- Email: [email protected]
Professional fee structures for contact lens patients
e6
Abstracts / Contact Lens & Anterior Eye 36 (2013) e1–e15
that anything new that is being tried is two steps forward but one step back. http://dx.doi.org/10.1016/j.clae.2013.08.025 KEYNOTE ADDRESS: Keratoconus management update Florence Malet E-mail address: fl[email protected]. Keratoconus is a non-inflammatory, bilateral, asymmetric, progressive steepening and thinning of the central cornea. Classification of the four stages has evolved with inclusion of new criterias such as corneal CCT, sphero-cylindric refraction and mean keratometric values. The current management strategy of this disease has also largely evolved during the past years with the introduction of new medico-surgical options. Corneal cross linking is now indicated in evolving keratoconus, deep lamellar corneal graft (KLAP) have replaced penetrating keratoplasty (decreasing corneal rejection risk), intra-corneal rings are routinely used in contact lens intolerant patients since femtolaser channels are easily performed for their insertion. Indications and contra-indications of these different medico- surgical treatments will be reviewed. However, corneal GP contact lenses remain the primary visual management for keratoconus and play a major role. New designs allow better mechanical alignment but contact lens tolerance is still an issue for some patients. Up-date materials combinations (hybrid lenses, piggy-backing) and others lens types (silicone softs, sclerals...) are interesting alternatives in such cases to obtain a better lens tolerance and they will be presented and discussed. Lens fitting philosophy of GP corneal lenses, scleral lenses and soft silicone lenses will be largely detailed.Indications in the current contact lens strategic management of keratoconus at different stages of the disease including lens fitting after medico-surgical treatments will be presented.Advancements in care of keratoconus and improvements of lens material and designs science will certainly provide a better quality of vision and quality of life for these patients. This presentation, after the recent classification of the four stages of keratoconus,will focus on different lens types fitted in keratoconic eyes. New medico-surgical treatments are part of care of the disease such cross-linking, lamellar corneal graft, intra corneal rings. However, contact lenses keep a major place in visual rehabilitation and their indications and fitting will be reviewed in non-operated corneas and in operated corneas. http://dx.doi.org/10.1016/j.clae.2013.08.026 Contact lens wear and care behaviours in a non-clinical population of subject age 12-21 years Kathryn Richdale (OD, PhD) ∗ , Beth Kinoshita (OD), Dawn Lam (OD), Meredith Jansen (OD, MS), Robin Chalmers (OD), G. Lynn Mitchell (MS) E-mail address: [email protected] (K. Richdale). Purpose: There is a paucity of information on soft contact lens (SCL) wear in minors outside controlled trials. The CLAY group developed a survey to assess age-related behavioral and environmental factors related to SCL complications, and administered it to a non-clinical sample of >300 wearers 18-33 years. This study aimed to extend the survey for use in minors. Method: Readability was assessed at a 5th grade level (FleschKincaid). Focus groups were conducted to ensure comprehension. The survey was administered to 268 SCL wearers 12-21 years in 5
US cities. Chi square analysis was used to compare differences by age bins. Results: Most respondents replaced SCLs monthly (37%), and according to recommended schedules, but 17% replaced only when “ripped, lost, or uncomfortable.” Closed-eye wear increased with age (sleeping in SCLs at least “sometimes”: 14% of 12-14 yrs, 22% of 15-17 yrs, 31% of 18-21 yrs, p = 0.036; napping in SCLs at least “sometimes”: 40% of 12-14 yrs, 68% of 15-17 yrs, 72% of 18-21 yrs, p < 0.001). Water exposure was common, with 77% showering in SCLs and 17% rinsing or storing SCLs in water at least “sometimes.” After removing those who don’t use a case, 15% stated they failed to discard leftover solution at least “sometimes” and 54% never replaced their case or did so only when “damaged, lost or dirty.” Conclusions: A surprising number of young wearers have already adopted “bad behaviours” for wearing and caring for their SCLs. Closed eye wear, exposure to water, and poor lens care product and case hygiene are known risk factors. Targeted education for teenagers and young adults is needed to reduce the risk of serious complications. http://dx.doi.org/10.1016/j.clae.2013.08.027 Professional fee structures for contact lens patients Neelam Patel (MOptom, MCOptom) ∗ , Shehzad Naroo (BSc (Hons), MSc, PhD, FCOptom, FIACLE, FAAO, FBCLA, FEAOO), Nicholas Rumney (MSc, FCOptom, Dip TP(IP), FAAO, FBCLA, FIACLE) E-mail address: [email protected] (N. Patel). Purpose: Contact lens practices offer contact lenses as cash sale items or as part of monthly payment plans. With increased competition as well as internet sales, patient