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Law E, Moledina M, Sexton I, Myerscough J. High Astigmatism Secondary to Peripheral Ectasia Recurrence in Postpenetrating Keratoplasty Eyes Managed With Miniscleral Contact Lenses. Eye Contact Lens 2023; 49:417-421. [PMID: 37595277 DOI: 10.1097/icl.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES After penetrating keratoplasty (PK) for keratoconus, vision can be impaired by high-degree astigmatism, particularly in those patients with recurrent peripheral ectasia. Scleral contact lenses (CLs) have long been used in the management of keratoconus both in treatment-naive corneas and those postcorneal transplants. We report the use of miniscleral CLs and their related visual and clinical outcomes in a series of patients with post-PK peripheral rim ectasia. METHODS In this retrospective case series, 5 patients (7 eyes) presented because of reduced visual acuity with their spectacles/CLs and/or reduced comfort with their existing rigid gas-permeable lenses. All patients in this series underwent PK more than two decades ago for keratoconus (mean 28.7 years±7.2). All patients demonstrated characteristic thinning at the graft-host junction, with anterior chamber deepening. Central corneas had remained clear in all patients inferring high visual potential. Contact lenses used were No 7 Comfort 15 miniscleral and the Onefit MED scleral with 14.5 mm and 15.6 mm diameters, respectively. RESULTS All eyes achieved a best-corrected visual acuity of 6/9 or greater. One case had difficulty with insertion and removal and has since discontinued wearing lens at this time. All others are successfully wearing the lenses regularly. CONCLUSION Despite advances in CL design, surgical management is still required in some patients. Miniscleral CLs are effective in the refractive management of peripheral ectasia in keratoconic post-PK eyes and should be considered in such eyes before proceeding with repeat surgical intervention.
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Affiliation(s)
- Elizabeth Law
- Department of Ophthalmology (E.L., M.M., I.S., J.M.), Southend University Hospital, Southend-on-Sea, United Kingdom; and Faculty of Medicine and Dentistry (J.M.), University of Plymouth, Plymouth, United Kingdom
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Asghari B, Brocks DC. Early Postoperative Therapeutic Scleral Lens Intervention for Penetrating Keratoplasty Complications in Atopic Keratoconjunctivitis. Eye Contact Lens 2023; 49:254-257. [PMID: 37167589 DOI: 10.1097/icl.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/13/2023]
Abstract
ABSTRACT A 52-year-old white man with keratoconus and severe atopic keratoconjunctivitis underwent penetrating keratoplasty (PK) for visual rehabilitation in the left eye. Post-PK complications included a persistent epithelial defect. Therapeutic scleral lens wear was initiated 2 weeks post-PK. Customizations were incorporated into the lens design to prevent suction and corneal hypoxia during lens wear. Post-PK herpes epithelial keratitis developed shortly thereafter, causing recurrence of a nonhealing epithelial defect. The patient was treated with oral antiviral therapy, discontinuation of dupilumab, and daily waking-hour scleral lens wear, which was used as an antibiotic drug delivery device. The cornea fully epithelialized, and best-corrected visual acuity improved to 20/40-2. The patient continued with daily waking-hour scleral lens wear and was without recurrence of persistent epithelial defect or herpes keratitis at 18 months. No scleral lens-related complications were observed despite the unconventional early intervention with a therapeutic scleral lens.
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Serramito-Blanco M, Cañadas P, Villa-Collar C, Carracedo G. Corneal Confocal Analysis after Scleral Lens Wear in Keratoconus Patients: A Pilot Study. Optom Vis Sci 2022; 99:800-6. [PMID: 36301598 DOI: 10.1097/OPX.0000000000001954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
SIGNIFICANCE Scleral lenses rely on the scleroconjunctival region without bearing the cornea, which could improve the symptoms and modify the corneal nerve plexus morphology. PURPOSE This study aimed to evaluate symptoms and changes in corneal nerve plexus morphology and density of Langerhans cells in keratoconus patients with and without intrastromal corneal ring before and after scleral lens wear. METHODS Sixteen scleral lens wearers with keratoconus were recruited for this short-term experimental pilot study. Subjects were divided into two groups: keratoconus group and intrastromal corneal ring segment group. All subjects were examined in two visits: baseline (before scleral lens wear) and after 6 months of scleral lens wear, after lens removal. The Schirmer I test, the Ocular Surface Disease Index, tear breakup time, and in vivo confocal microscopy were evaluated. RESULTS The mean age was 42.33 ± 11.27 years. A significant decrease in tear breakup time was found in the total group ( P = .01, Wilcoxon) compared with baseline. Ocular Surface Disease Index score had decreased after 6 months of scleral lens wear in the keratoconus with intrastromal corneal ring segment subgroup ( P = .03, Wilcoxon) and in the total group ( P = .001, Wilcoxon). No statistical changes in nerve density, tortuosity, and ramification were found for either the total group or the subgroup. However, the mean nerve length was higher in all groups, especially in the keratoconus subgroup ( P = .03, Wilcoxon) after 6 months of scleral lens wear. Regarding optical density, the total group showed a significant increase after 6 months of wearing ( P = .02, Wilcoxon). Finally, Langerhans cell density was not statistically different in any group. CONCLUSIONS These results suggest that scleral lens wearing improves the symptoms and increased the mean length nerves after 6 months of wear use in keratoconus patients.
