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Santodomingo-Rubido J, Carracedo G, Suzaki A, Villa-Collar C, Vincent SJ, Wolffsohn JS. Keratoconus: An updated review. Cont Lens Anterior Eye 2022; 45:101559. [PMID: 34991971 DOI: 10.1016/j.clae.2021.101559] [Citation(s) in RCA: 167] [Impact Index Per Article: 83.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/23/2021] [Accepted: 12/12/2021] [Indexed: 02/06/2023]
Abstract
Keratoconus is a bilateral and asymmetric disease which results in progressive thinning and steeping of the cornea leading to irregular astigmatism and decreased visual acuity. Traditionally, the condition has been described as a noninflammatory disease; however, more recently it has been associated with ocular inflammation. Keratoconus normally develops in the second and third decades of life and progresses until the fourth decade. The condition affects all ethnicities and both sexes. The prevalence and incidence rates of keratoconus have been estimated to be between 0.2 and 4,790 per 100,000 persons and 1.5 and 25 cases per 100,000 persons/year, respectively, with highest rates typically occurring in 20- to 30-year-olds and Middle Eastern and Asian ethnicities. Progressive stromal thinning, rupture of the anterior limiting membrane, and subsequent ectasia of the central/paracentral cornea are the most commonly observed histopathological findings. A family history of keratoconus, eye rubbing, eczema, asthma, and allergy are risk factors for developing keratoconus. Detecting keratoconus in its earliest stages remains a challenge. Corneal topography is the primary diagnostic tool for keratoconus detection. In incipient cases, however, the use of a single parameter to diagnose keratoconus is insufficient, and in addition to corneal topography, corneal pachymetry and higher order aberration data are now commonly used. Keratoconus severity and progression may be classified based on morphological features and disease evolution, ocular signs, and index-based systems. Keratoconus treatment varies depending on disease severity and progression. Mild cases are typically treated with spectacles, moderate cases with contact lenses, while severe cases that cannot be managed with scleral contact lenses may require corneal surgery. Mild to moderate cases of progressive keratoconus may also be treated surgically, most commonly with corneal cross-linking. This article provides an updated review on the definition, epidemiology, histopathology, aetiology and pathogenesis, clinical features, detection, classification, and management and treatment strategies for keratoconus.
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Affiliation(s)
| | - Gonzalo Carracedo
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Asaki Suzaki
- Clinical Research and Development Center, Menicon Co., Ltd., Nagoya, Japan
| | - Cesar Villa-Collar
- Department of Pharmacy, Biotechnology, Nutrition, Optics and Optometry, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Stephen J Vincent
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Australia
| | - James S Wolffsohn
- School of optometry, Health and Life Sciences, Aston University, Birmingham B4 7ET, United Kingdom
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Jacobs DS, Carrasquillo KG, Cottrell PD, Fernández-Velázquez FJ, Gil-Cazorla R, Jalbert I, Pucker AD, Riccobono K, Robertson DM, Szczotka-Flynn L, Speedwell L, Stapleton F. CLEAR - Medical use of contact lenses. Cont Lens Anterior Eye 2021; 44:289-329. [PMID: 33775381 DOI: 10.1016/j.clae.2021.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022]
Abstract
The medical use of contact lenses is a solution for many complex ocular conditions, including high refractive error, irregular astigmatism, primary and secondary corneal ectasia, disfiguring disease, and ocular surface disease. The development of highly oxygen permeable soft and rigid materials has extended the suitability of contact lenses for such applications. There is consistent evidence that bandage soft contact lenses, particularly silicone hydrogel lenses, improve epithelial healing and reduce pain in persistent epithelial defects, after trauma or surgery, and in corneal dystrophies. Drug delivery applications of contact lens hold promise for improving topical therapy. Modern scleral lens practice has achieved great success for both visual rehabilitation and therapeutic applications, including those requiring retention of a tear reservoir or protection from an adverse environment. This report offers a practical and relevant summary of the current evidence for the medical use of contact lenses for all eye care professionals including optometrists, ophthalmologists, opticians, and orthoptists. Topics covered include indications for use in both acute and chronic conditions, lens selection, patient selection, wear and care regimens, and recommended aftercare schedules. Prevention, presentation, and management of complications of medical use are reviewed.