loyalty is becoming increasingly difficult to maintain. Monthly payment plans are thought anecdotally to improve patient loyalty. This study aims to explore the benefits to the practice of monthly payment plans for contact lenses. Method: BBR Optometry Ltd is an independent practice based in Hereford, and offers monthly payment plans (EyelifeTM ) to their contact lens wearers. EyelifeTM is multi- tiered allowing contact lens patients to pay for services on a monthly direct debit, or for services in combination with contact lens products. This study compared service uptake, contact lens sales, spectacle dispenses, revenue and profitability between EyelifeTM members and ‘pay as you go’ (PAYG) patients over a fixed period of 18 months. Results: Daily disposable contact lens wearers who were EyelifeTM members generated greater income and profits. Service based revenue was £153.96, significantly higher (P < 0.001) than £83.50 for the PAYG group. Service based profitability was found to be reduced (£27.26) for the PAYG group, compared to £83.13 for the EyelifeTM group (P < 0.001). This also impacted overall profitability, causing the PAYG group to display lower profitability than the EyelifeTM group; £235.54 compared to £289.02 respectively, however there was no statistical significance (P = 0.231). Contact lens revenue was greater for the EyelifeTM group at £469.48 compared to £417.92, despite this group receiving discounted prices as part of their membership package. This suggets EyelifeTM members purchase a greater volume poor lens care product and case hygiene are known risk factors. Targeted education for teenagers and young adults of contact lens products and therefore display greater practice loyalty, which is confirmed by a significantly greater (P = 0.007) contact lens cost for the EyelifeTM members.
Abstracts / Contact Lens & Anterior Eye 36 (2013) e1–e15
However the two groups demonstrated no significant differences for spectacle dispense rates (P = 0.790) or average dispense values (P = 0.638). Conclusions: This study demonstrates that monthly payment plans are more advantageous in terms of practice loyalty and business model sustainability. Furthermore, the additional spend of the EyelifeTM group makes them an attractive and loyal practice builder. http://dx.doi.org/10.1016/j.clae.2013.08.028 Concordance with appropriate contact lens wearing habits in daily disposable lens wearers Sheila Hickson-Curran (MCOptom, FAAO, DipCCLRT, FBCLA) ∗ , Robin Chalmers (OD, FAAO, FBCLA), Lisa Keay (PhD), Bill Gleason (OD), Roger Albright (MBA) E-mail address: [email protected] (S. Hickson-Curran). Purpose: To describe experienced soft contact lens wearers’ wear patterns, assessment of ease of use of and degree of following wear and care instructions before and after fitting with daily disposable lenses (DD) in the TEMPO Registry (#NCT01467557). Method: Responses from 919 registered lens wearers’ electronic questionnaires were analysed for change after 4 months lens wear with Wilcoxon Signed Rank test. Comparison to ease of use with habitual lenses is described for former users of habitual lenses (n = 773). Logistic regression tested factors contributing to nonideal wear patterns after 4 months. Results: After 4 months, lens wearers dispensed DD lenses reported a significant improvement in the ease of care of their lenses (69.2% vs. 96.2% “extremely/very easy” at baseline and 4 months, respectively (p < 0.0001)) and that they were better at following instructions (67.8% vs. 90.9% “excellent/very good” at baseline and 4 months, respectively p < 0.0001) with no differences for new and experienced wearers (p > 0.2). Experienced wearers reported their DD lenses were “much/a little easier” (76.1%) to use compared with habitual lenses. After 4 months few patients reported overnight wear (89% with “never or <1 night/week”), 90% replaced lenses daily and 87% never stored then reused lenses. Sleeping in DD lenses was more common among wearers who wore their former lenses while sleeping (OR 10.6; 95% C.I. 7.1-16.0). Conclusions: This large post-market registry finds that wearers of DD lenses believe they follow instructions better than with their reusable lenses and the vast majority (≈90%) are using their DD lenses properly; replacing lenses daily, no reuse of DD lenses and no overnight wear. Wearers who wore lenses while sleeping before receiving their DD lenses were most likely to continue that behaviour and may need extra counselling during the refitting visit. http://dx.doi.org/10.1016/j.clae.2013.08.029 Gender differences in habitual contact lens wear and care patterns from a large contact lens registry Robin Chalmers (OD, FAAO, FBCLA) ∗ , Sheila Hickson-Curran (MCOptom, FAAO, DipCCLRT, FBCLA), Lisa Keay (PhD), William Gleason (OD), Roger Albright (MBA) E-mail address: [email protected] (R. Chalmers). Purpose: To compare baseline reports of habitual soft contact lens (SCL) wear and care patterns among 969 adult registered SCL wearers in the TEMPO Registry (#NCT01467557) by gender.
