The influence of contact lens wear on the corneal response to ultraviolet radiation

Rehabilitation of vision disabling corneal opacities: is there hope without corneal transplant?

OBJECTIVE

To evaluate the efficacy of contact lenses in visual rehabilitation of a series of patients with corneal scars/opacities.

METHOD

Retrospective review of case records of 158 patients (n=162 eyes) with poor vision subsequent to corneal scar/opacity, who underwent contact lens fitting, was done. Primary outcome assessed was quantum of additional improvement in vision with rigid gas permeable (RGP) or soft lenses over spectacles. Success was defined as visual improvement of ≥2 lines over that of spectacles and/or improvement of vision to ≥20/60 (LogMAR 0.48).

RESULTS

Rigid gas permeable lenses were fitted in 137 eyes and soft contact lenses in 25 eyes. Lenses were successful in improving visual acuity by two or more lines over that of spectacles in 70% eyes (113 of 162 eyes), of which RGP lens accounted for 85% (96 of 113 eyes). Alternative outcome of success was defined as attainment of reasonable functional vision of >20/60 (LogMAR 0.48). This could be achieved in 65% cases (105 of 162 eyes) of which 83% (88 eyes) were with use of RGP lenses. Almost one-fourth (23.4%) patients were children less than 15 years old. Soft contact lenses were attempted in 25 instances, where RGP lens could not be fitted and were successful in 17 (68%) of these. All these 17 patients were aphakes.

CONCLUSIONS

Rehabilitation of corneas with visually disabling corneal opacities is possible with usage of appropriate contact lenses even in young children.

Ultraviolet (UV) transmittance characteristics of daily disposable and silicone hydrogel contact lenses

The ultraviolet (UV) transmittance spectra of daily wear hydrogel and disposable silicone hydrogel contact lenses were measured. Average transmittance percentages were calculated for each lens for the entire UV spectrum and individually for the UVC, UVB and UVA portions of the spectrum. The significance of the differences in transmittance spectra obtained for the lenses was analysed using a one-way ANOVA planned comparisons test (alpha=0.05). The transmittance data were then used to calculate a UV protection factor (PF) for each contact lens brand tested. The PFs for 1-DAY ACUVUE MOIST (6.22), ACUVUE ADVANCE (10.02) and ACUVUE OASYS (11.96) contact lenses show that these contact lenses have superior UV-blocking capabilities. The PFs for Focus DAILIES (1.79), SofLens 1-day disposables (1.72), NIGHT & DAY (1.84), O2 Optix (1.99) and Purevision (2.62) show that these contact lenses posses more modest UV-blocking characteristics. This paper reviews the importance of protection of the anterior ocular surface from UV damage and quantifies the protection afforded by selected commercially available disposable contact lenses.

Damage to the rainbow trout (Oncorhyncus mykiss) lens following an acute dose of UVB

Rainbow trout (Oncorhynchus mykiss) were used to model the solar radiation-induced cataract that occurs in hatchery-reared lake trout (Salvelinus namaycush). Rainbow trout eyes were exposed to wideband predominantly UVB radiant energy from a filtered 1000W xenon source. Lenticular damage was assessed and classified and comeal damage noted. Lenticular threshold radiant exposure was 0.48 J.cm-2 which is in the same range as the mammalian lens. Permanent lenticular damage occurred at radiant exposure levels approximately twice the threshold for lenticular radiant exposure (also similar to the mammalian response). Slit-lamp and scanning electron microscopical results support the theory of post-exposure anterior subcapsular epithelial cell damage, lens fibre swelling, and eventual rupture, leading to areas of lower refractive index in the anterior subcapsular region of the lens.

Acute effects of ultraviolet-B irradiation on the corneal surface of the pigmented rabbit studied by quantitative scanning electron microscopy

The eyes of female pigmented rabbits were exposed to a single dose of UV-B (300 +/- 9 nm, 0.05 J/cm2 total dose) between 13.30 and 15.00 h. The average irradiance was 225 +/- 36 microW/cm2 delivered over 191 to 264 s. At various time periods thereafter (24, 48, 72 and 96 h post-irradiation), the animals were euthanized by pentobarbital overdose and the eyes fixed with 2% glutaraldehyde in 80 mM cacodylate buffer (pH 7.4, total osmolarity of 330-340 mOsm/L). Corneal quadrants were examined by high resolution scanning electron microscopy at 100 X and 500 X at-stage magnification at central, mid-peripheral and peripheral sites. The micrographs from the central cornea were subjected to a quantitative analysis using a computer based digitization system. A peak effect was observed at 48 h at which cellular exfoliation was noted at the corneal apex. In the region immediately adjacent to the exfoliating cells, the number of light and dark electron reflex cells decreased to 48 h while the numbers of medium-reflex cells decreased after 48 h. The relative surface area of all cells was also decreased at 48 h compared to unirradiated controls. Significant recovery was observed by 96 h. Mid-peripheral and peripheral sites were largely unaffected by this just supra-threshold irradiation.

Long-term effects of a single dose of ultraviolet-B on albino rabbit cornea--I. in vivo analyses

Both eyes of female albino rabbits (1.9 kg) were exposed to a single dose of UV-B (300 +/- 9 nm; 0.125 J/cm2 total dose) between 13.30 and 15.00 h. The average irradiance was 209 +/- 4 microW/cm2 delivered over 612 +/- 13 s. At various time periods thereafter (every 12 h for 3 days, 6, 7, 14, 28, 42, 56, 112, 224 and 336 days post-irradiation), the animals were subjected to a full slit lamp examination to evaluate the status of the cornea and the anterior segment along with optical or ultrasonic pachometry of central corneal thickness. The results were compared with studies on age-matched rabbits over the same time period. In response to the UV-B irradiation, the corneas showed a modest edema (20% increase in central corneal thickness) that peaked at 48 h. Nearly normal central corneal thickness returned in 6 days and followed by a secondary very slight swelling (less than 5%) that resolved by 14 days. The edema was accompanied by keratitis over the same period. Thereafter, both control and UV-B irradiated corneas progressively increased in thickness with age. Biomicroscopy also revealed the appearance of granular opacities in the corneal epithelium that peaked at 72-96 h and resolved over 28 days. In addition, very small microdot opacities of the corneal epithelium were present in the UV-B irradiated corneas that reached maximum at 72 h but persisted to some degree throughout the evaluation period. Biomicroscopy also revealed a progressive disruption of the homogeneous nature of the corneal stroma by the appearance of large 'bread crumb'-like opacities that started at 72 h and was still present at the end of the evaluation period. These results suggest that long-term evaluation of the cornea is important after acute UV-B exposure and indicate that acute exposure to UV-R can produce corneal changes resembling those reported following chronic exposure to UV-R-rich environments.