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Macedo-de-Araújo RJ, Seco RM, González-Méijome JM. Prospective assessment of corneal biomechanical properties and intraocular pressure after scleral lens wear: A 12-month follow-up study. Cont Lens Anterior Eye 2023; 46:102067. [PMID: 37863714 DOI: 10.1016/j.clae.2023.102067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023]
Abstract
PURPOSE To investigate the long-term influence of scleral lens (SL) wear on corneal biomechanical properties and intraocular pressure (IOP) in irregular and regular corneas. Secondary goal comprised evaluate the fluid reservoir (FR) thickness overtime and correlate it with the changes in corneal biomechanical parameters and IOP. METHODS Seventy (70) eyes with irregular corneas (IC Group) and 21 eyes with regular corneas (RC Group) were fitted with 16.4 mm SL and wore the lenses for 12 months. Corrected IOP (IOPcc), Goldmann equivalent IOP (IOPg) and corneal biomechanical parameters (Corneal Hysteresis (CH) and Corneal Resistance Factor (CRF)) were measured with Ocular Response Analyzer. Slit lamp images were analyzed with ImageJ software to assess FR thickness overtime. Measurements were taken at lens dispensing visit prior lens wear (LDV1) and after 60 min of lens wear (LDV2) and at 1, 6 and 12-month follow-up visits. Measurements were done immediately after lens removal. RESULTS There were no statistically significant differences on IOPcc, IOPg, CRF and CH over the follow-up visits in both groups. Mean IOPcc and IOPg fluctuations overtime were clinically insignificant and below 1 mmHg in both groups. IOPg, CH and CRF were significantly lower on IC Group (p < 0.001), although no statistically significant differences were found between groups for IOPcc. Regarding FR thickness, statistically significant differences were found over the follow-up on both groups, with a mean decrease of 186.29 µm on IC Group and 175.32 µm on RC Group (p < 0.001). Statistically significant moderate to high negative correlations between FR and IOPg, CRF and CH were found only in the RC Group. CONCLUSIONS Long-term SL wear was not associated to changes in corneal biomechanical parameters neither on IOP as measured after lens removal. Besides IOP measurement without SL removal, more studies are needed to investigate the potential relationship with SL fitting characteristics (namely FR thickness).
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Affiliation(s)
- Rute J Macedo-de-Araújo
- Clinical & Experimental Optometry Research Lab (CEORLab), University of Minho, Braga, Portugal; Physics Center of Minho and Porto Universities (CF-UM-UP), Braga, Portugal.
| | - Rita Maria Seco
- Clinical & Experimental Optometry Research Lab (CEORLab), University of Minho, Braga, Portugal; Physics Center of Minho and Porto Universities (CF-UM-UP), Braga, Portugal
| | - José M González-Méijome
- Clinical & Experimental Optometry Research Lab (CEORLab), University of Minho, Braga, Portugal; Physics Center of Minho and Porto Universities (CF-UM-UP), Braga, Portugal
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Montolío-Marzo E, Morales-Fernández L, Saenz-Frances San Baldomero F, García-Saenz S, García-Feijoo J, Piñero DP, Martínez-de-la-Casa JM. Easyton® transpalpebral versus Perkins applanation tonometry in different populations. Int Ophthalmol 2023; 43:3491-3497. [PMID: 37286775 DOI: 10.1007/s10792-023-02754-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 05/21/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To compare intraocular pressure (IOP) measurements obtained using the new transpalpebral Easyton® tonometer and Perkins applanation tonometer (PAT) in three different clinical populations. METHODS The participants of this prospective study were 84 subjects divided into the groups: 22 healthy children (G1), 42 healthy adults (G2), and 20 adult patients with primary open angle glaucoma (G3). The data recorded in 84 eyes of these subjects were age, sex, gender, central corneal thickness (CCT), and axial length (AL). In all eyes, IOP was determined in the same examination room by the same experienced examiner using Easyton® and PAT in random order. RESULTS Mean differences in IOP readings between Easyton® and PAT were 0.45 ± 1.97 (p = 0.295), - 0.15 ± 2.13 (p = 0.654), - 1.65 ± 3.22 (p = 0.033), and - 0.018 ± 2.50 mmHg (p = 0.500) in the groups G1, G2, G3, and whole sample (G4), respectively. Correlations between Easyton® and PAT IOP values were 0.668 (p = 0.001) for G1, 0.463 (p = 0.002) for G2, 0.680 (p < 0.001) for G3, and 0.605 (p < 0.001) for G4. Moderate to good agreement between the two tonometers was found in all groups according to intraclass correlation coefficients, which were 0.794 (p < 0.001) for G1, 0.632 (p < 0.001) for G2, 0.809 (p < 0.001) for G3, and 0.740 (p < 0.001) for G4. The lower and upper limits of agreement between the devices were - 5.1 and 4.7 mmHg, respectively, in the complete group. No correlation was noted between CCT or AL and the Easyton® IOP measurements. CONCLUSION IOP measurements obtained with Easyton® and PAT show an acceptable level of agreement mainly in healthy individuals, recommending it for IOP screening in children and in patients in which PAT measurement may be impared as patients with hemifacial spasms, corneal irregularities, or reduced mobility. It is not recommended for glaucoma patients follow-up.