e7
Method: At registration, self-administered electronic questionnaires from 295 males (age 35 ± 12 years) and 674 females (age 36 ± 12) were compared by Wilcoxon Signed Rank test or t-test. Gender differences in SCL wear patterns, CLDEQ-8 symptoms, assessment of ease of use, and ratings for following instructions were assessed. Results: Female SCL wearers had a significantly lower overall opinion of habitual SCLs (“excellent/very good” 36% vs. 44% males, p = 0.004), reported higher degree of dry eye (“very dry/dry” 26% vs. 18% males, p < 0.0001), and more eye sensitivity (“very sensitive/sensitive” 26% vs. 20% males, p = 0.02). Compared to males, females reported significantly higher frequency and intensity of all CLDEQ-8 symptoms; “frequent” or “constant” discomfort 23% vs. 13% males (p = 0.004), dryness 25% vs. 15% males (p = 0.0002), blurry changeable vision 13% vs. 7% males (p = 0.0006); and significantly higher intensity (4 or 5 on a 5 point scale) (p < 0.03). Wearing time was similar by gender (12.1 ± 3.7 hrs females vs. 12.3 ± 3.7 hrs for males (p = 0.3), but females reported significantly fewer comfortable hours/day (9.6 ± 4.2 hrs vs. 10.5 ± 3.8 hrs for males (p = 0.003). Habitual lens types were similar by gender (p = 0.4), both genders infrequently slept in lenses (29% males, 22% females with any EW, p = 0.8), and both believed they were complying with instructions to a similar degree (p = 1.0). Females were more likely to clean their habitual reusable lenses every day (67% vs. 56% for males, p = 0.008). Conclusions: Males generally reported a better SCL wearing experience than females in this sample, perhaps due to the female wearer’s willingness to report symptoms or tolerance to symptoms in general. Eye care practitioners should consider the wearer’s gender when counselling SCL wearers on methods to optimize the wearing experience. http://dx.doi.org/10.1016/j.clae.2013.08.030 Dry eye symptoms and plasma hormone levels A pilot study Fiona Stapleton (PhD DCLP FAAO FBCLA GradCertOcTher) ∗ , Ulrike Hampel (MD PhD), Noor Badarudin (BOptom), Isabelle Jalbert (OD PhD MPH FAAO), Michele Madigan (BOptom PhD), Blanka Golebiowski (BOptom PhD) E-mail address: [email protected] (F. Stapleton). Purpose: Dry eye symptoms are commonly reported particularly in women post-menopause. This study explored the relationship between levels of plasma sex hormones and dry eye symptoms. Method: A cross-sectional, single visit study was conducted. The study involved a convenience sample of 74 subjects without ocular surface disease, including 52 females (mean age 35.3 ± 13.4years, range 18.8-70.3) and 22 males (mean age 34.2 ± 13.8years, range 20.2-75.3). Subjects completed the Dry Eye Questionnaire (DEQ5) and numerical ratings of discomfort, dryness, foreign body (FB) sensation, burning and watering. Tear osmolarity (TearLab) and volume (Phenol Red Thread) were assessed. Venous blood was collected and plasma concentrations of oestradiol (E2) and total testosterone (TT) were determined using specific enzyme-linked immunosorbent assay. Associations were examined using Pearson’s or Spearman’s correlations, and differences between groups were assessed using independent samples t-test or Mann-Whitney U test, as appropriate. Results: Mean group E2 concentration was 65.2 ± 50.9pg/ml in females and 40.7 ± 23.8pg/ml in males; TT concentration was 0.49 ± 0.29 and 4.3 ± 1.6ng/ml respectively. Symptom reporting was higher in females (p < 0.05). Tear volume was reduced in females (p = 0.02); there was no difference in tear osmolarity. In
Abstracts / Contact Lens & Anterior Eye 36 (2013) e1–e15
that anything new that is being tried is two steps forward but one step back. http://dx.doi.org/10.1016/j.clae.2013.08.025 KEYNOTE ADDRESS: Keratoconus management update Florence Malet E-mail address: fl[email protected]. Keratoconus is a non-inflammatory, bilateral, asymmetric, progressive steepening and thinning of the central cornea. Classification of the four stages has evolved with inclusion of new criterias such as corneal CCT, sphero-cylindric refraction and mean keratometric values. The current management strategy of this disease has also largely evolved during the past years with the introduction of new medico-surgical options. Corneal cross linking is now indicated in evolving keratoconus, deep lamellar corneal graft (KLAP) have replaced penetrating keratoplasty (decreasing corneal rejection risk), intra-corneal rings are routinely used in contact lens intolerant patients since femtolaser