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Affiliation(s)
- Deborah S Jacobs
- Massachusetts Eye & Ear, Cornea and Refractive Surgery Service, Harvard Medical School, Boston, MA, USA.
| | | | | | | | | | | | | | | | | | - Loretta Szczotka-Flynn
- Department of Ophthalmology & Visual Science, Case Western Reserve University, Cleveland, OH, USA
| | - Lynne Speedwell
- Great Ormond Street Hospital for Children NHS Trust, Moorfields Eye Hospital, London, UK
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Australia
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Carballo-Alvarez J, Mari-Ribas M, Martin-Gonzalez A, Batres L. Is soft toric contact lenses fitting a feasible option to improve optical quality and visual performance in corneal ectasia? Cont Lens Anterior Eye 2021; 45:101434. [PMID: 33714679 DOI: 10.1016/j.clae.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/17/2021] [Accepted: 03/07/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess the feasibility of fitting soft toric contact lenses (STCL) in corneal ectasias and their impact on optical quality and visual performance. METHODS A total of 22 eyes were fitted with a molded STCL: 11 eyes/9 subjects with corneal ectasia and 11 healthy eyes/11 subjects. Wavefront aberrations were analyzed using a Hartmann-Shack aberrometer. Visual performance was measured under photopic (85 cd/m 2) and mesopic (≤3 cd/m 2) conditions. High-(96 %) and low- (10 %) contrast VA (HCVA and LCVA respectively) were assessed using the ETDRS charts and contrast sensitivity (CS) using the Pelli-Robson chart. RESULTS After STCL fitting in the ectatic corneas, oblique astigmatism increased 0.15±0.17 μm and 0.34 ± 0.36 μm for 3 mm- and mesopic pupil diameters, respectively. Mean defocus decreased 1.41 ± 0.36 μm and 2.17 ± 0.85 μm for the same pupil diameters. More positive values of vertical coma were found with a change of 0.05 ± 0.06 μm and 0.12 ± 0.10 μm for 3 mm and mesopic pupil diameters, respectively. Comparing changes between both groups, with a 3 mm pupil aperture, statistically significant differences (p < 0.05) were detected in oblique astigmatism, defocus, vertical secondary trefoil and horizontal secondary coma. In the group with corneal ectasia, photopic HCVA and LCVA improved 0.09 ± 0.11 logMAR and 0.12 ± 0.15 logMAR respectively. In mesopic conditions, HCVA, LCVA and CS improved 0.11 ± 0.12 logMAR, 0.18 ± 0.15 logMAR and 0.11 ± 0.07 log. units, respectively. CONCLUSIONS The analyzed molded soft toric contact lens is a feasible option for good vision in corneal ectasia with moderate irregularity and negative vertical coma.
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Affiliation(s)
| | - Marina Mari-Ribas
- Faculty of Optics and Optometry, Complutense University of Madrid, Spain
| | | | - Laura Batres
- Faculty of Optics and Optometry, Complutense University of Madrid, Spain
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Lim L, Lim EWL. Current perspectives in the management of keratoconus with contact lenses. Eye (Lond) 2020; 34:2175-2196. [PMID: 32641797 PMCID: PMC7784906 DOI: 10.1038/s41433-020-1065-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 05/30/2020] [Accepted: 06/22/2020] [Indexed: 11/08/2022] Open
Abstract
Our aim is to review current and significant articles on contact lens wear in keratoconus patients. A comprehensive literature search of PubMed was performed for the following topics on contact lens wear in keratoconus patients: (1) characteristics of contact lens wearers, (2) safety and efficacy, (3) complications, (4) fitting techniques, (5) contact lens wear after procedures/surgeries, (6) patient satisfaction. A total of 104 studies were finally selected and reviewed. Gas permeable (GP) lens wear provided significantly better vision than glasses. Special cone design lenses had better patient comfort levels though there was no difference in best corrected visual acuity among the GP lenses. Soft lenses showed good efficacy for the treatment of mild-to-moderate keratoconus with newer designs improving visual performance such as customised hydrogel and novel pinhole lenses. Scleral and hybrid lenses provide good visual acuity and comfort for keratoconic patients previously intolerant to RGP lenses. RGP lens wear post-cross linking (CXL) is relatively well-tolerated. Contact lenses may still be required post intrastromal corneal ring procedures and post keratoplasty. Scheimpflug imaging and anterior segment optical coherent tomography (ASOCT) are useful in contact lens fitting. Computerized contact lens fitting techniques could reduce the chair time of lens fitting as well as improve comfort and visual performance. Contact lenses play an important role in the visual rehabilitation of keratoconus patients. New contact lens designs and materials have significantly expanded the available fitting options for keratoconus patients. Imaging technology can be utilized to guide contact lens fitting.
