Advances in dry eye assessment, grading clinical signs and multifocal fitting are all topics at the cutting edge of current contact lens research. It was no coincidence that young researchers of the future addressed just these topics in their quest to be named CooperVision FORCE European Student of the Year.
FORCE (Future Ocular Research Creativity Event) is an annual competition pitching the very best European optometry students against one another. Students are invited to undertake a six to eight-week research project on a contact lens-related topic of their choice and to present their findings.
Around 200 students from across Europe took part this year and 70 went forward to their national finals. Teams from nine countries reached the second FORCE European final, held in Barcelona in April, where a panel of today’s leading European researchers and clinicians judged their projects.
Entries were invited for clinical trials, clinical review papers and case reports, and were judged for the evidence for and importance of the project, and the quality and clarity of presentation. This year, all the finalists conducted clinical studies as their research projects and the judges were impressed by the standard of the work.
‘2014 has exceeded 2013’s already very high standards,’ said chairman Nick Rumney. ‘Every one of the finalists came up with original research. All embraced originality and creativity, and a common thread was that all the topics were at the cutting edge of current thinking, showing the students are alert to what’s going on in research today.
‘If this is what we have to look forward to, the future of our profession is in very, very safe hands,’ he said.
Winning ways
Although the competition was closely fought, there could be only one winner, said Rumney, as Italian student Umberto Bassi from the Università degli Studi di Milano-Bicocca took the title 2014 CooperVision FORCE European Student of Year.
[CaptionComponent="415"]Under the supervision of Dr Marzia Lecchi, Bassi had devised an infra-red light tool to assess meibomian gland dropout in soft contact lens wearers and found that differences in clinical performance between lens materials became significant in patients who showed glandular dropout (see panel).
‘Umberto was distinctive for a number of reasons,’ said Rumney. ‘First, he kept the outcomes simple and didn’t complicate matters. Second, he asked a relatively simple question linking two distinct areas – meibomian gland dropout and clinical performance – based on the importance of lipid layers to each lens material. He then presented his data clearly and drew appropriate conclusions.
‘His presentation was crisp, clear, concise and mature. It was then delivered well in a language that was not his own.’
As his prize, Bassi receives a full delegate package, including travel and accommodation, for the American Academy of Optometry’s annual meeting in Denver, Colorado in November, courtesy of CooperVision. He will also have the chance to write a blog on his experiences, during and after the meeting.
Personal growth
So how did Bassi feel about winning this prestigious award? ‘It’s a fantastic sensation. I can’t express how pleased and proud I am to win FORCE European Student of the Year. This is a wonderful personal success that makes me confident for the future. At the same time it’s an important recognition, at a European level, of the quality of competence of Italian optometrists.’
Bassi described his experience of taking part in FORCE as ‘highly formative’. ‘It’s allowed me to meet experienced optometrists, talk with students from several European universities and learn new things from each of them – to look at topics from a different point of view.
‘It’s also been an occasion of personal growth, for example in managing my emotions during the exposure of my clinical trial.’
He thanked everyone involved in the organisation of FORCE for the chance to take part. ‘This is an amazing opportunity for every single student in the universities – we have to study, study and study again. It’s comforting to know that someone believes in our potential and is willing to invest in us.’
Bassi hopes that the award will be the start of a career path that could lead to research in the contact lens field. First, he plans to take a further degree in orthoptics to complete his knowledge of the visual system and vision care. Eventually he would like to find a job that will allow him to interact with other eye care professionals and broaden his outlook.
Unique experience
If FORCE has been a positive experience for Bassi, his supervisor at Milano-Bicocca, Dr Lecchi, said there have been many benefits to taking part. Of the 29 students graduating in optics and optometry at the university in 2013, eight submitted their thesis on a contact lens topic and were involved in the FORCE project.
‘For young students, the FORCE concept represents an extraordinary possibility to improve their knowledge of optics and contact lenses. It offers them the unique experience of explaining their project to a panel of experts in contact lenses and meeting other students of different nationalities and experiences. And for the winner there’s the opportunity to attend the American Academy meeting.’
FORCE allowed connections to be established among students, teachers and universities of different countries to grow the contact lens field. Collaboration within the university had also played a part in the winning project, she added.
‘I’m extremely happy for Umberto because I consider him one of the best students I had the chance to supervise,’ said Dr Lecchi. ‘He was very interested in the project and motivated in performing the tests he had designed. His research provided very interesting results, and evidence of clear differences in the effects of the two types of contact lens on tear film stability.’
Inspire and stimulate
Dimple Shah, CooperVision’s professional services and relations consultant for the European region explains FORCE’s aims: ‘We view this programme as a vital connection with students and universities for CooperVision. We run the programme every year to inspire students to see the variety and potential that contact lenses can bring both to their education and future work.
‘Another reason why FORCE is such an exciting programme to be involved with is that it stimulates future thinking around contact lens research.’