channels are easily performed for their insertion. Indications and contra-indications of these different medico- surgical treatments will be reviewed. However, corneal GP contact lenses remain the primary visual management for keratoconus and play a major role. New designs allow better mechanical alignment but contact lens tolerance is still an issue for some patients. Up-date materials combinations (hybrid lenses, piggy-backing) and others lens types (silicone softs, sclerals...) are interesting alternatives in such cases to obtain a better lens tolerance and they will be presented and discussed. Lens fitting philosophy of GP corneal lenses, scleral lenses and soft silicone lenses will be largely detailed.Indications in the current contact lens strategic management of keratoconus at different stages of the disease including lens fitting after medico-surgical treatments will be presented.Advancements in care of keratoconus and improvements of lens material and designs science will certainly provide a better quality of vision and quality of life for these patients. This presentation, after the recent classification of the four stages of keratoconus,will focus on different lens types fitted in keratoconic eyes. New medico-surgical treatments are part of care of the disease such cross-linking, lamellar corneal graft, intra corneal rings. However, contact lenses keep a major place in visual rehabilitation and their indications and fitting will be reviewed in non-operated corneas and in operated corneas. http://dx.doi.org/10.1016/j.clae.2013.08.026 Contact lens wear and care behaviours in a non-clinical population of subject age 12-21 years Kathryn Richdale (OD, PhD) ∗ , Beth Kinoshita (OD), Dawn Lam (OD), Meredith Jansen (OD, MS), Robin Chalmers (OD), G. Lynn Mitchell (MS) E-mail address: [email protected] (K. Richdale). Purpose: There is a paucity of information on soft contact lens (SCL) wear in minors outside controlled trials. The CLAY group developed a survey to assess age-related behavioral and environmental factors related to SCL complications, and administered it to a non-clinical sample of >300 wearers 18-33 years. This study aimed to extend the survey for use in minors. Method: Readability was assessed at a 5th grade level (FleschKincaid). Focus groups were conducted to ensure comprehension. The survey was administered to 268 SCL wearers 12-21 years in 5
US cities. Chi square analysis was used to compare differences by age bins. Results: Most respondents replaced SCLs monthly (37%), and according to recommended schedules, but 17% replaced only when “ripped, lost, or uncomfortable.” Closed-eye wear increased with age (sleeping in SCLs at least “sometimes”: 14% of 12-14 yrs, 22% of 15-17 yrs, 31% of 18-21 yrs, p = 0.036; napping in SCLs at least “sometimes”: 40% of 12-14 yrs, 68% of 15-17 yrs, 72% of 18-21 yrs, p < 0.001). Water exposure was common, with 77% showering in SCLs and 17% rinsing or storing SCLs in water at least “sometimes.” After removing those who don’t use a case, 15% stated they failed to discard leftover solution at least “sometimes” and 54% never replaced their case or did so only when “damaged, lost or dirty.” Conclusions: A surprising number of young wearers have already adopted “bad behaviours” for wearing and caring for their SCLs. Closed eye wear, exposure to water, and poor lens care product and case hygiene are known risk factors. Targeted education for teenagers and young adults is needed to reduce the risk of serious complications. http://dx.doi.org/10.1016/j.clae.2013.08.027 Professional fee structures for contact lens patients Neelam Patel (MOptom, MCOptom) ∗ , Shehzad Naroo (BSc (Hons), MSc, PhD, FCOptom, FIACLE, FAAO, FBCLA, FEAOO), Nicholas Rumney (MSc, FCOptom, Dip TP(IP), FAAO, FBCLA, FIACLE) E-mail address: [email protected] (N. Patel). Purpose: Contact lens practices offer contact lenses as cash sale items or as part of monthly payment plans. With increased competition as well as internet sales, patient loyalty is becoming increasingly difficult to maintain. Monthly payment plans are thought anecdotally to improve patient loyalty. This study aims to explore the benefits to the practice of monthly payment plans for contact lenses. Method: BBR Optometry Ltd is an independent practice based in Hereford, and offers monthly payment plans (EyelifeTM ) to their contact lens wearers. EyelifeTM is multi- tiered allowing contact lens patients to pay for services on a monthly direct debit, or for services in combination with