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Trial registered on ANZCTR
Registration number
ACTRN12623001224617
Ethics application status
Approved
Date submitted
19/10/2023
Date registered
28/11/2023
Date last updated
28/11/2023
Date data sharing statement initially provided
28/11/2023
Type of registration
Prospectively registered
Titles & IDs
Public title
Tackling tear film instability in contact lens wear
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Scientific title
Crossover trial comparing the impact of over-the-counter tear supplements with and without lipid components on tear film quality before and after contact lens wear in habitual soft contact lens wearers
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Secondary ID [1]
310603
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None
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Universal Trial Number (UTN)
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Trial acronym
TFiS-CL
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Contact lens discomfort
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Condition category
Condition code
Eye
328486
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0
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Diseases / disorders of the eye
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Brief name: Topically applied tear film supplements
Dose administered: A masked investigator would administer one drop/spray applied as a single application to each eye, on the day of examination 10 minutes before contact lenses are worn. Each participant will be tested for all of the interventions with one intervention randomly assigned per visit for a total of 3 intervention visits and 1 control visit. On each visit the participants will be asked to wear CL for no more than 30 minutes. The CL lenses will be discarded at end of each visit.
All the interventions used in this study are over-the-counter products commercially available in New Zealand and include two types of lubricating eye drops (Systane Ultra and Systane Complete, Alcon), one type of lubricating eye spray (Tears Again, Eye Spray, BioRevive) and one type of soft daily disposable silicone hydrogel contact lens (MyDay, Cooper Vision).
All test visits will be scheduled within 2 weeks from enrollment and there will be a minimum washout period of 24 hours between the test visits.
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Intervention code [1]
327179
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Treatment: Drugs
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Comparator / control treatment
Placebo
Visit with contact lenses but without application of any lubricating eye drops will serve as a control visit. This will be achieved by having an unmasked investigator pretending to install a drop from an empty bottle.
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Control group
Placebo
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Outcomes
Primary outcome [1]
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Lipid layer grade (LLG) as assessed subjectively by a masked investigator from interferometric videos captured by the Oculus Keratograph 5M.
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Assessment method [1]
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Timepoint [1]
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Measurements will be recorded at baseline, 10 minutes after application of treatment or placebo (no drops/spray application) and again 10 minutes after contact lenses are inserted.
Primary Timepoint: final assessment of each daily visit will be 10 minutes after contact lenses are inserted.
Assessment will be performed at baseline, 10 minutes after application of treatment or placebo (no drops/spray application) and again 10 minutes after contact lenses are inserted.
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Secondary outcome [1]
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Change in non-invasive tear breakup time (NIKBUT)
Assessment method: Measured objectively using automated software within the Oculus Keratograph 5M
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Assessment method [1]
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Timepoint [1]
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Assessment will be performed at baseline, 10 minutes after application of treatment or placebo (no drops/spray application) and again 10 minutes after contact lenses are inserted.
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Secondary outcome [2]
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Change in lipid layer thickness (LLT)
Assessment method: Measured objectively by the Johnson & Johnson TearScience Lipiview
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Assessment method [2]
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Timepoint [2]
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Assessment will be performed at baseline, 10 minutes after application of treatment or placebo (no drops/spray application) and again 10 minutes after contact lenses are inserted.
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Secondary outcome [3]
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Change in tear meniscus height (TMH)
Assessment method: Measured using digital calipers from an image collected with the Oculus Keratograph
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Assessment method [3]
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Timepoint [3]
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Assessment will be performed at baseline, 10 minutes after application of treatment or placebo (no drops/spray application) and again 10 minutes after contact lenses are inserted.
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Secondary outcome [4]
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Changes in the tear evaporation rate
Assessment method: Measured objectively using Delfin Eye-Vapo meter
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Assessment method [4]
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Timepoint [4]
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Assessment will be performed at baseline, 10 minutes after application of treatment or placebo (no drops/spray application) and again 10 minutes after contact lenses are inserted.
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Eligibility
Key inclusion criteria
- 18 years or older
- Habitual soft CL wearer (of at least 1 month prior to study enrolment)
- Willing and able to follow the protocol accurately and to attend four study visits within a two week period
- Willing to not wear CL or apply any eye drops within 12 hours of the test visits
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
Yes
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Key exclusion criteria
- Active ocular allergies
- Ocular surgery or dermatological treatments in the previous three months or planned during the study period
- Current or planned pregnancy or lactation during the study
- History of major systemic or ocular conditions
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation is not concealed as all participants will undergo assessment with all intervention and one control
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
All participants will undergo four assessment visits, including one with each of the three interventions and one with no-intervention in this study. The sequence of theses visits will be randomized. Randomisation sequence for all interventions or no-intervention visits of this study [Systane Complete (lubricating eye drops with lipid), Systane Ultra (lubricating eye drops without lipid), and TearsAgain (lubricating eye spray with lipids)] will be derived by computer-generated random number allocation prior to the study and will be applied to participants by an unmasked investigator. The masked investigator will collect the study data. The randomisation schedule will be pre-determined, advance of study start, and applied consecutively to enrolled participants, So that neither masked or unmasked investigators have any influence in treatment allocation.
