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H. Pult, C. Purslow, P. J. Murphy; P-Test: The New Standard to Predict the Dry Eye Symptoms in New Contact Lens Wearers?. Invest. Ophthalmol. Vis. Sci. 2009;50(13):536.
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Lid wiper epitheliopathy (LWE) and lid parallel conjunctival folds (LIPCOF) have been shown to give acceptable levels for prediction of dryness symptoms in contact lens wearers. This study investigates whether a combination of LWE and LIPCOF plus other tear film tests and subjective evaluation prior to contact lens fitting, is better able to predict contact lens induced dry eye (CLIDE) symptoms.
Tear meniscus height (TMH), non-invasive break-up time (NIBUT), hyperaemia, LIPCOF, phenol red thread test (PRTT), corneal and conjunctival staining and lid wiper epitheliopathy (LWE) of the right eyes of 33 randomly selected new SCL wearers (male = 12, female = 21, median age = 30.5 years; range = 19-44) were assessed in a longitudinal study. Symptoms were evaluated by the Ocular Surface Disease Index (OSDI) and subjects grouped into 20 symptomatics and 13 asymptomatics in later lens wear by the Contact Lens Dry Eye Questionnaire (CLDEQ). Subjects were fitted with Vifilcon A and Senofilcon A lenses for a 2 week period consecutively.
Limbal hyperaemia and LWE changed significantly during the study (p<0.004) but not LIPCOF (p≥0.318; temporal, nasal and Sum), bulbar hyperaemia (p=0.432), staining (p≥0.060). Limbal hyperaemia significantly decreased in Senofilcon A lenses. Wearing comfort of symptomatics significantly improved in Senofilcon A, (p=0.005). At the enrolment visit, subjects who became symptomatic later exhibited significantly decreased NIBUT, increased LIPCOF and OSDI (p<0.027). The best test combination to predict CLIDE (logistic regression analyses) was LIPCOF Sum (temporal plus nasal LIPCOF (summarized)) plus NIBUT and OSDI, (positive predictive value = 87.0% and accuracy =91.0%).
LIPCOF, NIBUT and OSDI are significant discriminators for dry eye symptoms in later contact lens wear, but not hyperaemia, TMH, PRTT, staining and LWE. The best test combination is NIBUT plus LIPCOF Sum and OSDI, named the Pult-Predictive-Test (P-Test).
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