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de Paula Yoneda P, Schellini SA, Padovani CR, Silva VF. Use of Soft Contact Lens for Esthetic and Functional Rehabilitation. Eye Contact Lens 2021; 47:383-387. [PMID: 34128481 DOI: 10.1097/icl.0000000000000809] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report the outcomes and complications of colored soft contact lenses (SCLs) to improve esthetic or eye function in visually impaired (VI) or blind patients. METHODS This retrospective study enrolled consecutive patients with unilateral or bilateral VI or blindness who had received colored SCLs to improve appearance or ocular function. Data were collected on demographics, complaints, complete ophthalmological examinations, types of SCL, follow-ups, and complications. RESULTS The study sample was comprised of 109 patients (ages 4-80 years). Eighty-six patients (78.89%) had unilateral blindness, and 14 patients (12.84%) had functional disorder. Most of the patients presenting for improved esthetic had anterior segment pathology (74/67.88%), mainly secondary to trauma (55/50.5%) resulting in leukoma (73/66.97%). Patients with functional VI (19/17.43%) received filtered SCLs for color blindness (7/6.42%), diplopia (7/6.42%), or photophobia (5/4.58%). No serious complications were observed in any cases, and 94.49% of patients were satisfied with the SCLs. CONCLUSION Colored SCLs can cover ocular surface imperfections in VI or blind eyes of patients who are seeking better cosmesis or improvement functional VI. Soft contact lenses with only one filter can cover imperfections of the ocular surface and improve vision in functional VI. Appropriate follow-up of these patients can reduce complication rates, resulting in good cosmesis and patient satisfaction with a positive impact on the lives of patients suffering from functional VI or blindness.
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Affiliation(s)
- Patrícia de Paula Yoneda
- Eye Department of Contat lenses (P.P.Y. and V.F.S.), Hospital Sadalla Amin Ghanem, Joinville, SC, Brazil; Department of Ophthalmology (S.A.S.), Medical School, State University of Sao Paulo-UNESP, Botucatu, SP, Brazil; and Department of Biostatistic (C.R.P.), Biosciences Institute, State University of Sao Paulo-UNESP, Botucatu, SP, Brazil
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Eye movements and the perceived location of phosphenes generated by intracranial primary visual cortex stimulation in the blind. Brain Stimul 2021; 14:851-860. [PMID: 33991713 DOI: 10.1016/j.brs.2021.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Restoring sight for the blind using electrical stimulation of the visual pathways is feasible but demands an understanding of the spatial mapping of the visual world at the site of targeted stimulation, whether in the retina, thalamus, or cortex. While a visual cortex stimulator can bypass the eye and create visual percepts, there is an inherent dissociation between this stimulation and eye movements. It is unknown whether and how robustly the brain maintains the oculomotor circuitry in patients with bare- or no-light perception. OBJECTIVE To critically and quantitatively evaluate the effect of eye movements have on phosphene locations elicited by cortical stimulation that bypasses the eyes in order to restore sight in blind subjects. METHODS The NeuroPace Responsive Neurostimulator (RNS) and the Orion visual cortical prosthesis devices were used to electrically stimulate the visual cortex of blind subjects with bare or no light perception. Eye positions were recorded synchronized with stimulation and the location of the percepts were measured using a handheld marker. RESULTS The locations of cortical stimulation-evoked percepts are shifted based on the eye position at the time of stimulation. Measured responses can be remapped based on measured eye positions to determine the retinotopic locations associated with the implanted electrodes, with remapped responses having variance limited by pointing error. CONCLUSIONS Eye movements dominate the perceived location of cortical stimulation-evoked phosphenes, even after years of blindness. By accounting for eye positions, we can mimic retinal mapping as in natural sight.
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Jacobs DS, Carrasquillo KG, Cottrell PD, Fernández-Velázquez FJ, Gil-Cazorla R, Jalbert I, Pucker AD, Riccobono K, Robertson DM, Szczotka-Flynn L, Speedwell L, Stapleton F. CLEAR - Medical use of contact lenses. Cont Lens Anterior Eye 2021; 44:289-329. [PMID: 33775381 DOI: 10.1016/j.clae.2021.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022]
Abstract
The medical use of contact lenses is a solution for many complex ocular conditions, including high refractive error, irregular astigmatism, primary and secondary corneal ectasia, disfiguring disease, and ocular surface disease. The development of highly oxygen permeable soft and rigid materials has extended the suitability of contact lenses for such applications. There is consistent evidence that bandage soft contact lenses, particularly silicone hydrogel lenses, improve epithelial healing and reduce pain in persistent epithelial defects, after trauma or surgery, and in corneal dystrophies. Drug delivery applications of contact lens hold promise for improving topical therapy. Modern scleral lens practice has achieved great success for both visual rehabilitation and therapeutic applications, including those requiring retention of a tear reservoir or protection from an adverse environment. This report offers a practical and relevant summary of the current evidence for the medical use of contact lenses for all eye care professionals including optometrists, ophthalmologists, opticians, and orthoptists. Topics covered include indications for use in both acute and chronic conditions, lens selection, patient selection, wear and care regimens, and recommended aftercare schedules. Prevention, presentation, and management of complications of medical use are reviewed.