contact lens products. This study compared service uptake, contact lens sales, spectacle dispenses, revenue and profitability between EyelifeTM members and ‘pay as you go’ (PAYG) patients over a fixed period of 18 months. Results: Daily disposable contact lens wearers who were EyelifeTM members generated greater income and profits. Service based revenue was £153.96, significantly higher (P < 0.001) than £83.50 for the PAYG group. Service based profitability was found to be reduced (£27.26) for the PAYG group, compared to £83.13 for the EyelifeTM group (P < 0.001). This also impacted overall profitability, causing the PAYG group to display lower profitability than the EyelifeTM group; £235.54 compared to £289.02 respectively, however there was no statistical significance (P = 0.231). Contact lens revenue was greater for the EyelifeTM group at £469.48 compared to £417.92, despite this group receiving discounted prices as part of their membership package. This suggets EyelifeTM members purchase a greater volume poor lens care product and case hygiene are known risk factors. Targeted education for teenagers and young adults of contact lens products and therefore display greater practice loyalty, which is confirmed by a significantly greater (P = 0.007) contact lens cost for the EyelifeTM members.
Abstracts / Contact Lens & Anterior Eye 36 (2013) e1–e15
However the two groups demonstrated no significant differences for spectacle dispense rates (P = 0.790) or average dispense values (P = 0.638). Conclusions: This study demonstrates that monthly payment plans are more advantageous in terms of practice loyalty and business model sustainability. Furthermore, the additional spend of the EyelifeTM group makes them an attractive and loyal practice builder. http://dx.doi.org/10.1016/j.clae.2013.08.028 Concordance with appropriate contact lens wearing habits in daily disposable lens wearers Sheila Hickson-Curran (MCOptom, FAAO, DipCCLRT, FBCLA) ∗ , Robin Chalmers (OD, FAAO, FBCLA), Lisa Keay (PhD), Bill Gleason (OD), Roger Albright (MBA) E-mail address: [email protected] (S. Hickson-Curran). Purpose: To describe experienced soft contact lens wearers’ wear patterns, assessment of ease of use of and degree of following wear and care instructions before and after fitting with daily disposable lenses (DD) in the TEMPO Registry (#NCT01467557). Method: Responses from 919 registered lens wearers’ electronic questionnaires were analysed for change after 4 months lens wear with Wilcoxon Signed Rank test. Comparison to ease of use with habitual lenses is described for former users of habitual lenses (n = 773). Logistic regression tested factors contributing to nonideal wear patterns after 4 months. Results: After 4 months, lens wearers dispensed DD lenses reported a significant improvement in the ease of care of their lenses (69.2% vs. 96.2% “extremely/very easy” at baseline and 4 months, respectively (p < 0.0001)) and that they were better at following instructions (67.8% vs. 90.9% “excellent/very good” at baseline and 4 months, respectively p < 0.0001) with no differences for new and experienced wearers (p > 0.2). Experienced wearers reported their DD lenses were “much/a little easier” (76.1%) to use compared with habitual lenses. After 4 months few patients reported overnight wear (89% with “never or <1 night/week”), 90% replaced lenses daily and 87% never stored then reused lenses. Sleeping in DD lenses was more common among wearers who wore their former lenses while sleeping (OR 10.6; 95% C.I. 7.1-16.0). Conclusions: This large post-market registry finds that wearers of DD lenses believe they follow instructions better than with their reusable lenses and the vast majority (≈90%) are using their DD lenses properly; replacing lenses daily, no reuse of DD lenses and no overnight wear. Wearers who wore lenses while sleeping before receiving their DD lenses were most likely to continue that behaviour and may need extra counselling during the refitting visit. http://dx.doi.org/10.1016/j.clae.2013.08.029 Gender differences in habitual contact lens wear and care patterns from a large contact lens registry Robin Chalmers (OD, FAAO, FBCLA) ∗ , Sheila Hickson-Curran (MCOptom, FAAO, DipCCLRT, FBCLA), Lisa Keay (PhD), William Gleason (OD), Roger Albright (MBA) E-mail address: [email protected] (R. Chalmers). Purpose: To compare baseline reports of habitual soft contact lens (SCL) wear and care patterns among 969 adult registered SCL wearers in the TEMPO Registry (#NCT01467557) by gender.