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Fisher D, Collins MJ, Vincent SJ. Scleral Lens Thickness and Corneal Edema Under Closed Eye Conditions. Eye Contact Lens 2022; 48:194-199. [PMID: 35580359 DOI: 10.1097/icl.0000000000000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the relationship between central lens thickness and central corneal edema during short-term closed eye scleral lens wear. METHODS Nine participants (mean age 30 years) with normal corneas wore scleral lenses (Dk 141) under closed eye conditions on separate days with nominal center thicknesses of 150, 300, 600, and 1,200 μm. Epithelial, stromal, and total corneal edema were measured using high-resolution optical coherence tomography immediately after lens application and after 90 min of wear, before lens removal. Data were corrected for variations in initial fluid reservoir thickness and compared with predictions from theoretical modeling of overnight scleral lens wear. RESULTS Scleral lens-induced central corneal edema was primarily stromal in nature. The mean±standard error of corrected total corneal edema was 4.31%±0.32%, 4.55%±0.42%, 4.92%±0.50%, and 4.83%±0.22% for the 150-, 300-, 600-, and 1,200-μm lenses, respectively. No significant differences in the corrected total corneal edema were observed across all thickness groups (P=0.20). Theoretical modeling of overnight scleral lens wear seemed to overestimate the relative increase in central corneal edema as a function of decreasing lens Dk/t for values lower than 25. CONCLUSION The magnitude of scleral lens-induced central corneal edema during short-term closed eye lens wear did not vary significantly with increasing central lens thickness. Theoretical modeling of overnight closed eye scleral lens wear seems to overestimate the effect of increasing lens thickness.
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Affiliation(s)
- Damien Fisher
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Australia
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Abstract
PURPOSE To examine the relationship between lens thickness and central corneal edema during short-term open-eye scleral lens wear, and to compare these empirical edema measurements with theoretical modelling. METHODS Nine participants (mean age 30 years) with normal corneas wore scleral lenses {Dk 141×10-11 cm3 O2 [cm]/([sec] [cm2] [mm Hg])} under open-eye conditions on separate days with nominal center thicknesses of 150, 300, 600, and 1,200 μm. Epithelial, stromal, and total corneal edema were measured using high-resolution optical coherence tomography immediately after lens application and after 90 min of wear, before lens removal. RESULTS Central corneal edema was primarily stromal in nature and increased with increasing central lens thickness. The mean±standard error total corneal edema was 1.14±0.22%, 1.36±0.26%, 1.74±0.30%, and 2.13±0.24% for the 150, 300, 600, and 1,200 μm lenses, respectively. A significant difference in stromal and total corneal edema was observed between the 1,200 and 150 μm thickness lenses only (both P<0.05). Theoretical modelling overestimated the magnitude of central corneal edema and the influence of central lens thickness when the scleral lens Dk/t was less than 20. CONCLUSION Scleral lens-induced central corneal edema during short-term open-eye lens wear increases with increasing central lens thickness. Theoretical models overestimated the effect of increasing scleral lens thickness upon central corneal edema for higher lens thickness values (lens Dk/t<20) when controlling for initial central fluid reservoir thickness.
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Affiliation(s)
- Damien Fisher
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, QLD, 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. Clin Optom (Auckl) 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Cagliari C, Schor P, Formentin L, Lipener C, Dos Santos MS, Oliveira H, Raulino Junior JNC, de Freitas D. Corneal Response to Scleral Contact Lens Wear in Keratoconus. Eye Contact Lens 2022. [PMID: 35389370 DOI: 10.1097/ICL.0000000000000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To verify corneal alterations in patients with keratoconus who wear scleral contact lenses (ScCLs), focusing on corneal endothelial assessment. METHODS Scleral contact lenses were fitted in 22 patients with keratoconus. During a 90-day follow-up, patients were assessed in three visits: at baseline, after 30 days, and after 90 days. Patients underwent visual acuity measurement, slitlamp biomicroscopy of the anterior segment, specular microscopy of the corneal endothelium, corneal pachymetry, measurement of the clearance between the cornea and the lens, and follow-up of ectasia. RESULTS Variables related to endothelial morphology and pachymetry values did not change significantly over time. Central clearance measurements decreased in the 90-day period. No progression of corneal ectasia was observed, neither were infectious or inflammatory processes in the same period. CONCLUSION Daily wear of ScCLs in patients with keratoconus was not associated with adverse effects on the cornea or endothelium over a period of 90 days nor was there evidence of disease progression. Central clearance values diminished over that period, but the significance of this observation remains unclear.