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Affiliation(s)
- Deborah S Jacobs
- Massachusetts Eye & Ear, Cornea and Refractive Surgery Service, Harvard Medical School, Boston, MA, USA.
| | | | | | | | | | | | | | | | | | - Loretta Szczotka-Flynn
- Department of Ophthalmology & Visual Science, Case Western Reserve University, Cleveland, OH, USA
| | - Lynne Speedwell
- Great Ormond Street Hospital for Children NHS Trust, Moorfields Eye Hospital, London, UK
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Australia
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Bafna RK, Kalra N, Sinha R. Modified head inversion technique for pterygium and pseudopterygium surgery combined with keratopigmentation. Eur J Ophthalmol 2020; 31:1426-1430. [PMID: 32962411 DOI: 10.1177/1120672120958308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE We describe a single sitting modified technique of pterygium surgery along with corneal tattooing for combined cosmetic rehabilitation in eyes with corneal opacity and pterygium or pseudopterygium. METHOD Five patients with corneal opacity due to healed keratitis/optically failed therapeutic grafts along with pterygium or pseudopterygium underwent combined pterygium surgery by head inversion technique and corneal tattooing in the same sitting. All patients had no visual prognosis in that eye and surgery was indicated for cosmetic reasons only. RESULTS At 6 months follow up no complications of pterygium surgery like recurrence, thinning, dellen, infections were noted in any patient. The dye was retained in the cornea and the cosmetic rehabilitation was excellent in all patients. DISCUSSION Corneal tattooing combined with pterygium/pseudopterygium surgery can be performed in a single sitting with this novel technique in eyes with no visual potential. This is particularly suitable for eyes with limbal stem cell deficiency or large pterygia/pseudopterygia where conjunctival autograft is not advisable. These patients are often apprehensive for an allograft from their only seeing other eye.
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Affiliation(s)
- Rahul Kumar Bafna
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nidhi Kalra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sinha
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Balgos JD, Amesty MA, Rodriguez AE, Al-Shymali O, Abumustafa S, Alio JL. Keratopigmentation combined with strabismus surgery to restore cosmesis in eyes with disabling corneal scarring and squint. Br J Ophthalmol 2019; 104:785-789. [PMID: 31527061 DOI: 10.1136/bjophthalmol-2019-314539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Therapeutic corneal pigmentation has modernly evolved into different sophisticated techniques to camouflage cosmetically disabling corneal opacities and scars with good reported outcomes. Blind eyes frequently suffer from strabismus which further deteriorates the cosmesis of the patient. Combined keratopigmentation (KTPG) with strabismus surgery may be an option for these patients. METHODS A total of 72 consecutive patients were retrospectively reviewed in this investigation. Main outcome measures were postoperative residual squint, and cosmesis evaluated by an independent observer, patient satisfaction, reoperation rates for KTPG and squint, and complications. RESULTS A total of 72 consecutive patients and 73 eyes that underwent KTPG and strabismus surgery were included in this study. Mean follow-up time was 2.5±3 years. Patient age ranged from 5 to 83 years, with 93% having visual acuity worse than 0.1. 14 eyes (24.5%) underwent repeated KTPG, 24 (42.1%) had repeated strabismus surgery. 14 patients (19.4%) had a repeat muscle surgery, although 55 (76.4%) of the 72 patients achieved orthotropia or had deviations within 10 prism dioptres at the end of the follow-up period. Corneal microperforation was encountered in two (2.8%) patients and conjunctival staining in 10 eyes. Cosmesis was good for all patients. Patients who required repeat KTPG or strabismus surgery, or those in whom orthotropia was not totally restored, considered their cosmetic appearance sufficiently improved. CONCLUSION Corneal KTPG combined with strabismus surgery provides good cosmesis for patients with corneal scarring and strabismus with minimal complications. Reoperation rates are relatively high in the short term to accomplish an optimal cosmetic result.
