Differences in Practitioner Experience, Practice Type, and Profession in Attitudes Toward Growing Contact Lens Practice

OBJECTIVE: To investigate eye care practitioners' attitudes and perceptions toward potential interventions that can enhance contact lens (CL) practice across the world, and how this is influenced by their practice setting. METHODS: A self-administered, anonymized survey was constructed in English and then forward and backward translated into six more languages. The survey was distributed online via social media platforms and mailing lists involving reputed international professional bodies. RESULTS: In total, 2,222 responses from 27 countries with sufficient responses were analyzed (53% females, median age- 37 years). Most of the respondents were optometrists (81.9%) and 47.6% were from stand-alone/independent practices. Median working experience in CL prescribing was 11.0 years (IQR: 18.0, 4-22 years). Over two-third of them declared themselves to be very hopeful (22.9%) or hopeful (45.1%) about the future of their CL practice. Among the potential interventions proposed, continuous update of knowledge and skills and competently managing CL-related complications were rated the most important (median score: 9/10 for each). Practitioners working in national/regional retail chains expressed higher proactivity in recommending CLs (9/10) than those in local chains, hospitals, and universities (for all 8/10, P <0.05). National differences were also identified in eye care practitioner attitudes and perceptions ( P <0.05). CONCLUSIONS: The study provided important information to delineate a variety of elements characterizing CL practice across the world. These insights can serve as a basis to design strategies at national and international levels

Public awareness of common eye diseases in Jordan

Abstract Background Cataract, glaucoma, diabetic retinopathy and dry eye disease are common with high prevalence in Jordan. This study aims to assess the awareness of these ocular diseases among Jordanian population. Method A self-designed questionnaire was developed in Arabic and used to interview people in different provinces of Jordan. Socio-demographic data e.g. age, gender and level of education was reported. Public awareness of four ocular diseases; cataract, glaucoma, diabetic retinopathy (DR) and dry eye disease (DED) was assessed. Questions about familiarity with the diseases, familiarity with their risk factors and participants’ source of knowledge were asked. Moreover, awareness of the effect of these disease on the eye whether they are blinding, preventable, treatable and/or the vision is back to normal following treatment was also assessed. Results A total of 802 participants (232 males and 570 females) completed the questionnaire. The average age (± standard deviation) of the study participants was 28 ± 11.6 (range 18 to 80 years old). Awareness of cataract, glaucoma, DR and DED was reported by 31%, 38%, 37% and 52% of the study population, respectively. Family/relatives/friends and mass media appeared to be the most common sources of knowledge. Age and level of education of the participants were significantly associated with the level of disease awareness. Conclusion This work shows that the level of awareness of the four ocular diseases among Jordanians is good and compares with many reports in the developed and developing countries. Familiarity and knowledge about ocular diseases is essential as it would increase the chance of the subject being tested and thus diagnosed early enough if any problem occurred. Better understanding of the disease would encourage subjects to seek medical care sooner which in turn would prevent visual impairment. Therefore, awareness campaigns should be made to target unaware population

The cellular basis for biocide-induced fluorescein hyperfluorescence in mammalian cell culture

Clinical examination of the ocular surface is commonly carried out after application of sodium fluorescein in both veterinary and medical practice by assessing the resulting ‘staining’. Although localized intensely stained regions of the cornea frequently occur after exposure to ‘adverse’ clinical stimuli, the cell biology underlying this staining is unknown, including whether intense fluorescein staining indicates the presence of damaged cells. Ocular exposure to certain contact lens multipurpose solutions (MPS) gives rise to intense fluorescein staining referred to as solution induced corneal staining (SICS), and we have made use of this phenomenon with Vero and L929 cell culture models to investigate the fundamental biology of fluorescein interactions with cells. We found that all cells take up fluorescein, however a sub-population internalize much higher levels, giving rise to brightly staining ‘hyperfluorescent’ cells within the treated cultures, which contain fluorescein throughout the cell cytoplasm and nucleus. The numbers of these hyperfluorescent cells are significantly increased after exposure to MPS associated with SICS. Surprisingly, hyperfluorescent cells did not show higher levels of staining with propidium iodide, a marker of lysed cells. Consistently, treatment with the cytolytic toxin benzalkonium chloride resulted in almost all cells staining with propidium iodide, and the complete abolition of fluorescein hyperfluorescence. Finally we found that internalization of fluorescein and its loss from treated cells both require cellular activity, as both processes were halted after incubation at 4°C. We conclude that fluorescein hyperfluorescence can be replicated in three diverse cell cultures, and is increased by MPS-treatment, as occurs clinically. The process involves the concentration of fluorescein by a sub-population of cells that are active, and does not occur in lysed cells. Our data suggest that corneal staining in the clinic reflects active living cells, and is not directly caused by dead cells being produced in response to adverse clinical stimuli

Awareness and Knowledge of the Effect of Ultraviolet (UV) Radiation on the Eyes and the Relevant Protective Practices: A Cross-Sectional Study from Jordan