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Valdes G, Romaguera M, Serramito M, Cerviño A, Gonzalo Carracedo G. OCT applications in contact lens fitting. Cont Lens Anterior Eye 2021; 45:101540. [PMID: 34799247 DOI: 10.1016/j.clae.2021.101540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/03/2021] [Accepted: 11/08/2021] [Indexed: 11/15/2022]
Abstract
Optical Coherence Tomography (OCT) is a noninvasive, high-speed, high-resolution imaging technology based in the Michaelson interferometry. A near-infrared light beam is used to register the intensity variations for the light backscattered on each sample layer. Due to the high repeatability on corneal measurements, spectral domain OCT (SD-OCT) is the gold standard when talking about in vivo, non-invasive anterior segment imaging. Changes in the morphology of various ocular surfaces such as the cornea, conjunctiva, limbus or tear film with soft (SCL), rigid, corneal or scleral lens (SL) wear can be described by OCT measurements. For instance, evaluation of the corneoscleral region is essential on SL fitting. For orthokeratology lenses central epithelial thinning and peripheral thickening and their regression could be quantified with OCT after Ortho-K lens wear. Blood vessel compression on the landing zone as well as vault thickness and fluid reservoir (FR) turbidity could be imaged with OCT. Tear film evaluation on contact lens wearers is essential because its use could lead to variations on the biochemical components in tears. Changes in tear meniscus dynamics and several parameters such as volume (TMV), tear meniscus height (HMT) and turbidity could be determined with OCT and positively correlated with the instillation of different ophthalmic solutions with Non-Invasive Break Up Time (NIBUT) and Schirmer test values. This manuscript shows the increasing applicability of OCT technology for the in vivo characterization of contact lens fitting and interaction with the ocular surface in a faster, safer and non-invasive way. Future research will still allow exploring OCT imaging to its full potential in contact lens practice, as there is still a significant amount of information contained in the images that are not yet easy to extract, analyze and give clinical value.
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Affiliation(s)
- Gonzalo Valdes
- Ocupharm Research Group, Faculty of Optic and Optometry, Universidad Complutense de Madrid, Madrid, Spain.
| | - Maria Romaguera
- Ocupharm Research Group, Faculty of Optic and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Maria Serramito
- Ocupharm Research Group, Faculty of Optic and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Alejandro Cerviño
- Optometry Research Group, Department of Optics, Optometry and Vision Sciences, Universidad de Valencia, Valencia, Spain
| | - G Gonzalo Carracedo
- Ocupharm Research Group, Faculty of Optic and Optometry, Universidad Complutense de Madrid, Madrid, Spain
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Nau CB, Dodda S, Hodge DO, Schornack MM. Quadrant-Specific Changes in Corneal and Tear Fluid Reservoir Thickness for After 2 Hours of Wear. Eye Contact Lens 2021; 47:582-7. [PMID: 34673669 DOI: 10.1097/ICL.0000000000000808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To measure corneal swelling and thickness of the tear fluid reservoir (TFR) after wearing scleral lenses (SLs). METHODS Thirty-five participants had 1 eye fitted with each of three SLs (15.0-mm Jupiter, 18.2-mm Jupiter, and 18.0-mm Digiform). Scheimpflug images were obtained before wear, after application, after 2 hr of wear, and after removal. Initial and final TFR thickness and corneal thickness were measured in the central cornea and 3 mm from the center in the superior, inferior, temporal, and nasal quadrants. RESULTS Corneal thickness increased with wear, but no between-lens differences were observed in the superior (P=0.09), inferior (P=0.38), or temporal (P=0.53) quadrants. The greatest change in central and nasal cornea thickness was with the 15.0-mm SL (P<0.001). All areas showed settling, with no between-lens differences. Greater final TFR thickness was noted for the superior and nasal quadrants with the 18.0-mm SL (P<0.001), and less final TFR thickness was noted in the inferior (P<0.001) and temporal (P<0.001) quadrants with the 15.0-mm SL. Corneal thickness was not associated with the final TFR thickness. CONCLUSIONS The greatest corneal swelling was observed in the inferior quadrant with the 15.0-mm SL, although this lens had the least TFR thickness inferiorly. TFR thickness alone did not account for observed corneal swelling.
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Nadarajah V. Case Report: Modified Piggyback System to Treat Peripheral Iridotomies and Degenerative Myopia. Optom Vis Sci 2021; 98:446-9. [PMID: 33967251 DOI: 10.1097/OPX.0000000000001683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
SIGNIFICANCE This report details how a case with degenerative myopia and symptoms secondary to laser peripheral iridotomies is managed with a modified piggyback contact lens system. The benefits of using a system with tinted and gas-permeable (GP) lenses are discussed. PURPOSE This study aimed to report the positive outcome of a modified piggyback system in the treatment of degenerative myopia and iris abnormalities. CASE REPORT A patient with degenerative myopia presented with visual disturbances secondary to laser peripheral iridotomies in both eyes. A modified piggyback system was trialed using a corneal GP lens overlaying a tinted soft contact lens to provide optimal vision and visual comfort in both eyes. After optimizing the fit, there was a reduction in glare and improved vision. CONCLUSIONS Hard contact lenses often provide superior optics and vision compared with soft lenses, especially to patients with high refractive errors. Patients who require hard lenses and also have visual disturbances secondary to iris abnormalities could be managed with a modified piggyback contact lens systems using a corneal GP lens and tinted soft lens.