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Affiliation(s)
- Li Lim
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.
- Singapore Eye Research Institute, 20 College Road Discovery Tower Level 6, The Academia, Singapore, 169856, Singapore.
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - Elizabeth Wen Ling Lim
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore, 119228, Singapore
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Abstract
Keratoconus (KC) is a progressive disease that leads to a decrease in visual acuity and quality and impairs vision-related quality of life. Contact lens (CL) application has a primary place and importance in the correction of the optic problems due to the disease. The corneal changes and increased irregular astigmatism that occur with KC progression necessitate special CL designs and fitting methods. In addition to disease stage, the patient's lens tolerance also plays a role in the application of CLs in KC patients. With recent advances in materials and design technology, the CLs used in the treatment of KC have developed considerably and there are various types available. In this review, we discuss the wide range of CLs, including rigid and soft lenses, hybrid and scleral lenses, and even custom lens designs, in light of recent scientific advances.
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Affiliation(s)
| | - Sevda Aydın Kurna
- University of Health Sciences Turkey, Fatih Sultan Mehmet Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Turkey
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Montalt JC, Porcar E, España-Gregori E, Peris-Martínez C. Visual quality with corneo-scleral contact lenses after intracorneal ring segment (ICRS) implantation for keratoconus management. Cont Lens Anterior Eye 2019; 42:111-116. [DOI: 10.1016/j.clae.2018.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/17/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
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Scleral lens after intracorneal ring segments in patients with keratoconus. Cont Lens Anterior Eye 2018; 41:234-237. [DOI: 10.1016/j.clae.2017.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 10/13/2017] [Accepted: 10/13/2017] [Indexed: 11/23/2022]
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Carracedo G, Canales J, Gonzalez P, Recchioni A, Carpena-Torres C, Carballo-Álvarez J. The effect of soft contact lens thickness in visual function after intracorneal ring segments surgery. Cont Lens Anterior Eye 2018; 41:180-186. [DOI: 10.1016/j.clae.2017.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 08/29/2017] [Accepted: 09/29/2017] [Indexed: 11/26/2022]
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Abstract
PURPOSE To analyze the variation in vertical coma and the rest of ocular aberrations before and after fitting prismatic soft contact lenses (PSCL). METHODS Thirty-seven eyes of 20 healthy subjects (24.30±2.03 years) were evaluated to analyze the variation in ocular wavefront aberrations before and after fitting PSCL of different base-down prism values (1.0, 1.5, and 2.0 prism diopters [PD]), designed to study its influence in the compensation of vertical coma aberration. A Hartmann-Shack sensor with a wavelength of 780 nm was used, considering a pupil size of 3 mm. In addition, the influence of PSCL in visual function under photopic conditions in terms of high-contrast visual acuity and contrast sensitivity was evaluated. RESULTS There was statistically significant differences (P<0.05) in ocular aberrations from first to seventh order after fitting PSCL, but only the differences in vertical tilt, horizontal tilt, defocus, vertical astigmatism, and vertical coma were clinically relevant (Strehl ratio <0.8). The mean of vertical coma (μm) was 0.022±0.030 for control, 0.045±0.064 for 1.0 PD (P=0.645), 0.048±0.053 for 1.5 PD (P=0.037), and 0.074±0.047 for 2.0 PD (P<0.001). The changes in visual function under photopic conditions were not clinically relevant. CONCLUSIONS PSCL induce a magnitude of vertical coma aberration directly proportional to prism value without affecting the rest of ocular high-order aberrations.