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Affiliation(s)
- Elena Montolío-Marzo
- Ophthalmology Unit, Department of Inmunology, Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid and Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain.
| | - Laura Morales-Fernández
- Ophthalmology Unit, Department of Inmunology, Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid and Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
| | - Federico Saenz-Frances San Baldomero
- Ophthalmology Unit, Department of Inmunology, Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid and Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
| | - Sofía García-Saenz
- Ophthalmology Unit, Department of Inmunology, Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid and Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
| | - Julián García-Feijoo
- Ophthalmology Unit, Department of Inmunology, Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid and Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
| | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Jose M Martínez-de-la-Casa
- Ophthalmology Unit, Department of Inmunology, Ophthalmology and ORL, Faculty of Medicine, Hospital Clinico San-Carlos, Universidad Complutense de Madrid and Instituto de Investigación Sanitaria del Hospital Clínico San-Carlos (IdISSC), Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
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Litvin TV, Tse V, Chung L, Zhou Y, Tan B, Han Y, Lin MC. Effect of Scleral Contact Lens Size and Duration of Wear on Intraocular Pressure. Eye Contact Lens 2023; 49:e357-e363. [PMID: 37418306 PMCID: PMC10510754 DOI: 10.1097/icl.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To evaluate the effects of scleral lens size and the duration of wear on intraocular pressure (IOP) during lens wear. METHODS Healthy adults were recruited for this prospective and randomized study. Intraocular pressure measurements were performed using a pneumotonometer. A block randomization was used to assign the order of scleral lens diameter of either 15.6 mm or 18.0 mm for 5-hr bilateral wear over a course of two visits. Scleral IOP (sIOP) was measured during the predetermined intervals, 1.25 hr apart, during the 5-hr scleral lens wear. Corneal IOP (cIOP) was measured before and after the scleral lens wear. The primary outcome measure was the mean change in sIOP from prelens insertion baseline. RESULTS Corneal IOP unchanged after scleral lens removal compared with the baseline measurements ( P =0.878). Smaller and larger lenses introduced significantly higher sIOP at 2.5 hr after lens insertion with the mean (95% CI) increase of 1.16 (0.54, 1.78) mm Hg and 1.37 (0.76, 1.99) mm Hg, respectively. There was no difference in IOP change between the smaller and larger diameter lenses ( P =0.590). CONCLUSIONS Well-fitted scleral lenses do not result in clinically significant changes in intraocular pressure during 5-hr lens wear in young and healthy individuals.