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Alipour F, Jamshidi Gohari S, Azad N, Mehrdad R. Miniscleral Contact Lens in Pediatric Age Group: Indications, Safety, and Efficacy. Eye Contact Lens 2021; 47:408-412. [PMID: 34001712 DOI: 10.1097/icl.0000000000000798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report indications, fitting feasibility, and safety of miniscleral design (MSD) lenses in children. METHODS Medical records of patients aged <18 years at the time of referral to Contact Lens Clinic of Farabi Eye Hospital, because of inadequate spectacle-corrected visual acuity, rigid gas-permeable or soft contact lens intolerance, and ocular surface disease were reviewed. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), best-corrected vision with the lens (CCVA), lens parameters, and comfortable daily wearing time (CDWT) were documented. RESULTS Seventy-two eyes of 52 pediatric patients were fitted with MSD lens over a 9-year period. The indications for MSD lens fitting were keratoconus (29 eyes), corneal scarring from ocular trauma (16 eyes), ocular surface diseases (25 eyes), and postkeratitis corneal scar (2 eyes). The average UCVA and the mean difference between CCVA and BSCVA were 1.20 and 0.55 logarithm of the minimal angle of resolution, respectively, which shows statistically significant improvement. This significant increase in vision was even seen in those who were referred for the management of ocular surface diseases. The mean CDWT for most patients was 10 hr/day. CONCLUSION Miniscleral design lens can be used as a safe and helpful modality to provide good vision and comfort in children experiencing ectatic disorders, traumatic corneal scars, and ocular surface diseases.
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Affiliation(s)
- Fateme Alipour
- Eye Research Center (F.A., S.J.G.), Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran ; School of Biology, College of Science (N.A.), University of Tehran, Tehran, Iran; and Center for Research on Occupational Diseases (R.M.), Tehran University of Medical Sciences, Tehran, Iran
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Abstract
SIGNIFICANCE There is debate concerning corneal oxygenation during scleral lens wear due to the potential additive hypoxic effect of a lens plus a fluid reservoir. This study investigated the agreement between theoretical models and empirical measurements of scleral lens-induced corneal edema with respect to central fluid reservoir thickness. PURPOSE The purpose of this study was to examine the effect of altering the fluid reservoir thickness on central corneal edema during short-term open-eye scleral lens wear and to compare these empirical measurements with predictive theoretical models. METHODS Ten participants (age, 30 ± 4 years) with normal corneas wore highly oxygen-permeable scleral lenses (141 Dk ×10 cm O2 (cm)/[(s) (cm) (mmHg)]) on separate days with either a low (mean, 144; 95% confidence interval [CI], 127 to 160 μm), medium (mean, 487; 95% CI, 443 to 532 μm), or high (mean, 726; 95% CI, 687 to 766 μm) initial fluid reservoir thickness. Epithelial, stromal, and total corneal edema were measured using high-resolution optical coherence tomography after 90 minutes of wear, before lens removal. Data were calculated or extracted from published theoretical models of scleral lens-induced corneal edema for comparison. RESULTS Scleral lens-induced central corneal edema was stromal in nature and increased with increasing fluid reservoir thickness; mean total corneal edema was 0.69% (95% CI, 0.34 to 1.04%), 1.81% (95% CI, 1.22 to 2.40%), and 2.11% (95% CI, 1.58 to 2.65%) for the low, medium, and high thickness groups, respectively. No significant difference in corneal edema was observed between the medium and high fluid reservoir thickness groups (P = .37). "Resistance in series" oxygen modeling overestimated the corneal edema observed for fluid reservoir thickness values greater than 400 μm. CONCLUSIONS Scleral lens-induced central corneal edema increases with increasing reservoir thickness, but plateaus at a thickness of around 600 μm, in agreement with recent theoretical modeling that incorporates factors related to corneal metabolism.
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Kim YH, Lin MC, Radke CJ. Central-to-peripheral corneal edema during wear of embedded-component contact lenses. Cont Lens Anterior Eye 2021; 45:101443. [PMID: 33846087 DOI: 10.1016/j.clae.2021.101443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/12/2021] [Accepted: 04/01/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE With active investigation underway for embedded-circuit contact lenses, safe oxygen supply of these novel lenses remains a question. Central-to-peripheral corneal edema for healthy eyes during wear of soft contact (SCL) and scleral lenses (SL) with embedding components is assessed. METHODS Various 2-dimensional (2D) designs of SL and SCL with embedded components are constructed on Comsol Multiphysics 5.5. Local corneal swelling associated with the designed lenses is determined by a recently developed 2D metabolic-swelling model. Settled central post-lens tear-film thicknesses (PoLTFs) are set at 400 μm and 3 μm for SL and SCL designs, respectively. Each lens design has an axisymmetric central and an axisymmetric peripheral embedment. Oxygen permeability (Dk) of the lens and the embedments ranges from 0 to 200 Barrer. Dimensions and location of the embedments are varied to assess optimal-design configurations to minimize central-to-peripheral corneal edema. RESULTS By adjusting oxygen Dk of the central embedment, the peripheral embedment, or the lens matrix polymer, corneal swelling is reduced by up to 2.5 %, 1.5 %, or 1.4 % of the baseline corneal thickness, respectively, while keeping all other parameters constant. A decrease in PoLTF thickness from 400 μm to 3 μm decreases corneal edema by up to 1.8 % of the baseline corneal thickness. Shifting the peripheral embedment farther out towards the periphery and towards the anterior lens surface reduces peak edema by up to 1.3 % and 0.6 % of the baseline corneal thickness, respectively. CONCLUSIONS To minimize central-to-peripheral corneal edema, embedments should be placed anteriorly and far into the periphery to allow maximal limbal metabolic support and oxygen transport in the polar direction (i.e., the θ-direction in spherical coordinates). High-oxygen transmissibility for all components and thinner PoLTF thickness are recommended to minimize corneal edema. Depending on design specifications, less than 1 % swelling over the entire cornea is achievable even with oxygen-impermeable embedments.