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Affiliation(s)
- Joan D Balgos
- Research & Development Department and Cornea and Ocular Surface Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Alicante, Spain
| | - Maria A Amesty
- Ocular, Plastic, Reconstructive, Lacrimal and Orbital Surgery Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Alicante, Spain
| | - Alejandra E Rodriguez
- Research & Development Department and Cornea and Ocular Surface Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Alicante, Spain
| | - Olena Al-Shymali
- Research & Development Department and Cornea and Ocular Surface Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Alicante, Spain
| | - Sabat Abumustafa
- Department of Ophthalmology, Ahmadi Hospital Kuwait, Kuwait City, Kuwait
| | - Jorge L Alio
- Refractive Surgery Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Alicante, Spain .,Department of Ophthalmology, Universidad Miguel Hernández de Elche, Elche, Alicante, Spain
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White Sclera Painted Contact Lens for Masking of Conjunctival Neovascularization and Hyperemia Following Cosmetic Eye Whitening Procedure. Eye Contact Lens 2019; 46:e24-e26. [PMID: 31478914 DOI: 10.1097/icl.0000000000000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We describe a case of a 37-year-old veteran with recurrent conjunctival hyperemia 5 years after an eye-whitening conjunctivectomy procedure with mitomycin C who desired to have a repeat procedure by the original surgeon. Instead, the patient was counseled and successfully fitted with white sclera painted contact lenses to mask the regrowth of his conjunctival vasculature with excellent cosmetic results and comfort. Further eye-whitening surgery was, therefore, avoided. We conclude that hand-painted white sclera contact lenses with regular ocular surface health monitoring can be offered as a cosmetic, safer, and economical alternative to patients in order to avoid eye-whitening procedures known to induce ocular ischemia.
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Sauer A, Bourcier T. Microbial keratitis as a foreseeable complication of cosmetic contact lenses: a prospective study. Acta Ophthalmol 2011; 89:e439-42. [PMID: 21401905 DOI: 10.1111/j.1755-3768.2011.02120.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE A recent study shows that the relative risk of contact lenses (CL)-related microbial keratitis (MK) is highly increased with cosmetic contact lenses (CosCL). The aim of our study is to illustrate the implications of the CosCL on the occurence of MK and to describe the subpopulation of CosCL wearers. METHODS A prospective multicenter study was conducted in 12 French University Hospitals on all lenses wearers presenting with MK between July 2007 and July 2009, including CosCL wearers. Patients had a complete ophthalmological examination and were interviewed by a 50 items anonymous 'questionnaire' to determine subject demographics and lenses wear history. The CosCL-related MK subpopulation (case) was described and finally compared to (noncosmetic) CL-related MK (control). RESULTS Two hundred and fifty-six patients were included for contact lenses-related MK. Thirty-two of them (12.5%) were seen for MK after wearing CosCL. Compared with CL, CosCL wearers are younger (21 versus 27 years of age) and recent wearers (3 versus 9 years). CosCL were rarely dispensed by eye care professionals increasing the risk of MK (OR, 12.3). Education about lens care and handling was deficient for most of CosCL wearers (OR, 26.5). Sixty per cent of CosCL cases versus 13% of CL-related MK had a final visual acuity less than 20/200. CONCLUSION Patients who acquire CosCL are less likely to be instructed on appropriate lenses use and basic hygiene rules. Consequently, CosCL wearers are experiencing acute vision-threatening infections.
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Affiliation(s)
- Arnaud Sauer
- Department of Ophthalmology, Strasbourg University Hospital, Strasbourg, France.
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Chang KC, Kwon JW, Han YK, Wee WR, Lee JH. The epidemiology of cosmetic treatments for corneal opacities in a Korean population. KOREAN JOURNAL OF OPHTHALMOLOGY 2010; 24:148-54. [PMID: 20532140 PMCID: PMC2882077 DOI: 10.3341/kjo.2010.24.3.148] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 05/04/2010] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe etiologies and clinical characteristics of corneal opacities leading patients to seek cosmetic treatments. Methods The medical records of 401 patients who presented for cosmetic improvement in corneal opacities between May 2004 and July 2007 were retrospectively reviewed. The following parameters were analyzed: age, gender, cause of corneal opacity, time course of the corneal disease, associated diseases, prior and current cosmetic treatments, visual acuity, location and depth of the corneal opacity, and the presence of either corneal neovascularization or band keratopathy. A single practitioner examined all patients. Results The most common causes of corneal opacity were ocular trauma (203 eyes, 50.6%), retinal disease (62 eyes, 15.5%), measles (38 eyes, 9.5%), and congenital etiologies (22 eyes, 5.5%). Prior treatments included iris colored contact lenses (125 eyes, 31.1%) and corneal tattooing (34 eyes, 8.46%). A total of 321 of 401 eyes underwent cosmetic treatment for corneal opacities. The most common treatment performed after the primary visit was corneal tattooing (261 eyes, 64.92%). Conclusions This is the first study to investigate the causes and clinical characteristics of patients presenting for cosmetic treatment of corneal opacities rather than for functional improvement. Various cosmetic interventions are available for patients with corneal opacities, and these should be individualized for the needs of each patient.
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Affiliation(s)
- Ki Cheol Chang
- Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
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