens wearers and 11 healthy volunteer subjects (controls). Results: The appearance of the bulbar conjunctiva is consistent with known histology of this tissue based on light and electron microscopy. The thickness of the bulbar conjunctival epithelium of lens wearers (30.9 ± 1.1 μm) was less than that of controls (32.9 ± 1.1 μm) (P < 0.0001). Superficial and basal bulbar conjunctival epithelial cell densities in contact lens wearers were 91% and 79% higher, respectively, than that in controls (P < 0.0001). No difference was observed in goblet and Langerhans cell density between lens wearers and controls. Conjunctival microcysts were observed in greater numbers, and were larger in size, in lens wearers compared with controls. Conclusions: The effects of contact lens wear on the human bulbar conjunctiva can be investigated effectively at a cellular level using LSCM. The observations in this study suggest that contact lens wear can induce changes in the bulbar conjunctiva such as epithelial thinning and accelerated formation and enlargement of microcysts, increased epithelial cell density, but has no impact on goblet or Langerhans cell density.

Soft toric contact lens prescribing in different countries

There have been significant improvements in toric soft contact lens design over the past decade. Data from our international contact lens prescribing survey were mined to assess recent trends in toric soft contact lens fitting. This survey was conducted by sending up to 1000 survey forms to contact lens fitters in Australia, Canada, Japan, the Netherlands, Norway, the UK and the USA each year between 2000 and 2009. Practitioners were asked to record data relating to the first 10 contact lens fits or refits performed after receiving the forms and to return them to us for analysis. The data revealed a gradual increase in the extent of toric soft lens fitting this century. Excluding Japan – which had a consistently low rate of soft toric lens fitting over the survey period – soft toric lenses now represent over 35% of all soft lenses prescribed; it can be assumed that, on average (and again excluding Japan), all cases of astigmatism 0.75 D or less remains uncorrected among contact lens wearers. Toric lenses are fitted more to those who are older, full-time wearers and reusable lens wearers, and less to those wearing silicone hydrogel and extended wear lenses.

The role of emotional labour and role stress on burnout and psychological strain in high contact service employees

This study examines the relationships between job demands (in the form of role stressors and emotional management) and employee burnout amongst high contact service employees. Employees in customer facing roles are frequently required to manage overwhelming, conflicting or ambiguous demands, which they may feel ill-equipped to handle. Simultaneously, they must manage the emotions they display towards customers, suppressing some, and expressing others, be they genuine or contrived. If the in-role effort required of employees exceeds their inherent capacity to cope, burnout may result. Burnout, in turn, can have serious detrimental consequences for the psychological well being of employees. We find that both emotional management and role stressors impact burnout. We also confirm that burnout predicts psychological strain. In line with the Job Demands and Resources Model, we examine the mitigating impact of perceived support on these relationships but do not find a significant mitigating impact.

Obituary - Rigid contact lenses

Scleral and corneal rigid lenses represented 100 per cent of the contact lens market immediately prior to the invention of soft lenses in the mid-1960s. In the United Kingdom today, rigid lenses comprise 2 per cent of all new lens fits. Low rates of rigid lens fitting are also apparent in 27 other countries which have recently been surveyed. Thus, the 1998 prediction of the author that rigid lenses – also referred to as ‘rigid gas permeable’ (RGP) lenses or ‘gas permeable’ (GP) lenses – would be obsolete by the year 2010 has essentially turned out to be correct. In this obituary, the author offers 10 reasons for the demise of rigid lens fitting: initial rigid lens discomfort; intractable rigid lens-induced corneal and lid pathology; extensive soft lens advertising; superior soft lens fitting logistics; lack of rigid lens training opportunities; redundancy of the rigid lens ‘problem solver’ function; improved soft toric and bifocal/varifocal lenses; limited uptake of orthokeratology; lack of investment in rigid lenses; and the emergence of aberration control soft lenses. Rigid lenses are now being fitted by a minority of practitioners with specialist skills/training. Certainly, rigid lenses can no longer be considered as a mainstream form of contact lens correction. May their dear souls (bulk properties) rest in peace.

In vivo performance of melimine as an antimicrobial coating for contact lenses in models of CLARE and CLPU

Purpose: One strategy to minimize bacteria-associated adverse responses such as microbial keratitis, contact lens–induced acute red eye (CLARE), and contact lens induced peripheral ulcers (CLPUs) that occur with contact lens wear is the development of an antimicrobial or antiadhesive contact lens. Cationic peptides represent a novel approach for the development of antimicrobial lenses.---------- Methods: A novel cationic peptide, melimine, was covalently incorporated into silicone hydrogel lenses. Confirmation tests to determine the presence of peptide and anti-microbial activity were performed. Cationic lenses were then tested for their ability to prevent CLPU in the Staphylococcus aureus rabbit model and CLARE in the Pseudomonas aeruginosa guinea pig model. ---------- Results: In the rabbit model of CLPU, melimine-coated lenses resulted in significant reductions in ocular symptom scores and in the extent of corneal infiltration (P < 0.05). Evaluation of the performance of melimine lenses in the CLARE model showed significant improvement in all ocular response parameters measured, including the percentage of eyes with corneal infiltrates, compared with those observed in the eyes fitted with the control lens (P ≤ 0.05). ---------- Conclusions: Cationic coating of contact lenses with the peptide melimine may represent a novel method of prevention of bacterial growth on contact lenses and consequently result in reduction of the incidence and severity of adverse responses due to Gram-positive and -negative bacteria during lens wear.

An international survey of contact lens prescribing for presbyopia

Purpose: The aim was to determine world-wide patterns of fitting contact lenses for the correction of presbyopia. Methods: Up to 1,000 survey forms were sent to contact lens fitters in each of 38 countries between January and March every year over five consecutive years (2005 to 2009). Practitioners were asked to record data relating to the first 10 contact lens fittings or refittings performed after receiving the survey form. Results: Data were received relating to 16,680 presbyopic (age 45 years or older) and 84,202 pre-presbyopic (15 to 44 years) contact lens wearers. Females are over-represented in presbyopic versus pre-presbyopic groups, possibly reflecting a stronger desire for the cosmetic benefits of contact lenses among older women. The extent to which multifocal and monovision lenses are prescribed for presbyopes varies considerably among nations, ranging from 79 per cent of all soft lenses in Portugal to zero in Singapore. There appears to be significant under-prescribing of contact lenses for the correction of presbyopia, although for those who do receive such corrections, three times more multifocal lenses are fitted compared with monovision fittings. Presbyopic corrections are most frequently prescribed for full-time wear and monthly replacement. Conclusions: Despite apparent improvements in multifocal design and an increase in available multifocal options in recent years, practitioners are still under-prescribing with respect to the provision of appropriate contact lenses for the correction of presbyopia. Training of contact lens practitioners in presbyopic contact lens fitting should be accelerated and clinical and laboratory research in this field should be intensified to enhance the prospects of meeting the needs of presbyopic contact lens wearers more fully.