Shah believes that the programme brings many additional benefits for the students. 'FORCE is a great opportunity for the students to develop a network with other students across Europe and also with colleagues from across CooperVision Europe. This type of opportunity can be a great catalyst to support their future careers and development.
‘We have had excellent feedback on the programme from participating universities and colleges. With an increasing numbers of participants each year, this programme is gaining real momentum. FORCE provides educational institutions with a reason to increase their focus on contact lenses.’
The winning project
Discomfort is the main cause of dropout from contact lens wear and around 30-50 per cent of wearers report dryness symptoms. Loss of meibomian gland function, defined as glandular dropout, has been recognised as a possible cause of dryness. Glandular dropout leads to hyposecretion of the tear film lipid layer making it less stable and efficient, and increasing tear evaporation and osmolarity. Umberto Rossi set out to compare the clinical performance of two soft lens materials (omafilcon A and balafilcon A), chosen for differences in surface and bulk properties, to assess whether performance could be influenced by meibomian gland function and determine which material would be more suitable for fitting wearers with glandular dropout.
Bassi used an experimental infrared light tool and adapted a high-definition webcam to reveal gland function and morphology not seen under visible light (pictured). He fitted 25 existing soft lens wearers in both eyes for two weeks of daily wear with each lens type, and compared glandular dropout before and after wear.
In the 40 per cent of subjects with glandular dropout (>20 per cent) at the first visit, the non-invasive tear breakup time was significantly shorter and they had a higher Ocular Surface Disease Index score, indicating a less stable tear film and more dryness symptoms.
In patients without dropout the two lens types showed very similar clinical performance, but differences became significant in the wearers with glandular dropout and increased as wear progressed.
Omafilcon A lenses provided better tear film stability in patients with glandular dropout and a significant reduction of dryness symptoms in both groups. The most likely reason was the presence of phosphorylcholine in the lens material.
The study highlighted the importance of meibomian gland function visible only using infrared light on contact lens performance.
The UK finalist
[CaptionComponent="416"]Not many students have the chance to subject their classmates to a wind tunnel during their final-year project, as well as getting their hands on the very latest equipment for examining the tear film. But UK finalist Claire Gorman from Plymouth University did just that.
Supervised by Dr Daniela Oehring and Professor Christine Purslow, her project looked at the stability of the pre-lens tear film under environmental challenge. Subjects wore five different contact lens types and were seated 1m in front of a wind tunnel with wind speed of 30 km/h for 0, 30, 60, 120 and 300 seconds, to simulate windy conditions.
Non-invasive keratograph break-up time (NIK-BUT), and limbal and bulbar redness, were then measured using the Oculus Keratograph 5M (pictured). In the naked eye, NIK-BUT decreased with air draught exposure time but with lenses in place NIK-BUT improved. Eyes wearing comfilcon A and omafilcon A saw the biggest improvement. There was no significant change in redness.
Practitioners should consider the environment their patients would be in before recommending lens types, she said.
Gorman reached the final by taking the UK Student of the Year title at CooperVision’s Student Summit in September, where seven UK universities fielded entrants. So how did she feel about her experience of FORCE? ‘Being selected to take part was a huge privilege. It was such an exciting, innovative experience that I’d definitely recommend to anyone thinking about going into research in the future.
‘Not only was it an amazing experience to get to Barcelona and present my findings, it was so much fun and so interesting to meet students from across Europe and find out about how optometry differs across the different countries. It’s definitely fed my hunger to do more research and hopefully to have the opportunity to present again!’
The finalists and topics
Tereza Ševcíková, Czech Technical University in Prague, Czech Republic. Dry eye syndrome and the impact of lifestyle
Célia Noir and Anouck Barbarin, L’Université de Franche-Comté, Besançon, France. Influence of soft contact lenses on the lid wiper
Julia Hebenstreit and Andrea Reinke, Beuth Hochschule für Technik, Berlin, Germany. Review of supplier recommendation for multifocal soft contact lenses
Henrietta Szabó, Semmelweis University, Budapest, Hungary. Computer vision syndrome and contact lens wearing
Umberto Bassi, Università degli Studi di Milano-Bicocca, Milan, Italy. Comparison between different contact lens materials in relationship with meibomian gland function observed through infra-red light
Daria Rajchel, Adam Mickiewicz University in Poznan, Poland. Influence of hyaluronan on dehydration and states of water in soft contact lens materials
Eduardo García and Soraya de las Heras, University of Valladolid, Spain. Analysis of quality of vision in young myopic subjects wearing multifocal contact lenses as treatment for myopia control
Julia Ahlin, Karolinska Institutet, Solna, Sweden. Influence of experience and knowledge when grading contact lens complications
Claire Gorman, Plymouth University, UK. Stability of the pre-lens tear film under environmental challenge
For more details, visit www.coopervisionforce.com