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Qiu SX, Fadel D, Hui A. Scleral Lenses for Managing Dry Eye Disease in the Absence of Corneal Irregularities: What Is the Current Evidence? J Clin Med 2024; 13:3838. [PMID: 38999403 PMCID: PMC11242693 DOI: 10.3390/jcm13133838] [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: 05/01/2024] [Revised: 06/15/2024] [Accepted: 06/26/2024] [Indexed: 07/14/2024] Open
Abstract
Scleral lenses (SLs) are large-diameter rigid contact lenses that are a mainstay treatment for eyes with corneal irregularities. In recent years, there has been increased interest in the role of managing dry eye disease (DED) with SLs, as many patients with DED have reported symptomatic relief with SL wear. The role of SLs for DED management when there are associated corneal irregularities is supported by individual case reports and studies. This has prompted practitioners to begin advocating using SLs in DED cases, even in the absence of associated corneal irregularities and other ocular surface diseases (OSDs). There have also been discussions on potentially placing SLs earlier in the treatment hierarchy of DED, where it currently sits at a more advanced level of intervention (Step 3) in the TFOS DEWS II Report. This review will present the currently available, albeit sparse, evidence that supports and suggests this practice, as well as ancillary evidence supporting the purported benefits of SL wear in DED. The advantages of SL wear, such as corneal healing, absence of tear evaporation and contact lens dehydration, and improved visual acuity with associated increased wear comfort, and how this will benefit DED patients will be explored. Conversely, the challenges associated with fitting SLs in DED patients, including increased midday fogging, poor wettability, and subjective patient satisfaction, will also be presented, as well as a discussion on the key considerations for SL fitting in this population. Overall, while more research is needed to support the use of SLs in DED patients without associated corneal irregularities and other forms of OSD, the use of these lenses may prove to have a potentially wider role given their reported ancillary benefits in these populations.
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Affiliation(s)
- Sharon X Qiu
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Daddi Fadel
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Alex Hui
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW 2052, Australia
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Balıkçı AT, Ulutaş HG. Evaluation of Corneal Parameters and Meibomian Gland Alterations After Corneal Cross-Linking in Patients With Progressive Keratoconus. Eye Contact Lens 2023; 49:110-115. [PMID: 36729083 DOI: 10.1097/icl.0000000000000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 11/07/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The aim of the study was to evaluate the changes in corneal parameters and meibomian gland alterations after corneal cross-linking (CXL) for progressive keratoconus. METHODS Thirty nine eyes of 39 keratoconus patients were treated with CXL. Corneal topography, specular microscopy, the Ocular Surface Disease Index© (OSDI), noninvasive tear break-up time (NITBUT), and meibography indices were evaluated preoperatively and at the first, third, and sixth months after CXL. RESULTS The flattest keratometry (K1) ( P =0.003), steepest keratometry (K2) ( P <0.001), apex, central, and thinnest corneal thicknesses ( P <0.001) showed significant differences after cross-linking, whereas the changes in the maximum keratometry (Kmax) were not significant ( P =0.140). The endothelial cell density, coefficient of variation, and hexagonality were unchanged. The NITBUT values decreased after cross-linking; however, there was no significant change in OSDI index ( P =0.313), meiboscore ( P =0.392), and meibomian gland loss degrees ( P =0.300). No change was detected in the morphology of the meibomian glands after CXL. CONCLUSION In eyes with keratoconus, a flattening in keratometry readings and thinning in corneal thickness were observed after CXL. The corneal endothelium is protected by dextran-free riboflavin. Cross-linking procedure causes dry eye by changing the corneal structure without affecting the morphology of the meibomian glands.
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Affiliation(s)
- Ayşe Tüfekçi Balıkçı
- University of Health Sciences (A.T.B.), Ankara Training and Research Hospital, Department of Ophthalmology, Ankara, Turkey; and University of Health Sciences (H.G.U.), Bursa Yüksek Ihtisas Training and Research Hospital, Department of Ophthalmology, Bursa, Turkey
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Bubnova IA, Sarkisova KG. [Changes in precorneal tear film and ocular surface in keratoconic patients after corneal collagen cross-linking]. Vestn Oftalmol 2022; 138:118-123. [PMID: 35801890 DOI: 10.17116/oftalma2022138031118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The article reviews the current available data on the signs and symptoms of dry eye syndrome (DES) in patients with keratoconus (KC), describes the clinical features of DES in KC patients and the morphological features of this type of keratectasia that lead to manifestations of the «dry eye», and highlights the risk factors, consequences of therapeutic measures, concomitant ophthalmological and general somatic diseases that contribute to the development of DES in KC.