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Affiliation(s)
- Young Hyun Kim
- Vision Science Group, University of California, Berkeley, CA, 94720, United States; Chemical and Biomolecular Engineering Department, University of California, Berkeley, CA, 94720, United States; Clinical Research Center, School of Optometry, University of California, Berkeley, CA, 94720, United States
| | - Meng C Lin
- Vision Science Group, University of California, Berkeley, CA, 94720, United States; Clinical Research Center, School of Optometry, University of California, Berkeley, CA, 94720, United States
| | - Clayton J Radke
- Vision Science Group, University of California, Berkeley, CA, 94720, United States; Chemical and Biomolecular Engineering Department, University of California, Berkeley, CA, 94720, United States.
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15
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Stapleton F, Bakkar M, Carnt N, Chalmers R, Vijay AK, Marasini S, Ng A, Tan J, Wagner H, Woods C, Wolffsohn JS. CLEAR - Contact lens complications. Cont Lens Anterior Eye 2021; 44:330-67. [DOI: 10.1016/j.clae.2021.02.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
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16
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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18
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Abstract
SIGNIFICANCE Cytokine and protease analysis revealed relative changes in the post-lens tear film of scleral lenses with low and high limbal clearances. Results from this study indicate that midperipheral lens fit is an important fitting feature that can impact the inflammatory response of a keratoconic eye. PURPOSE The purpose of this study was to investigate changes in levels of inflammatory mediators in the post-lens tear film of keratoconic scleral lens wearers with varying limbal clearance designs. METHODS Twenty-two keratoconic eyes were fitted with two sets of scleral lenses that were consistent in lens diameter and central sagittal depth but varied in limbal clearance by approximately 50 μm. Lenses were worn in a randomly assigned order for a 2-week period each. At each follow-up visit, immediately after lens removal, tear samples were collected with a microcapillary tube (10 μL, 0.5 mm in diameter) from the bowl of the inverted scleral lens. Tear cytokine and protease analysis was performed using a multiplex electrochemiluminescent array (Meso Scale Discovery, Rockville, MD) instrument. Levels of interleukins 1, 6, and 8; tumor necrosis factor α; and matrix metalloproteinases 1 and 9 were compared and analyzed. RESULTS Levels of interleukin 1β, tumor necrosis factor α, and matrix metalloproteinase 1 increased with high limbal clearance (P = .01, .006, and .02, respectively). No change in interleukins 6 and 8 levels was found (P > .05). A decrease in matrix metalloproteinase 9 was noted in post-lens tear film of scleral lenses with high limbal clearance (P = .10). DISCUSSION Relative changes in the cytokine and protease levels were found when comparing low and high limbal clearance, indicating that the midperipheral lens fit is an important feature that can impact the inflammatory response of the keratoconic eye.
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Affiliation(s)
- Debby Yeung
- School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
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19
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Fisher D, Collins MJ, Vincent SJ. Fluid reservoir thickness and corneal oedema during closed eye scleral lens wear. Cont Lens Anterior Eye 2021; 44:102-107. [DOI: 10.1016/j.clae.2020.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/05/2020] [Accepted: 08/09/2020] [Indexed: 01/12/2023]
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20
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Fisher D, Collins MJ, Vincent SJ. Conjunctival prolapse during open eye scleral lens wear. Cont Lens Anterior Eye 2021; 44:115-9. [DOI: 10.1016/j.clae.2020.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 12/18/2022]
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21
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Phillis K, Brocks D, Carrasquillo KG. Case Report: Use of Prosthetic Replacement of the Ocular Surface Ecosystem Treatment of Traumatic Lid Ptosis in a Pediatric Patient. Optom Vis Sci 2020; 97:1029-33. [PMID: 33259377 DOI: 10.1097/OPX.0000000000001612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE This report shares the long-term outcomes of an uncommon use of prosthetic replacement of the ocular surface ecosystem (PROSE) treatment and scleral lenses in the treatment for patients with ptosis who are not surgical candidates. PURPOSE This study aimed to describe a case of pediatric traumatic lid ptosis and follow-up during an 8-year period with PROSE treatment. CASE REPORT A 7-year-old Honduran girl presented with a history of severe cranial, facial, and ocular trauma as a result of a motor vehicle accident. Significant ptosis with left-sided facial paralysis and irregular astigmatism significantly reduced the patient's visual function in the left eye. She was evaluated and treated with a scleral prosthetic device in the left eye to improve vision, the ocular surface, and overall function for activities of daily living. After 8 years of PROSE treatment, acuity in the left eye remained stable at 20/25. The corneal health remained stable throughout this period, without complications of corneal neovascularization or corneal edema. CONCLUSIONS Prosthetic replacement of the ocular surface ecosystem treatment provided support of the ocular surface and mechanical left upper eyelid lift in a traumatic eyelid ptosis, ultimately providing improved visual function during an extensive 8-year period in a pediatric patient. Further studies are needed to evaluate the applicability of this approach in broader ptosis cases.
