A Microscopic Examination of the Conjunctiva in Contact Lens Wear - Assignment Example

The Proposed A confocal microscopic examination of the conjunctiva in contact lens wear * The Proposed Supervisor: * The objective of the research program is to make a detailed examination of the bulbar and superior palpebral conjunctiva in contact lens wearers and age- and sex-matched non-lens-wearing control subjects, using a Heidelberg Laser Scanning Confocal Microscope by a random study of 40 equally divided contact and non contact lens wearers (control group) to study the alteration whether increase or decrease in the superficial conjunctival epithelial cell density. Introduction Under the Introduction, I would like you to write more about the following points: - 1. Identification of the problem that will be investigated 2. The proposed research to be in the contexts of current research field 3. What is the significant of the research, and how it will be used to make original contribution to the existing knowledge. A number of previous studies have reported a compromise of the conjunctiva during contact lens wear, presumably as a result of the direct mechanical effects of lens wear; these include conjunctival staining, hyperaemia, chemosis and folding, and an apparent depletion of the number of conjunctival goblet cells (inferred from impression cytology studies). In a study conducted by Aragona P, Ferreri G, Micali A, Puzzolo D. in 1998 to detect the morphological changes of the conjunctival epithelium in contact lens wearers evaluated by impression cytology, it was found that cellularity, nucleus to cytoplasm ratio and goblet cell distribution were altered. In another study by Knop E, Brewitt H. in 1992 , where they discovered using the impression cytology technique on contact lens wearers that enlargement of the conjunctival cells took place as well as flattening of their cells. They also noted a decrease in the number of goblet cells. The late finding was contrary to what Connor C.G., Campbell J.B., Steel S.A., Burke J.H. have found in 1994 of an increase of goblet cells in daily contact lens wearers. As the conjunctiva has an important functional demand on the eye helping in keeping the eye moist and its cleansing effect through tears, it is thus an important first defence against debris and pathogens. Direct in vivo observation of the conjunctiva at a cellular level using the confocal microscope is likely to provide important new insights into the impact of contact lens wear on the ocular surface. This study is aimed to conclude results from in vivo research of those contact lens wearers. The significance of this research is to give more focused results on the effect of contact lenses contributing to add more knowledge to this specific aspect and whether or not any compromisation of the conjunctiva takes place. Please add a new paragraph as follows:- Program of research and investigation: - Under this heading, I would like you to write about To Clearly State the research problem, research key questions, sub question or hypotheses or key issues that will be tested or addressed This research will perform its investigation to describe the possible effects of lens wearing on 20 candidates to discuss the conjunctival hazardous effects (if present) and either confirm or deny the hypothesis in question. Inspection will be done at a cellular level to further investigate any changes that may occur in the conjunctiva cells including epithelial cells, goblet cells and cellular density. According to Adar S, Kanpolat A, Surucu S, Ucakhan OO 1997 “Epithelial changes were noted to be more frequent and more severe in symptomatic patients than in those without any complaints.” Moon JW, Shin KC, Lee HJ, Wee WR, Lee JH, Kim MK. 2006 also found that “The ocular surface changes in keratoconus may be directly related to contact lens wear” The hypothesis is that contact lenses do not produce any significant effect on the conjunctiva, mainly superficial conjunctival epithelial cell density (it is unclear whether this would be an increase or decrease) and results in a decrease in superficial conjunctival epithelial goblet density. My aim will be to reject the hypothesis in order to prove that effects do in reality cause conjunctival changes at a cellular level studied under the microscope. Questions to be asked include: What type of problems do contact lenses impose? What changes can occur? Does the number of goblet cells change? Does the epithelial cell density alter? Are there any signs of inflammation that occur? * Design of the Proposed Research (methodology and research  1. Clearly Identify the tasks to be undertaken includes a clear statement of the theoretical formworks underpinning how you are going to carry out the design and plan; Includes a design study and methodological frameworks with adequate discussions 2. How the method and plan is going to be resourced and funded including the technical support