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Affiliation(s)
- Taras V Litvin
- Herbert Wertheim School of Optometry & Vision Science (T.V.L., V.T., M.C.L.); Clinical Research Center (V.T., L.C., Y.Z., B.T., M.C.L.), Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA; and Department of Ophthalmology (T.V.L., Y.H.), University of California San Francisco, California
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Queiruga-Piñeiro J, Barros A, Lozano-Sanroma J, Fernández-Vega Cueto A, Rodríguez-Uña I, Merayo-LLoves J. Assessment by Optical Coherence Tomography of Short-Term Changes in IOP-Related Structures Caused by Wearing Scleral Lenses. J Clin Med 2023; 12:4792. [PMID: 37510907 PMCID: PMC10381863 DOI: 10.3390/jcm12144792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The mechanism that could increase intraocular pressure (IOP) during scleral lens (SL) wear is not fully understood, although it may be related to compression of the landing zone on structures involved in aqueous humor drainage. METHODS Thirty healthy subjects were fitted with two SLs of different sizes (L1 = 15.8 mm, L2 = 16.8 mm) for 2 h in the right eye and left eye as a control. Central corneal thickness (CCT), parameters of iridocorneal angle (ICA), Schlemm's canal (SC), and optic nerve head were measured before and after wearing both SLs. IOP was measured with a Perkins applanation tonometer before and after lens removal and with a transpalpebral tonometer before, during (0 h, 1 h, and 2 h), and after lens wear. RESULTS CCT increased after wearing L1 (8.10 ± 4.21 µm; p < 0.01) and L2 (9.17 ± 4.41 µm; p < 0.01). After L1 removal, the ICA parameters decreased significantly (p < 0.05). With L2 removal, nasal and temporal SC area and length were reduced (p < 0.05). An increased IOP with transpalpebral tonometry was observed at 2 h of wearing L1 (2.55 ± 2.04 mmHg; p < 0.01) and L2 (2.53 ± 2.22 mmHg; p < 0.01), as well as an increased IOP with Perkins applanation tonometry after wearing L1 (0.43 ± 1.07 mmHg; p = 0.02). CONCLUSIONS In the short term, SL resulted in a slight increase in IOP in addition to small changes in ICA and SC parameters, although it did not seem to be clinically relevant in healthy subjects.
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Affiliation(s)
- Juan Queiruga-Piñeiro
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Alberto Barros
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Javier Lozano-Sanroma
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Andrés Fernández-Vega Cueto
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Department of Surgery and Medical-Surgical Specialities, Universidad de Oviedo, 33006 Oviedo, Spain
| | - Ignacio Rodríguez-Uña
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Department of Surgery and Medical-Surgical Specialities, Universidad de Oviedo, 33006 Oviedo, Spain
| | - Jesús Merayo-LLoves
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Department of Surgery and Medical-Surgical Specialities, Universidad de Oviedo, 33006 Oviedo, Spain
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Schornack MM, Nau CB, Harthan J, Shorter E, Nau A, Fogt J. Current Trends in Scleral Lens Prescription, Management, and Evaluation. Eye Contact Lens 2023; 49:56-62. [PMID: 36694309 PMCID: PMC9881749 DOI: 10.1097/icl.0000000000000957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To report current trends in scleral contact lens prescription and management, including lens designs prescribed, care products recommended, and procedures performed during routine scleral lens (SL) evaluation. METHODS An online survey was designed by the Scleral Lenses in Current Ophthalmic Practice Evaluation study team and administered to eye care practitioners attending a specialty contact lens meeting. The survey was available from November 8, 2019, through March 31, 2020. Participants' demographic data were collected, along with information on lens diameters, landing zone (LZ) designs, recommended care products, and components of routine SL evaluation. RESULTS In total, 715 participants responded to at least one of the survey items of interest. Most lenses prescribed (63%) were 16 mm or more in diameter. Lenses with toric LZs were the most frequently prescribed (48%), followed by spherical (40%), quadrant-specific (8%), and impression-based or image-based designs (3%). Most participants (61%) recommended hydrogen peroxide products for lens care. Nonpreserved saline in a single-use vial was most frequently recommended to fill the bowl of the lens before application. Intraocular pressure was measured during SL evaluation by 45% of participants; 38% of participants routinely measured corneal thickness. CONCLUSIONS Practitioners increasingly are prescribing SLs with advanced LZ designs. Most practitioners recommend hydrogen peroxide-based disinfection systems and single-use vials of nonpreserved saline for lens care and application. Because differences in components of routine SL evaluations were reported, clinicians may benefit from reaching a consensus on essential components of SL evaluation.