Background: Overexposure to ultraviolet (UV) radiation is linked to serious adverse health effects that are cumulative in nature and affect children more than adults. UV radiation has also been reported to have serious complications for the eye, particularly in areas with a high UV radiation index. Increasing public awareness about the harmful effects of UV radiation on the eye and promoting awareness about protection against UV radiation may prevent eye disease related to UV radiation damage and help in the improvement of public health in general. This study aims to assess public awareness and knowledge of UV radiation and practices toward UV protection in Jordan, which is a country recognized as having a relatively high UV index throughout the year. Methods: A cross-sectional study was performed using an online questionnaire using Google Forms® to assess people’s awareness, knowledge, practices toward eye protection from UV radiation, and the reasons for not wearing UV-protective eyeglasses in Jordan. Sociodemographic information of participants including age, gender, education level, and employment status was also acquired. People’s knowledge on UV protection and harmfulness was measured via rewarding their correctly answered knowledge questions with one mark and zero for incorrectly answered questions based on key answers defined from the literature. Results: A total of 1331 participants (77% females and 23% males) with an average age of 26(±10) years completed the online questionnaire. Participants showed generally high levels of knowledge and awareness about UV radiation and its harmful effects. Nevertheless, participants showed a low level of knowledge about the link between UV radiation and some of the ocular diseases in the questionnaire. Practices toward UV radiation protection where inadequate, with 59% of the respondents reporting that they do not use any protective eyewear from natural UV radiation. The main reported reason for not wearing UV-protective sunglasses was uncertainty in the efficiency of UV protection in sunglasses, as reported by 47% of the participants who do not wear UV-protective sunglasses. Conclusions: The awareness of UV radiation and its harmful effects is high in the studied population. Participant knowledge is also relatively high in relation to nature of solar UV radiation, other synthetic sources of UV radiation, and the most dangerous UV exposure time. However, low participant knowledge was measured on the association between UV radiation with ocular disease and the role of UV-protective eyeglasses. Participant practice toward UV radiation protection was found to be insufficient. Thus, it is important to further increase the knowledge of damaging effects of solar and synthetic UV radiation and emphasize the benefits of eye protection from UV radiation. Eye care practitioners should target youth by different strategies including health campaigns, media, and clinics

Dependence of cellular loss or entry of fluorescein on cellular activity.

<p>The proportion of hyperfluorescent L929 cells is shown after control (n = 12 wells) or MPS (n = 8 wells) treatment, for cells treated at 37°C with fluorescein, and then washed and observed at either 37°C or 4°C. Cultures held at 4°C do not release fluorescein (A). Conversely cells treated with fluorescein at either 37°C or 4°C, prior to observation at 4°C (the latter to prevent further change in fluorescein hyperfluoresence after treatment) are shown; cultures treated at 4°C appear to accumulate much lower levels of fluorescein (n = 4 wells) (B). Data shown are representative of several experiments; bars represent standard deviation and standard error in A and B, respectively.</p

Fluorescein and propidium iodine staining of hCTEpi cells treated with MPS.

<p>hTCEpi cultures were treated with hCTEpi growth medium containing 25% ReNu MultiPlus® MPS or PBS (control) and stained with Hoescht 33342, propidium iodide and fluorescein following an overnight incubation. Typical appearance of control cells is shown after Hoescht 33342 staining (A), propidium iodide staining (B) and fluorescein staining (C), with the equivalents for MPS-treated cells shown in (D) to (F) (in all cases n = 6 wells). The numbers of fluorescein hyperfluorescent cells clearly increased after MPS-treatment. Importantly hyperfluorecent cells were not also found to stain strongly with PI (one example is indicated by the circle). Data shown are representative of several experiments. Scale bars in (A) to (F) represent 100 µm.</p

Fluorescein and propidium iodine staining of cells treated with MPS or benzalkonium chloride.

<p>L929 cultures were treated with growth medium containing 25% ReNu MultiPlus® MPS or PBS (control) and stained with Hoescht 33342, propidium iodide and fluorescein following an overnight incubation. Typical appearance of control cells is shown after Hoescht 33342 staining (A), propidium iodide staining (B) and fluorescein staining (C), with the equivalents for MPS-treated cells shown in (D) to (F). No correlation was evident between propidium iodide-staining cells and fluorescein hyperfluorescent cells. Notably the number of hyperfluorescent cells was significantly increased after MPS-treatment for both L929 (n = 20 wells) and Vero cultures (n = 6 wells) (p≤0.01) (G). However the overall numbers of PI-staining cells did not increase in L929 cells (n = 20 wells) (H) (this was not tested for Vero cells). Conversely treatment with benzalkonium chloride dramatically increased the number of PI-positive cells, but resulted in no detectable fluorescein hyperfluorescent cells (I). Data shown are representative of several experiments. Scale bars in (A) to (F) represent 100 µm. Bars in (G) to (I) represent standard error.</p

Fluorescein staining of control cell populations.

<p>L929 cell cultures were treated with fluorescein and Hoescht 33342 prior to observation. Nuclear staining is shown in (A) and fluorescein staining in (B) with typical hyperfluorecent cells visible. Images were obtained using the ArrayScan®II system and cells categorized by fluorescein intensity with hyperfluorescent cells identified shown in (C). ‘Solution induced corneal staining’, as seen on a slit lamp biomicroscope, is shown (D) for comparison, in which characteristic hyperfluorescent punctate spots are readily apparent. The proportion of hyperfluorescent cells in L929 (n = 20) and Vero cultures (n = 6) was similar (E), with bars showing standard error. Confocal microscopic analysis of Draq5 (a nuclear stain) and fluorescein-stained L929 cells, revealed the presence of fluorescein throughout the interior of the cell, with numerous highly intense fluorescein-containing structures being visible in the cytoplasm, especially of hyperfluorescent cells (F shows a single confocal ‘slice’ through the cells, and (G) shows the orthogonal view; a 3D reconstruction of staining along the white and yellow axes). Treating control cells with the membrane-slective stain Vybrant ® DiI confirmed the likely appearance after staining with a compound, which localizes on the cell surface, providing further confirmation that fluorescein has entered cells (H). Data shown are representative of several experiments. Scale bars in (A) to (C) represent 100 µm and in (F) to (H) represent 20 µm.</p