to be provided and the key equipment required. The project will be done on a basis of a randomized masked study of about 20 lens wearers and 20 non-lens wearing controls. They will be age and sex identical to try to minimize variability and make the factors common and as close as possible to decrease the margin of error and drawbacks. Qualitative observations of the bulbar and superior palpebral conjunctiva will be made using the Heidelberg Laser Scanning Confocal Microscope, and attempts will be made to quantify superficial conjunctival epithelial cell density and superficial conjunctival epithelial goblet density in the two groups. The hypothesis is that contact lens wear alters superficial conjunctival epithelial cell density (it is unclear whether this would be an increase or decrease) and results in a decrease in superficial conjunctival epithelial goblet density. Appropriate statistical analysis of paired data will be applied. The process of preparing this proposal according to proposed research program: First a title is stated and professor elected. After stating the hypothesis and the aim of the study, an abstract and a primarily introduction is written. Information is then collected from various resources such as journals, books and online documents to be analysed and write a literature review of findings of the same topic if present or any similar investigations that took place concerning the subject in hand. The research is conducted clearly stating the methodology, sample taken, questions asked to the volunteers and questionnaires provided for reference. Results are afterwards stated with any calculations done or statistical measures done. A conclusion is finally drawn from all this experiment. References of any tables, figures, appendices are attached at the end. A table of contents is constructed upon all the above modifications. Flowchart: References The references are to be included in the paragraphs as per the example in the attached document and to be listed as show below. Adar S, Kanpolat A, Surucu S, Ucakhan OO. Conjunctival impression cytology in patients wearing contact lenses. Cornea. 1997 May;16(3):289-94. Allansmith MR, Baird RS, Greiner JV. Density of goblet cells in vernal conjunctivitis and contact lens-associated giant papillary conjunctivitis. Arch Ophthalmol. 1981 May;99(5):884-5. Allen RJ, Dev Borman A, Saleh GM. Applanation tonometry in silicone hydrogel contact lens wearers.Cont Lens Anterior Eye. 2007 Mar 21 Ajamian Paul C., Where Has All The SLK Gone? Review of Optemetry, Vol. No: 139:04Issue: 4/15/02 http://www.revoptom.com/index.asp?page=2_488.htm Anshu, Munshi MM, Sathe V, Ganar A. Conjunctival impression cytology in contact lens wearers.Cytopathology. 2001 Oct;12(5):314-20. Aragona P, Ferreri G, Micali A, Puzzolo D. Morphological changes of the conjunctival epithelium in contact lens wearers evaluated by impression cytology. Eye. 1998;12 ( Pt 3a):461-6. Barabino S, Rolando M, Camicione P, Chen W, Calabria G. Effects of a 0.9% sodium chloride ophthalmic solution on the ocular surface of symptomatic contact lens wearers. Can J Ophthalmol. 2005 Feb;40(1):45-50. Bhatia RP, Lipika R, Garbyal RS, Mohan K. Corneal and conjunctival impression cytology in soft contact lens wearers. Ann Ophthalmol (Skokie). 2006 Summer;38(2):117-20. Bohnke M, Thaer A, Schipper I. Confocal microscopy reveals persisting stromal changes after myopic photorefractive keratectomy in zero haze corneas. Br J Ophthalmol. 1998 Dec;82(12):1393-400. Bourne WM, Hodge DO, McLaren JW. Estimation of corneal endothelial pump function in long-term contact lens wearers. Invest Ophthalmol Vis Sci. 1999 Mar;40(3):603-11. Cakmak SS, Unlu MK, Karaca C, Nergiz Y, Ipek S. Effects of soft contact lenses on conjunctival surface. Eye Contact Lens. 2003 Oct;29(4):230-3. Calder L, Balasubramanian S, Stiell I. Lack of consensus on corneal abrasion management: results of a national survey. CJEM. 2004 Nov;6(6):402-7. Caroline Patrick J., & Mark P. André , A New Look at Vascularized Limbal Keratitis, Part 1, Contact Lens Spectrum, February 2006, from http://www.clspectrum.com/article.aspx?article=12947 Caroline Patrick J., Mark P. André , A New Look at Vascularized Limbal Keratitis, Part 1, Contact Lens Spectrum, March 2006 Chou Brian, FDA-reported Adverse Events by Lens Type, Contact Lens Spectrum, December 2006, from http://www.clspectrum.com/article.aspx?article=13158 Connor CG, Campbell JB, Steel SA, Burke JH. The effects of daily wear contact lenses on goblet cell density. J Am Optom Assoc. 1994 Nov;65(11):792-4. Contact Dermatitis, Children’s Hospital of Pittsburgh, http://www.chp.edu/greystone/allergy/contact.php Donshik PC, Suchecki JK, Ehlers WH. Peripheral corneal infiltrates associated with contact lens wear. Trans Am Ophthalmol Soc. 1995;93:49-60; discussion 60-4. Efron N, Perez-Gomez I, Morgan PB. Confocal microscopic observations of stromal keratocytes during extended contact lens wear. Clin Exp Optom. 