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Affiliation(s)
- Muriel M Schornack
- Department of Ophthalmology (M.M.S. and C.B.N.), Mayo Clinic, Rochester, MN; Illinois College of Optometry (J.H.), Chicago, IL; Department of Ophthalmology and Visual Sciences (E.S.), University of Illinois at Chicago, Chicago, IL; Korb and Associates (A.N.), Boston, MA; and College of Optometry, The Ohio State University (J.F.), Columbus, OH
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Schornack MM, Vincent SJ, Walker MK. Anatomical and physiological considerations in scleral lens wear: Intraocular pressure. Cont Lens Anterior Eye 2023; 46:101535. [PMID: 34824016 DOI: 10.1016/j.clae.2021.101535] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 02/06/2023]
Abstract
Intraocular pressure (IOP) is maintained through complex and interrelated systems which control aqueous production and drainage, and it has been suggested that scleral lens (SL) wear may disrupt these vital homeostatic processes. This review provides an overview of anatomical and physiological processes that control IOP, identifies potential effects of SLs on these regulatory mechanisms, and examines studies that have attempted to quantify the effect of SLs on IOP. Lack of access to the cornea during SL wear makes accurate assessment of IOP challenging; therefore, a range of different assessment techniques and instruments have been employed to quantify IOP during and following SL wear. Some studies have evaluated IOP using standard techniques prior to lens application and following lens removal, or through a large central fenestration. Other studies have utilised instruments that facilitate assessment of IOP on the peripheral cornea or conjunctiva overlying the sclera (e.g. Schiotz, transpalpebral, and pneumatonometry). Two studies have recently evaluated changes in optic nerve structure during SL wear. Conflicting results have been reported on this topic, much of which examines changes in IOP in healthy subjects over limited periods of time. Currently, only a few studies have reported on long-term effects of SL wear on IOP in habitual SL wearers (after lens removal). Future research in this area must not only consider the fact that ocular conditions treated with SLs may potentially alter corneal biomechanical properties which can influence IOP, but also that these properties may be further altered by SL wear. Monitoring other risk factors for glaucoma (permanent alterations in optic nerve physiology, visual field defects) could provide a more comprehensive assessment of potentially increased risk of glaucomatous optic neuropathy due to SL wear. Ongoing clinical assessment of optic nerve structure and function is advisable in patients at risk for glaucoma who require SLs.
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Affiliation(s)
| | - Stephen J Vincent
- Queensland University of Technology (QUT), Centre for Vision and Eye Research, School of Optometry and Vision Science, Contact Lens and Visual Optics Laboratory, Queensland, Australia.
| | - Maria K Walker
- University of Houston College of Optometry, The Ocular Surface Institute, Houston, TX, USA.
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Tear Exchange, Intraocular Pressure, and Wear Characteristics of Quadrant-specific Versus Spherical Haptic Scleral Lenses. Eye Contact Lens 2022; 48:460-465. [PMID: 35973376 DOI: 10.1097/icl.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To compare scleral lenses (SLs) with a quadrant-specific (study lens) or a spherical (habitual lens) landing zone in a crossover study. METHODS Seven participants (eight eyes) wore each of two lenses for 2 weeks before measurements. We measured visual acuity, contrast sensitivity, intraocular pressure (IOP), fluid reservoir clearance, corneal thickness, tear exchange, and lens experience. Variables were compared between lenses and before and after 2 hr of wear. RESULTS The visual acuity was not different between the study lens, 0.12 logarithm of the minimum angle of resolution (logMAR), and habitual lens, 0.18 logMAR (median, P = 1.0). Contrast sensitivity was 1.3% under the study lens and 1.6% under the habitual lens ( P = 0.94). IOP did not change after 2 hr of wear for either lens (study lens, P = 0.33 and habitual lens, P = 0.74), and corneal thickness did not change during wear of either lens ( P = 0.44). The fluorescein concentration under the study lens did not change after 2 hr (99% of initial concentration; P = 0.84) but decreased to 46% of initial concentration under the habitual lens ( P = 0.008). Lens comfort was slightly better with the study lens (5.0 vs. 4.0, respectively; P = 0.05). CONCLUSIONS SLs with spherical or quadrant-specific landing zones provide good vision and do not affect IOP or corneal thickness. However, tear exchange is greater under spherical lenses than under quadrant-specific lenses. The quadrant-specific lens provides greater patient comfort.
