Report of the Definition & Classification Subcommittee Members: Kelly Nichols (Chair & SC Liason)

1. Report of the Definition & Classification Subcommittee Members: Kelly Nichols (Chair & SC Liason) Rachel Redfern Jean Jacob J. Daniel Nelson Desmond Fonn Lance Forstot Jing-Feng Huang Brien Holden Jason Nichols (Harmonization Subcommittee Member)

2. Definition & Classification Subcommittee • Workshop goals/ mission related to our committee: • “To develop a contemporary understanding of the definition, classification, epidemiology and neurobiology of contact lens discomfort (CLD)” • Concepts to be covered: • Lack of consistent terminology, a definition, and a classification scheme • Review and clarification of existing terminologyin CLD • References for this presentation will be shown at the end

3. Definition & Classification Subcommittee • End of day discomfort is an important factor and one of the most common complaints associated with contact lens wear discontinuation1-8 • Comfort: “A condition or feeling of pleasurable ease, well-being, and contentment”9 • Discomfort: “A mental or bodily distress or something that disturbs one’s comfort”9

4. Definition & Classification Subcommittee • Attributes of comfortable and successful lens wear10 • The ability to wear the lens without sensation (lack of lens awareness) • Visual clarity • Complete tolerance including the ability to wear lenses as long as desired

5. Definition & Classification Subcommittee • Designing the definition • The committee addressed the following questions: • What is CLD? • How is CLD characterized? • What factors are associated with or causative of CLD (classification)? • What are the resultant outcomes of CLD?

6. Definition & Classification Subcommittee Contact Lens Discomfort (CLD) is a condition that is characterized by episodic or persistent adverse ocular sensations related to lens wear either with or without visual disturbance, resulting from reduced compatibility between the contact lens and ocular environment, which can lead to decreased wearing time and discontinuation of contact lens wear.

7. Definition & Classification Subcommittee Contact Lens Discomfort (CLD) is a condition that is characterized by episodic or persistent adverse ocular sensations related to lens wear either with or without visual disturbance, resulting from reduced compatibility between the contact lens and ocular environment, which can lead to decreased wearing time and discontinuation of contact lens wear. Condition: A defective state of health.11-12

8. Definition & Classification Subcommittee Contact Lens Discomfort (CLD) is a conditionthat is characterized by episodic or persistent adverse ocular sensations related to lens wear either with or without visual disturbance, resulting from reduced compatibility between the contact lens and ocular environment, which can lead to decreased wearing time and discontinuation of contact lens wear. • Episodic: having symptom-free periods that alternate with the presence of symptoms.13

9. Definition & Classification Subcommittee Contact Lens Discomfort (CLD) is a condition that is characterized by episodic or persistent adverse ocular sensations related to lens wear either with or without visual disturbance, resulting from reduced compatibility between the contact lens and ocular environment, which can lead to decreased wearing time and discontinuation of contact lens wear. Persistent: existing or continuing for a long time; continuing to exist despite interference or treatment.14

10. Definition & Classification Subcommittee Contact Lens Discomfort (CLD) is a condition that is characterized by episodic or persistent adverse ocular sensationsrelated to lens wear either with or without visual disturbance, resulting from reduced compatibility between the contact lens and ocular environment, which can lead to decreased wearing time and discontinuation of contact lens wear. Adverse ocular sensations: the increased perception, awareness, and feeling of the lens on the ocular surface, which can include symptoms of dryness and irritation.

11. Definition & Classification Subcommittee Contact Lens Discomfort (CLD) is a condition that is characterized by episodic or persistent adverse ocular sensations related to lens wear either with or without visual disturbance, resulting from reduced compatibility between the contact lens and ocular environment, which can lead to decreased wearing time and discontinuation of contact lens wear. • Visual disturbance: The perception, after contact lens adaptation, of transient visual symptoms and/or measurable visual disruption related to the wearing of the contact lens.  

12. Definition & Classification Subcommittee Contact Lens Discomfort (CLD) is a condition that is characterized by episodic or persistent adverse ocular sensations related to lens wear either with or without visual disturbance, resulting from reduced compatibilitybetween the contact lens and ocular environment, which can lead to decreased wearing time and discontinuation of contact lens wear. • Compatibility: a state of the lens existing in harmony.15

13. Definition & Classification Subcommittee Contact Lens Discomfort (CLD) is a condition that is characterized by episodic or persistent adverse ocular sensations related to lens wear either with or without visual disturbance, resulting from reduced compatibility between the contact lens and ocular environment, which can lead to decreased wearing time and discontinuation of contact lens wear. • Ocular environment: cornea, conjunctiva, eyelids, tear film, and all associated glands.