2002 May;85(3):156-60. Efron N, Mutalib HA, Perez-Gomez I, Koh HH. Confocal microscopic observations of the human cornea following overnight contact lens wear. Clin Exp Optom. 2002 May;85(3):149-55. Epstein Arthur B. Allergy, Eyedrops and Contact Lenses, Contact Lens Spectrum April 2001, from http://www.clspectrum.com/article.aspx?article=11957 Debbasch C, Pisella PJ, Rat P, Warnet JM, Baudouin C. Evaluation of free radical production by conjunctival impression cytology of patients treated with long-term antiglaucoma drugs or of contact lens wearers J Fr Ophtalmol. 2000 Mar;23(3):239-44. Desmond Fonn, and Alisa Sivak, Benefits and Challenges of High-Dk/t Materials, Contact Lens Spectrum, February 2005, http://www.clspectrum.com/article.aspx?article=12742 du Toit Renée, Deborah Sweeney, Desmond Fonn, , and Judith Stern, Managing Silicone Hydrogel Complications, , Contact Lens Spectrum, May 2002, http://www.clspectrum.com/article.aspx?article=12150 Hollingsworth JG, Efron N. Confocal microscopy of the corneas of long-term rigid contact lens wearers. Cont Lens Anterior Eye. 2004 Jun;27(2):57-64. Kallinikos P, Efron N. On the etiology of keratocyte loss during contact lens wear. Invest Ophthalmol Vis Sci. 2004 Sep;45(9):3011-20. Knop E, Brewitt H. Conjunctival cytology in asymptomatic wearers of soft contact lenses. Graefes Arch Clin Exp Ophthalmol. 1992;230(4):340-7. Knop E, Brewitt H. Induction of conjunctival epithelial alterations by contact lens wearing. A prospective study. Ger J Ophthalmol. 1992;1(3-4):125-34. Krohn Jeffrey, Treating Allergy in Contact Lens Patients, Contact Lens Spectrum. April 2006, http://www.clspectrum.com/article.aspx?article=13002 Ladage PM, Jester JV, Petroll WM, Bergmanson JP, Cavanagh HD. Vertical movement of epithelial basal cells toward the corneal surface during use of extended-wear contact lenses. Invest Ophthalmol Vis Sci. 2003 Mar;44(3):1056-63. Lakkis C; Brennan NA. Bulbar conjunctival fluorescein staining in hydrogel contact lens wearers. CLAO J.  1996; 22(3):189-94 Lievens CW, Connor CG, Murphy H. Comparing goblet cell densities in patients wearing disposable hydrogel contact lenses versus silicone hydrogel contact lenses in an extended-wear modality. Eye Contact Lens. 2003 Oct;29(4):241-4. Mack Carla, and Jeff Schafer, Managing Contact Lens Complications, Contact Lens Spectrum, December 2004 From http://www.clspectrum.com/article.aspx?article=12724 Many Contact Lens Wearers Find Their Lenses Uncomfortable, Disruptive When Experiencing Eye-Allergy Symptoms, Survey, Medical News Today,15 Jul 2006 from http://www.medicalnewstoday.com/medicalnews.php?newsid=47322 Moon JW, Shin KC, Lee HJ, Wee WR, Lee JH, Kim MK. The effect of contact lens wear on the ocular surface changes in keratoconus. Eye Contact Lens. 2006 Mar;32(2):96-101. New Survey Reveals Contact Lens Wearers Find Their Lenses Uncomfortable, Disruptive When Experiencing Eye-Allergy Symptoms, Jacksonville, FL United States 07/11/2006 from http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/07-11-2006/0004394558&EDATE= Patel SV, McLaren JW, Hodge DO, Bourne WM. Confocal microscopy in vivo in corneas of long-term contact lens wearers. Invest Ophthalmol Vis Sci. 2002 Apr;43(4):995-1003. Patel S, McLaren J, Hodge D, Bourne W. Normal human keratocyte density and corneal thickness measurement by using confocal microscopy in vivo. Invest Ophthalmol Vis Sci. 2001 Feb;42(2):333-9. Shovlin Joseph P. 23RD Annual Contact Lens Report: The Great Contact Lens Debates, Review of Optemetry, April 1999 from http://www.revoptom.com/archive/issue/ro04intro.htm Shovlin Joseph P. Lens-Induced Stem Cell Deficit, Review of Optemetry , Vol. No: 143:03Issue: 3/15/2006 http://www.revoptom.com/index.asp?page=2_1665.htm Simon P, Jaison SG, Chopra SK, Jacob S. Conjunctival impression cytology in contact lens wearers. Indian J Ophthalmol. 2002 Dec;50(4):301-6. Stapleton F, Kasses S, Bolis S, Keay L. Short term wear of high Dk soft contact lenses does not alter corneal epithelial cell size or viability. Br J Ophthalmol. 2001 Feb;85(2):143-6. Trittibach P, Cadez R, Eschmann R, Sarra GM, Boehnke M, Frueh BE. Determination of microdot stromal degenerations within corneas of long-term contact lens wearers by confocal microscopy. Eye Contact Lens. 2004 Jul;30(3):127-31. Ventocilla M, , John Stamler, Contact Lens Complications, September 8, 2006 http://www.emedicine.com/oph/topic651.htm Walker J, Young G, Hunt C, Henderson T. Multi-centre evaluation of two daily disposable contact lenses. Cont Lens Anterior Eye. 2007 Mar 27 Ziegler Dave A., Boosting Your Contact Lens Practice Profitability, Contact Lens Spectrum, September 2005, http://www.clspectrum.com/article.aspx?article=12868 Zhivov A, Stave J, Vollmar B, Guthoff R. In vivo confocal microscopic evaluation of langerhans cell density and distribution in the corneal epithelium of healthy volunteers and contact lens wearers. Cornea. 2007 Jan;26(1):47-54. Read More