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Nau A, Shorter ES, Harthan JS, Fogt JS, Nau CB, Schornack M. Multicenter review of impression-based scleral devices. Cont Lens Anterior Eye 2020; 44:101380. [PMID: 33199216 DOI: 10.1016/j.clae.2020.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/18/2020] [Accepted: 10/28/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe outcomes using impression based-scleral devices for the management of anterior segment disease. METHODS Retrospective chart review identified all patients who were fitted with impression-based scleral devices between January 1, 2013 and June 30, 2019 at three specialty contact lens practices. Patient demographic data, indication for device use, visual and physiological outcomes, as well as details of the fitting process and survival of device use were determined. RESULTS Forty-four patients (70 eyes) were included in the study. Primary indications for device use included corneal irregularity (28 patients, 44 eyes) and ocular surface disease (16 patients, 26 eyes). Fifty-four percent of patients had more than one ocular surface condition, and 39 % of patients had undergone at least one anterior segment surgical procedure. Twenty-nine patients had unsuccessfully attempted to wear standard scleral lenses prior to being fit with impression-based devices. Visual acuity improved significantly with impression-based devices compared to habitual correction (p < 0.001). Completion of the fitting process (including visit to acquire the impression and post-fitting assessments) required an average of 4 [1.5] visits.Ideal haptic alignment was achieved with 74 % and complete limbal clearance was achieved in 83 % of fits. Device use was discontinued due to complications in two eyes. CONCLUSION Patients with complex eye disease who are unable to successfully wear standard scleral lenses successfully may achieve visual and therapeutic success with impression-based devices.
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Affiliation(s)
- Amy Nau
- Korb & Associates, Boston, MA, USA; New England College of Optometry, Boston, MA, USA.
| | | | | | - Jennifer S Fogt
- Ohio State University College of Optometry, Columbus, OH, USA
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23
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Kim YH, Lin MC, Radke CJ. Letter to the Editor: "Fluid reservoir thickness and corneal oedema during closed eye scleral lens wear," by Damien Fisher, Michael J. Collins, and Stephen J. Vincent. Cont Lens Anterior Eye 2021; 44:123. [PMID: 33153900 DOI: 10.1016/j.clae.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/08/2020] [Indexed: 11/20/2022]
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24
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Fisher D, Collins MJ, Vincent SJ. Fluid reservoir thickness and corneal oedema during closed eye scleral lens wear: Experimental and theoretical outcomes. Cont Lens Anterior Eye 2020; 44:124-125. [PMID: 33109472 DOI: 10.1016/j.clae.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/08/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Damien Fisher
- Queensland University of Technology (QUT), Centre for Vision and Eye Research, School of Optometry and Vision Science, Contact Lens and Visual Optics Laboratory, Australia.
| | - Michael J Collins
- Queensland University of Technology (QUT), Centre for Vision and Eye Research, School of Optometry and Vision Science, Contact Lens and Visual Optics Laboratory, Australia
| | - 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, Australia
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Harthan JS, Schornack M, Nau CB, Nau AC, Fogt JS, Shorter ES. Current U.S. based optometric scleral lens curricula and fitting recommendations: SCOPE educators survey. Cont Lens Anterior Eye 2020; 44:101353. [PMID: 32951995 DOI: 10.1016/j.clae.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/27/2020] [Accepted: 07/31/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe current components of scleral lens curricula at U.S. based optometry colleges and universities. METHODS Contact lens educators were surveyed between June 2019 and August 2019 regarding their optometric scleral lens curriculum. Respondents were asked to describe their experience and involvement in optometric scleral lens education as well as to describe components of scleral lens curricula. Educators were also asked to identify sources of information upon which they rely on in order to stay informed about new developments and best practices in scleral lens prescription and management. RESULTS Most programs begin scleral lens education during the 3rd year of optometric education (71.2 %; n = 52). Students complete an estimated 18.0 ± 18.1 (range 2-100) scleral lens evaluations during training (n = 36). Ideal fitting characteristics taught include central corneal clearance of 206.3 ± 44 microns (range 150-350, n = 40), limbal clearance of 62.1 ± 23.6 microns (range 20-100, n = 36) with one clock hour or less of conjunctival vascular compression (n = 41). Educators ranked in-person continuing education (61 %, 22/36) followed by contact lens laboratory consults (22 %, 8/36) as the two most important sources of information on best practices in scleral lens prescription and management. CONCLUSIONS Educators are uniquely positioned to guide the next generation of eyecare providers by incorporating and disseminating new research findings into their scleral lens curricula.