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Kumar M, Shetty R, Lalgudi VG, Roy AS, Khamar P, Vincent SJ. Corneal Biomechanics and Intraocular Pressure Following Scleral Lens Wear in Penetrating Keratoplasty and Keratoconus. Eye Contact Lens 2022; 48:206-209. [PMID: 35333810 DOI: 10.1097/icl.0000000000000886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare corneal biomechanics and intraocular pressure (IOP) in keratoconus and penetrating keratoplasty eyes before and after nonfenestrated scleral lens wear. METHODS Twenty-three participants were enrolled, and 37 eyes were included in the analysis (11 penetrating keratoplasty and 26 keratoconus). A range of corneal biomechanical parameters and IOP were measured using the CORVIS ST before and after 8 hr of nonfenestrated scleral lens wear (Keracare, Acculens, Denver, CO). RESULTS Before lens wear, penetrating keratoplasty eyes displayed significantly greater median values for central corneal thickness (97 μm thicker, P=0.02), IOP (3.89 mm Hg higher, P=0.01), and biomechanical parameter A2 length (0.48 mm longer, P=0.003) compared with keratoconic eyes. No significant changes in corneal biomechanical parameters or IOP were observed after scleral lens wear in either group (all P>0.05). CONCLUSION Although nonfenestrated scleral contact lenses can induce a subatmospheric pressure after lens settling and compress tissue surrounding the limbus, no significant changes were detected in the corneal biomechanical parameters studied using CORVIS ST after scleral lens wear in eyes with penetrating keratoplasty and keratoconus.
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Affiliation(s)
- Mukesh Kumar
- Narayana Nethralaya (M.K., R.S., V.G.L., A.S.R., P.K.), Bangalore, India; and Centre for Vision and Eye Research (S.J.V.), School of Optometry & Vision Science, Queensland University of Technology, Brisbane, Australia
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Macedo-de-Araújo RJ, Fadel D, Barnett M. How Can We Best Measure the Performance of Scleral Lenses? Current Insights. CLINICAL OPTOMETRY 2022; 14:47-65. [PMID: 35418790 PMCID: PMC9000539 DOI: 10.2147/opto.s284632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
Scleral lenses (SLs) present several unique advantageous characteristics for patients. As these lenses are mainly fitted in severely diseased eyes, a thorough evaluation of the ocular surface before and after SL fitting and the on-eye SL fitting evaluation are essential and help minimize potential physiological complications. This review will explore the current and emerging techniques and instrumentation to best measure SL performance ensuring optimal lens fitting, visual quality, comfort and physiological responses, highlighting some potential complications and follow-up recommendations. A single physician could perform the great majority of evaluations. Still, the authors consider that the assessment of SL fitting should be a collaborative and multidisciplinary job, involving contact lens practitioners, ophthalmologists and the industry. This publication has reviewed the most up-to-date work and listed the most used techniques; however, the authors encourage the development of more evidence-based recommendations for SL clinical practice.