e7
Method: At registration, self-administered electronic questionnaires from 295 males (age 35 ± 12 years) and 674 females (age 36 ± 12) were compared by Wilcoxon Signed Rank test or t-test. Gender differences in SCL wear patterns, CLDEQ-8 symptoms, assessment of ease of use, and ratings for following instructions were assessed. Results: Female SCL wearers had a significantly lower overall opinion of habitual SCLs (“excellent/very good” 36% vs. 44% males, p = 0.004), reported higher degree of dry eye (“very dry/dry” 26% vs. 18% males, p < 0.0001), and more eye sensitivity (“very sensitive/sensitive” 26% vs. 20% males, p = 0.02). Compared to males, females reported significantly higher frequency and intensity of all CLDEQ-8 symptoms; “frequent” or “constant” discomfort 23% vs. 13% males (p = 0.004), dryness 25% vs. 15% males (p = 0.0002), blurry changeable vision 13% vs. 7% males (p = 0.0006); and significantly higher intensity (4 or 5 on a 5 point scale) (p < 0.03). Wearing time was similar by gender (12.1 ± 3.7 hrs females vs. 12.3 ± 3.7 hrs for males (p = 0.3), but females reported significantly fewer comfortable hours/day (9.6 ± 4.2 hrs vs. 10.5 ± 3.8 hrs for males (p = 0.003). Habitual lens types were similar by gender (p = 0.4), both genders infrequently slept in lenses (29% males, 22% females with any EW, p = 0.8), and both believed they were complying with instructions to a similar degree (p = 1.0). Females were more likely to clean their habitual reusable lenses every day (67% vs. 56% for males, p = 0.008). Conclusions: Males generally reported a better SCL wearing experience than females in this sample, perhaps due to the female wearer’s willingness to report symptoms or tolerance to symptoms in general. Eye care practitioners should consider the wearer’s gender when counselling SCL wearers on methods to optimize the wearing experience. http://dx.doi.org/10.1016/j.clae.2013.08.030 Dry eye symptoms and plasma hormone levels A pilot study Fiona Stapleton (PhD DCLP FAAO FBCLA GradCertOcTher) ∗ , Ulrike Hampel (MD PhD), Noor Badarudin (BOptom), Isabelle Jalbert (OD PhD MPH FAAO), Michele Madigan (BOptom PhD), Blanka Golebiowski (BOptom PhD) E-mail address: [email protected] (F. Stapleton). Purpose: Dry eye symptoms are commonly reported particularly in women post-menopause. This study explored the relationship between levels of plasma sex hormones and dry eye symptoms. Method: A cross-sectional, single visit study was conducted. The study involved a convenience sample of 74 subjects without ocular surface disease, including 52 females (mean age 35.3 ± 13.4years, range 18.8-70.3) and 22 males (mean age 34.2 ± 13.8years, range 20.2-75.3). Subjects completed the Dry Eye Questionnaire (DEQ5) and numerical ratings of discomfort, dryness, foreign body (FB) sensation, burning and watering. Tear osmolarity (TearLab) and volume (Phenol Red Thread) were assessed. Venous blood was collected and plasma concentrations of oestradiol (E2) and total testosterone (TT) were determined using specific enzyme-linked immunosorbent assay. Associations were examined using Pearson’s or Spearman’s correlations, and differences between groups were assessed using independent samples t-test or Mann-Whitney U test, as appropriate. Results: Mean group E2 concentration was 65.2 ± 50.9pg/ml in females and 40.7 ± 23.8pg/ml in males; TT concentration was 0.49 ± 0.29 and 4.3 ± 1.6ng/ml respectively. Symptom reporting was higher in females (p < 0.05). Tear volume was reduced in females (p = 0.02); there was no difference in tear osmolarity. In