14. Definition & Classification Subcommittee Contact Lens Discomfort (CLD) is a condition that is characterized by episodic or persistent adverse ocular sensations related to lens wear either with or without visual disturbance, resulting from reduced compatibility between the contact lens and ocular environment, which can lead to decreased wearing time and discontinuation of contact lens wear. • Wearing time: total and comfortable wearing time includes the hours the lens can be worn with comfort, as well as total time the lens is worn.

15. Definition & Classification Subcommittee Contact Lens Discomfort (CLD) is a condition that is characterized by episodic or persistent adverse ocular sensations related to lens wear either with or without visual disturbance, resulting from reduced compatibility between the contact lens and ocular environment, which can lead to decreased wearing time and discontinuation of contact lens wear. • Discontinuation of lens wear: ultimate cessation of lens wear.1-3, 6, 16

16. Definition & Classification Subcommittee • Additional terminology/ caveats: • CLD occurs while a contact lens is worn; removal of the lenses mitigates the condition, in particular the adverse ocular sensations • CLD is generally not related to insertion of or adaption to a contact lens • The terms contact lens dry eye or contact lens induced dry eye (CLDE) should be used to describe the pathophysiology of pre-existing dry eye in a contact lens wearer • CLD may or may not be accompanied by physical signs, and the full range of severity can occur • CLD is reported to impact a patient’s quality of life

17. Definition & Classification Subcommittee

18. Definition & Classification Subcommittee • Summary • Successful contact lens wear can be best described as harmonious coexistence of the contact lens on the eye without any adverse effects • Ultimately, the ideal contact lens has material, design, and care characteristics allowing for optimal fit and wear, vision, and comfort, with minimal patient and environment effects, thereby preventing discontinuation, promoting ocular health, and improving quality of life

19. Definition & Classification Subcommittee References • Pritchard N, Fonn D, Brazeau D. Discontinuation of contact lens wear: A survey. Int Contact Lens Clin. 1999;26:157-162. • Young G, Veys J, Pritchard N, Coleman S. A multi-centre study of lapsed contact lens wearers. Ophthalmic Physiol Opt. 2002;22:516-527. • Jutai J, Day H, Woolrich W, Strong G. The predictability of retention and discontinuation of contact lenses. Optometry. 2003;74:299-308. • Young G. Why one million contact lens wearers dropped out. Contact Lens Anterior Eye. 2004;27:83-85. • Riley C, Young G, Chalmers R. Prevalence of ocular surface symptoms, signs, and uncomfortable hours of wear in contact lens wearers: The effect of refitting with daily-wear silicone hydrogel lenses (senofilconA). Eye Contact Lens. 2006;32:281-286. • Richdale K, Sinnott LT, Skadahl E, Nichols JJ. Frequency of and factors associated with contact lens dissatisfaction and discontinuation. Cornea. 2007;26:168-174. • Santodomingo-Rubido J, Barrado-Navascues E, Rubido-Crespo MJ. Ocular surface comfort during the day assessed by instant reporting in different types of contact and non-contact lens wearers. Eye Contact Lens. 2010;36:96-100. • McMonnies CW. Psychological and other mechanisms for end-of-day soft lens symptoms. Optom Vis Sci. 2013;90:e175-181.

20. Definition & Classification Subcommittee References, cont. • Definition of comfort. In: Editors of the AH Dictionary, ed. The American Heritage Dictionary of the English Language. Fourth ed: Houghton Mifflin Harcourt; 2009. • Best N, Drury L, Wolffsohn JS. Predicting success with silicone-hydrogel contact lenses in new wearers. Contact Lens Anterior Eye. 2013. • Merriam-Webster. Definition of condition. http://www.merriamwebster.com/medical/condition Accessed July 3, 2013. • Dictionary.com. Definition of condition. http://www.dictionary.comAccessed July 03, 2013. • Miller-Keane, O'Toole MT. Definition of episodic. In: Saunders, ed. Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health. Seventh ed; 2005. • Merriam-Webster. Definition of persistent. http://www.merriamwebster.com/dictionary/persistent Accessed July 3, 2013. • Medical-Dictionary. Definition of compatibility. http://medicaldictionary.thefreedictionary.com/compatibility Accessed July 3, 2013. • DumbletonK, Woods CA, Jones LW, Fonn D. The impact of contemporary contact lenses on contact lens discontinuation. Eye Contact Lens. 2013;39:93-99.

21. Thank you! QUESTIONS?