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Affiliation(s)
| | | | | | - Amy C Nau
- Korb & Associates, 400 Commonwealth Ave #2, Boston, MA, United States
| | - Jennifer S Fogt
- The Ohio State University College of Optometry, Columbus, OH, United States
| | - Ellen S Shorter
- University of Illinois at Chicago, Chicago, IL, United States
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26
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Abstract
SIGNIFICANCE Because the prognosis of corneal regrafting is worse than a primary graft, it is pertinent to recognize other clinical management options to postpone the need for surgical intervention. Scleral lenses are a viable option in achieving excellent vision and comfort for post-graft patients; however, close monitoring is vital to success. PURPOSE The purpose of this study was to report a case in which a post-graft keratoconus patient can be successfully fit and refit with scleral lenses as their corneal tissue changes shape with time. Ultimately, the goal for this patient was to delay the need for regrafting procedures. CASE REPORT This case presents a 57-year-old patient who has undergone penetrating keratoplasty in both eyes secondary to keratoconus. His original corneal grafts were 15 years or older. Because of a history of graft rejection in the right eye, he had a regraft in 2004. The left eye has signs of early rejection. The patient has been a scleral lens wearer since 2008. Within the past 24 months, he has required lens adjustments and refits because his fragile corneal tissue has changed shape. Lens changes were indicated when he presented with complaints of fogging associated with redness and irritation. We continued to work closely with the patient's corneal ophthalmologist, who recommended we maximize scleral lens wear in lieu of a corneal regraft. Because of the change from an oblate to prolate cornea, fitting this patient in a scleral lens has been a challenging task. CONCLUSIONS Scleral lenses are a viable option in post-graft patients who present with ectatic changes to their corneal tissue. This patient continues to see 20/20 in each eye and comfortably wears his lenses for up to 6 hours. By fitting this patient in a scleral lens, we have been able to avoid the need for a regraft and the possible negative outcomes that can be associated.
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Dhallu SK, Huarte ST, Bilkhu PS, Boychev N, Wolffsohn JS. Effect of Scleral Lens Oxygen Permeability on Corneal Physiology. Optom Vis Sci 2020; 97:669-75. [DOI: 10.1097/opx.0000000000001557] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Pucker AD. 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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kim YH, Lin MC, Radke CJ. Limbal Metabolic Support Reduces Peripheral Corneal Edema with Contact-Lens Wear. Transl Vis Sci Technol 2020; 9:44. [PMID: 32832249 PMCID: PMC7414613 DOI: 10.1167/tvst.9.7.44] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/14/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the influence of limbal metabolic support on corneal edema during scleral-lens (SL) and soft-contact-lens (SCL) wear for healthy lens wearers. Methods A two-dimensional (2D) model of the cornea and sclera was designed on Comsol Multiphysics 5.4 along with SL and SCL architectures to mimic lens-wear induced hypoxia. The cornea is suffused with oxygen and metabolites from the limbus and aqueous humor. Air oxygen is supplied from and carbon dioxide is expelled to the atmosphere. Lens-oxygen permeability (Dk) was adjusted to investigate lens-wear safety against edema in different wear conditions. The 2D concentrations of oxygen, carbon dioxide, bicarbonate, lactate, sodium, chloride, glucose, and pH are quantified. Central-to-peripheral swelling of the cornea is determined by the change in stromal hydration caused by changing metabolite concentrations at the endothelium during hypoxia. Results The metabolic model assesses central-to-peripheral corneal swelling with different types of lenses, and oxygen Dks. Limbal metabolic support reduces edema from the periphery to approximately 1 mm away from the central cornea. Despite thicker lens designs, the peripheral cornea exhibits practically zero swelling due to limbal metabolic support. Conclusions The metabolic model accurately predicts central-to-peripheral corneal edema with various contact-lens designs, post-lens tear-film thicknesses, and lens oxygen Dk values. Despite the thicker periphery of most contact-lens designs, lactate and bicarbonate support from the limbus significantly reduces peripheral and mid-peripheral corneal edema, whereas oxygen has a lesser effect. Translational Relevance By utilizing metabolic kinetics, we provide a 2D computational tool to predict oxygenation safety across the entire cornea with various types and designs of contact lenses.