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Affiliation(s)
- I A Bubnova
- Research Institute of Eye Diseases, Moscow, Russia
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Shorter E, Harthan J, Nau A, Fogt J, Cao D, Schornack M, Nau C. Dry Eye Symptoms in Individuals With Keratoconus Wearing Contact Lenses. Eye Contact Lens 2021; 47:515-519. [PMID: 34424225 PMCID: PMC8385958 DOI: 10.1097/icl.0000000000000802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess dry eye symptoms associated with different contact lens modalities in patients with keratoconus using a dry eye questionnaire. METHODS An online survey was distributed by the National Keratoconus Foundation. The survey asked participants to report demographic characteristics, current optical correction, age at the time of diagnosis of keratoconus, and contact lens history. The 12-item Ocular Surface Disease Index (OSDI) questionnaire was also completed. Data from participants wearing the same contact lens modality bilaterally were analyzed. RESULTS The survey was completed by 197 individuals wearing the same contact lens modality bilaterally. The average age of participants at the time of the survey was 47.2±14.8 years (range: 15-87 years), and the average age at which keratoconus was diagnosed was 26.1±9.9 years (range: 8-55 years). The mean overall OSDI score of all participants was 40.2±22.8 (range: 0-100). There was no difference in the mean OSDI scores based on current contact lens modality type (F=1.79; n=187; P=0.13). Based on an OSDI score of 33 or higher, 90% of participants reported symptoms indicative of dry eye disease. Scleral lens wearers reported less discomfort on the individual items related to windy and low-humidity conditions. CONCLUSIONS Individuals with keratoconus, irrespective of contact lens modality, report a high incidence of dry eye symptoms.
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Affiliation(s)
- Ellen Shorter
- Department of Ophthalmology and Visual Sciences (E.S., D.C.), University of Illinois at Chicago, Chicago, IL; Cornea Center for Clinical Excellence (J.H.), Illinois College of Optometry, Chicago, IL; Korb & Associates (A.N.), Boston, MA; College of Optometry (J.F.), Ohio State University College of Optometry, Columbus, OH; and Mayo Clinic (M.S., C.N.), Rochester, MN
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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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Crawford AZ, Zhang J, Gokul A, McGhee CNJ, Ormonde SE. The Enigma of Environmental Factors in Keratoconus. Asia Pac J Ophthalmol (Phila) 2020; 9:549-556. [PMID: 33284230 DOI: 10.1097/apo.0000000000000334] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Keratoconus is an ectatic disorder with highly complex and varied causes including genetic variations and environmental factors. Its prevalence varies widely between regions and countries. Many environmental factors have been proposed to be associated with keratoconus, but the interpretation of their individual contributions is difficult due to the presence of many confounding variables. The current literature was reviewed to evaluate the strength of the associations and the causative effects of environmental factors on keratoconus. Ethnicity and consanguinity have been revealed as important determinants for geographical variations in keratoconus prevalence. Eye rubbing, atopy, floppy eyelid syndrome, contact lens wear, pregnancy, and thyroid hormone disturbances are likely associated with keratoconus. The first 4 factors can induce ocular surface inflammation, matrix metalloproteinase release, and keratocyte apoptosis, consistent with the postulated etiology of keratoconus. The associations of keratoconus with UV exposure, cigarette smoking, personality, and sex were less convincing once confounding factors were considered. Future studies powered for multivariate analysis of factors discussed will hopefully shed light on what is truly important in the development and progression of keratoconus.
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Affiliation(s)
- Alexandra Z Crawford
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Jie Zhang
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Akilesh Gokul
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Sue E Ormonde
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
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The scientific dry eye disease journey: From the beginning to the end of the beginning. Cont Lens Anterior Eye 2017; 41:1-4. [PMID: 29162386 DOI: 10.1016/j.clae.2017.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bonner DR, Winokur EJ. The “Eyes” Have It: Reviewing Keratoconus, the Nurse Practitioner Perspective. J Nurse Pract 2017. [DOI: 10.1016/j.nurpra.2017.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Molecular and Histopathological Changes Associated with Keratoconus. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7803029. [PMID: 28251158 PMCID: PMC5303843 DOI: 10.1155/2017/7803029] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/16/2016] [Accepted: 01/04/2017] [Indexed: 12/13/2022]
Abstract
Keratoconus (KC) is a corneal thinning disorder that leads to loss of visual acuity through ectasia, opacity, and irregular astigmatism. It is one of the leading indicators for corneal transplantation in the Western countries. KC usually starts at puberty and progresses until the third or fourth decade; however its progression differs among patients. In the keratoconic cornea, all layers except the endothelium have been shown to have histopathological structural changes. Despite numerous studies in the last several decades, the mechanisms of KC development and progression remain unclear. Both genetic and environmental factors may contribute to the pathogenesis of KC. Many previous articles have reviewed the genetic aspects of KC, but in this review we summarize the histopathological features of different layers of cornea and discuss the differentially expressed proteins in the KC-affected cornea. This summary will help emphasize the major molecular defects in KC and identify additional research areas related to KC, potentially opening up possibilities for novel methods of KC prevention and therapeutic intervention.
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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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