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Nonsurgical Procedures for Keratoconus Management. J Ophthalmol 2017; 2017:9707650. [PMID: 29430305 PMCID: PMC5753012 DOI: 10.1155/2017/9707650] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/02/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives To describe the past 20 years' correction modalities for keratoconus and their visual outcomes and possible complications. Methods A review of the published literature related to the visual outcomes and possible complications in the context of keratoconus management using nonsurgical procedures for the last 20 years (glasses and contact lenses) was performed. Original articles that reported the outcome of any correction modalities of keratoconus management were reviewed. Results The most nonsurgical procedure used on keratoconus management is the contact lens fitting. Soft contact lenses and soft toric contact lenses, rigid gas-permeable contact lenses, piggyback contact lens system, hybrid contact lenses, and scleral and corneoscleral contact lenses form the contemporary range of available lens types for keratoconus management with contact lenses. All of them try to restore the vision, improve the quality of life, and delay surgical procedures in patients with this disease. Complications are derived from the intolerance of using contact lens, and the use of each depends on keratoconus severity. Conclusions In the context of nonsurgical procedures, the use of contact lenses for the management of keratoconic patients represents a good alternative to restore vision and improve the quality of live in this population.
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Puell MC, Carballo-Álvarez J. Forward light scatter and visual acuity before and after intrastromal corneal ring segment implantation at different stages of keratoconus. Acta Ophthalmol 2016; 94:e738-e743. [PMID: 27129433 DOI: 10.1111/aos.13056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/15/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE To assess forward light scatter (stray light) before and after intrastromal corneal ring segment (ICRS) implantation at different stages of keratoconus and to examine correlation between postoperative stray light and visual acuity (VA). METHODS In 27 eyes of 27 subjects with keratoconus, stray light was determined using the compensation comparison technique before and 6 months after ICRS implantation. Monocular corrected distance VA (CDVA) was measured using a high-contrast logMAR letter chart. Corneal higher-order aberrations (HOAs), contrast sensitivity (CS) and minimum corneal thickness (CT) were also measured. RESULTS Mean CDVA was 0.42 ± 0.28 preoperatively and 0.24 ± 0.15 logMAR postoperatively (p < 0.01). Mean corneal coma-like aberration decreased postoperatively (RMS 0.55 ± 1.18 μm, p < 0.01). Minimum CT increased 25.31 ± 18.59 μm (p < 0.01). Mean preoperative and postoperative stray light were 1.36 ± 0.31 and 1.48 ± 0.32 log units, respectively (p < 0.01). Mean changes produced in stray light (worsening) were 0.03 ± 0.21 (p > 0.05) for stage I, 0.13 ± 0.14 (p = 0.013) for stage II and 0.18 ± 0.21 (p = 0.023) for stage III. Significant positive correlation (r = 0.47, p = 0.01) was detected between postoperative stray light and postoperative CDVA such that as stray light increased, CDVA worsened (higher logMAR values). Postoperative stray light was neither associated with HOAs, CS nor minimum CT. CONCLUSIONS Stray light values in these patients with keratoconus were higher than normal preoperatively. In eyes with stage II and III keratoconus, stray light increased 6 months after ICRS placement. Higher postoperative stray light was correlated with a worse visual acuity outcome.
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Affiliation(s)
- María Cinta Puell
- Applied Vision Research Group; Faculty of Optics and Optometry; Complutense University of Madrid; Madrid Spain
| | - Jesús Carballo-Álvarez
- Applied Vision Research Group; Faculty of Optics and Optometry; Complutense University of Madrid; Madrid Spain
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Feasibility of custom-made hydrogel contact lenses in keratoconus with previous implantation of intracorneal ring segments. Cont Lens Anterior Eye 2015; 38:351-6. [DOI: 10.1016/j.clae.2015.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 02/11/2015] [Accepted: 03/31/2015] [Indexed: 11/21/2022]
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Romero-Jiménez M, Santodomingo-Rubido J, González-Meijóme JM, Flores-Rodriguez P, Villa-Collar C. Which soft lens power is better for piggyback in keratoconus? Part II. Cont Lens Anterior Eye 2015; 38:48-53. [DOI: 10.1016/j.clae.2014.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 09/18/2014] [Accepted: 09/26/2014] [Indexed: 11/30/2022]
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