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Affiliation(s)
- Young Hyun Kim
- Vision Science Group, University of California, Berkeley, CA, USA.,Chemical and Biomolecular Engineering Department, University of California, Berkeley, CA, USA.,Clinical Research Center, School of Optometry, University of California, Berkeley, CA, USA
| | - Meng C Lin
- Vision Science Group, University of California, Berkeley, CA, USA.,Clinical Research Center, School of Optometry, University of California, Berkeley, CA, USA
| | - Clayton J Radke
- Vision Science Group, University of California, Berkeley, CA, USA.,Chemical and Biomolecular Engineering Department, University of California, Berkeley, CA, USA
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Kramer EG, Vincent SJ. Intraocular pressure changes in neophyte scleral lens wearers: A prospective study. Cont Lens Anterior Eye 2020; 43:609-612. [PMID: 32507406 DOI: 10.1016/j.clae.2020.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE To examine the variation in intraocular pressure (IOP) during the first six months of scleral lens wear. METHODS Thirty-two neophyte scleral lens wearers were recruited and IOP was measured using Goldman applanation tonometry before, and after 1 and 6 months of scleral lens wear (following lens removal). All scleral lenses were designed based on scleral topography or an impression of the ocular surface. Central corneal thickness and the central post-lens fluid reservoir thickness were quantified using optical coherence tomography. RESULTS Post-lens removal IOP displayed an increasing trend after 1 and 6 months of lens wear, but the magnitude of change was not clinically or statistically significant using several repeated measures analyses to account for sporadic missing longitudinal data (mean increase of 1 mmHg or less, p > 0.05). Central corneal thickness and the central post-lens fluid reservoir remained stable throughout the first six months of lens wear. CONCLUSION IOP measured following lens removal did not vary significantly during the first 6 months of lens wear in scleral lens neophytes. Further research is required to determine if IOP varies during lens wear, following lens removal, or after longer-term lens wear due to suction forces or tissue compression beneath the landing zone.
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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, Institute of Health and Biomedical Innovation, Queensland, Australia.
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Vincent SJ, Fadel D. Optical considerations for scleral contact lenses: A review. Cont Lens Anterior Eye 2019; 42:598-613. [DOI: 10.1016/j.clae.2019.04.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 01/07/2023]
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Macedo-de-araújo RJ, Amorim-de-sousa A, van der Worp E, González-méijome JM. Clinical Findings and Ocular Symptoms Over 1 Year in a Sample of Scleral Lens Wearers. Eye Contact Lens 2020; 46:e40-55. [DOI: 10.1097/icl.0000000000000672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shahnazi KC, Isozaki VL, Chiu GB. Effect of Scleral Lens Wear on Central Corneal Thickness and Intraocular Pressure in Patients With Ocular Surface Disease. Eye Contact Lens 2020; 46:341-7. [DOI: 10.1097/icl.0000000000000670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tan B, Tse V, Kim YH, Lin K, Zhou Y, Lin MC. Effects of scleral-lens oxygen transmissibility on corneal thickness: A pilot study. Cont Lens Anterior Eye 2019; 42:366-372. [DOI: 10.1016/j.clae.2019.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 03/20/2019] [Accepted: 04/03/2019] [Indexed: 11/26/2022]
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35
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Tse V, Tan B, Kim YH, Zhou Y, Lin MC. Tear dynamics under scleral lenses. Cont Lens Anterior Eye 2018; 42:43-48. [PMID: 30545775 DOI: 10.1016/j.clae.2018.11.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 11/17/2018] [Accepted: 11/28/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate post-lens tear dynamics at two different time points during scleral lens wear in two cohorts with 10 neophytes each. METHODS All subjects wore bilaterally scleral lenses for 5 h on 3 separate visits. Post-lens tear exchange was measured using Out-in method, which required 5 μL of 2% FITC-Dextran instilled on the bulbar conjunctiva during lens wear. Time taken to observe the first sign of fluorescence in post-lens tear reservoir was recorded with a stopwatch. Out-in measurements were collected at 5-hour post-lens insertion in Group 1 and compared with those obtained at 20 min of lens wear in Group 2. Tear dynamics under the lens was observed in Group 2 with fluorogram using a modified slit-lamp technique (Tan et al., 2018) to monitor post-lens fluorescence intensity and with high-resolution spectral domain optical coherence tomography (ENVISU 2300; Bioptigen Inc.) to measure post-lens tear thickness (PoLTT) over 5 h of lens wear. RESULTS 60% of subjects in Group 1 achieved Out-in times less than 5 min at 5-hour post-lens insertion, compared with 67% of subjects at 20-min lens wear (Tan et al., 2018). Using qualitative analysis on 60 series of data in Group 2 to compare the changes in fluorescence intensity and PoLTT with respect to lens-wearing time, 27% was due to lens settling, 13% was due to tear exchange and mixing while 60% indicated tear dynamics under scleral lenses was due to a combination of tear exchange, mixing, and lens settling. CONCLUSION Tear flow into tear reservoir under a scleral lens on subjects with healthy cornea occurred at 20 min and 5 h after lens insertion. After 5 h of lens wear, roughly one third of the subjects had no tear flow into post-lens reservoir, as the observed decline in post-lens tear fluorescence was predominately due to lens settling.
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Affiliation(s)
- Vivien Tse
- Clinical Research Center, School of Optometry, University of California, Berkeley, United States
| | - Bo Tan
- Clinical Research Center, School of Optometry, University of California, Berkeley, United States
| | - Young Hyun Kim
- Clinical Research Center, School of Optometry, University of California, Berkeley, United States; Vision Science Graduate Program, University of California, Berkeley, United States; Chemical and Biomolecular Engineering Department, University of California, Berkeley, United States
| | - Yixiu Zhou
- Clinical Research Center, School of Optometry, University of California, Berkeley, United States
| | - Meng C Lin
- Clinical Research Center, School of Optometry, University of California, Berkeley, United States; Vision Science Graduate Program, University of California, Berkeley, United States.
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