Simple randomisation using a randomisation table created by computer software (i.e., computerised sequence generation).
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Crossover
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
Sample Size: 34
Justification:
Sample size requirements were determined from non-parametric adjusted power calculations conducted using NCSS PASS 2002 (Utah, USA), with lipid layer grade as the designated outcome, and the standard deviation estimated to be approximately 1 grade. The power calculation showed that a minimum of 34 participants is required to detect a clinically significant difference of 1 lipid layer grade, with 80% power (ß equal 0.2), at a two-sided statistical significance level of 5% (a equal 0.05). Allowing for a 10% participant dropout rate or loss to follow-up by the 3rd visit, requiring a total of 38 participants to be recruited.
Statistical Analysis:
The difference between treatment outcomes will be assessed using repeated measures two-way analysis of variance (ANOVA) for continuous variables with normal distributions confirmed by Kolmogorov-Smirnov testing (p > 0.05). Non-normally distributed continuous and ordinal data will be converted to rank-values prior to undergoing analysis. Categorical data (treatment satisfaction) will be compared using Fisher's exact test. All tests will be two-tailed and p less than 0.05 considered significant.
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
11/12/2023
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Actual
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Date of last participant enrolment
Anticipated
15/05/2024
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Actual
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Date of last data collection
Anticipated
29/05/2024
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Actual
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Sample size
Target
34
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Accrual to date
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Final
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Recruitment outside Australia
Country [1]
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New Zealand
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State/province [1]
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Auckland
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Funding & Sponsors
Funding source category [1]
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University
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Name [1]
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University of Auckland
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Address [1]
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85 Park Road, Grafton Campus, Auckland 1023
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Country [1]
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New Zealand
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Primary sponsor type
University
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Name
The University of Auckland
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Address
85 Park Road, Grafton, Auckland 1023
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Country
New Zealand
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
316805
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Country [1]
316805
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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The Auckland Health Research Ethics Committee (AHREC)
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Ethics committee address [1]
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The University of Auckland Private Bag 92019 Auckland 1142
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Ethics committee country [1]
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New Zealand
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Date submitted for ethics approval [1]
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Approval date [1]
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13/09/2023
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Ethics approval number [1]
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AH26619
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Summary
Brief summary
Background: Contact lenses (CLs) are a popular choice for correcting refractive error, offering freedom from spectacles and improving quality of life for wearers but they destabilise the tear film overlying the ocular surface, risking ocular surface desiccation and discomfort symptoms for the wearer. Topical artificial tear supplements are the recommended treatment for patients with dryness symptoms, with or without CLs, and are available in a range of modalities, with and without lipid components. The behaviour of the eyedrops in the presence of a CL differs from that in the non-CL wearing eye but has been poorly characterised. Understanding the interactions between CLs and different drop modalities is critical to ensuring patients are offered sound, evidence-based advice. This study seeks to address the gap in knowledge by evaluating the impact of drop modalities with and without lipid components on tear film stability both in the presence of CL wear and without. Objectives: To evaluate the relative short-term effects on the pre-ocular and pre-lens tear film quantity and quality (its non-invasive tear film break-up time, tear meniscus height, lipid layer grade, lipid layer thickness and tear evaporation rate) following application of lubricating eye drops or eye spray. Study Design: Prospective, randomised, investigator-masked, controlled clinical trial (for n=38 participants with or without symptoms of dry eye. Study hypothesis: The lipid layer grade will be higher with instillation of a lipid drop than an aqueous drop, following application of a contact lens.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Prof Jennifer P. Craig
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Address
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Department of Ophthalmology, The University of Auckland Private Bag 92019, Auckland, 1142
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Country
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New Zealand
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Phone
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+64 099238173
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Jennifer P. Craig
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Address
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Department of Ophthalmology, The University of Auckland Private Bag 92019, Auckland, 1142
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Country
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New Zealand
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Phone
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+64 099238173
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Jennifer P Craig
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Address
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Department of Ophthalmology, The University of Auckland Private Bag 92019, Auckland, 1142
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Country
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New Zealand
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Phone
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+64 099238173
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Fax
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Email
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Doc. No.
Type
Citation
Link
Email
Other Details
Attachment
20636
Ethical approval
386599-(Uploaded-11-10-2023-10-34-51)-Study-related document.pdf
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
Download to PDF