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Affiliation(s)
- Rute J Macedo-de-Araújo
- Clinical & Experimental Optometry Research Laboratory (CEORLab), Physics Centre of Minho and Porto Universities (CF-UM-UP), University of Minho, Braga, Portugal
| | | | - Melissa Barnett
- Davis Eye Center, University of California, Sacramento, CA, USA
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Ganjei AY, Shlager GGL, Brocks D. Scleral Tonometry Precision During Scleral Lens Wear: A Pilot Study. CLINICAL OPTOMETRY 2021; 13:341-350. [PMID: 35002349 PMCID: PMC8725838 DOI: 10.2147/opto.s339411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE To evaluate the reproducibility, and therefore the utility, of using traditional tonometry devices for measuring intraocular pressure (IOP), while a prosthetic replacement of the ocular surface ecosystem device (PD) or scleral lens is applied to the eye. PATIENTS AND METHODS Twenty subjects (40 eyes) with keratoconus were enrolled. With PD applied, the first 10 consecutive patients had IOP measured multiple times with a handheld tonometer (Tono-Pen AVIA, Reichert, Depew, NY) on the superotemporal sclera 1 mm posterior to the PD edge. This identical procedure was repeated for the next 10 consecutive patients with a pneumatonometer (Model 30, Reichert, Depew, NY). Once three reliable measurements, as defined by the study protocol, were obtained for an eye, the procedure was repeated with the same tonometer device on the fellow eye. RESULTS The mean standard deviation for reliable IOP measurements was ±2.92 mmHg, median (IQR) of 2.62 (1.68 to 3.53) mmHg in the handheld tonometer group and ±1.98 mmHg in the pneumatonometer group. There was no statistically significant difference between the groups (p = 0.07). The mean IOP range for the reliable IOP measurements was 5.5 ± 3.80 mmHg, median (IQR) of 5 (3 to 7) mmHg for the handheld tonometer group and 3.71 ±1.12 mmHg in the pneumatonometer group. There was no statistically significant difference between the groups (p = 0.06). CONCLUSION Handheld tonometry and pneumatonometry have poor reproducibility when used to measure scleral IOP in keratoconus patients, while a PD is applied to the eye. An alternative research model and methodology should be investigated and confirmed to have precision prior to proceeding with further analysis of any relationship between scleral lens wear and IOP.
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Affiliation(s)
- Allen Y Ganjei
- Department of Medical Education, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Gabriel G L Shlager
- Department of Medical Education, Tufts University School of Medicine, Boston, MA, USA
| | - Daniel Brocks
- Department of Ophthalmology, BostonSight, Needham, MA, USA
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Barnett M, Courey C, Fadel D, Lee K, Michaud L, Montani G, van der Worp E, Vincent SJ, Walker M, Bilkhu P, Morgan PB. CLEAR - Scleral lenses. Cont Lens Anterior Eye 2021; 44:270-288. [PMID: 33775380 DOI: 10.1016/j.clae.2021.02.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 12/25/2022]
Abstract
Scleral lenses were the first type of contact lens, developed in the late nineteenth century to restore vision and protect the ocular surface. With the advent of rigid corneal lenses in the middle of the twentieth century and soft lenses in the 1970's, the use of scleral lenses diminished; in recent times there has been a resurgence in their use driven by advances in manufacturing and ocular imaging technology. Scleral lenses are often the only viable form of contact lens wear across a range of clinical indications and can potentially delay the need for corneal surgery. This report provides a brief historical review of scleral lenses and a detailed account of contemporary scleral lens practice including common indications and recommended terminology. Recent research on ocular surface shape is presented, in addition to a comprehensive account of modern scleral lens fitting and on-eye evaluation. A range of optical and physiological challenges associated with scleral lenses are presented, including options for the clinical management of a range of ocular conditions. Future applications which take advantage of the stability of scleral lenses are also discussed. In summary, this report presents evidence-based recommendations to optimise patient outcomes in modern scleral lens practice.
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Affiliation(s)
- Melissa Barnett
- University of California, Davis Eye Center, Sacramento, CA, United States.
| | | | | | - Karen Lee
- University of Houston, College of Optometry, Houston, TX, United States
| | | | - Giancarlo Montani
- Università del Salento, Dipartimento di Matematica e Fisica CERCA, Lecce, Italy
| | - Eef van der Worp
- Eye-Contact-Lens Research & Education, Amsterdam, NL, Netherlands
| | - Stephen J Vincent
- Queensland University of Technology (QUT), Centre for Vision and Eye Research, School of Optometry and Vision Science, Contact Lens and Visual Optics Laboratory, Brisbane, Australia
| | - Maria Walker
- University of Houston, College of Optometry, Houston, TX, United States
| | - Paramdeep Bilkhu
- School of Optometry & Vision Science, Aston University, Birmingham, United Kingdom
| | - Philip B Morgan
- Eurolens Research, Division of Pharmacy and Optometry, University of Manchester, Manchester, United Kingdom
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Advances in Scleral Lenses. Optom Vis Sci 2020; 97:658-660. [DOI: 10.1097/opx.0000000000001580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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